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Zerbinati P, Bemporad J, Massimiani A, Bianchini E, Mazzoli D, Glorioso D, della Vecchia G, De Luca A, De Blasiis P. Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure. J Pers Med 2024; 14:116. [PMID: 38276238 PMCID: PMC10817262 DOI: 10.3390/jpm14010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Internally rotated and adducted shoulder is a common posture in upper limb spasticity. Selective peripheral neurectomy is a useful and viable surgical technique to ameliorate spasticity, and the lateral pectoral nerve (LPN) could be a potential good target to manage shoulder spasticity presenting with internal rotation. However, there are some limitations related to this procedure, such as potential anatomical variability and the necessity of intraoperative surgical exploration to identify the target nerve requiring wide surgical incisions. This could result in higher post-surgical discomfort for the patient. Therefore, the aim of our study was to describe a modification of the traditional selective peripheral neurectomy procedure of the LPN through the perioperative ultrasound-guided marking of the target nerve with methylene blue. The details of the localization and marking procedure are described, as well as the surgical technique of peripheral selective neurectomy and the potential advantages in terms of nerve localization, surgical precision and patients' post-surgical discomfort. We suggest that the proposed modified procedure could be a valid technique to address some current limitations and move the surgical treatment of spasticity toward increasingly tailored management due to the ease of nerve identification, the possibility of handling potential anatomical variability and the resulting smaller surgical incisions.
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Affiliation(s)
- Paolo Zerbinati
- Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy (J.B.); (D.G.)
| | - Jonathan Bemporad
- Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy (J.B.); (D.G.)
| | - Andrea Massimiani
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (A.M.); (E.B.)
| | - Edoardo Bianchini
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (A.M.); (E.B.)
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, 47992 Rimini, Italy;
| | - Davide Glorioso
- Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy (J.B.); (D.G.)
| | - Giuseppe della Vecchia
- Department of Women, Child, General and Specialistic Surgery, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Antonio De Luca
- Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5, 80138 Naples, Italy;
| | - Paolo De Blasiis
- Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni, 5, 80138 Naples, Italy;
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