Architectural changes in healthy muscle after denervation have not yet been reported. This study aimed to investigate architectural changes in the medial head of the gastrocnemius muscle (GCM) after aesthetic tibial nerve ablation in healthy adults using ultrasonography (US). The effects of tibial nerve ablation were verified by visual observation and surface electromyography analysis. US images of medial GCMs were taken by one trained physician using B-mode and real-time US with a linear-array probe before nerve ablation, at 1 week after nerve ablation and at 3 months after nerve ablation in an anatomic standing position with the feet about shoulder-width apart in 19 healthy adults (17 females and 2 males). Muscle thickness was significantly reduced on the left side at 1 week and 3 months after the procedure and on the right side at 3 months after the procedure (p<0.050). Although fascicle length was not significantly changed, pennation angle was significantly reduced on both sides at 3 months after the procedure (p<0.050). Muscle thickness and pennation angle of the muscle fascicle were significantly reduced, although fascicle length was not significantly changed, after tibial nerve ablation in the medial GCM of healthy adults.
Adult ; Denervation ; Electromyography ; Female ; Foot ; Gas Chromatography-Mass Spectrometry ; Head ; Humans ; Muscle, Skeletal ; Posture ; Tibial Nerve ; Ultrasonography

In the evaluation of peripheral nerve injury, nerve conduction studies and needle electromyography mainly focus on anatomical localization and functional evaluation of lesions. Whereas neuromuscular ultrasound has an advantage in structural assessment of lesions. In addition, muscle ultrasound can also be used to demonstrate muscle denervation without causing pain. We report a case of traumatic ulnar nerve injury at hand in which muscle ultrasound contributed to precise localization by provided detailed information about the extent of muscle denervation.
Electromyography ; Hand ; Humans ; Muscle Denervation ; Needles ; Neural Conduction ; Neuroanatomy ; Peripheral Nerve Injuries ; Peripheral Nerves ; Ulnar Nerve ; Ulnar Neuropathies ; Ultrasonography

Congenital unilateral lower lip paralysis (CULLP) is a rare condition characterized by inversion and absent depressive movement of the affected lower lip while moving the mouth, which is recognized when the infant cries. CULLP is a variation of facial paralysis caused by abnormal development of marginal mandibular nerve, hypoplasia of the depressor labii inferioris muscle or depressor anguli oris muscle. This report introduces two cases of congenital unilateral lower lip palsy, presenting a balancing technique involving the resection of the depressor labii inferioris on the non-affected side.
Facial Paralysis ; Humans ; Infant ; Lip* ; Mandibular Nerve ; Mouth ; Muscle Denervation ; Paralysis*

Paralabral cysts of the shoulder are rare, and there are few reports available that describe anteroinferior paralabral cysts arising from a detached antero-inferior glenoid labral tear without shoulder instability. We report an antero-inferior labral tear without shoulder instability in adolescent overhead athlete associated with paralabral cyst that leads to axillary nerve neurapraxia. Although nonoperative management of such labral lesions may provide symptoms of relief, it may not be enough for the athlete to return to the game. However, surgical treatment in this case provides successful recovery and rapid return to playing baseball play without having to worry about the progression of muscle denervation.
Adolescent* ; Athletes* ; Baseball ; Humans ; Muscle Denervation ; Shoulder

Focal myositis is a rare, benign inflammatory pseudotumor of the skeletal muscle of unknown etiology. In Korea, there is no case report of focal myositis, which is not combined with connective tissue disease. We present an unusual case of focal myositis with ankle contracture, involving more than two muscles. A 26-year-old man visited our clinic complaining of right ankle contracture and leg muscle pain. Physical examination revealed no muscle weakness or any other neurological abnormality. T2-weighted magnetic resonance imaging of the right leg demonstrated diffuse high signal intensity of the right gastrocnemius, flexor digitorum longus, and tibialis anterior muscles. Needle electromyography showed profuse denervation potentials with motor unit action potentials of short duration and small amplitude from the involved muscles. All these findings suggested a diagnosis of focal inflammatory myositis and the patient was put under oral prednisolone and physical therapy.
Action Potentials ; Adult ; Animals ; Ankle ; Connective Tissue Diseases ; Contracture ; Denervation ; Electromyography ; Granuloma, Plasma Cell ; Humans ; Korea ; Leg ; Magnetic Resonance Imaging ; Muscle Weakness ; Muscle, Skeletal ; Muscles ; Myositis ; Needles ; Physical Examination ; Prednisolone

The latissimus dorsi myocutaneous flap was one of the first methods of breast reconstruction described. However, a standard latissimus dorsi flap alone often does not provide sufficient volume for breast reconstruction and has been performed with an implant to achieve adequate breast volume. The design of an extended latissimus dorsi flap has evolved to include the parascapular and scapular fat-fascia extension in addition to lumbar fat for additional volume. The main advantage of the extended latissimus dorsi flap is that it can provide autologous tissue to the reconstructed breast without an implant and with an acceptable donor site contour and scar. The extended latissimus dorsi flap elevation is of dissection in plane just beneath the fascia superficialis, leaving the deep fat attached to the surface of the muscle. The fat left attached to the surface of the muscle is well vascularized by the perforators coming from the muscle itself. Division of the humeral attachment of the muscle is performed for an adequate excursion of the flap. Denervation of the thoracodorsal nerve is recommended for preventing postoperative involuntary muscle contraction. Patients should be warned of the potential donor site seroma. The extended latissimus dorsi flap proved to be a reliable option for totally autologous breast reconstruction in selected patients. The flap is reliable, and the procedure is technically straightforward and consistent.
Breast ; Cicatrix ; Contracts ; Denervation ; Fascia ; Female ; Humans ; Imidazoles ; Mammaplasty ; Muscle, Smooth ; Muscles ; Nitro Compounds ; Seroma ; Tissue Donors

PURPOSE: Surgery for thyroid gland requires skin incisions that can result in postsurgical neck scar. To overcome this, many surgeons performed a endoscopic thyroidectomy. But, this approach had a some problems. One of postoperative problems, iatrogenic cervical dystonia(CD) may occur. At common, CD is defined as a syndrome characterized by prolonged muscle contraction causing twisting, repetitive movements or abnormal posture. Botulinum toxin A(BTA, Botox(R), Allergan, Irvine, CA, USA) is well known treatment agent in the treatment of CD. So, the authors applied BTA injection in rare case with iatrogenic CD resulting in endoscopic thyroidectomy. METHODS: A 43-year-old female had endoscopic subtotal thyroidectomy operation 3 years ago. She had symptoms such as progressive cervical pain, abnormal neck posture, depression, and sleep difficulty. About 1 year later, the patient who had previous myomectomy of the clavicular head of sternocleidomastoid muscle, however, symptoms were not improved. And then the patient received BTA therapy in our department. The 2 units per 0.1mL solution was administered in a 1mL tuberculin syringe. RESULTS: The dose of BTA used in the patient was 36 units for vertical platysmal bands, superficially, and 10 units for ipsilateral sternocleidomastoid muscle, intramuscularly. After 2 weeks, additional the dose of BTA used in the patient was 5 points for remained scar bands, superficially. Complications related to injection such as significant swallowing difficulties, neck muscle weakness, or sensory change were not observed. In 9 months follow-up, the patient maintained a good result from the method of BTA injection alone. CONCLUSION: The basic concept is selective denervation for the hyperactive individual muscles and scar bands. We conclude that BTA is an effective and safe treatment for CD despite the iatrogenic and complex presentation of this complication.
Adult ; Botulinum Toxins ; Cicatrix ; Deglutition ; Denervation ; Depression ; Female ; Follow-Up Studies ; Head ; Humans ; Muscle Contraction ; Muscles ; Neck ; Neck Muscles ; Neck Pain ; Posture ; Skin ; Thyroid Gland ; Thyroidectomy ; Torticollis ; Tuberculin

The aim of this study was to delineate the shape of the popliteus muscle and determine the correct motor point site for treating spasticity. A total of 22 legs from 13 fresh Korean cadavers were evaluated. The x-axis was set as a transverse line across the lateral and medial epicondyle of the femur and the y-axis as a vertical line at the midpoint of the medial malleolus of the tibia and lateral malleolus of the fibula. The popliteus muscle is an obtuse triangle in shape. Superior, medial, and inferior angles were 27.2+/-4.3degrees, 114.8+/-19.8degrees, and 38.0+/-18.8degrees respectively. The lengths of the superior, medial, and lateral sides of the triangle were 7.6+/-1.0 cm, 6.2+/-1.0 cm, and 11.9+/-1.5 cm respectively. Nerve branches ran superficially on the periosteum of the tibia and entered the popliteus on its superficial surface. The diverging point of the nerve branch entered the popliteus from the tibial nerve located at the midline of the popliteal fossa and 17% of the leg length above the intercondylar line. Most nerve entry points (83.3%) were within a 2.0x3.0 cm rectangle with the center located at -1.0 cm (-7%) on the x-axis and -3.3 cm (-9%) on the y-axis.
Cadaver ; Denervation ; Femur ; Fibula ; Leg ; Muscle Spasticity ; Muscles ; Periosteum ; Tibia ; Tibial Nerve

OBJECTIVETo compare the effect of botulinum neurotoxin A (BTA) and denervation in inducing masseter muscle atrophy in rabbits to provide experimental evidence for the safe clinical application of BTA.

METHODSSeventy-five healthy adult New Zealand white rabbits were randomized equally into denervation group, BTA group and normal control group. In the former two groups, the rabbits were subjected to right masseter muscle denervation and botulinum (3 µg/kg) injection at the muscle, respectively, with the left side as the control. The thickness of the denervated masseter was determined using B type ultrasound and its weight measured after the treatment.

RESULTSThe thickness of the masseter muscle on the experimental side was significantly decreased to 50.80% and 54.07%, and its weight to 66.80% and 56.16% of the normal level after denervation and BTA injection, respectively.

CONCLUSIONBTA-induced denervation produces less potent atrophy-inducing effect on skeletal muscle than surgical denervation. BTA causes atrophy mainly at the injection site of the target muscle without significant diffusion or toxicity to the muscular cells.

Animals ; Botulinum Toxins, Type A ; toxicity ; Female ; Male ; Masseter Muscle ; drug effects ; pathology ; Muscle Denervation ; Muscular Atrophy ; pathology ; Rabbits

OBJECTIVE: To investigate the changes of apoptosis related factors after denervation and disuse in skeletal muscles and to find out the role of apoptosis in atrophic process. METHOD: 30 male Sprague-Dawley rats, 8 weeks of age were treated with three different atrophy models (10 rats in each group); hind-limbs suspension (HS) as a disuse model, complete denervation by sciatic nerve transsection (CD) and partial denervation by sciatic nerve crushing (PD). At 2 weeks and 4 weeks after each experiment, both gastrocnemius were dissected and their weights were measured. Western blotting for BAX and Bcl-2 and TUNEL assay were used to assess the changes of apoptosis related factors in muscle cell. RESULTS: The muscle weight of PD and CD group decreased 38.6%, 65.6%, respectively, of intact side at 4 weeks after injuries. The loss of muscle weight in HS group was smaller than that of denervated muscles. CD group showed high expression of BAX (3.45+/-0.32-->2.87+/-0.48) and Bcl-2 (3.63+/-0.40-->3.33+/-0.50) at 2 and 4 weeks after denervation, but in PD group, BAX at 2 weeks significantly decreased at 4 weeks (3.40+/-0.55-->2.13+/-0.25). In HS group, their expressions were slightly increased only immediate after 14 days suspension (BAX: 1.30+/-0.38 and Bcl-2: 1.29+/-0.28). CD group showed higher number of positive nuclei (27.6+/-8.8%) than PD group (10.4+/-5.3%) and HS group (4.4+/-1.6%) in TUNEL assay. CONCLUSION: Unlike temporary increase of apoptosis related factors in disuse, increase of these factors are remarkable and persisted after denervation. Muscle apoptosis may be the major cause of muscle atrophy during degeneration process.
Animals ; Apoptosis ; Atrophy ; Blotting, Western ; Denervation ; Humans ; In Situ Nick-End Labeling ; Male ; Muscle Cells ; Muscle, Skeletal ; Muscles ; Muscular Atrophy ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; Weights and Measures