1
|
Pirri C, Torre DE, Stecco C. Fascial plane blocks: from microanatomy to clinical applications. Curr Opin Anaesthesiol 2024; 37:526-532. [PMID: 39108103 PMCID: PMC11356744 DOI: 10.1097/aco.0000000000001416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
PURPOSE OF REVIEW In the last 20 years, advancements in the understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) have gained popularity due to their validated safety profile and relative ease. They are used in various clinical settings for surgical and nonsurgical indications. Growing evidence suggests a link between the microscopic anatomy of fasciae and their mechanism of action. As a result, knowledge of these aspects is urgently needed to better optimise pain management. The purpose of this review is to summarise the different microscopic aspects of deep/muscular fascia to expand our understanding in the performance of FPBs. RECENT FINDINGS There is ample evidence to support the role of FPBs in pain management. However, the exact mechanism of action remains unclear. Fasciae are composed of various structural elements and display complex anatomical characteristics at the microscopic level. They include various cell types embedded within an extracellular matrix abundant in collagens and hyaluronan. Increasingly, numerous studies demonstrated their innervation that contributes to their sensory functions and their role in proprioception, motor coordination and pain perception. Lastly, the diversity of the cellular and extracellular matrix, with their viscoelastic properties, is essential to understanding the FPBs' mechanism of action. SUMMARY Physicians must be aware of the role of fascial microscopic anatomy and better understand their properties to perform FPBs in a conscious manner and enhance pain management.
Collapse
Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua
| | - Debora Emanuela Torre
- Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell’Angelo, Venice Mestre, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua
| |
Collapse
|
2
|
Mika A, Oleksy Ł, Fede C, Pirri C, Stecco C. Editorial: Fascia as a multi-purpose structure of connective tissue - dysfunction, diagnostics and treatment. Front Med (Lausanne) 2024; 11:1472116. [PMID: 39206164 PMCID: PMC11349619 DOI: 10.3389/fmed.2024.1472116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Anna Mika
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, Kraków, Poland
| | - Łukasz Oleksy
- Faculty of Health Sciences, Department of Physiotherapy, Jagiellonian University Medical College Krakow, Kraków, Poland
- Department of Orthopedics, Traumatology and Hand Surgery, Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
- Oleksy Medical & Sports Sciences, Rzeszów, Poland
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| |
Collapse
|
3
|
Slater AM, Barclay SJ, Granfar RMS, Pratt RL. Fascia as a regulatory system in health and disease. Front Neurol 2024; 15:1458385. [PMID: 39188704 PMCID: PMC11346343 DOI: 10.3389/fneur.2024.1458385] [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: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
Neurology and connective tissue are intimately interdependent systems and are critical in regulating many of the body's systems. Unlocking their multifaceted relationship can transform clinical understanding of the mechanisms involved in multisystemic regulation and dysregulation. The fascial system is highly innervated and rich with blood vessels, lymphatics, and hormonal and neurotransmitter receptors. Given its ubiquity, fascia may serve as a "watchman," receiving and processing information on whole body health. This paper reviews what constitutes fascia, why it is clinically important, and its contiguous and interdependent relationship with the nervous system. Unquestionably, fascial integrity is paramount to human locomotion, interaction with our environment, bodily sense, and general physical and emotional wellbeing, so an understanding of the fascial dysregulation that defines a range of pathological states, including hypermobility syndromes, autonomic dysregulation, mast cell activation, and acquired connective tissue disorders is critical in ensuring recognition, research, and appropriate management of these conditions, to the satisfaction of the patient as well as the treating practitioner.
Collapse
Affiliation(s)
- Alison M. Slater
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia
| | - S. Jade Barclay
- Neuromuscular Imaging Research Lab, The Kolling Institute, St Leonards, NSW, Australia
- Hypermobility and Performance Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rouha M. S. Granfar
- School of Pharmacy and Medical Sciences, Griffith University, Southport, QLD, Australia
| | - Rebecca L. Pratt
- Department of Foundational Medical Studies, William Beaumont School of Medicine, Rochester, MI, United States
| |
Collapse
|
4
|
Noten K, van Amstel R. From Muscle-Bone Concept to the ArthroMyoFascial Complex: A Pragmatic Anatomical Concept for Physiotherapy and Manual Therapy. Life (Basel) 2024; 14:799. [PMID: 39063554 PMCID: PMC11278034 DOI: 10.3390/life14070799] [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: 05/27/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND In physiotherapy, the classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle-bone concept. METHOD This study is a narrative review and ultrasound observation. RESULTS Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. CONCLUSION The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle-bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.
Collapse
Affiliation(s)
- Karl Noten
- Fysio Science Department, Fysio Physics Group, 3401 IJsselstein, The Netherlands;
| | - Robbert van Amstel
- Fysio Science Department, Fysio Physics Group, 3401 IJsselstein, The Netherlands;
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
| |
Collapse
|
5
|
Loffi RG, Cruz TKF, Paiva GM, Souto DO, Barreto SR, Santana PAN, Nascimento AAAC, Costa FRM, Cota EB, Haase VG. Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2024; 11:191. [PMID: 38397303 PMCID: PMC10887636 DOI: 10.3390/children11020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.
Collapse
Affiliation(s)
- Renato Guimarães Loffi
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
| | - Thalita Karla Flores Cruz
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Giulia Moreira Paiva
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Deisiane Oliveira Souto
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
| | - Simone Rosa Barreto
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Patrícia Aparecida Neves Santana
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Amanda Aparecida Alves Cunha Nascimento
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Fabiana Rachel Martins Costa
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Psicologia: Cognição e Comportamento, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Elisa Braz Cota
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
| | - Vitor Geraldi Haase
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
- Programa de Pós-Graduação em Psicologia: Cognição e Comportamento, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| |
Collapse
|
6
|
Leduc L, Leclère M, Gauthier LG, Marcil O, Lavoie J. Severe asthma in horses is associated with increased airway innervation. J Vet Intern Med 2024; 38:485-494. [PMID: 38054207 PMCID: PMC10800206 DOI: 10.1111/jvim.16941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Altered innervation structure and function contribute to airway hyperresponsiveness in human asthma, yet the role of innervation in airflow limitation in asthma in horses remains unknown. HYPOTHESIS To characterize peribronchial innervation in horses with asthma. We hypothesized that airway innervation increases in horses with asthma compared with controls. ANIMALS Formalin-fixed lung samples from 8 horses with severe asthma and 8 healthy horses from the Equine Respiratory Tissue Biobank. Ante-mortem lung function was recorded. METHODS Blinded case-control study. Immunohistochemistry was performed using rabbit anti-s100 antibody as a neuronal marker for myelinating and non-myelinating Schwann cells. The number and cumulative area of nerves in the peribronchial region and associated with airway smooth muscle were recorded using histomorphometry and corrected for airway size. RESULTS Both the number (median [IQR]: 1.87 × 10-5 nerves/μm2 [1.28 × 10-5 ]) and the cumulative nerve area (CNA; 1.03 × 10-3 CNA/μm2 [1.57 × 10-3 ]) were higher in the peribronchial region of horses with asthma compared with controls (5.17 × 10-6 nerves/μm2 [3.76 × 10-6 ], 4.14 × 10-4 CNA/μm2 [2.54 × 10-4 ], Mann-Whitney, P = .01). The number of nerves within or lining airway smooth muscle was significantly higher in horses with asthma (4.47 × 10-6 nerves/μm2 [5.75 × 10-6 ]) compared with controls (2.26 × 10-6 nerves/μm2 [1.16 × 10-6 ], Mann-Whitney, P = .03). CONCLUSIONS AND CLINICAL IMPORTANCE Asthma in horses is associated with greater airway innervation, possibly contributing to airway smooth muscle remodeling and exacerbating severity of the disease.
Collapse
Affiliation(s)
- Laurence Leduc
- Department of Clinical Sciences, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | - Mathilde Leclère
- Department of Clinical Sciences, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | | | | | - Jean‐Pierre Lavoie
- Department of Clinical Sciences, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| |
Collapse
|
7
|
Kara M, Ricci V, Pirri C, Sekizkardeş M, Cocco G, Stecco C, Kaymak B, Özçakar L. Sonographic guide for botulinum toxin injections for chronic migraine headache: EURO-MUSCULUS/USPRM approach. Clin Neurol Neurosurg 2023; 232:107883. [PMID: 37467578 DOI: 10.1016/j.clineuro.2023.107883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
Application of botulinum toxin A (BoNT-A) into the muscles of the head and neck area has become a widespread and reliable treatment modality for chronic migraine. The mechanism of action for BoNT-A is the inhibition of acetylcholine and local nociceptive peptide release at the terminal nerve endings. Cranial sutures have the highest concentration of nociceptive structures; therefore BoNT-A injection into the suture lines - as opposed to head and neck muscles - has been proposed for the treatment of chronic migraine. Nerve endings in sutures rapidly absorb BoNT-A and transfer it across the afferent nerve fibers in dura mater via orthodromic and antidromic transmission. In this article, ultrasound-guided BoNT-A application around the cranial sutures will be illustrated. It is noteworthy that suture injections would be safer and more efficient when applied with such guidance.
Collapse
Affiliation(s)
- Murat Kara
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy.
| | - Carmelo Pirri
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy
| | - Merve Sekizkardeş
- Marmara University, Pendik Training and Research Hospital, Department of Physical and Rehabilitation Medicine, İstanbul, Turkey
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Carla Stecco
- Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131 Padova, Italy
| | - Bayram Kaymak
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey
| |
Collapse
|
8
|
Fede C, Petrelli L, Pirri C, Tiengo C, De Caro R, Stecco C. Detection of Mast Cells in Human Superficial Fascia. Int J Mol Sci 2023; 24:11599. [PMID: 37511360 PMCID: PMC10380524 DOI: 10.3390/ijms241411599] [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: 06/24/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The recent findings showed that the superficial fascia is a fibrous layer in the middle of hypodermis, richly innervated and vascularized, and more complex than so far demonstrated. This study showed the presence of mast cells in the superficial fascia of the human abdomen wall of three adult volunteer patients (mean age 42 ± 4 years; 2 females, 1 male), by Toluidine Blue and Safranin-O stains and Transmission Electron Microscopy. Mast cells are distributed among the collagen bundles and the elastic fibers, near the vessels and close to the nerves supplying the tissue, with an average density of 20.4 ± 9.4/mm2. The demonstration of the presence of mast cells in the human superficial fascia highlights the possible involvement of the tissue in the inflammatory process, and in tissue healing and regeneration processes. A clear knowledge of this anatomical structure of the hypodermis is fundamental for a good comprehension of some fascial dysfunctions and for a better-targeted clinical practice.
Collapse
Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Cesare Tiengo
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| |
Collapse
|
9
|
Albertin G, Astolfi L, Fede C, Simoni E, Contran M, Petrelli L, Tiengo C, Guidolin D, De Caro R, Stecco C. Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen. Life (Basel) 2023; 13:life13030836. [PMID: 36983991 PMCID: PMC10058564 DOI: 10.3390/life13030836] [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: 02/11/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Recently, the superficial fascia has been recognized as a specific anatomical structure between the two adipose layers-the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). The evaluation of specific characteristics of cells, fibers, blood circulation, and innervation has shown that the superficial fascia has a clear and distinct anatomical identity, but knowledge about lymphatic vessels in relation to the superficial fascia has not been described. The aim of this study was to evaluate the presence of lymphatic vessels in the hypodermis, with a specific focus on the superficial fascia and in relation to the layered subdivision of the subcutaneous tissue into SAT and DAT. Tissue specimens were harvested from three adult volunteer patients during abdominoplasty and stained with D2-40 antibody for the lymphatic endothelium. In the papillary dermis, a huge presence of lymphatic vessels was highlighted, parallel to the skin surface and embedded in the loose connective tissue. In the superficial adipose tissue, thin lymphatic vessels (mean diameter of 11.6 ± 7.71 µm) were found, close to the fibrous septa connecting the dermis to the deeper layers. The deep adipose tissue showed a comparable overall content of lymphatic vessels with respect to the superficial layer; they followed the blood vessel and had a larger diameter. In the superficial fascia, the lymphatic vessels showed higher density and a larger diameter, in both the longitudinal and transverse directions along the fibers, as well as vessels that intertwined with one another, forming a rich network of vessels. This study demonstrated a different distribution of the lymphatic vessels in the various subcutaneous layers, especially in the superficial fascia, and the demonstration of the variable gauge of the vessels leads us to believe that they play different functional roles in the collection and transport of interstitial fluid-important factors in various surgical and rehabilitation fields.
Collapse
Affiliation(s)
- Giovanna Albertin
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Laura Astolfi
- Bioacoustics Research Laboratory, Department of Neuroscience (DNS), University of Padova, 35129 Padova, Italy
- Interdepartmental Research Center of International Auditory Processing Project in Venice (I-APPROVE), Department of Neurosciences, University of Padova, Santi Giovanni e Paolo Hospital, ULSS3 Serenissima, 30122 Venezia, Italy
| | - Caterina Fede
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Edi Simoni
- Bioacoustics Research Laboratory, Department of Neuroscience (DNS), University of Padova, 35129 Padova, Italy
- Interdepartmental Research Center of International Auditory Processing Project in Venice (I-APPROVE), Department of Neurosciences, University of Padova, Santi Giovanni e Paolo Hospital, ULSS3 Serenissima, 30122 Venezia, Italy
| | - Martina Contran
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Lucia Petrelli
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Cesare Tiengo
- Clinic of Plastic Surgery, Padova University Hospital, 35128 Padova, Italy
| | - Diego Guidolin
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Raffaele De Caro
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Carla Stecco
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| |
Collapse
|
10
|
Devantéry K, Morin M, Grimard J, Gaudreault N. Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized before-and-after Experimental Study. Bioengineering (Basel) 2023; 10:bioengineering10030332. [PMID: 36978723 PMCID: PMC10045407 DOI: 10.3390/bioengineering10030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
The thoracolumbar fascia (TLF) may be a pain generator, given its rich innervation. Structural and biomechanical changes have also been documented in adults with chronic non-specific low back pain (LBP). Myofascial techniques (MFTs) are commonly used in manual therapy and are hypothesized to reduce tissue stiffness and pain. However, evidence for these effects is limited. The objective of this study was to evaluate the immediate effects of a standardized MFT compared to a simulated MFT on: (1) the stiffness of the TLF and erector spinae muscles (shear-wave sonoelastography), (2) the thickness of the TLF (B-mode ultrasound), and (3) pain intensity (numerical rating scale). Forty-nine participants with chronic non-specific LBP were included in a randomized before-and-after experimental study. Outcome measures were collected before (T0) and immediately after the intervention (T1). Pain intensity was also assessed on day two (T2) and seven (T7). The MFT group showed a significant decrease in left erector spinae muscle stiffness and left TLF thickness compared to the simulated group. In addition, there was a significant reduction in pain intensity in the MFT group compared to the simulated group at T1 and T2. The results of this study suggest that MFT results in immediate tissue changes and transient pain reduction in patients with LBP.
Collapse
|
11
|
Park YE, Lee SE, Eom YS, Cho JM, Yang JW, Kim MS, Kwon HD, Lee JW, Park D. Infrared thermographic changes after decompression surgery in patients with carpal tunnel syndrome. BMC Musculoskelet Disord 2023; 24:79. [PMID: 36717815 PMCID: PMC9887906 DOI: 10.1186/s12891-023-06193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Digital infrared thermal imaging (DITI), which detects infrared rays emitted from body surface to create a body heat map, has been utilized at various musculocutaneous conditions. Notably, DITI can demonstrate autonomic vasomotor activity in the nerve-innervated area, and thus may be of use in carpal tunnel syndrome (CTS). In this study, we compared DITI findings before and after carpal tunnel release (CTR) surgery in patients with unilateral CTS to investigate the corresponding neurophysiological changes. METHODS In this retrospective cohort study, DITI parameters such as the temperature differences between the median and ulnar nerve territories and median nerve-innervated digital anisometry were measured. Subjective symptom duration, pain scale, and ultrasonographic findings were also compared before and after CTR. Patients were evaluated before and 6 weeks after CTR, respectively. RESULTS A total of 27 patients aged 59.0 ± 11.2 years were finally included. After CTR, median nerve-innervated thermal anisometry was improved (2.55 ± 0.96 °C to 1.64 ± 1.34 °C; p = 0.003). The temperature differences between the median and ulnar nerve territories were not significantly changed. Subjective pain, the Simovic Weinberg Clinical Scale, and palmar bowing of the flexor retinaculum were also significantly improved (p < 0.001 for all comparisons). CONCLUSIONS Our results demonstrated that DITI findings could reflect an improvement in autonomic function after CTR. Therefore, DITI can be an objective method to assess pre- and post-operative neurophysiologic changes in CTS.
Collapse
Affiliation(s)
- Yeo Eun Park
- grid.416665.60000 0004 0647 2391Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, 10444 Goyang, Republic of Korea
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea
| | - Yoon Sik Eom
- Department of Orthopedic Surgery, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea
| | - Jae Man Cho
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea
| | - Joong Won Yang
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea
| | - Man Su Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea
| | - Heum Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea
| | - Jang Woo Lee
- grid.416665.60000 0004 0647 2391Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, 10444 Goyang, Republic of Korea
| | - Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, 37659 Pohang, Republic of Korea ,grid.49100.3c0000 0001 0742 4007Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Republic of Korea
| |
Collapse
|
12
|
Dong Y, Zhang D, Cao Y, Zhang Y, Sun X, Chen T, Zhang Y, Xu G. Mathematical analysis for spatial distribution of vessels, mast cells and adipocytes in superficial fascia. Front Physiol 2022; 13:1026019. [PMID: 36452040 PMCID: PMC9702360 DOI: 10.3389/fphys.2022.1026019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 12/18/2023] Open
Abstract
As a novel origin of adipocytes, the superficial fascia, a typical soft connective tissue, has abundant adipocytes and preadipocytes, accompanied by numerous mast cells. Blood vessels pass through the fascia to form a network structure. The more reasonable statistical analysis methods can provide a new method for in-depth study of soft connective tissue by clarifying the spatial distribution relation between cells (point structure) and blood vessels (linear structure). This study adopted the Guidolin et al. statistical analysis methods used by epidemiology and ecology to quantitatively analyze the distribution pattern and correlations among blood vessels, adipocytes, and mast cells. Image-processing software and self-written computer programs were used to analyze images of whole-mounted fascia, and the relevant data were measured automatically. Voronoi's analysis revealed that the vascular network was non-uniformly distributed. In fascia with average area of 3.75 cm2, quantitative histological analysis revealed 81.16% of mast cells and 74.74% of adipocytes distributed within 60 μm of blood vessels. A Spearman's correlation coefficient (rs) of >0.7 showed the co-distribution of the two types of cells under different areas. Ridge regression analysis further revealed the spatial correlation among blood vessels, adipocytes and mast cells. The combination of classical epidemiological analysis and extended computer program analysis can better analyze the spatial distribution relation between cells and vessels and should provide an effective analysis method for study of the histology and morphology of fascia and related connective tissues.
Collapse
Affiliation(s)
- Yingyue Dong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Dandan Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yingri Cao
- Department of Civil Engineering, Tsinghua University, Beijing, China
| | - Yanfei Zhang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaozhe Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Tongsheng Chen
- Key Laboratory of Functional and Clinical Translational Medicine, Department of Physiology, Xiamen Medical College, Xiamen, China
| | - Yuanyuan Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Guoheng Xu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| |
Collapse
|