1
|
Brun D, Hamel O, Montané E, Scandella M, Castel-Lacanal E, De Boissezon X, Philippe M, David G, Cormier C. Functional outcomes following surgery for spastic hip adductor muscles in ambulatory and non-ambulatory adults. J Rehabil Med 2024; 56:jrm18356. [PMID: 38528325 PMCID: PMC10985928 DOI: 10.2340/jrm.v56.18356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To evaluate functional outcomes of surgery of spastic hip adductor muscles (obturator neurotomy with or without adductor longus tenotomy) in ambulatory and non-ambulatory patients, using preoperatively defined personalized goals. DESIGN Retrospective observational descriptive study. PATIENTS Twenty-three patients with adductor spasticity who underwent obturator neurotomy between May 2016 and May 2021 at the Clinique des Cèdres, Cornebarrieu, France, were included. METHODS Postoperative functional results were evaluated in accordance with the Goal Attainment Scaling method. Patients were considered "responders" if their score was ≥ 0. Secondary outcomes included spasticity, strength, hip range of motion and change in ambulatory capacity. When data were available, a comparison of pre- and postoperative 3-dimensional instrumented gait analysis was also performed. RESULTS Among the 23 patients only 3 were non-walkers. Seventeen/22 patients achieved their main goal and 14/23 patients achieved all their goals. Results were broadly similar for both walking goals (inter-knee contact, inter-feet contact, fluidity, walking perimeter, toe drag) and non-walking goals (intimacy, transfer, pain, posture, dressing). CONCLUSION Surgery of spastic hip adductor muscles results in functional improvement in ambulation, hygiene, dressing and posture and can be offered to patients with troublesome adductor overactivity. The use of a motor nerve block is recommended to define relevant goals before the surgery.
Collapse
Affiliation(s)
- Daphnée Brun
- Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France
| | - Olivier Hamel
- Neurosurgery Department, Neurosciences Pole, CAPIO, Clinique des Cèdres, Cornebarrieu
| | - Emmeline Montané
- University Hospital of Toulouse, Department of Physical and Rehabilitation Medicine, Toulouse, France
| | - Marino Scandella
- University Hospital of Toulouse, Laboratory of Gait Analysis, Toulouse, France
| | - Evelyne Castel-Lacanal
- University Hospital of Toulouse, Department of Physical and Rehabilitation Medicine, Toulouse, France
| | - Xavier De Boissezon
- University Hospital of Toulouse, Department of Physical and Rehabilitation Medicine, Toulouse, France
| | - Marque Philippe
- ToNIC (Toulouse NeuroImaging Center), Inserm, University of Toulouse 3, Toulouse, France
| | - Gasq David
- University Hospital of Toulouse, Department of Physiological Explorations, Toulouse, France
| | - Camille Cormier
- Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France.
| |
Collapse
|
2
|
Bulisani BM, Ströher M, Rossi FMB, de Oliveira Leite MA, Rodrigues MR, Gomes LGL, Waisberg J. Robotic-Assisted Resection of a Benign Schwannoma of the Obturator Nerve: A Rare Case. Am J Case Rep 2024; 25:e942083. [PMID: 38347715 PMCID: PMC10877639 DOI: 10.12659/ajcr.942083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/31/2023] [Accepted: 12/11/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Neurilemmomas are rare tumors derived from the Schwann cells that comprise the peripheral nerve sheaths. They have a slow growth and rarely display malignancy. Early diagnosis is rare, and the treatment consists by surgical resection. Although robotic-assisted surgery is commonly used for treating retroperitoneal diseases, there are few reports of resection of retroperitoneal and pelvic schwannoma through robotic-assisted surgery. In the present study, we reported a case of complete excision of a benign retroperitoneal schwannoma of the obturator nerve by robotic-assisted surgery. CASE REPORT A 51-year-old woman was referred by her gynecologist for left pelvic discomfort of a 3-month duration. The physical examination was normal, but a computerized tomography scan of the abdomen and pelvis showed an expansive pelvic lesion in the topography of the left iliac vessels, a hypodense contrast enhancement measuring 4.6×3.4 cm. Magnetic resonance imaging showed an extraperitoneal lesion located medially and inferiorly to the left external iliac vessels, with a size of 4.9×3.7 cm, and of probable neural etiology. Surgical resection of the tumor was recommended because of the diagnostic hypothesis of obturator nerve schwannoma. CONCLUSIONS This case showed that retroperitoneal neurilemmomas are difficult to diagnose owing to a lack of specific symptoms, and the best treatment is complete tumor resection. The use of robotic techniques gives greater dexterity to the surgeon, since it provides high-definition 3-dimensional vision, which can make the removal of retroperitoneal tumors susceptible to minimally invasive resection in a safe and effective way.
Collapse
Affiliation(s)
| | - Marina Ströher
- Department of General Surgery, Universidade Municipal de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | | | | | - Murilo Rocha Rodrigues
- Surgery of the Digestive System, RR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil
| | | | - Jaques Waisberg
- Department of Surgery, Centro Universitário FMABC/Faculdade de Medicina do ABC, Santo André, SP, Brazil
| |
Collapse
|
3
|
Muwal S, Singh Meena D, Gupta A. Comparison of Ultrasound Versus Ultrasound With Nerve Stimulation-Guided Obturator Nerve Block to Prevent Adductor Spasm in Patients Undergoing Transurethral Resection of Bladder Tumor: A Randomized Controlled Study. Cureus 2024; 16:e53062. [PMID: 38410312 PMCID: PMC10896273 DOI: 10.7759/cureus.53062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Background This study aimed to compare ultrasound versus ultrasound with nerve stimulation-guided obturator nerve block (ONB) for the prevention of adductor spasm in patients undergoing transurethral resection of bladder tumor (TURBT). Methodology This randomized controlled study included 240 adult patients in the age group of 30 to 70 years undergoing TURBT for lateral and posterolateral wall bladder tumors who fulfilled the American Society of Anesthesiologists grade I and II criteria. The patients were divided into two groups: group U (n = 120) included patients who underwent ONB using an ultrasound-guided technique and group UN (n = 120) included patients who underwent ONB using ultrasound with the nerve stimulation technique. Block performance time, adductor jerks/spasms, adductor muscle power, and patient and surgeon satisfaction were compared. A P-value <0.05 was considered statistically significant. Results The mean block performance time in group U was significantly less (4.4 ± 0.82 minutes) than in group UN (6.55 ± 0.37 minutes). Compared to group U, group UN had significantly fewer adductor jerks/spasms during the surgery (7.76% vs. 20.35%, p = 0.006), significantly more surgeon satisfaction (92.24% vs. 79.65%, p = 0.006), significantly more patient satisfaction (92.24% vs. 79.65%, p = 0.006), and comparable complications (excessive bleeding and minor bladder injury) and adductor muscle power after the block (p > 0.05). Conclusions ONB using the nerve stimulation technique under ultrasound guidance has a longer mean block performance time, a higher success rate, and higher surgeon satisfaction than ONB under ultrasound guidance only.
Collapse
Affiliation(s)
- Simmi Muwal
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Dharam Singh Meena
- Anesthesiology and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Arushi Gupta
- Anesthesiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| |
Collapse
|
4
|
Di Franco C, Cipollini C, Figà Talamanca G, Tazioli G, Patroncini S, Calistri M, Briganti A. Saphenous and Sciatic Nerve Blockade with and without Obturator Nerve Block for Tibial Plateau Levelling Osteotomy Surgery in Dogs: A Randomized Controlled Trial. Animals (Basel) 2023; 13:3792. [PMID: 38136829 PMCID: PMC10740557 DOI: 10.3390/ani13243792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The objective of our study was to compare the efficacy of sciatic and saphenous ultrasound nerve blocks with and without US-guided obturator nerve block in dogs undergoing tibial-plateau-levelling-osteotomy (TPLO) surgery. This study was developed in two phases: identification of an ultrasound window in the inguinal region for obturator nerve block and utilization of it in dogs undergoing TPLO. Dogs were assigned randomly to one of two groups: one received the three blocks with 0.5% ropivacaine (ON group) and the second one (NoON group) with NaCl instead of ropivacaine for the obturator block. In phase 1, the obturator nerve was visible between the pectineus and the abductor muscles and was approached using an in-plane technique. It was possible to use the ultrasound window for phase two. The number of dogs that received at least one bolus of intraoperative rescue analgesia in the NoON group (12/15 dogs) was significantly higher (p = 0.003) in comparison with the ON group (4/15). An ultrasound window to block the obturator nerve in the inguinal compartment with an in-plane technique was found. The use of this approach could produce adequate analgesia with less motor function impairment in dogs for TPLO surgery.
Collapse
Affiliation(s)
- Chiara Di Franco
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (C.D.F.); (C.C.); (S.P.)
| | - Chiara Cipollini
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (C.D.F.); (C.C.); (S.P.)
| | - Giacomo Figà Talamanca
- Clinica Veterinaria Valdinievole, Monsummano Terme, 51015 Pistoia, Italy; (G.F.T.); (G.T.); (M.C.)
| | - Giulio Tazioli
- Clinica Veterinaria Valdinievole, Monsummano Terme, 51015 Pistoia, Italy; (G.F.T.); (G.T.); (M.C.)
| | - Stefano Patroncini
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (C.D.F.); (C.C.); (S.P.)
| | - Maurizio Calistri
- Clinica Veterinaria Valdinievole, Monsummano Terme, 51015 Pistoia, Italy; (G.F.T.); (G.T.); (M.C.)
| | - Angela Briganti
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (C.D.F.); (C.C.); (S.P.)
| |
Collapse
|
5
|
Pretterklieber B, Pretterklieber ML, Kerschan-Schindl K. Topographical Anatomy of the Adductor Muscle Group in the Albino Rat ( Rattus norvegicus). Life (Basel) 2023; 13:2096. [PMID: 37895477 PMCID: PMC10608503 DOI: 10.3390/life13102096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
In comparative anatomy, the adductor muscles are said to be quite variable and to often cause difficulty in separation. The arrangement of these muscles and the possible occurrence of the adductor minimus and obturator intermedius muscles in the albino rat has not been investigated. The aim of this study was to accurately describe the adductor muscles in the albino rat (Rattus norvegicus). We hypothesized that all adductor muscles are constantly present and can be separated in a constant manner, and that the adductor minimus and obturator intermedius muscles are constant structures. Both pelvic limbs of 30 formalin-embalmed male albino rats were carefully dissected. The identification of the individual muscles was made based on their position in relation to the two branches of the obturator nerve and by comparing our results with previous findings in other species including humans. All examined rats had two gracilis muscles. The adductor longus muscle was the most superficial and smallest individual. The adductor brevis split into two parts of insertion-the femoral and genicular parts. The adductor magnus and minimus muscles could be separated constantly. The obturator intermedius muscle was a constant structure next to the obturator externus muscle. The adductor muscles of the albino rat were constantly separable and could be clearly assigned to their names. Further research is needed to investigate these muscles, especially the obturator intermedius muscle, in other species including humans.
Collapse
Affiliation(s)
- Bettina Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria;
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael L. Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, 8036 Graz, Austria;
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Katharina Kerschan-Schindl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| |
Collapse
|
6
|
Iwanaga J, Reina F, Ishak B, Reina MA, Dumont AS, Tubbs RS. Revisiting the Muscular Innervation of the Obturator Nerve: Application to Neurotization Procedures. Kurume Med J 2023. [PMID: 37062725 DOI: 10.2739/kurumemedj.ms682009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Our goal was to revisit the innervation of the adductor muscles of the thigh and add new evidence to currently existing knowledge. METHODS Ten thighs from five fresh frozen cadavers were dissected. Obturator nerve innervation to the pectineus, obturator externus, adductor brevis, adductor magnus, adductor longus, and gracilis was documented. RESULTS The adductor longus and gracilis were innervated by the anterior branch in 100%, and the adductor magnus was innervated by the posterior branch in 100%. The adductor brevis was supplied by both the anterior and posterior branches in 90%. The obturator externus was innervated by the posterior branch in 60% and a direct branch from the main trunk in 10%. No innervation of the obturator externus by the obturator nerve was found in 30%. CONCLUSIONS The obturator externus and adductor brevis need to be explored further to clarify their innervation.
Collapse
Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences
- Department of Neurology, Tulane Center for Clinical Neurosciences
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Francisco Reina
- Neuroscience, Embryology, Molecular Oncology and Clinical Anatomy Group (NEOMA), School of Medicine, University of Girona
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital
| | - Miguel Angel Reina
- School of Medicine, CEU San Pablo University
- Department of Anesthesiology, Madrid-Montepríncipe University Hospital
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences
- Department of Neurology, Tulane Center for Clinical Neurosciences
- Department of Structural & Cellular Biology, Tulane University School of Medicine
- Department of Anatomical Sciences, St. George's University
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System
| |
Collapse
|
7
|
Portela DA, Cavalcanti M, Teixeira JG, Gandy KY, Zamora G, Stern AW, Jones R, Fuensalida SE, Chiavaccini L, Romano M, Otero PE. Lumbosacral plexus block using a combination of ultrasound-guided lateral pre-iliac and parasacral approaches in cats. Vet Anaesth Analg 2023; 50:188-196. [PMID: 36775670 DOI: 10.1016/j.vaa.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe an ultrasound-guided lateral pre-iliac (LPI) and parasacral (PS) approach in feline cadavers (phase I) and compare the perioperative analgesic use and complications in cats administered LPI and PS blocks (group PNB) or epidural anesthesia (group EPI) for pelvic limb surgery (phase II). STUDY DESIGN Experimental uncontrolled, anatomic and retrospective cohort study. ANIMALS A group of eight feline cadavers and 52 medical records. METHODS Bilateral LPI and PS approaches with 0.1 mL kg-1 of dye to stain the femoral and obturator nerves and the lumbosacral trunk, respectively, were performed on each cadaver. Nerve staining effect was evaluated upon dissections (phase I). Perioperative analgesics use, and complication rates were retrospectively compared between groups PNB and EPI (phase II). Continuous data were compared using the Mann-Whitney U test and the prevalence of events with Fisher's exact test. Differences were considered significant when p < 0.05. RESULTS Dissections revealed that the LPI approach stained 94% and 75% of the femoral and obturator nerves, respectively. The PS approach stained 100% of the lumbosacral trunks. Cats enrolled in group PNB (n = 23) were administered lower doses of intraoperative opioids than those in group EPI (n = 25) (p = 0.006). Intraoperative rescue analgesia was required in 60% and 17.4% of cats enrolled in groups EPI and PNB, respectively (p = 0.003). Group PNB required more intraoperative anticholinergics than group EPI (p = 0.02). There were no differences in postoperative pain scores, analgesic use and complication rates. CONCLUSIONS AND CLINICAL RELEVANCE The ultrasound-guided LPI and PS approach stained the femoral/obturator nerves and the lumbosacral trunk, respectively, in feline cadavers. Furthermore, PNB was associated with lower intraoperative opioid use and similar postoperative pain and analgesic use compared with epidural anesthesia in a cohort of cats undergoing surgery of the pelvic limb.
Collapse
Affiliation(s)
- Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
| | - Mariana Cavalcanti
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Jorge G Teixeira
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Keith Y Gandy
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Gustavo Zamora
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Adam W Stern
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Rachel Jones
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Santiago E Fuensalida
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Romano
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Pablo E Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
8
|
Johnston BR, Bazarek S, Sten M, McIntyre BS, Fine N, De EJB, McGovern F, Lemos N, Ruggieri MR, Barbe MF, Brown JM. Restoring bladder function using motor and sensory nerve transfers: a cadaveric feasibility study. J Neurosurg Spine 2023; 38:258-264. [PMID: 36208430 PMCID: PMC9898215 DOI: 10.3171/2022.8.spine22291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Bladder dysfunction after nerve injury has a variable presentation, and extent of injury determines whether the bladder is spastic or atonic. The authors have proposed a series of 3 nerve transfers for functional innervation of the detrusor muscle and external urethral sphincter, along with sensory innervation to the genital dermatome. These transfers are applicable to only cases with low spinal segment injuries (sacral nerve root function is lost) and largely preserved lumbar function. Transfer of the posterior branch of the obturator nerve to the vesical branch of the pelvic nerve provides a feasible mechanism for patients to initiate detrusor contraction by thigh adduction. External urethra innervation (motor and sensory) may be accomplished by transfer of the vastus medialis nerve to the pudendal nerve. The sensory component of the pudendal nerve to the genitalia may be further enhanced by transfer of the saphenous nerve (sensory) to the pudendal nerve. The main limitations of coapting the nerve donors to their intrapelvic targets are the bifurcation or arborization points of the parent nerve. To ensure that the donor nerves had sufficient length and diameter, the authors sought to measure these parameters. METHODS Twenty-six pelvic and anterior thigh regions were dissected in 13 female cadavers. After the graft and donor sites were clearly exposed and the branches identified, the donor nerves were cut at suitable distal sites and then moved into the pelvis for tensionless anastomosis. Diameters were measured with calipers. RESULTS The obturator nerve was bifurcated a mean ± SD (range) of 5.5 ± 1.7 (2.0-9.0) cm proximal to the entrance of the obturator foramen. In every cadaver, the authors were able to bring the posterior division of the obturator nerve to the vesical branch of the pelvic nerve (located internal to the ischial spine) in a tensionless manner with an excess obturator nerve length of 2.0 ± 1.2 (0.0-5.0) cm. The distance between the femoral nerve arborization and the anterior superior iliac spine was 9.3 ± 1.8 (6.5-15.0) cm, and the distance from the femoral arborization to the ischial spine was 12.9 ± 1.4 (10.0-16.0) cm. Diameters were similar between donor and recipient nerves. CONCLUSIONS The chosen donor nerves were long enough and of sufficient caliber for the proposed nerve transfers and tensionless anastomosis.
Collapse
Affiliation(s)
| | - Stanley Bazarek
- 1Department of Neurosurgery, Brigham and Women's Hospital, Boston
| | - Margaret Sten
- 2Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian S McIntyre
- 3Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Noam Fine
- 4Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elise J B De
- 4Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis McGovern
- 4Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nucelio Lemos
- 5Department of Obstetrics & Gynaecology, University of Toronto, Ontario, Canada; and
| | - Michael R Ruggieri
- 6Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Mary F Barbe
- 6Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Justin M Brown
- 2Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
9
|
Shima D, Kinoshita T, Umemoto Y, Yasuoka Y, Hashizaki T, Asaeda M, Nishimura Y, Yahata T, Shimoe T, Tajima F. Case report: Physical findings, physical therapy practice, and characteristics of disability of activities of daily living caused by obturator nerve palsy after neurotmesis. Front Neurol 2023; 14:1062018. [PMID: 36761343 PMCID: PMC9902874 DOI: 10.3389/fneur.2023.1062018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/05/2023] [Indexed: 01/26/2023] Open
Abstract
The obturator nerve originates from the lumbar plexus and innervates sensation in the thigh and movement of the adductor muscle group of the hip. Reports on physical therapy for patients with obturator nerve injuries have been limited due to insufficient injuries, and there have been no reports on rehabilitation after neurotmesis. Furthermore, there are no reports on the status of activities of daily living (ADL) and details of physical therapy in patients with paralysis of the adductor muscle group. In this study, we reported on a patient with adductor paralysis due to obturator neurotmesis, including the clinical symptoms, characteristics of ADL impairment, and effective movement instruction. The patient is a woman in her 40's who underwent laparoscopic total hysterectomy, bilateral adnexectomy, and pelvic lymph node dissection for uterine cancer (grade-2 endometrial carcinoma). During pelvic lymph node dissection, she developed an obturator nerve injury. She underwent nerve grafting during the same surgery by the microsurgeon. Donor nerve was the ipsilateral sural nerve with a 3-cm graft length. Due to obturator nerve palsy, postoperative manual muscle test results were as follows: adductor magnus muscle, 1; pectineus muscle, 1; adductor longs muscle, 0; adductor brevis muscle, 0; and gracilis muscle, 0. On postoperative day 6, the patient could independently perform ADL; however, she was at risk of falling toward the affected side when putting on and taking off her shoes while standing on the affected leg. The patient was discharged on postoperative day 8. Through this case, we clarified the ADL impairment of a patient with adductor muscle palsy following obturator neurotmesis, and motion instruction was effective as physical therapy for this disability. This case suggests that movement instruction is important for acute rehabilitation therapy for patients with hip adductor muscle group with obturator neurotmesis.
Collapse
Affiliation(s)
- Daichi Shima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,*Correspondence: Yasunori Umemoto ✉
| | - Yoshinori Yasuoka
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Takamasa Hashizaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Makoto Asaeda
- Faculty of Wakayama Health Care Sciences, Takarazuka University of Medical and Health Care, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Shiwa-gun, Japan
| | - Tamaki Yahata
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Shimoe
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
10
|
Lim EJ, Sakong S, Son WS, Kim H, Cho JW, Oh JK. Usefulness of the obturator hook technique for guiding the initial trajectory control in infra-acetabular screw placement. J Orthop Surg (Hong Kong) 2021; 29:2309499021996838. [PMID: 33641537 DOI: 10.1177/2309499021996838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Proper placement of infra-acetabular screws is technically demanding; there is a limited safe zone for screw fixation because of the complexity of the bone anatomy around the hip joint and the vulnerability of the major neurovascular bundles in the pelvic cavity. We aimed to present the obturator hook technique as a surgical technique for infra-acetabular screw placement in acetabular and pelvic fractures and report its radiological outcomes. METHODS Patients treated with infra-acetabular screw placement using the obturator hook technique between January 2015 and August 2020 were enrolled in this study. We collected data on demographics, surgical approach, reduction status, complications, and outcomes. The radiological outcomes of infra-acetabular screw placement based on computed tomography findings were evaluated as follows: success, articular penetration, or out of the bone. RESULTS Thirty-five patients underwent infra-acetabular screw placement (26 men, 9 women; mean age, 55 years; range, 27-90 years). One patient underwent bilateral infra-acetabular screw placement; therefore, 36 infra-acetabular screws were inserted in all patients. An ideal placement was achieved with 27 infra-acetabular screws (27/36, 75%). Seven infra-acetabular screws (7/36, 19%) showed articular penetration, and two infra-acetabular screws (2/36, 6%) were placed outside the bone. One patient with articular penetration and mechanical symptoms of the hip joint required screw replacement. No other complications, including obturator nerve and vascular injuries, were observed. CONCLUSION The obturator hook technique could be a favorable and individualized method for infra-acetabular screw placement in patients with acetabular and pelvic fractures. LEVEL OF EVIDENCE IV, retrospective descriptive study.
Collapse
Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Seungyeob Sakong
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Whee Sung Son
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - HanJu Kim
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, 58934Guro Hospital, Korea University Medical Center, Seoul, Korea
| |
Collapse
|
11
|
Emamhadi M, Aghaei I, Noroozi Guilandehi S, Emamhadi R, Shabani M. Successful restoration of knee extension after transferring of the anterior branch of the obturator nerve: a case study. Int J Neurosci 2021; 132:1128-1131. [PMID: 33349084 DOI: 10.1080/00207454.2020.1865948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Femoral nerve palsy occurs after trauma, surgical procedures and tumors and leads to loss of quadriceps functions, disability and decreased quality of life. The aim of this report was to describe a successful restoration of knee extension by transferring the anterior branch of the obturator nerve to selective branches of the femoral nerve at the thigh level.Methods: We describe a 27-year-old male who had quadriceps femoris muscle paralysis after surgical evacuation for retroperitoneal hematoma five months ago. Since proximal stump of femoral nerve was not accessible, we transferred anterior branch of obturator nerve to selective branches of femoral nerve for reconstruction of quadriceps femoris muscle.Results: After four months, he regained quadriceps muscle strength M3 and began to walk. He achieved full muscle strength (M5) nine months after surgery and was able to walk up-stairs easily 14 months after surgery and atrophy of the quadriceps was improved.Conclusion: The anterior branch of the obturator nerve is an available donor nerve with an excellent functional recovery for the reconstruction of knee extension when proximal stump of femoral nerve is not reachable or the repair needs a long graft.
Collapse
Affiliation(s)
- Mohammadreza Emamhadi
- Brachial Plexus and Peripheral Nerve Injury Center, Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran
| | - Iraj Aghaei
- Department of Neuroscience, Neuroscience Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Roxana Emamhadi
- Department of Biotechnology, School of Basic Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Mohammad Shabani
- Intracellular Recording Lab, Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
12
|
Abstract
Reports in the literature have presented the feasibility of a minimally invasive resection of retroperitoneal or pelvic schwannomas. However, there are only a few reports in the literature about a robot-assisted nerve-sparing approach towards obturator schwannomas. We present a case of a concomitant excision of a symptomatic obturator nerve schwannoma in a patient undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy. The patient complained about an ongoing, low-grade sensory dysfunction in the left proximal thigh area, without loss of muscular function. A preoperative pelvic MRI incidentally showed a thickening of the left obturator nerve of about 1 cm. During pelvic lymphadenectomy, the thickening was identified, an axial incision was made to the nerve sheath, and a small tumor mass (9 mm x 5 mm x 3 mm) was excised, thereby decompressing the nerve fibers and simultaneously preserving the continuity of the obturator nerve. The nerve sheath was closed using a 7-0 monofilament suture. Frozen section biopsy that was undertaken during the surgical procedure excluded the presence of a malignancy. There were no intra- or postoperative complications. Postoperatively, the patient described a temporary sensory dysfunction of the left inner-thigh area, which regressed completely. The histopathological result confirmed a benign schwannoma of the obturator nerve. In experienced hands, the robot-assisted approach appears safe and feasible as a technique to excise a schwannoma of the obturator nerve, without the need to proceed to a full nerve resection.
Collapse
Affiliation(s)
- Nikolaos Liakos
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital Gronau, Gronau, DEU
| | - Mikolaj A Mendrek
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital Gronau, Gronau, DEU
| | - Joern H Witt
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital Gronau, Gronau, DEU
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital Gronau, Gronau, DEU
| |
Collapse
|
13
|
Uehara H, Yamazaki T, Kameyama H, Iwaya A, Gohda Y, Chinen I, Kubota A, Aoki M, Kobayashi K, Sato D, Yokoyama N, Kuwabara S, Otani T. Internal hernia beneath the obturator nerve after robot-assisted lateral lymph node dissection for rectal cancer: A case report and literature review. Asian J Endosc Surg 2020; 13:578-581. [PMID: 32180365 DOI: 10.1111/ases.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
A 63-year-old man who underwent robot-assisted laparoscopic low anterior resection and right lateral lymph node dissection (LLND) for rectal cancer presented with right thigh pain, nausea, vomiting, and abdominal pain on postoperative day 17. CT revealed dilated small bowel in the pelvis, and a small bowel loop was detected outside the internal iliac artery branch. Emergent laparoscopic surgery revealed the migration of the small bowel into the space beneath the right obturator nerve. The herniated bowel was reduced, and the obturator nerve was sharply dissected from the herniated bowel and preserved. The hernial orifice was left unrepaired. Postoperative recovery was uneventful, and the right thigh pain disappeared. It is important to consider the possibility of internal herniation beneath the obturator nerve after minimally invasive lateral lymph node dissection for rectal cancer.
Collapse
Affiliation(s)
- Hiroaki Uehara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Toshiyuki Yamazaki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hitoshi Kameyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Yousuke Gohda
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Itaru Chinen
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Kubota
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Makoto Aoki
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Kazuaki Kobayashi
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Daisuke Sato
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoyuki Yokoyama
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Tetsuya Otani
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| |
Collapse
|
14
|
Abstract
Primary multiple obturator nerve schwannomas originate from Schwann cells and are extremely rare. Patients with schwannomas are asymptomatic and a retroperitoneal schwannoma is often misdiagnosed as an adnexal mass. In the present study, we describe a 58-year-old woman in whom a right adnexal mass accompanied by endometrial polyp was found incidentally through transvaginal ultrasound. The mass was diagnosed as multiple obturator nerve schwannomas after laparoscopy. Immunohistochemical assay confirmed the schwannomas to be positive for SOX10. To our knowledge, this is the first report to demonstrate a case of multiple schwannomas originating from the obturator nerve and treated by laparoscopic resection.
Collapse
Affiliation(s)
- Xuechai Bai
- Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Li
- Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojing Li
- Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Siyu Cao
- Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Wang
- Department of Gynecology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
15
|
Topdagi Yilmaz EP, Topdaği YE, Bilge N, Kumtepe Y. Comparison of the harmonic scalpel with scissors in women who experience obturator nerve injury during lymph node dissection for gynaecological malignancies. Ginekol Pol 2019; 90:577-581. [PMID: 31686414 DOI: 10.5603/gp.2019.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Lymphadenectomy is crucial for accurate staging in most gynecological malignancies. Serious complications can occur during the surgery. The present study aimed to present the early and late findings associated with obturator nerve injury, which is rarely observed during lymphadenectomy but can result in serious sequela if not noticed. MATERIAL AND METHODS The files of the patients who underwent lymphadenectomy at our clinic between 2012 and 2018 were examined. Patients with obturator nerve incisions were identified retrospectively. RESULTS In total, 287 women patients underwent lymphadenectomy at our clinic between 2012 and 2018. Examination of surgical notes revealed that nine patients underwent obturator nerve incisions using a scissor or a harmonic scalpel (energy- activated ultrasonic scissors). With respect to management of obturator nerve damage, no significant difference was found between the use of a harmonic scalpel and scissors (p < 1.000) and the trendelenburg and lithotomy positions (p < 0.167). In addition, no significant difference was found between laparoscopy and laparotomy in terms of surgical type (p < 0.167). At 6 months post-operatively, sensory-motor examinations and EMG findings of the patients were completely normal. CONCLUSIONS Surgeries performed for gynaecological malignancies have high mortality and morbidity rates. Moreover, in the event of a complication such as nerve damage during laparoscopy, successful management of the complication before the patient undergoes laparotomy allows the patient to continue benefitting from the advantages of the laparoscopy. The results of our study show that these high-risk surgeries should be performed in advanced and well-equipped medical centres by teams experienced in gynaecological oncology.
Collapse
Affiliation(s)
| | | | - Nuray Bilge
- Department of Neurology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Yakup Kumtepe
- Atatürk University Medical Faculty, Department of Obstetrics and Gynecology, Erzurum, Turkey
| |
Collapse
|
16
|
Cascella M, Quarto G, Grimaldi G, Izzo A, Muscariello R, Castaldo L, Di Caprio B, Bimonte S, Del Prete P, Cuomo A, Perdonà S. Neuropathic painful complications due to endopelvic nerve lesions after robot-assisted laparoscopic prostatectomy: Three case reports. Medicine (Baltimore) 2019; 98:e18011. [PMID: 31725673 PMCID: PMC6867760 DOI: 10.1097/md.0000000000018011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Robot-assisted laparoscopic prostatectomy (RALP) is the most frequent strategy used for the surgical remedy of patients with localized prostate cancer. Although there is awareness about potential patient positioning nerve injuries, iatrogenic nerve lesions are less described in the literature. Here, we report 3 cases of patients who presented with neuropathic painful complications due to RALP-associated nerve lesions. PATIENT CONCERNS A 62-year-old patient (case 1), a 72-year-old male (case 2), and a 57-year-old patient (case 3) presented at the clinic with symptoms of neuropathic pain after RALP surgery. DIAGNOSIS Patients were diagnosed with a potential injury of different branches of the pudendal nerve (cases 1 and 2), and left obturator nerve (case 3). INTERVENTIONS Patients underwent multimodal pharmacologic treatment through pregabalin, weak opioids, strong opioid, paracetamol, and adjuvants. In cases 2 and 3, a multidisciplinary approach was needed. As the patients responded to conservative treatment, invasive approaches were not necessary. OUTCOMES After treatment, the patients of case 1 showed pain relief after 4 days, paresthesia resolved in 15 days, whereas the anal crushing sensation lasted for approximately 1 month. In case 2, after 4 weeks of treatment, the patient experienced a considerable decrement in pain intensity with complete response after 4 months. In case 3, pain relief was achieved after 2 days, motor symptoms recovery after 2 weeks, and neuropathic features resolved completely after 5 weeks although the obturator sign resolved within 2 months. LESSONS The RALP-associated neurologic injuries may occur even when performed by highly experienced surgeons. A better understanding of the potential iatrogenic nerve lesions can surely allow an improvement in the surgical technique. A multidisciplinary approach and early multimodal pain strategy are mandatory for managing these complications.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Paola Del Prete
- Direzione Scientifica, Istituto Nazionale Tumori, IRCCS - Fondazione G. Pascale, Naples, Italy
| | | | | |
Collapse
|
17
|
Staples B, Ennedy E, Kim T, Nguyen S, Shore A, Vu T, Labovitz J, Wedel M. Cutaneous Branch of the Obturator Nerve Extending to the Medial Ankle and Foot: A Report of Two Cadaveric Cases. J Foot Ankle Surg 2019; 58:1267-1272. [PMID: 31350139 DOI: 10.1053/j.jfas.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
The area of skin supplied by the cutaneous branch of the obturator nerve (CBO) is highly variable. Although most introductory anatomy texts describe the CBO as innervating only a portion of the medial thigh, there are numerous reports in the literature of CBOs passing the knee to innervate the proximal, middle, or even distal leg. There are no previous reports of CBOs extending to the ankle and foot. Herein we describe 2 cases of CBOs extending at least to the medial foot. Both cases were discovered incidentally, during routine cadaver dissections by osteopathic and podiatric medical students in the anatomy laboratory of Western University of Health Sciences in California. In both instances, the anomalously long CBOs shared several characteristics: (1) they arose as direct branches of the anterior division of the obturator nerve, not from the subsartorial plexus; (2) they coursed immediately posterior to the great saphenous vein from the distal thigh to the distal leg, only deviating away from the saphenous vein just above the medial malleolus; and (3) they terminated in radiating fibers to the posterior half of the medial ankle and foot. In both cases, the saphenous branch of the femoral nerve was present but restricted to the area anterior to the great saphenous vein. It is likely that the variant CBOs carried fibers of the L4 spinal nerve and thus provided cutaneous innervation to the medial foot and ankle, a function most commonly reserved for the saphenous branch of the femoral nerve distal to the knee. Saphenous neuropathy is a common postoperative complication of saphenous cutdowns for coronary artery bypass grafts, so the potential involvement of a long CBO can add additional complexity to regional anesthetic blocks for foot and ankle surgery and procedures such as vein harvesting for coronary artery bypass grafts.
Collapse
Affiliation(s)
- Brittany Staples
- Student, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA; Chief Surgical Resident, SSM Health DePaul Hospital, St. Louis, MO.
| | - Edward Ennedy
- Student, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA; Resident, Medical City Forth Worth and University of North Texas Health Science Center, Fort Worth, TX
| | - Tae Kim
- Student, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA
| | - Steven Nguyen
- Student, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA; Resident, Einstein Healthcare Network, Philadelphia, PA
| | - Andrew Shore
- Student, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA; Resident, University of Missouri School of Medicine, Kansas City, MO
| | - Thomas Vu
- Student, Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA; Resident, Mercy Health, Muskegon, MI
| | - Jonathan Labovitz
- Professor, Department of Podiatric Medicine, Surgery, and Biomechanics, and Associate Dean of Clinical Education and Graduate Placement, Western University of Health Sciences College of Podiatric Medicine, Pomona, CA
| | - Mathew Wedel
- Associate Professor, Department of Anatomy, Western University of Health Sciences College of Osteopathic Medicine of the Pacific and College of Podiatric Medicine, Pomona, CA
| |
Collapse
|
18
|
Naber J, Lee N, Kapural L. Clinical efficacy assessment of cooled radiofrequency ablation of the hip in patients with avascular necrosis. Pain Manag 2019; 9:355-359. [PMID: 31215846 DOI: 10.2217/pmt-2018-0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: This pilot case series examined feasibility of anterior radiofrequency approach under combined ultrasound and fluoroscopy guidance to control pain from avascular necrosis of the hip. Patients & methods: Data on 11 consecutive patients were collected on longevity of cooled radiofrequency ablation (CRFA), pain relief and opioid use. Results: The average age was 56 (28-66), BMI 29.5 (16.5-34), in four women and three men. Their average opioid use was 92 mg MS04 equivalents (median 35 mg). The pain score decreased to 3.3 after the CRFA. Five patients claimed more than 50% of pain relief. The average time interval of greater than 50% of pain relief from the CRFA was 70-250 days. Conclusion: CRFA may be an effective treatment of chronic pain from avascular necrosis.
Collapse
Affiliation(s)
- Jeremy Naber
- Residency Program, Department of Anesthesiology, Wake Forest University, School of Medicine, Winston-Salem, NC, 145 Kimel Park Drive, Winston-Salem, NC 27103, USA
| | - Nicholas Lee
- Carlinas Pain Institute and Center for Clinical Research, Winston-Salem, NC, 145 Kimel Park Drive, Winston-Salem, NC 27, USA
| | - Leonardo Kapural
- Carlinas Pain Institute and Center for Clinical Research, Winston-Salem, NC, 145 Kimel Park Drive, Winston-Salem, NC 27, USA
| |
Collapse
|
19
|
Abstract
Case History: Dairy cows recumbent following calving on farms in South Gippsland, Australia were examined during two 3-month seasonal calving periods in 2011 and 2012 as part of a larger study of 218 recumbent cows. A cohort of 104 cows diagnosed with calving paralysis following dystocia was derived from the larger group, which were examined with 3 days of becoming recumbent. A thorough medical and musculoskeletal clinical examination was performed on each cow including flexor-withdrawal and patellar reflex tests, and postural assessment in the lifted position, unless the facilities were not available. Cows were diagnosed with one or more neurological syndromes: sciatic, tibial paresis, obturator or femoral, based on clinical findings consistent with damage to these peripheral nerves or their nerve roots. Clinical Findings: Evidence of sciatic syndrome was found in 100/104 (96.2%) cows and 146/172 (84.9%) affected hind limbs either as the sole neuropathy or in combination with tibial paresis, obturator or femoral syndromes. Pelvic damage was also present in 3/104 (2.8%) cows. Obturator syndrome was diagnosed in 30/104 (29%) cows and 45/172 (26.2%) affected hind limbs but not apparently as the sole reason for the recumbency. Femoral syndrome occurred in 16/104 (15.4%) cows and 21/172 (12.2%) affected hind limbs and was the only syndrome recorded in one cow. Clinical Relevance: Sciatic syndrome was the most common neurological syndrome observed in cows with calving paralysis. The other major nerves arising from the lumbo-sacral plexus were also affected and the various syndromes associated with damage to these nerves or their ventral nerve roots occurred in many combinations. Calving paralysis should be thought of as a paresis or paralysis resulting from damage to the ventral nerve roots of the lumbo-sacral plexus as any of the nerves originating from this plexus can be damaged during dystocia either individually or in combination with other nerves from the plexus.
Collapse
Affiliation(s)
- P J Poulton
- a Tarwin Veterinary Group , Leongatha , Victoria , Australia
| | - A D Fisher
- b Faculty of Veterinary and Agricultural Sciences , University of Melbourne , Werribee , Victoria , Australia
| | - P D Mansell
- b Faculty of Veterinary and Agricultural Sciences , University of Melbourne , Werribee , Victoria , Australia
| | - M F Pyman
- b Faculty of Veterinary and Agricultural Sciences , University of Melbourne , Werribee , Victoria , Australia
| |
Collapse
|
20
|
Lasso JM, Maranillo E, Martinez-Pascual P, Goñi E, Vazquez T, Sanudo J, Pascual-Font A. Anatomical study of the masseteric and obturator nerves: Application to face transplant and reanimation procedures. Clin Anat 2019; 32:612-617. [PMID: 30786070 DOI: 10.1002/ca.23357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/17/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
Abstract
The masseteric nerve (MN) and the anterior branch of the obturator nerve (ON) that innervate the transferred gracilis muscle have proved highly efficient for reanimating paralyzed facial muscles when muscle transfer is required. Previous researchers have published the total axonal load for myelinated fibers in both nerves. However, the real motor axonal load has not been established. We performed the study on 20 MN and 13 ON. The segments of the MN and the ON were embedded in paraffin, sectioned at 10 μm, and stained following a standard immunohistochemical procedure using anti-choline acetyltransferase to visualize the motor fibers. The MN has a higher axonal load than the ON. There were statistically significant differences between the axonal load of the proximal segment of the MN and the ON. These findings confirm that end-to-end anastomoses between the MN and the ON should preferably use the proximal segment. However, MN neurotomy should ideally be performed between the proximal and distal segments, preserving innervation to the deep fascicles. Our results show that the MN is ideal as a donor motor nerve for reinnervating transplanted muscle for dynamic reanimation of the paralyzed face. The neurotomy should ideally be performed between the first and second collateral branches of the MN. Clin. Anat. 32:612-617, 2019. © 2019 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jose M Lasso
- Department of Plastic Surgery, Hospital Gregorio Marañón, Madrid, Spain
| | - Eva Maranillo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Ender Goñi
- Department of Plastic Surgery, Hospital Gregorio Marañón, Madrid, Spain
| | - Teresa Vazquez
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Jose Sanudo
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Aran Pascual-Font
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
21
|
Alavi CE, Asgari SA, Falahatkar S, Rimaz S, Naghipour M, Khoshrang H, Jafari M, Herfeh N. Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor. Turk J Urol 2017; 43:507-511. [PMID: 29201516 DOI: 10.5152/tud.2017.96992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/17/2017] [Indexed: 11/22/2022]
Abstract
Objective To determine whether spinal anesthesia combined with obturator nerve blockade (SOB) is effective in preventing obturator nerve stimulation, jerking and bladder perforation during transurethral resection of bladder tumor (TURBT). Material and methods In this clinical trial, 30 patients were randomly divided into two groups: spinal anesthesia (SA) and SOB. In SA group, 2.5 cc of 0.5% bupivacaine was injected intrathecally using a 25-gauge spinal needle and in SOB after spinal anesthesia, a classic obturator nerve blockade was performed by using nerve stimulation technique. Results There was a statistically significant difference between jerking in both groups (p=0.006). During the TURBT, surgeon satisfaction was significantly higher in SOB group compared to SA group (p=0.006). There was no significant correlation between sex, patient age and location of bladder tumor between the groups (p>0.05). Conclusion Obturator nerve blockade by using 15 cc lidocaine 1% is effective in preventing adductor muscle spasms during TURBT.
Collapse
Affiliation(s)
- Cyrus Emir Alavi
- Anesthesiology Research Center, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed Alaeddin Asgari
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Siavash Falahatkar
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Siamak Rimaz
- Anesthesiology Research Center, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadreza Naghipour
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Hossein Khoshrang
- Anesthesiology Research Center, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehdi Jafari
- Anesthesiology Research Center, School of Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Nadia Herfeh
- Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
22
|
Takahashi H, Hara M, Tsuboi K, Sagawa H, Ishiguro H, Matsuo Y, Takeyama H. Laparoscopically resected obturator nerve schwannoma: A case report. Asian J Endosc Surg 2016; 9:307-310. [PMID: 27217293 DOI: 10.1111/ases.12291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/21/2016] [Accepted: 03/07/2016] [Indexed: 11/29/2022]
Abstract
Obturator nerve schwannomas are very rare. To date, only nine cases have been reported in the English-language literature; none of these were diagnosed preoperatively. A 68-year-old woman was admitted with left lower abdominal pain. CT and MRI revealed a mass 30 mm in diameter in the left obturator fossa, suggesting a retroperitoneal tumor. Because CT and MRI revealed clear continuity with the left obturator nerve, this case was diagnosed as an obturator nerve schwannoma. Tumor enucleation was performed by laparoscopy. On histopathological examination, this case was diagnosed as a benign obturator nerve schwannoma. Postoperatively, the patient developed weakness of the adductor muscle but recovered within 6 months with rehabilitation therapy. Preoperative diagnosis of obturator nerve schwannomas is quite difficult, but careful inspection of CT and MRI is important to identify the original nerve of schwannoma preoperatively. Accordingly, laparoscopic resection is a good treatment option.
Collapse
Affiliation(s)
- Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Masayasu Hara
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ken Tsuboi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Sagawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideyuki Ishiguro
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromitsu Takeyama
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| |
Collapse
|
23
|
Gupta G, Radhakrishna M, Etheridge P, Besemann M, Finlayson RJ. Radiofrequency denervation of the hip joint for pain management: case report and literature review. US Army Med Dep J 2014:41-51. [PMID: 24706242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND A 55-year-old male presented with severe pain and functional limitations as a result of left hip osteoarthritis. He had failed multiple treatments while waiting for a hip arthroplasty, including physical therapy, medications, and various intra-articular injections. Thermal radiofrequency lesioning of the obturator and femoral articular branches to the hip joint was offered in the interim. OBJECTIVES To our knowledge, this is the first report to describe an inferior-lateral approach for lesioning the obturator branch, the clinical application of successive lesions to increase denervation area, and outcomes in a patient receiving a second treatment with previously good results. METHODS To discuss relevant and technical factors for this specific case, we reviewed previous literature on hip joint radiofrequency and critically evaluated previous anatomic studies in the context of radiofrequency. RESULTS The first treatment provided significant benefit for a period of 6 months. A second treatment was employed providing only mild to moderate benefit until his joint replacement surgery 4 months later. Literature review revealed studies of low quality secondary to small sample sizes, patient selection methodology, inclusion of patients with heterogenous etiologies for pain, variable needle placement techniques, and lack of measurement of functional outcomes. LIMITATIONS Case report and low quality studies in existing literature. CONCLUSIONS Hip joint radiofrequency denervation is a promising avenue for adjunctive treatment of hip pain. Further cadaveric studies are required to clarify a multitude of technical parameters. Once these are well defined, future clinical studies should consider pain, functional, and economic outcomes in their design.
Collapse
Affiliation(s)
- Gaurav Gupta
- Alan Edwards Pain Management Unit, Dept of Anesthesia, Montreal General Hospital, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
24
|
Abstract
PURPOSE Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP. MATERIALS AND METHODS The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation. RESULTS The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs. CONCLUSION ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.
Collapse
Affiliation(s)
- Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
| | | | | | | |
Collapse
|
25
|
Kim SH, Kim DH, Yoon DM, Yoon KB. Clinical effectiveness of the obturator externus muscle injection in chronic pelvic pain patients. Pain Pract 2013; 15:40-6. [PMID: 24308439 DOI: 10.1111/papr.12138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/15/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because of its anatomical location and function, the obturator externus (OE) muscle can be a source of pain; however, this muscle is understudied as a possible target for therapeutic intervention in pain practice. In this retrospective observational study, we evaluated the clinical effectiveness of the OE muscle injection with a local anesthetic in chronic pelvic pain patients with suspected OE muscle problems. METHODS Twenty-three patients with localized tenderness on the inferolateral side of the pubic tubercle accompanied by pain in the groin, anteromedial thigh, or hip were studied. After identifying the OE with contrast dye under fluoroscopic guidance, 5 to 8 mL of 0.3% lidocaine was injected. Pain scores were assessed before and after injection; patient satisfaction was also assessed. RESULTS Mean pain score decreased by 44.7% (6.6 ± 1.8 to 3.5 ± 0.9, P < 0.001) 2 weeks after OE muscle injection as compared with pain score before injection. In addition, 82% of patients (19 of 23 patients) reported excellent or good satisfaction during 2 weeks after injection. No patients reported complications from OE muscle injection. CONCLUSIONS Fluoroscopy-guided injection of the OE muscle with local anesthetic reduced pain scores and led to a high level of satisfaction at short-term follow-up in patients with suspected OE muscle problem. The results of this study suggest that OE muscle injection may be a valuable therapeutic option for a select group of chronic pelvic pain patients who present with localized tenderness in the OE muscle that is accompanied by groin, anteromedial thigh, or hip pain.
Collapse
Affiliation(s)
- Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
26
|
Choi EJ, Byun JM, Nahm FS, Lee PB. Obturator nerve block with botulinum toxin type B for patient with adductor thigh muscle spasm -a case report-. Korean J Pain 2011; 24:164-8. [PMID: 21935496 PMCID: PMC3172331 DOI: 10.3344/kjp.2011.24.3.164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/25/2022] Open
Abstract
Obturator nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the obturator nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had obturator nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received obturator nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm.
Collapse
Affiliation(s)
- Eun Joo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | | |
Collapse
|
27
|
Kumka M. Critical sites of entrapment of the posterior division of the obturator nerve: anatomical considerations. J Can Chiropr Assoc 2010; 54:33-42. [PMID: 20195424 PMCID: PMC2829684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
IN THE CURRENT ANATOMIC STUDY, SPECIAL ATTENTION WAS GIVEN TO THE RELATIONSHIP OF THE POSTERIOR DIVISION OF THE OBTURATOR NERVE TO SURROUNDING STRUCTURES: the obturator canal and the fibromuscular and vascular structures of the medial thigh region. These intimate relationships may, in certain conditions, constitute critical sites of entrapment of the posterior division of the obturator nerve and may present a diagnostic challenge to the manual practitioner. Knowledge of the potential sites of entrapment of the posterior division of the obturator nerve can aid in differential diagnosis of peripheral neuropathies, provide an anatomic basis for obturator nerve pathology, and guide effective patient management, including the application of modern diagnostic techniques and safe surgical procedures.
Collapse
Affiliation(s)
- Myroslava Kumka
- Correspondence should be addressed to: Myroslava Kumka, MD, PhD, Canadian Memorial Chiropractic College, Department of Anatomy, 6100 Leslie Street, Toronto, ON M2H 3J1, Canada. Tel: (416) 482-2340 ext:175.
| |
Collapse
|