152 results on '"Anne Agur"'
Search Results
2. THE ROLE OF WOMEN IN THE TEACHING-RESEARCH OF ANATOMY IN MEDICINE IN CANADA
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Claudia Krebs and Anne Agur
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Anatomy ,educación médica ,Medicine ,Pathology ,RB1-214 - Abstract
None
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- 2023
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3. Gross and applied anatomy pedagogical approaches in occupational therapy education: protocol for a scoping review
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Emily S Ho, Anne Agur, Andrea Duncan, Erica Dove, Kelly Hennessy, Athena Kirou-Mauro, and Lorna Aitkens
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Medicine - Published
- 2022
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4. DR. KEITH LEON MOORE, BA, MSC, PHD, HON. D.SC (OSU), HON. D.SC (WU) FIAC, FRSM, FAAA
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Anne Agur and Arthur (Art) Dalley
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Medicine ,Pathology ,RB1-214 - Published
- 2020
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5. Automatic three-dimensional reconstruction of fascicles in peripheral nerves from histological images.
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Daniel Tovbis, Anne Agur, Jeremy P M Mogk, and José Zariffa
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Medicine ,Science - Abstract
Computational studies can be used to support the development of peripheral nerve interfaces, but currently use simplified models of nerve anatomy, which may impact the applicability of simulation results. To better quantify and model neural anatomy across the population, we have developed an algorithm to automatically reconstruct accurate peripheral nerve models from histological cross-sections. We acquired serial median nerve cross-sections from human cadaveric samples, staining one set with hematoxylin and eosin (H&E) and the other using immunohistochemistry (IHC) with anti-neurofilament antibody. We developed a four-step processing pipeline involving registration, fascicle detection, segmentation, and reconstruction. We compared the output of each step to manual ground truths, and additionally compared the final models to commonly used extrusions, via intersection-over-union (IOU). Fascicle detection and segmentation required the use of a neural network and active contours in H&E-stained images, but only simple image processing methods for IHC-stained images. Reconstruction achieved an IOU of 0.42±0.07 for H&E and 0.37±0.16 for IHC images, with errors partially attributable to global misalignment at the registration step, rather than poor reconstruction. This work provides a quantitative baseline for fully automatic construction of peripheral nerve models. Our models provided fascicular shape and branching information that would be lost via extrusion.
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- 2020
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6. Micro-biomechanics of the Kebara 2 hyoid and its implications for speech in Neanderthals.
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Ruggero D'Anastasio, Stephen Wroe, Claudio Tuniz, Lucia Mancini, Deneb T Cesana, Diego Dreossi, Mayoorendra Ravichandiran, Marie Attard, William C H Parr, Anne Agur, and Luigi Capasso
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Medicine ,Science - Abstract
The description of a Neanderthal hyoid from Kebara Cave (Israel) in 1989 fuelled scientific debate on the evolution of speech and complex language. Gross anatomy of the Kebara 2 hyoid differs little from that of modern humans. However, whether Homo neanderthalensis could use speech or complex language remains controversial. Similarity in overall shape does not necessarily demonstrate that the Kebara 2 hyoid was used in the same way as that of Homo sapiens. The mechanical performance of whole bones is partly controlled by internal trabecular geometries, regulated by bone-remodelling in response to the forces applied. Here we show that the Neanderthal and modern human hyoids also present very similar internal architectures and micro-biomechanical behaviours. Our study incorporates detailed analysis of histology, meticulous reconstruction of musculature, and computational biomechanical analysis with models incorporating internal micro-geometry. Because internal architecture reflects the loadings to which a bone is routinely subjected, our findings are consistent with a capacity for speech in the Neanderthals.
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- 2013
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7. Effect of motivational behaviors and race/ ethnicity on academic success in physical therapy students: a preliminary study
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Philip Fabrizio, Anne Agur, and Shannon Groff
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education ,Anatomy - Abstract
Objectives: Doctor of Physical Therapy (DPT) program admissions criteria and markers indicative of academic success appear to be mismatched. Acceptance into a DPT program implies that students have developed self-regulated learning strategies however, motivation behaviors are not typically assessed during the admissions process. The aim of this study was to determine direct effects of motivational behaviors and race/ethnicity on academic success and the moderating effect of race/ethnicity on motivational behaviors. Methods: Thirty-three first-year DPT students participated during their first foundational course, clinical anatomy. Motivation subscales from the motivated strategies for learning questionnaire (MSLQ) were used to assess student motivation behaviors which were then compared to course grades. Results: Self-efficacy for learning and performance was significantly correlated with course grade [r(31)=0.44, p< 0.05]. Course grade differed at a statistically significant level by race/ethnicity [t(31)=2.93, p
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- 2021
8. Inter- and intra-rater reliability of carpal tunnel volume measurement
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Karen D. Gordon, Michele Oliver, Mackenzie J. Miller, Drew A. Anderson, and Anne Agur
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Orthodontics ,medicine.anatomical_structure ,business.industry ,Volume measurement ,Biomedical Engineering ,Computational Mechanics ,Medicine ,Radiology, Nuclear Medicine and imaging ,Carpal tunnel ,Intra-rater reliability ,business ,Computer Science Applications - Published
- 2021
9. Typical m. triceps surae morphology and architecture measurement from 0 to 18 years: A narrative review
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Ali Mirjalili, Ghaliya Salim Al Masruri, Justin Fernandez, Matthew Bell, Behzad Hajarizadeh, Sîan A Williams, Anne Agur, and Ngaire Stott
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medicine.medical_specialty ,Histology ,Adolescent ,M. triceps surae ,Imaging modalities ,Young Adult ,Physical medicine and rehabilitation ,Triceps surae muscle ,medicine ,Humans ,Child ,Muscle, Skeletal ,Molecular Biology ,Ecology, Evolution, Behavior and Systematics ,Ultrasonography ,Leg ,medicine.diagnostic_test ,business.industry ,Confounding ,Ultrasound ,Infant ,Reproducibility of Results ,Skeletal muscle ,Magnetic resonance imaging ,Cell Biology ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Narrative review ,Anatomy ,business ,Developmental Biology - Abstract
The aim of this review was to report on the imaging modalities used to assess morphological and architectural properties of the m. triceps surae muscle in typically developing children, and the available reliability analyses. Scopus and MEDLINE (Pubmed) were searched systematically for all original articles published up to September 2020 measuring morphological and architectural properties of the m. triceps surae in typically developing children (18 years or under). Thirty eligible studies were included in this analysis, measuring fibre bundle length (FBL) (n = 11), pennation angle (PA) (n = 10), muscle volume (MV) (n = 16) and physiological cross-sectional area (PCSA) (n = 4). Three primary imaging modalities were utilised to assess these architectural parameters in vivo: two-dimensional ultrasound (2DUS; n = 12), three-dimensional ultrasound (3DUS; n = 9) and magnetic resonance imaging (MRI; n = 6). The mean age of participants ranged from 1.4 years to 18 years old. There was an apparent increase in m. gastrocnemius medialis MV and pCSA with age; however, no trend was evident with FBL or PA. Analysis of correlations of muscle variables with age was limited by a lack of longitudinal data and methodological variations between studies affecting outcomes. Only five studies evaluated the reliability of the methods. Imaging methodologies such as MRI and US may provide valuable insight into the development of skeletal muscle from childhood to adulthood; however, variations in methodological approaches can significantly influence outcomes. Researchers wishing to develop a model of typical muscle development should carry out longitudinal architectural assessment of all muscles comprising the m. triceps surae utilising a consistent approach that minimises confounding errors.
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- 2021
10. A dynamic ultrasonographic in vivo study of the musculoaponeurotic architecture of the human masseter muscle
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Anne Agur, R. Leekam, Ernest W.N. Lam, S.E. Perschbacher, Bernard Liebgott, and Teodora-Iunia Gheorghe
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Adult ,Male ,Contraction (grammar) ,Intraclass correlation ,Asymptomatic ,Pathology and Forensic Medicine ,Masseter muscle ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,In vivo ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Ultrasonography ,Masseter Muscle ,business.industry ,Ultrasound ,Reproducibility of Results ,030206 dentistry ,Intra-rater reliability ,Anatomy ,Normative database ,030220 oncology & carcinogenesis ,Female ,Surgery ,Oral Surgery ,medicine.symptom ,business ,Muscle Contraction - Abstract
Objective In the present study, we sought to investigate the in vivo musculoaponeurotic architecture of the masseter muscle (MM) volumetrically with ultrasound in asymptomatic participants. It was hypothesized that the mean fiber bundle length (FBL) and mean aponeurotic height of laminae of the MM differ significantly between the relaxed state and maximally contracted state upon elevation of the mandible. Study Design The MM was investigated volumetrically in 12 male and 12 female asymptomatic participants (mean age, 25.8 ± 4.1 years) using ultrasound. The mean FBL and mean height of aponeuroses in the relaxed and maximally contracted states were compared using paired t tests, with significance established at P ≤ .05. Intrarater reliability was assessed using the intraclass correlation coefficient (ICC). Results The MM consisted of the superficial head (SH) and deep head, each arranged in multiple laminae. Fiber bundles extended between superior and inferior aponeuroses and/or bone. Statistically significant differences (P ≤ .05) were observed in mean FBL and in mean height of aponeuroses between the relaxed and contracted states only in superficial laminae of the SH. Conclusions These results suggest there is differential contraction of the laminae of the MM in the transition from relaxed to contracted states. Future comparison with pathologic patients can be made on the basis of an established normative database.
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- 2021
11. Anatomical Detail and Accuracy of the Pernkopf Atlas and Examples of Clinical Impact
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Anne Agur
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Computer science ,Atlas (topology) ,General Medicine ,Cartography - Abstract
The high fidelity anatomical structural detail seen in the Pernkopf atlas remains unmatched in other references, including surgical anatomy atlases. An example of serial dissection illustrations are examined herein, in relation to an anatomically based clinical question. The question is about radiofrequency nerve ablation, an image-guided procedure that provides a non-opioid alternative to treat joint pain. To perform these image-guided procedures effectively, the location and course of the nerve(s) being targeted is very important. Although the patient had good pain relief, the clinician was concerned about the patient's loss of sensation around the anus following an ablation procedure of the nerves innervating the sacroiliac joint, and asked for more information about the clunial nerves and their relevance to this procedure. The anatomical illustrations in the Pernkopf atlas are highly detailed and drawn from serially dissected specimens from the skin superficially to the level of the origin of the nerves from the vertebral column deeply. Tracing the clunial nerves through five serial illustrations provided the necessary anatomical insight required to answer this clinical question for development of the ablation procedure. This atlas could play a significant role in educating future clinicians and surgeons and provide answers to anatomically related clinical quandaries. However, the atlas must always be used by first acknowledging its origins and history. Image credit: Table of Contents image provided by the Medical University of Vienna, MUW-Andruck-180ll-Seite-1.
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- 2022
12. Three-dimensional muscle architecture of the infant and adult trapezius: a cadaveric pilot study
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Luke R. Bradshaw, Anne Agur, Mikaela L. Stiver, S. Ali Mirjalili, and Ethan M. Breinhorst
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Health Care Sciences and Services ,business.industry ,Medicine ,Anatomy ,Sağlık Bilimleri ve Hizmetleri ,business ,Muscle architecture ,Cadaveric spasm ,cadaver,digitization,infant,muscle architecture,skeletal muscle,trapezius - Abstract
Objectives: The elaborate morphometry of the human trapezius muscle facilitates its involvement in numerous active movements of the shoulder girdle and passive stabilization of the upper extremity. Despite its functional importance throughout the lifespan, little is known about the 3D architecture of trapezius at any post-natal timepoints. Accordingly, the aim of this preliminary cadaveric study was to digitize, quantify, model, and compare the 3D architecture of trapezius at two temporal extremes: infancy and adulthood. Methods: We examined trapezius in two female formalin-embalmed cadavers, aged 6 months and 72 years, respectively. We meticulously dissected each muscle, allowing us to digitize and model the comprehensive muscle architecture in situ at the fiber bundle level. We quantified standard architectural parameters to facilitate comparison between each functional partition of trapezius (i.e., descending, transverse, ascending) and proportionally between the infant and adult specimens. Results: We found markedly different patterns in fiber bundle length range, physiological cross-sectional area, and muscle volume within and between muscles. Notably, the proportional physiological cross-sectional area of the ascending and descending partitions was equal (1:1) in the infant, in contrast to 3:1 in the adult. The transverse partitions were proportionally similar, accounting for over half of the whole muscle physiological cross-sectional area in both specimens. Conclusion: This study provides preliminary insights into infant and adult trapezius architecture at an unparalleled level of detail and precision. The quantifiable architectural differences appear to coincide with functional development-a notion that warrants further investigation in larger samples and with longitudinal approaches.
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- 2021
13. Evaluation of nerve capture using classical landmarks for genicular nerve radiofrequency ablation: 3D cadaveric study
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John Tran, Anne Agur, and Philip Peng
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Denervation ,Radiofrequency Ablation ,Knee Joint ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Soft tissue ,3d model ,General Medicine ,Anatomy ,Ablation ,Quadriceps Muscle ,law.invention ,Anesthesiology and Pain Medicine ,law ,Cannula tip ,Cadaver ,Humans ,Medicine ,business ,Cadaveric spasm - Abstract
Background and objectivesRadiofrequency (RF) denervation of the superolateral genicular nerve (SLGN), superomedial genicular nerve (SMGN) and inferomedial genicular nerve (IMGN) is commonly used to manage chronic knee joint pain. However, knowledge of articular branches captured, using classical landmarking techniques, remains unclear. In order to enhance and propose new RF procedures that conceivably capture a greater number of articular branches, more detailed cadaveric investigation is required. The objectives were to (1) determine which articular branches are captured or spared using classical landmarking techniques, and (2) evaluate the anatomical feasibility of classical landmarking techniques using three-dimensional (3D) modeling technology.MethodsUltrasound-guided classical superolateral/superomedial/inferomedial landmarking techniques were used to position RF cannulae in five specimens. The articular branches, bony and soft tissue landmarks, and cannula tip position, were meticulously dissected, digitized and modeled in 3D. Simulated lesions were positioned at the cannula tip, on the 3D models, to determine which articular branches were captured or spared. Capture rates of articular branches were compared.ResultsIn all specimens, classical superolateral/superomedial techniques captured the transverse deep branches of SLGN and SMGN, and articular branches of lateral and medial nerve to vastus intermedius, while sparing distal branches of SLGN/SMGN. The inferomedial technique captured anterior branches of IMGN while sparing the posterior and inferior branches.ConclusionsThis study provides anatomical evidence supporting the effectiveness of classical landmarking for genicular nerve ablation; however, each technique resulted in sparing of articular branches. The extensive innervation of the knee joint suggests the use of supplementary landmarks to improve capture rates and potentially patient outcomes.
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- 2020
14. The endoscopic transpterional port approach: anatomy, technique, and initial clinical experience
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Francesco Doglietto, Mazda K Turel, Krunal Patel, Hugo Andrade-Barazarte, Fred Gentili, Rachel Tymianski, Michael Tymianski, Ivan Radovanovic, Vitor Mendes Pereira, and Anne Agur
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MCA = middle cerebral artery ,medicine.medical_specialty ,anatomy ,Endoscope ,ICA = internal carotid artery ,medicine.medical_treatment ,ETPA = endoscopic transpterional port approach ,cavernous sinus ,ACoA = anterior communicating artery ,CN = cranial nerve ,PCoA = posterior communicating artery ,SAH = subarachnoid hemorrhage ,aneurysms ,endoscopy ,mRS = modified Rankin Scale ,oncology ,skull base ,surgical technique ,transpterional approach ,Pterion ,Port (medical) ,Modified Rankin Scale ,Cadaver ,medicine ,Craniotomy ,medicine.diagnostic_test ,business.industry ,Endoscopy ,medicine.anatomical_structure ,Cavernous sinus ,Radiology ,business - Abstract
OBJECTIVEThe evolution of microsurgical and endoscopic techniques has allowed the development of less invasive transcranial approaches. The authors describe a purely endoscopic transpterional port craniotomy to access lesions involving the cavernous sinus and the anterolateral skull base.METHODSThrough single- or dual-port incisions and with direct endoscopic visualization, the authors performed an endoscopic transpterional port approach (ETPA) using a 4-mm straight endoscope in 8 sides of 4 formalin-fixed cadaveric heads injected with colored latex. A main working port incision is made just below the superior temporal line and behind the hairline. An optional 0.5- to 1-cm second skin port incision is made on the lateral supraorbital region, allowing multiangle endoscopic visualization and maneuverability. A 1.5- to 2-cm craniotomy centered over the pterion is done through the main port, which allows an extradural exposure of the cavernous sinus region and extra/intradural exposure of the frontal and temporal cranial fossae. The authors present a pilot surgical series of 17 ETPA procedures and analyze the surgical indications and clinical outcomes retrospectively.RESULTSThe initial stage of this work on cadavers provided familiarity with the technique, standardized its steps, and showed its anatomical limits. The clinical ETPA was applied to gain access into the cavernous sinus, as well as for aneurysm clipping and meningioma resection. Overall, perioperative complications occurred in 1 patient (6%), there was no mortality, and at last follow-up all patients had a modified Rankin Scale score of 0 or 1.CONCLUSIONSThe ETPA provides a less invasive, focused, and direct route to the cavernous sinus, and to the frontal and temporal cranial fossae, and it is feasible in clinical practice for selected indications with good results.
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- 2020
15. Parametric Multi-Scale Modeling of the Zygomaticus Major and Minor: Implications for Facial Reanimation
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Anne Agur, John A Tran, Munawar Peer, Joel Davies, Adel Y. Fattah, and Zhi Li
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business.industry ,Facial Paralysis ,Facial Muscles ,General Medicine ,Anatomy ,medicine.disease ,Lateral margin ,Smiling ,Facial paralysis ,Line of action ,Facial Expression ,medicine.anatomical_structure ,Otorhinolaryngology ,Facial reanimation ,Zygomatic bone ,medicine ,Cadaver ,Humans ,Surgery ,Fiber bundle ,business ,Facial symmetry ,Orbit (anatomy) - Abstract
Facial paralysis can severely impact functionality and mental health. Facial reanimation surgery can improve facial symmetry and movement. Zygomaticus minor (Zmin) and zygomaticus major (Zmaj) are 2 important perioral muscles, that function to elevate the upper lip, contributing to the formation of a smile. The objective of this study was to analyze the morphology in three-dimensional (3D) and quantify architectural parameters of Zmin and Zmaj. In ten formalin-embalmed specimens, Zmin and Zmaj were serially dissected and digitized at the fiber bundle level. The 2 muscles were modeled in 3D to construct high fidelity models. The 3D models were used to assess muscle morphology and quantify architectural parameters including mean fiber bundle length, physiological cross-sectional area, and line of action. Zygomaticus minor fiber bundles were oriented horizontally or slightly obliquely and had a muscular attachment to the medial modiolus. Zygomaticus minor was found to either have no partitions or medial and lateral partitions. Specimens with partitions were divided into type 1 and type 2. Type 1 consisted of a medial partition with fiber bundles attaching to the zygomatic bone at the inferior margin of the orbit. The type 2 medial partition attached to the lateral margin of the orbit to attach to the zygomatic bone. Zygomaticus major had obliquely oriented fiber bundles with most specimens having inferior and superior partitions attaching to the inferior aspect of the zygomatic bone. Zygomaticus major was found to have a greater mean fiber bundle length and physiological cross-sectional area than Zmin. The direction of the line of action of Zmin and Zmaj was closely related to fiber bundle arrangement. Detailed 3D anatomical understanding of Zmin and Zmaj, at the fiber bundle level, is critical for reconstructive surgeons performing dynamic facial reanimation. This data can be used to assist with selecting the ideal donor site for reconstruction.
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- 2021
16. Overview of the Innervation of the Hip Joint
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Jessi Jo G. Barnett, Shayan Shakeri, and Anne Agur
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musculoskeletal diseases ,business.industry ,Radiofrequency ablation ,Rehabilitation ,Musculoskeletal Physiological Phenomena ,Physical Therapy, Sports Therapy and Rehabilitation ,Nerve Block ,Anatomy ,law.invention ,law ,Medicine ,Humans ,Hip Joint ,Anatomic Landmarks ,Image guidance ,business ,Joint (geology) - Abstract
The innervation of the hip joint has been investigated for over 200 years by anatomists and clinicians. Knowledge of the distribution and location of these nerves relative to anatomic landmarks visible with image guidance is important for optimizing nerve blocks and radiofrequency ablation procedures. In this article, the innervation of the anterior and posterior hip joint is reviewed, focusing on the source of articular branches, their course, termination, and relationship to anatomic landmarks. The innervation of the hip joint is multifaceted, with articular nerves originating from many sources in close proximity to and distant from the hip joint.
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- 2021
17. Overview of Innervation of Shoulder and Acromioclavicular Joints
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Anne Agur, Sharon Switzer-McIntyre, and John Tran
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musculoskeletal diseases ,Denervation ,Shoulder ,Radiofrequency ablation ,business.industry ,Shoulder Joint ,Rehabilitation ,Pectoral Nerves ,Physical Therapy, Sports Therapy and Rehabilitation ,Anatomy ,law.invention ,medicine.anatomical_structure ,Acromioclavicular Joint ,law ,Chronic shoulder pain ,medicine ,Cadaver ,Acromioclavicular joint ,Humans ,Shoulder joint capsule ,Shoulder joint ,business ,Joint Capsule - Abstract
Detailed understanding of the course and location of articular nerves supplying the shoulder joint is paramount to the successful utilization of image-guided radiofrequency ablation to manage chronic shoulder pain. In this article, the origin, course, and relationship to anatomic landmarks of articular nerves supplying the shoulder and acromioclavicular joints are discussed. The shoulder joint capsule was consistently reported to receive innervation from multiple sources including the suprascapular, axillary, subscapular, and lateral pectoral nerves. The acromioclavicular joint received innervation from suprascapular and lateral pectoral nerves. The consistent relationship of articular branches to anatomic landmarks provides the basis for specific image-guided targeting.
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- 2021
18. Overview of the Innervation of Ankle Joint
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John R Han, John Tran, and Anne Agur
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musculoskeletal diseases ,Chronic joint pain ,business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,Nerve Block ,Anatomy ,musculoskeletal system ,law.invention ,medicine.anatomical_structure ,law ,Joint capsule ,medicine ,Nerve block ,Humans ,Ankle ,Tibial Nerve ,business ,Joint (geology) ,Ankle Joint ,Joint Capsule - Abstract
In this article, the literature describing the origin, course, and termination of the nerves innervating the ankle joint is reviewed and discussed. The anterior aspect of the joint capsule receives innervation from articular branches from the saphenous, superficial, and deep fibular nerves; laterally from the sural and superficial fibular nerves; and medially and posteriorly from the saphenous and tibial nerves. Comprehensive mapping of the trajectory, spatial relationships, and termination of the articular branches innervating the ankle joint capsule will aid in developing new and improving existing image-guided nerve block and radiofrequency ablation protocols to treat chronic joint pain.
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- 2021
19. Aberrant Hypoglossal Nerve During Neck Dissection
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Anne Agur, Joshua D. Horton, Tyler M. Rist, Terrence A. Day, Joel C. Davies, and Vilija J. Vaitaitis
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Hypoglossal Nerve ,business.industry ,medicine.medical_treatment ,Neck dissection ,Anatomy ,Middle Aged ,Free Tissue Flaps ,Diagnosis, Differential ,Text mining ,Otorhinolaryngology ,Carcinoma, Squamous Cell ,Medicine ,Humans ,Neck Dissection ,Surgery ,Female ,Mouth Neoplasms ,business ,Hypoglossal nerve - Published
- 2021
20. Do Motivation and Race/Ethnicity Impact Success in an Anatomy Course for Doctor of Physical Therapy Students?
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Shannon L Groff, Philip A. Fabrizio, and Anne Agur
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Race ethnicity ,Medical education ,Genetics ,Psychology ,Molecular Biology ,Biochemistry ,Biotechnology ,Course (navigation) - Published
- 2021
21. Ultrasound-guided maxillary nerve block: an anatomical study using the suprazygomatic approach
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Yelda Jozaghi, Gaston Echaniz, Anne Agur, Vincent W. S. Chan, and Jason T. Maynes
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medicine.medical_treatment ,Dissection (medical) ,03 medical and health sciences ,0302 clinical medicine ,Anesthesia, Conduction ,030202 anesthesiology ,Cadaver ,Interquartile range ,Maxillary Nerve ,Humans ,Medicine ,Ultrasonography, Interventional ,Pterygopalatine fossa ,business.industry ,Ultrasound ,Maxillary nerve ,Nerve Block ,030206 dentistry ,General Medicine ,medicine.disease ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Nerve block ,business ,Nuclear medicine ,Cadaveric spasm - Abstract
Although a maxillary nerve (MN) block reportedly provides satisfactory analgesia for midface surgery and chronic maxillofacial pain syndromes, a safe and reliable MN block technique has not been reported. The goal of this anatomical study was to quantify the various angles and depth of the block needle, as well as to evaluate the impact of volume on the extent of injectate spread that might influence anesthetic coverage and block-related complications. Following an ultrasound-guided suprazygomatic MN block with dye injection, a dissection was performed in the pterygopalatine fossa (PPF) of four lightly embalmed cadaveric specimens. Half of the specimens were injected with 5 mL of dye, and the other half with 1 mL of dye. The needle depth was measured from the ultrasound images and using rubber markers. Following injection, dissection was performed to map the area of dye spread. The median [interquartile range (IQR)] distance from the skin to the PPF was 37 [36–43] mm and 47 [40–50] mm by ultrasound and rubber marker methods, respectively. The median [IQR] needle orientation was 14 [11–32] degrees inferiorly and 15 [10–17] degrees posteriorly. The PPF was consistently dyed in the 5 mL group, but sporadically dyed in the 1 mL group. In the 5 mL group, spread outside of the PPF was seen. We showed that 5 mL of injectate far exceeds the capacity of the PPF, leading to drug spread outside of the PPF. Moreover, we found that 1 mL of injectate largely covered the nerve, suggesting a more efficacious and safer block procedure. This finding will need confirmation in future clinical studies.
- Published
- 2019
22. Evaluation of suprascapular nerve radiofrequency ablation protocols: 3D cadaveric needle placement study
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John Tran, Anne Agur, and Philip Peng
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Fossa ,biology ,business.industry ,Radiofrequency ablation ,General Medicine ,Anatomy ,Suprascapular nerve ,biology.organism_classification ,Trunk ,law.invention ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,law ,Needle placement ,Medicine ,Shoulder joint ,business ,Suprascapular notch ,Cadaveric spasm - Abstract
Background and objectivesImage-guided intervention of the suprascapular nerve is a reported treatment to manage chronic shoulder joint pain. The suprascapular nerve is conventionally targeted at the suprascapular notch; however, targeting of its branches, the medial and lateral trunks, which are given off just posterior to the notch has not been considered. Since the lateral trunk supplies the posterior supraspinatus and articular branches to the glenohumeral joint capsule, while the medial trunk provides motor innervation to the anterior region, it may be possible to preserve some supraspinatus activation if the medial trunk is spared. The main objective was to investigate whether midpoint between suprascapular and spinoglenoid notches is the optimal target to capture articular branches of lateral trunk while sparing medial trunk.MethodsIn 10 specimens, using ultrasound guidance, one 17 G needle was placed at the suprascapular notch and a second at midpoint between suprascapular and spinoglenoid notches. The trunks and needles were exposed in the supraspinous fossa, digitized and modeled in 3D. Lesion volumes were added to the models to asses medial and lateral trunk capture rates. Mean distance of needle tips to origin of medial trunk was compared.ResultsConventional notch technique captured both lateral and medial trunks, whereas a midpoint technique captured only lateral trunk. Mean distance of needles from the origin of medial trunk was 5.10±1.41 mm (notch technique) and 14.99±5.53 mm (midpoint technique).ConclusionsThe findings suggest that the midpoint technique could spare medial trunk of suprascapular nerve, while capturing lateral trunk and articular branches. Further clinical investigation is required.
- Published
- 2019
23. A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release
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Anne Agur, Brian Rambaransingh, Robert S. Burnham, Eldon Loh, Larry Playfair, and Shannon L. Roberts
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Wrist Joint ,medicine.medical_specialty ,Percutaneous ,Less invasive ,Thread (computing) ,030230 surgery ,law.invention ,03 medical and health sciences ,Carpal ligament ,0302 clinical medicine ,Randomized controlled trial ,law ,Carpal tunnel release ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Ultrasonography, Interventional ,Surgery Articles ,030222 orthopedics ,business.industry ,Carpal Tunnel Syndrome ,Ultrasound guided ,Median Nerve ,Surgery ,Ligaments, Articular ,business - Abstract
Background: Open carpal tunnel release typically requires several weeks of recovery. A less invasive, ultrasound-guided percutaneous technique of releasing the transverse carpal ligament using a thread (thread carpal tunnel release [TCTR]) has been described. To date, its clinical effectiveness and safety have been evaluated exclusively by the group that developed the technique, using a single outcome measure without a control comparison. The objective of this study was to independently evaluate the safety and effectiveness of TCTR using multiple outcome measures and a control comparison. Methods: A convenience sample of 20 participants with refractory moderate or severe carpal tunnel syndrome underwent TCTR of their most symptomatic hand. Outcome measures included pre-TCTR and 1-, 3-, and 6-month post-TCTR Boston questionnaire; pre-, 3-, and 6-month post-TCTR monofilament sensibility, strength, ultrasound, and electrodiagnostic testing; weekly post-TCTR phone interviews for 1 month; and satisfaction surveys at 3 and 6 months post-TCTR. Results: No complications were reported. During the month post-TCTR, significant prompt improvements in hand pain and dysfunction occurred. The following significant improvements were demonstrated in the treated versus control hand: Boston Questionnaire scores, median nerve distal motor latency, transcarpal tunnel motor and sensory conduction velocities and sensory nerve action potential amplitudes. No significant differences in sensibility, pinch or grip strength, median nerve cross-sectional area (CSA) at the carpal tunnel inlet, or wrist: forearm median nerve CSA ratio were documented between TCTR and control sides. Satisfaction with the TCTR procedure was high (85%-90%). Conclusions: This study supports previous reports that the TCTR procedure is safe and effective.
- Published
- 2019
24. The three-dimensional shoulder pain alignment (3D-SPA) mobilization improves pain-free shoulder range, functional reach and sleep following stroke: a pilot randomized control trial
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Anne Agur, Denyse Richardson, Qazi Zain Sohail, Ross Baker, Liza A M Pain, Debbie Hebert, and Karl Zabjek
- Subjects
musculoskeletal diseases ,Shoulder ,030506 rehabilitation ,medicine.medical_specialty ,Pilot Projects ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Randomized controlled trial ,Scapula ,Shoulder Pain ,law ,Humans ,Medicine ,Humerus ,cardiovascular diseases ,Range of Motion, Articular ,Stroke ,Mobilization ,Shoulder Joint ,business.industry ,Rehabilitation ,Pain free ,medicine.disease ,Biomechanical Phenomena ,medicine.anatomical_structure ,Hemiparesis ,Clavicle ,medicine.symptom ,Sleep ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose: Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whet...
- Published
- 2019
25. Muscle architecture of vastus medialis obliquus and longus and its functional implications: A three‐dimensional investigation
- Author
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Denyse Richardson, Anne Agur, Nancy H. McKee, Karl Zabjek, Valera Castanov, Maxine D. Vienneau, Syed Ahmed Hassan, and Shayan Shakeri
- Subjects
Male ,Histology ,Vastus medialis ,Sarcomere ,Medial patellar retinaculum ,Quadriceps Muscle ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Fascia lata ,Humans ,Medicine ,Patellar stabilization ,Aged ,Aged, 80 and over ,0303 health sciences ,business.industry ,030206 dentistry ,General Medicine ,Anatomy ,Vastus medialis obliquus ,medicine.anatomical_structure ,030301 anatomy & morphology ,Adductor magnus tendon ,Female ,business ,Muscle architecture - Abstract
Vastus medialis (VM) has two partitions, longus (VML), and obliquus (VMO), which have been implicated in knee pathologies. However, muscle architecture of VMO and VML has not been documented volumetrically. The aims of this study were to determine and compare the muscle architecture of VMO and VML in three-dimensional (3D) space, and to elucidate their relative functional capabilities. Twelve embalmed specimens were used in this study. Each specimen was serially dissected, digitized (Microscribe™ MX), and modeled in 3D (Autodesk Maya®). Architectural parameters: fiber bundle length (FBL), proximal (PPA)/distal (DPA) pennation angle, and physiological cross-sectional area (PCSA) were compared using descriptive statistics/t-tests. Sarcomere lengths (SLs) were measured and compared from six biopsy sites of VM. VMO and VML were found to have superficial and deep parts based on fiber bundle attachments to aponeuroses, medial patellar retinaculum, and adductor magnus tendon. The superficial part of VMO was further subdivided into superior and inferior partitions. Architecturally, VMO was found to have significantly shorter mean FBL, greater mean PPA and DPA, and smaller mean PCSA than VML. VML was found to be connected to the fascia lata by thin fascial bands, not present in VMO. SLs of VMO and VML were comparable. VMO and VML are architecturally and functionally distinct, as evidenced by marked differences in their musculoaponeurotic geometry, attachment sites, and architectural parameters. VMO likely contributes greater to medial patellar stabilization, whereas VML, with a larger relative excursion and force-generating capability, to the extension of the knee. Clin. Anat. 32:515-523, 2019. © 2019 Wiley Periodicals, Inc.
- Published
- 2019
26. Gross and applied anatomy pedagogical approaches in occupational therapy education: protocol for a scoping review
- Author
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Erica Dove, Kelly Hennessy, Athena Kirou-Mauro, Lorna Aitkens, Andrea Duncan, Anne Agur, and Emily S Ho
- Subjects
Review Literature as Topic ,Occupational Therapists ,Occupational Therapy ,Research Design ,Humans ,Learning ,Curriculum ,General Medicine ,Computer-Assisted Instruction - Abstract
IntroductionHistorically, dissection is considered the ‘gold standard’ for teaching foundational anatomy to student occupational therapists. However, many programmes no longer have access to gross anatomy laboratory resources, as it is considered too costly. To address this limitation, applied anatomy instructors have developed innovative novel approaches to teach gross and applied anatomy to student occupational therapists, including live/surface anatomy, medical imaging, and more recently, computer-aided instruction. The types of different anatomy pedagogical approaches used and their impact on learning outcomes in occupational therapy education are unclear. The purpose of this scoping review is to map the types of musculoskeletal gross and applied anatomy pedagogical approaches used in occupational therapy curricula.Methods and analysisUsing Arksey and O’Malley’s (2005) six-stage scoping review framework, approximately 304 different search combinations will be searched across five electronic library databases (ie, MEDLINE, Embase, CINAHL, AMED and ERIC) from their inception to December 2021, in addition to conducting consultation exercises with relevant stakeholders. After title/abstract and full-text screening, included articles will be charted, collated and summarised.Ethics and disseminationThis study will not involve human or animal subjects. Therefore, research ethics approval is not required. The proposed scoping review will help the research, institutional and clinical rehabilitation communities to better understand the types of musculoskeletal gross and applied anatomy pedagogical approaches used to foster, build and promote musculoskeletal foundational knowledge in occupational therapy education. This could potentially inform the future physical medicine course curricula in occupational therapy programmes. The findings of this review will be disseminated to occupational therapy instructors, occupational therapists, researchers and organisations offering occupational therapy programmes (eg, Universities).
- Published
- 2022
27. Synthetic Simulator for Surgical Training in Tracheostomy and Open Airway Surgery
- Author
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Karen A. Gordon, Marvin Estrada, Anne Agur, Nikolaus E. Wolter, Robert V. Harrison, Ashley R. Deonarain, Thomas Looi, and Evan J. Propst
- Subjects
Adult ,Animal Use Alternatives ,Male ,Models, Anatomic ,Adolescent ,medicine.medical_treatment ,Sus scrofa ,Manikins ,03 medical and health sciences ,Tracheostomy ,0302 clinical medicine ,Tracheotomy ,Cadaver ,Otolaryngologists ,medicine ,Content validity ,Animals ,Humans ,030223 otorhinolaryngology ,Simulation ,Face validity ,Surgeons ,business.industry ,Cartilage ,Laryngostenosis ,Gold standard (test) ,Plastic Surgery Procedures ,Costal cartilage ,Airway Obstruction ,Costal Cartilage ,Trachea ,High Fidelity Simulation Training ,medicine.anatomical_structure ,Otorhinolaryngology ,Thyroid Cartilage ,Models, Animal ,Printing, Three-Dimensional ,Tomography, X-Ray Computed ,Airway ,business ,Neck ,030217 neurology & neurosurgery - Abstract
OBJECTIVE(S) To create and validate a synthetic simulator for teaching tracheostomy and laryngotracheal reconstruction (LTR) using anterior costal cartilage and thyroid ala cartilage grafts. METHODS A late adolescent/adult neck and airway simulator was constructed based on CT scans from a cadaver and a live patient. Images were segmented to create three-dimensional printed molds from which anatomical parts were casted. To evaluate the simulator, expert otolaryngologists - head and neck surgeons performed tracheostomy and LTR using anterior costal cartilage and thyroid ala cartilage grafts on a live anesthetized porcine model (gold standard) followed by the synthetic simulator. They evaluated each model for face validity (realism and anatomical accuracy) and content validity (perceived effectiveness as a training tool) using a five-point Likert scale. For each expert, differences for each item on each simulator were compared using Wilcoxon Signed-Rank tests with Sidak correction. RESULTS Nine expert faculty surgeons completed the study. Experts rated face and content validity of the synthetic simulator an overall median of 4 and 5, respectively. There was no difference in scores between the synthetic model and the live porcine model for any of the steps of any of the surgical procedures. CONCLUSION The synthetic simulator created for this study has high face and content validity for tracheostomy and LTR with anterior costal cartilage and thyroid ala cartilage grafts and was not found to be different than the live porcine model for these procedures. LEVEL OF EVIDENCE 5 Laryngoscope, 131:E2378-E2386, 2021.
- Published
- 2021
28. High Fidelity 3D Anatomical Visualization of the Fibre Bundles of the Muscles of Facial Expression as In situ
- Author
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John Tran, Zhi Li, Azam Khan, Jacobo Bibliowicz, Jeremy P.M. Mogk, and Anne Agur
- Subjects
Facial expression ,Computer science ,business.industry ,Image processing ,3d model ,Pattern recognition ,Visualization ,High fidelity ,medicine.anatomical_structure ,3d space ,medicine ,Aponeurosis ,Artificial intelligence ,business ,Gesture - Abstract
The ability to express emotion through facial gestures impacts social and mental health. The production of these gestures is the result of the individual function and complex synergistic activities of the muscles of facial expression. Visualization and modelling techniques provide insight into how the muscles individually and collectively contribute to the shaping and stiffening of facial soft tissues. However, due to lack of detailed anatomical data, modellers are left to heuristically define the inner structure of each muscle, often resulting in a relatively homogeneous distribution of muscle fibres, which may not be accurate. Recent technological advances have enabled the reconstruction of entire muscles in 3D space as In situ using dissection, digitization and 3D modelling at the fibre bundle/aponeurosis level. In this chapter, we describe the use of this technology to visualize the muscles of facial expression and mastication at the fibre bundle level. The comprehensive 3D model provides novel insights into the asymmetry and complex interrelationships of the individual muscles of facial expression. These data possess great value to improve the anatomical fidelity of biomechanical models, and subsequently simulations, of facial gestures. Furthermore, these data could advance imaging and image processing techniques that are used to derive models.
- Published
- 2021
29. Diagnostic block and radiofrequency ablation of the acromial branches of the lateral pectoral and suprascapular nerves for shoulder pain: a 3D cadaveric study
- Author
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Anne Agur, John Tran, Nimish Mittal, and Philip Peng
- Subjects
Shoulder ,Fossa ,Radiofrequency ablation ,medicine.medical_treatment ,Dissection (medical) ,Coracoid process ,law.invention ,medicine.nerve ,law ,Shoulder Pain ,medicine ,Cadaver ,Humans ,Radiofrequency Ablation ,Lateral pectoral nerve ,biology ,business.industry ,General Medicine ,Anatomy ,Suprascapular nerve ,medicine.disease ,biology.organism_classification ,Scapula ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Nerve block ,business ,Cadaveric spasm - Abstract
Background and objectivesAcromial branches of the lateral pectoral and suprascapular nerves have been proposed as targets for diagnostic block and radiofrequency ablation to treat superior shoulder pain; however, the nerve capture rates of these procedures have not been investigated. The objectives of this study were to use dissection and 3D modeling technology to determine the course of these acromial branches, relative to anatomical landmarks, and to evaluate nerve capture rates using ultrasound-guided dye injection and lesion simulation.MethodsUltrasound-guided dye injections, targeting the superior surface of coracoid process and floor of supraspinous fossa, were performed (n=5). Furthermore, needles targeting the superior and posterior surfaces of the coracoid process were placed under ultrasound guidance to simulate needle electrode position (n=5). Specimens were dissected, digitized, and modeled to determine capture rates of acromial branches of lateral pectoral and suprascapular nerves.ResultsThe course of acromial branches of lateral pectoral and suprascapular nerves were documented. Dye spread capture rates: acromial branches of lateral pectoral and suprascapular nerves were captured in all specimens. Lesion simulation capture rates: (1) when targeting superior surface of coracoid process, the entire acromial branch of lateral pectoral nerve was captured in all specimens and (2) when targeting posterior surface of coracoid process, the acromioclavicular and bursal branches of acromial branch of suprascapular nerve were captured in all specimens; coracoclavicular branch was captured in 3/5 specimens.ConclusionsThis study supports the anatomical feasibility of ultrasound-guided targeting of the acromial branches of lateral pectoral and suprascapular nerves. Further clinical investigation is required.
- Published
- 2020
30. Three-dimensional architecture of the great toe muscles: functional implications in hallux valgus
- Author
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Valera Castanov, Maxine D. Vienneau, Diane Tyczynski, S. Ahmed Hassan, Takamitsu Arakawa, and Anne Agur
- Subjects
Orthodontics ,Valgus ,Three dimensional architecture ,biology ,Computer science ,Health Care Sciences and Services ,fiber bundle lenght,great toe,hallux valgus,muscle architecture,PCSA,pennation angle,volume ,Anatomy ,Sağlık Bilimleri ve Hizmetleri ,biology.organism_classification - Abstract
Objectives: Imbalance of great toe musculature has been identified as a factor in the development of hallux valgus. The musculoaponeurotic architecture, an important determinant of function, has not been investigated volumetrically in the great toe musculature. The purpose of this study was to reconstruct the abductor halluces (ABDH), adductor halluces (ADH), flexor hallucis brevis medial (FHBM) and lateral (FHBL) heads volumetrically and to quantify and compare their architectural parameters and functional characteristics. Methods: Ten formalin-embalmed specimens were dissected, digitized and modelled (Autodesk Maya®). Fiber bundle length (FBL) and physiological cross-sectional area (PCSA) of the muscles were compared using descriptive and parametric statistics. Results: The spatial arrangement of aponeuroses (AP) / fiber bundles (FB) and architectural parameters varied throughout the volume of each muscle. The PCSA of the medial (ABDH/FHBM) and lateral (ADH/FHBL) musculature was similar; however, the medial musculature had significantly greater mean FBL. Conclusion: Each muscle had varying AP/FB arrangement. The similar PCSA of the medial and lateral musculature suggests that their relative force generating capabilities are balanced in asymptomatic individuals.
- Published
- 2020
31. Structural abnormalities in the temporalis musculo-aponeurotic complex in chronic muscular temporomandibular disorders
- Author
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Luke A. Henderson, Iacopo Cioffi, Irit Weissman-Fogel, Ernest W.N. Lam, Howard C. Tenenbaum, Massieh Moayedi, Pei-Yuan Tony He, Karen D. Davis, Gaurav Krishnamoorthy, and Anne Agur
- Subjects
Muscle tissue ,Thalamus ,Temporal Muscle ,Somatosensory system ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,medicine ,Humans ,Trigeminal Nerve ,business.industry ,Chronic pain ,Anatomy ,Temporomandibular Joint Disorders ,medicine.disease ,Muscles of mastication ,Magnetic Resonance Imaging ,Peripheral ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Nociception ,Neurology ,Aponeurosis ,Neurology (clinical) ,Brainstem ,business ,030217 neurology & neurosurgery - Abstract
Some forms of chronic pain are thought to be driven and maintained by nociceptive input, which can drive plasticity within nociceptive pathways. We have previously identified abnormalities along the entire nociceptive pathway in chronic myalgic temporomandibular disorders (mTMD), including the trigeminal nerves, brainstem pathways, and in the thalamus and somatosensory cortex. These data suggest that there is a peripheral nociceptive drive in mTMD, but the source of this nociceptive activity remains unknown. Here, our aim was to determine whether structural abnormalities exist in the muscles of mastication of patients with chronic mTMD. Specifically, we tested whether the volume of the temporalis muscle and its tendon-aponeurosis complex (TAC, a structure that dissipates forces in a muscle) in mTMD patients differ compared to age- and sex-matched controls. To do so, we segmented these structures on T1-weighted structural magnetic resonance images. We found that muscle volumes in mTMD were not different to controls. However, the mTMD group had significantly smaller volumes of the bilateral temporalis TAC, and thus a smaller TAC-to-muscle volume ratio. These findings were consistent across 2 independent cohorts of 17 mTMD patients, compared to 17 age- and sex-matched controls. We propose a model where reduced TAC-to-muscle ratio could result in a predisposition to muscle tissue injury. In sum, abnormalities of the temporalis muscles in mTMD supports our hypothesis that chronic mTMD pathophysiology may be related to peripheral nociceptive barrage originating from the muscles of mastication.
- Published
- 2020
32. Anatomical Study of the Innervation of Anterior Knee Joint Capsule
- Author
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Philip Peng, Anne Agur, Ehtesham Baig, Karen Lam, Michael Gofeld, and John Tran
- Subjects
Male ,musculoskeletal diseases ,Knee Joint ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Cadaver ,medicine ,Humans ,Guided intervention ,Tibial nerve ,Ultrasonography, Interventional ,Aged ,Aged, 80 and over ,Radiofrequency Ablation ,Articular capsule of the knee joint ,business.industry ,General Medicine ,Anatomy ,musculoskeletal system ,Anesthesiology and Pain Medicine ,Nerve block ,Female ,Obturator nerve ,Sciatic nerve ,Anatomic Landmarks ,Cadaveric spasm ,business ,Joint Capsule ,030217 neurology & neurosurgery - Abstract
Background and objectives Peripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve block supplying the posterior knee joint capsule require knowledge of the innervation of the posterior capsule. The objectives of this cadaveric study were to determine the course, frequency, and distribution of the articular branches innervating the posterior knee joint capsule and their relationships to anatomical landmarks. Methods Fifteen lightly embalmed specimens were meticulously dissected. The origin of articular branches was identified, their frequency recorded, and the course documented in relation to anatomical landmarks. The capsular distribution of articular branches was documented and a frequency map generated. Results In all specimens, articular branches from the posterior division of the obturator and tibial nerves were found to supply the posterior capsule. Additionally, articular branches from common fibular nerve and sciatic nerve were found in eight (53%) and three (20%) specimens, respectively. The capsular distribution of tibial nerve spanned the entire posterior capsule. The posterior division of obturator nerve supplied the superomedial aspect of the posterior capsule overlapping with the tibial nerve. The superolateral aspect of the posterior capsule was innervated by the tibial nerve and, when present, the common fibular/sciatic nerves. Conclusions Frequency map of the course and distribution of the articular branches and their relationship to anatomical landmarks form an anatomical basis for peripheral nerve block approaches that provide analgesia to the posterior knee joint capsule.
- Published
- 2018
33. Biceps Tendon Sheath Injection: An Anatomical Conundrum
- Author
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Anne Agur, Mark F. Hurdle, and Michael Gofeld
- Subjects
musculoskeletal diseases ,Contrast Media ,Biceps ,Injections ,Tendons ,Upper Extremity ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Cadaver ,Bicipital groove ,Joint capsule ,medicine ,Humans ,Muscle, Skeletal ,Ultrasonography, Interventional ,Shoulder Joint ,business.industry ,General Medicine ,Anatomy ,musculoskeletal system ,medicine.disease ,Tendon ,Tendon sheath ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Arm ,Shoulder joint ,Neurology (clinical) ,Tendinopathy ,business ,030217 neurology & neurosurgery - Abstract
Objective Long head biceps tendon peritendinous or sheath injections are routinely administered at or immediately distally to the bicipital groove. The main indication for injection remains the clinical diagnosis or treatment of biceps tendinopathy, although true inflammation of the tendon within the bicipital groove is rare. Because the tendon sheath is merely an extension of the joint cavity, it is plausible to assume that an injection into the sheath would result in intraarticular spread. Surprisingly, such an anatomical tenet has a vague confirmation in the published clinical literature. This experiment was undertaken to investigate patterns of injectate spread when peri-tendon injection at the bicipital groove is performed. Design An experimental cadaveric study. Setting An institutional clinical anatomy laboratory. Methods Twelve ultrasound-guided methylene blue injections of the bicep tendon sheath were performed on cadaver specimens. Dissections and gross examination of staining of the internal joint surfaces were performed. Visual confirmation of the intra- and/or extra-articular spread of the injectate was performed. Results In 11 specimens, injected contrast was found spreading onto the entire internal joint surface, including glenoid cartilage. One extraarticular injection was attributable to a technical issue. Conclusions The experiment confirmed continuity of the joint capsule and the biceps tendon sheath. These results suggest a low diagnostic utility of peritendinous injections at the level of the bicep groove. Such injections would likely result in intraarticular deposit of the injectate. Nonetheless, this approach may be utilized as an alternative simplified access to the glenohumeral joint.
- Published
- 2018
34. Peripheral Nerve Stimulation for Chronic Shoulder Pain: A Proof of Concept Anatomy Study
- Author
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Anne Agur and Michael Gofeld
- Subjects
Models, Anatomic ,Shoulder ,medicine.medical_specialty ,Peripheral nerve stimulation ,Electric Stimulation Therapy ,Stimulation ,Proof of Concept Study ,03 medical and health sciences ,0302 clinical medicine ,Shoulder Pain ,Cadaver ,Humans ,Pain Management ,Medicine ,030212 general & internal medicine ,business.industry ,Ultrasound ,General Medicine ,Spinal cord ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Neurology ,Chronic shoulder pain ,Neurology (clinical) ,Radiology ,Chronic Pain ,business ,Cadaveric spasm ,Lead Placement ,030217 neurology & neurosurgery - Abstract
Objectives Although spinal cord and dorsal root ganglia stimulation may be effective for managing regional pain syndromes, a more targeted approach is perhaps more appealing for discrete anatomical structures. Chronic shoulder pain is a common musculoskeletal problem with significant socioeconomic impact. A peripheral nerve stimulation of the axillary and suprascapular nerves may prove to be effective as a long-term solution for this indication. In anticipation of the future experimental research and clinical utilization, a sound methodology for the lead placement was developed, and its feasibility is tested in a cadaveric study. Materials and methods Normal anatomy was corroborated with ultrasound scans of live models and cadaver specimens. A step-by-step ultrasound-guided implantation technique was designed. The procedure was completed targeting both the axillary and suprascapular nerves. The accuracy of the lead placement was confirmed by dissections. Results The implanted devices were found adjacent to the target nerves within 0.5-1 cm distance. Conclusions The anatomical dissections confirmed the accuracy of ultrasound-guided placement of the lead. The described method is based on normal anatomy and appeared to be reproducible by following the outlined procedural steps.
- Published
- 2018
35. Anatomical Comparison of Radiofrequency Ablation Techniques for Sacroiliac Joint Pain
- Author
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Alison Stout, Nathan Swain, Eldon Loh, Anne Agur, Paul Dreyfuss, and Shannon L. Roberts
- Subjects
Male ,Radiofrequency ablation ,Lumbosacral Plexus ,Sacroiliac joint pain ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Cadaver ,Surgical skills ,medicine ,Humans ,Pain Management ,Fluoroscopy ,Aged ,Aged, 80 and over ,Sacroiliac joint ,Radiofrequency Ablation ,medicine.diagnostic_test ,business.industry ,Sacroiliac Joint ,General Medicine ,Middle Aged ,Denervation ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Needle placement ,Female ,Neurology (clinical) ,Nuclear medicine ,business ,Cadaveric spasm ,030217 neurology & neurosurgery - Abstract
Objective To compare the percentage of sacral lateral branches (LBs) that would be captured if lesions were created by seven current sacroiliac joint (SIJ) radiofrequency ablation (RFA) techniques: three monopolar and four bipolar. Design Cadaveric fluoroscopy study. Setting Anatomy and surgical skills laboratories. Subjects Forty cadaveric SIJs. Methods LBs were exposed, radiopaque wires were sutured to LBs, and anterior-posterior fluoroscopic images through the S1 superior endplate were obtained. Lesions that would be created by 17 versions of seven current SIJ RFA techniques were mapped on the fluoroscopic images. These 17 versions were compared: 1) percentage of LBs that would be captured; 2) percentage of SIJ specimens in which 100% of LBs would be captured; and 3) percentage of LBs that would not be captured at each level (S1-S4). Results Both the mean LB and 100% capture rates were greater for the bipolar techniques (93.4-99.7% and 62.5-97.5%, respectively) than for the monopolar techniques (49.6-99.1% and 2.5-92.5%, respectively) evaluated. For the bipolar techniques, 1.5-29.2% of LBs would not be captured at S1 and 0% at S2-S4 vs 0-29.2% at S1-S4 for the cooled monopolar techniques vs 36.9-100% at S1-S4 for the conventional monopolar technique. Conclusions The findings suggest that, if lesions were created, the RFA needle placement locations of the bipolar techniques evaluated may be capable of capturing all LBs, but those of the current monopolar techniques evaluated may not. Future in vivo imaging studies are required to compare the lesion morphology generated by different SIJ RFA techniques and correlate the findings with clinical outcomes.
- Published
- 2018
36. Quantitative comparison of cranial approaches in the anatomy laboratory: A neuronavigation based research method
- Author
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Marco Maria Fontanella, Ivan Radovanovic, Mayoorendra Ravichandiran, Fred Gentili, Jimmy Qiu, Francesco Doglietto, Walter Kucharczyk, Gelareh Zadeh, Francesco Belotti, and Anne Agur
- Subjects
Neuronavigation ,3D rendering ,Anatomical study ,Comparison ,Neurosurgical approach ,Quantification ,Research method ,Computer science ,business.industry ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,Anatomy ,Basic Study ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,business ,030217 neurology & neurosurgery - Abstract
AIM To describe the development and validation of a novel neuronavigation-based method, which allows the quantification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid. METHODS The method was initially developed with commercially-available hardware for coordinate collection (a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software (ApproachViewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachViewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method. RESULTS The accuracy of ApproachViewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachViewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches. CONCLUSION This new research method and software allows semi-automated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.
- Published
- 2017
37. Architecture of the Suprahyoid Muscles: A Volumetric Musculoaponeurotic Analysis
- Author
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Sunita Mathur, Ali Mahdi, Forrest Kip Sawyer, Andrew Hope, Rosemary Martino, Anne Agur, and Stephanie M. Shaw
- Subjects
Male ,Linguistics and Language ,Dissection (medical) ,Language and Linguistics ,03 medical and health sciences ,Speech and Hearing ,Imaging, Three-Dimensional ,0302 clinical medicine ,Swallowing ,Neck Muscles ,medicine ,Humans ,Statistical analysis ,Aponeurosis ,Aged, 80 and over ,business.industry ,Digastric muscle ,Dissection ,Hyoid bone ,Hyoid Bone ,Organ Size ,030206 dentistry ,Anatomy ,medicine.disease ,Deglutition ,medicine.anatomical_structure ,Pharyngeal Muscles ,Suprahyoid muscles ,Female ,business ,Muscle architecture ,030217 neurology & neurosurgery - Abstract
Purpose Suprahyoid muscles play a critical role in swallowing. The arrangement of the fiber bundles and aponeuroses has not been investigated volumetrically, even though muscle architecture is an important determinant of function. Thus, the purpose was to digitize, model in three dimensions, and quantify the architectural parameters of the suprahyoid muscles to determine and compare their relative functional capabilities. Method Fiber bundles and aponeuroses from 11 formalin-embalmed specimens were serially dissected and digitized in situ. Data were reconstructed in three dimensions using Autodesk Maya. Architectural parameters were quantified, and data were compared using independent samples t -tests and analyses of variance. Results Based on architecture and attachment sites, suprahyoid muscles were divided into 3 groups: anteromedial, superolateral, and superoposterior. Architectural parameters differed significantly ( p < .05) across muscles and across the 3 groups, suggesting differential roles in hyoid movement during swallowing. When activated simultaneously, anteromedial and superoposterior muscle groups could work together to elevate the hyoid. Conclusions The results suggest that the suprahyoid muscles can have individualized roles in hyoid excursion during swallowing. Muscle balance may be important for identifying and treating hyolaryngeal dysfunction in patients with dysphagia.
- Published
- 2017
38. Evaluation of the Effectiveness and Safety of Ultrasound-Guided Percutaneous Carpal Tunnel Release
- Author
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Shannon L. Roberts, Anne Agur, Eldon Loh, Larry Playfair, and Robert S. Burnham
- Subjects
Male ,Wrist Joint ,Percutaneous ,Physical Therapy, Sports Therapy and Rehabilitation ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,Humans ,Medicine ,Carpal tunnel syndrome ,Carpal Bones ,Ultrasonography, Interventional ,Aged ,Aged, 80 and over ,Orthodontics ,030222 orthopedics ,business.industry ,Dissection ,Rehabilitation ,Ultrasound ,musculoskeletal system ,medicine.disease ,Carpal Tunnel Syndrome ,Median nerve ,Median Nerve ,body regions ,Carpal bones ,medicine.anatomical_structure ,Ligaments, Articular ,Ligament ,Female ,Anatomic Landmarks ,business ,Cadaveric spasm - Abstract
OBJECTIVE The looped thread carpal tunnel release (TCTR) procedure is a minimally invasive percutaneous technique performed under ultrasound (US) to transect the transverse carpal ligament in patients with carpal tunnel syndrome. Study objectives were to evaluate the accuracy of identifying key US landmarks, safety, effectiveness, and technical difficulty of TCTR. DESIGN Fourteen lightly embalmed cadaveric distal forearm-hand specimens were subject to US identification of key landmarks, TCTR procedure, and post-TCTR dissection. Outcome measures of interest were (1) correspondence between key landmarks (median nerve and 4 bony pillars of transverse carpal ligament) identified on US and anatomical structures exposed by dissection, (2) percentage of the transverse carpal ligament transected and location of the transection, (3) frequency of damage to adjacent structures, (4) time to complete procedure, and (5) operator assessment of technical difficulty of each TCTR procedure (0 = extremely easy, 10 = extremely difficult). RESULTS (1) Skin markings delineating the position of US-visualized landmarks corresponded almost perfectly to anatomical dissection. (2) Nine (64.2%) of 14 specimens had complete division of the transverse carpal ligament. In the remaining 5 specimens, an average of 68.8% of the ligament was transected. (3) No adjacent structures were damaged. (4) Time to complete the procedure was on average 9.9 ± 4.6 minutes. (5) Average procedural difficulty was 4.3/10. CONCLUSIONS Thread carpal tunnel release is potentially a safe, quick, and effective procedure to transect the transverse carpal ligament. Future clinical investigation is recommended.
- Published
- 2017
39. Quantification and Comparison of Neurosurgical Approaches in the Anatomy Laboratory: Description and Validation of a Novel, Navigation-based Method
- Author
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Walter Kucharczyk, Ivan Radovanovic, Anne Agur, Fred Gentili, Francesco Doglietto, Mayoorendra Ravichandiran, Gelareh Zadeh, Jimmy Qiu, Francesco Belotti, and Marco Maria Fontanella
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Environmental ethics ,Medical physics ,Neurology (clinical) ,business - Published
- 2017
40. Visualising a rare and complex case of advanced hilar cholangiocarcinoma
- Author
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Anne Agur, Paul D. Greig, Jia Qu, Paul Kelly, Jodie Jenkinson, A. Fung, Gordon Tait, and Ian D. McGilvray
- Subjects
medicine.medical_specialty ,Visual Arts and Performing Arts ,medicine.medical_treatment ,Video Recording ,Portal vein ,Health Professions (miscellaneous) ,050105 experimental psychology ,03 medical and health sciences ,Atlases as Topic ,Imaging, Three-Dimensional ,0302 clinical medicine ,Transplant surgery ,medicine ,Hepatectomy ,Humans ,0501 psychology and cognitive sciences ,Portal Vein ,business.industry ,General surgery ,05 social sciences ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Surgical education ,Video education ,business ,Klatskin Tumor - Abstract
The Toronto Video Atlas of Liver, Pancreas, Biliary, and Transplant Surgery (TVASurg) is a free online library of three-dimensional (3D) animation-enhanced surgical videos, designed to instruct surgical fellows in hepato-pancreato-biliary (HPB) and transplant procedures. The video ‘Klatskin tumours: Extended left hepatectomy with complex portal vein reconstruction and in situ cold perfusion of the liver’, which is available to watch at http://TVASurg.ca, is a unique and valuable visual resource for surgeons in training to assist them in learning this rare procedure. This paper describes the methodologies used in producing this 3D animation-enhanced surgical video.
- Published
- 2017
41. A Cadaveric Study Evaluating the Feasibility of an Ultrasound-Guided Diagnostic Block and Radiofrequency Ablation Technique for Sacroiliac Joint Pain
- Author
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Anne Agur, Shannon L. Roberts, Robert S. Burnham, and Eldon Loh
- Subjects
Male ,Lateral sacral crest ,medicine.medical_specialty ,Radiofrequency ablation ,Iliac crest ,law.invention ,Facet joint ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Cadaver ,medicine ,Humans ,Ultrasonography, Interventional ,Aged ,Aged, 80 and over ,Sacroiliac joint ,business.industry ,Ultrasound ,Sacroiliac Joint ,General Medicine ,Middle Aged ,Arthralgia ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Catheter Ablation ,Feasibility Studies ,Female ,sense organs ,Radiology ,Cadaveric spasm ,business ,030217 neurology & neurosurgery - Abstract
Background and Objectives Ultrasound (US)–guided diagnostic block/radiofrequency ablation (RFA) along the lateral sacral crest (LSC) has been proposed for managing sacroiliac joint (SIJ) pain. We sought to investigate (1) ease of visualization of bony landmarks using US; (2) consistency of US-guided needle placement along the LSC; and (3) percentage of the posterior sacral network (PSN) innervating the SIJ complex that would be captured if an RFA strip lesion were created between the needles. Methods In 10 cadaveric specimens, 3 needles were placed bilaterally along the LSC from the first to third transverse sacral tubercles (TSTs) using US guidance. The PSN, SIJ, and needles were exposed, digitized, and modeled 3-dimensionally. Ease of visualization of bony landmarks, frequency of needle placement along the LSC, and percentage of the PSN that would be captured if an RFA strip lesion were created between the needles were determined. Results The LSC, TST2, TST3, and first to third posterior sacral foramina were easily visualized using US; TST1 was somewhat obscured by the iliac crest in some specimens. Needles were placed along the LSC in 18 of 20 specimens; in the first 2 of 20 specimens, needle 1 was placed at the L5/S1 facet joint. On average, 93% (95% confidence interval, 87%–98%) of the PSN would be captured if an RFA strip lesion were created between the needles. Conclusions The findings suggest that US-guided needle placement along the LSC is consistent and could capture most or all of the PSN. A clinical study evaluating the outcomes of this technique is in progress.
- Published
- 2017
42. DEVELOPMENT OF AN IN VIVO ULTRASOUND PROTOCOL TO STUDY THE MUSCULOAPONEUROTIC ARCHITECTURE OF THE MASSETER DURING MANDIBULAR PROTRUSION AND LATERAL EXCURSION
- Author
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V. Vassandacoumara, S.E. Perschbacher, R. Leekam, Ernest W.N. Lam, Bernard Liebgott, Anne Agur, and T.I. Gheorghe
- Subjects
Orthodontics ,education.field_of_study ,business.industry ,Population ,Ultrasound ,Pathology and Forensic Medicine ,Masseter muscle ,Maximum intercuspation ,In vivo ,Lateral excursion ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Surgery ,Oral Surgery ,Ultrasonography ,business ,education ,Cadaveric spasm - Abstract
Background Temporomandibular disorders (TMDs) affect 5% to 12% of the population and lead to disability and pain. It has been suggested that architectural changes occur in the masseter muscle (MM) in TMDs. However, studies on normal in vivo MM architecture are scarce. Previously, our laboratory examined MM architectural changes during maximum intercuspation. Objective This work is an extension of our earlier studies in that it incorporates border jaw movements. It is hypothesized that a prototype in vivo ultrasonography protocol that will detect MM architectural changes during mandibular protrusion and lateral excursion can be developed. Materials and Methods The study was on the development of a prototype in vivo ultrasonography protocol based on cadaveric data. Results A protocol was successfully developed by identifying optimal probe positions and sites to visualize the MM laminae in mandibular protrusion and lateral excursion. The development involved correlation of anatomic specimens with in vivo ultrasonography, which enabled quantification and comparison of fiber bundle length, muscle thickness, and aponeurotic height. Discussion A novel ultrasonography protocol that will facilitate better understanding of normal MM morphology during mandibular protrusion and lateral excursion was developed. In the future, this protocol could be used as a basis to study MM changes in TMDs.
- Published
- 2020
43. Pediatric Radiology correction based on 1881 book
- Author
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S. Ali Mirjalili, Joel A. Vilensky, Carlos A. Suárez-Quian, and Anne Agur
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,MEDLINE ,Mediastinum ,Magnetic resonance imaging ,Pediatric Radiology ,medicine.anatomical_structure ,Pediatrics, Perinatology and Child Health ,medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,business ,Neuroradiology - Published
- 2020
44. Biaxial quantification of deep layer transverse carpal ligament elastic properties by sex and region
- Author
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Bryan Mathers, Anne Agur, Michele Oliver, and Karen D. Gordon
- Subjects
Adult ,Male ,Wrist Joint ,0206 medical engineering ,Biophysics ,ComputingMilieux_LEGALASPECTSOFCOMPUTING ,02 engineering and technology ,GeneralLiterature_MISCELLANEOUS ,03 medical and health sciences ,Carpal ligament ,Sex Factors ,0302 clinical medicine ,Sex factors ,Elastic Modulus ,Cadaver ,ComputingMilieux_COMPUTERSANDEDUCATION ,medicine ,Humans ,Orthopedics and Sports Medicine ,Carpal tunnel syndrome ,Aged ,Aged, 80 and over ,ComputingMilieux_THECOMPUTINGPROFESSION ,business.industry ,Foundation (engineering) ,Structural engineering ,Middle Aged ,medicine.disease ,Carpal Tunnel Syndrome ,020601 biomedical engineering ,Transverse plane ,Ligaments, Articular ,Female ,business ,030217 neurology & neurosurgery ,Geology - Abstract
The transverse carpal ligament is a major component of the carpal tunnel and is an important structure in the etiology of carpal tunnel syndrome. The current study aimed to quantify biaxial elastic moduli of the transverse carpal ligament and compare differences between sex and region (Radial and Ulnar).Biaxial testing of radial and ulnar samples from twenty-two (thirteen male, nine female) human fresh frozen cadaveric transverse carpal ligaments was performed. Elastic moduli and stiffness were calculated and compared.Biaxial elastic moduli of the transverse carpal ligament ranged from 0.76MPa to 3.38MPa, varying based on region (radial and ulnar), testing direction (medial-lateral and proximal-distal) and sex. Biaxial elastic moduli were significantly larger in the medial-lateral direction than the proximal-distal direction (P0.001). Moduli were significantly larger ulnarly than radially (P=0.001). No significant differences due to gender were noted.The regional variations in biaxial elastic moduli of the transverse carpal ligament may help improve non-invasive treatment methods for carpal tunnel syndrome, specifically manipulative therapy. The smaller biaxial elastic moduli found in the radial region suggests that manipulative therapy should be focused on the radial aspect of the transverse carpal ligament. The trend where female transverse carpal ligaments had larger stiffness in the ulnar location than males suggests that that the increased prevalence of carpal tunnel syndrome in women may be related to an increased stiffness of the transverse carpal ligament, however further work is warranted to evaluate this trend.
- Published
- 2016
45. Revisiting the anatomical evidence supporting the classical landmark of genicular nerve ablation
- Author
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Philip Peng, Anne Agur, and John Tran
- Subjects
Landmark ,Knee Joint ,Radiofrequency ablation ,business.industry ,medicine.medical_treatment ,Pain medicine ,MEDLINE ,Nerve Block ,General Medicine ,Anatomy ,Ablation ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,law ,Nerve block ,medicine ,Humans ,Knee ,business ,030217 neurology & neurosurgery - Abstract
To the Editor We read with great interest the recent publication by Fonkoue et al regarding genicular nerve ablation.[1][1] However, we are concerned with the conclusion of this paper which stated ‘This study confirms that the anatomical landmarks currently used for fluoroscopy-guided GNB need to
- Published
- 2019
46. Evaluation of the proximal adductor canal block injectate spread: a cadaveric study
- Author
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John Tran, Vincent W. S. Chan, Anne Agur, and Philip Peng
- Subjects
Articular capsule of the knee joint ,Vastus medialis ,business.industry ,Adductor canal ,General Medicine ,Anatomy ,musculoskeletal system ,Saphenous nerve ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Femoral triangle ,medicine ,Obturator nerve ,Aponeurosis ,Cadaveric spasm ,business - Abstract
Background and objectives Quadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the proximal and distal adductor canal. US-guided proximal adductor canal injection has not been investigated using these sonographic landmarks. The objectives of this cadaveric study were to evaluate dye injectate spread and quantify the capture rates of nerves supplying articular branches to the knee joint capsule using a proximal adductor canal injection technique. Methods A US-guided proximal adductor canal injection with 10 mL of dye was performed in seven lightly embalmed specimens. Following injection, specimens were dissected to document dye spread and frequency of nerve staining. Results Following proximal adductor canal injection, dye spread consistently stained the deep surface of sartorius, vastoadductor membrane, aponeurosis of the vastus medialis obliquus, and adductor canal. The saphenous nerve, posteromedial branch of nerve to vastus medialis, superior medial genicular nerve and genicular branch of obturator nerve were captured in all specimens at the proximal adductor canal. There was minimal to no dye spread to the distal femoral triangle, anterior division of the obturator nerve and anterior branches of nerve to vastus medialis. Conclusions This anatomical study provides some insights into the mechanism of analgesia to the knee following a proximal adductor canal injection and its motor sparing properties. Further clinical investigation is required to confirm cadaveric findings.
- Published
- 2019
47. Response to Sebastian
- Author
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John, Tran, Vincent, Chan, Philip, Peng, and Anne, Agur
- Subjects
Pain, Postoperative ,Thigh ,Humans ,Nerve Block - Published
- 2019
48. Verification of intramuscular electromyography electrode placement for neuromuscular partitions of infraspinatus
- Author
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Soo Y. Kim, Talia Alenabi, Shayan Shakeri, Anne Agur, and Clark R. Dickerson
- Subjects
Male ,Biophysics ,Neuroscience (miscellaneous) ,Infraspinatus muscle ,Intramuscular electromyography ,03 medical and health sciences ,Rotator Cuff ,0302 clinical medicine ,Medicine ,Humans ,Rotator cuff ,Electrode placement ,Electrodes ,business.industry ,Teres minor muscle ,Electromyography ,Reproducibility of Results ,030229 sport sciences ,Anatomy ,Ultrasound guidance ,medicine.anatomical_structure ,Needle placement ,Neurology (clinical) ,business ,Cadaveric spasm ,030217 neurology & neurosurgery - Abstract
The infraspinatus muscle is composed of three neuromuscular partitions: superior, middle and inferior. Although methods for fine-wire EMG electrode insertion into these partitions have been developed and used, it has yet to be verified. The purpose of this cadaveric EMG needle placement study was to assess the accuracy and reproducibility of a protocol used to target the three partitions of infraspinatus. On seven shoulder specimens, two investigators inserted needles into each superior, middle and inferior partition according to a previously developed protocol. Each was blinded to the other's insertion sites. The specimens were dissected and the location of each needle was digitized and modeled in 3D. Of the 42 needles that were inserted, 32 were placed in the targeted partition. The highest accuracy rate occurred for the middle partition (100%), followed by the inferior (71.4%) and then the superior (57.1%). When the needles were not placed in the targeted partition, they were located in the neighboring partition within infraspinatus or the teres minor muscle. The current study showed the middle partition could be targeted accurately, whereas the superior and inferior partitions were more challenging. Ultrasound guidance may be necessary to ensure accurate placement into all parts of infraspinatus.
- Published
- 2019
49. Comprehensive 3D Architecture of the Adult Human Trapezius: A Cadaveric Study
- Author
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Dinesh Kumbhare, Kaija Käärid, Anne Agur, and Mikaela L. Stiver
- Subjects
0303 health sciences ,medicine.medical_specialty ,business.industry ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,030220 oncology & carcinogenesis ,Genetics ,Medicine ,Architecture ,business ,Cadaveric spasm ,Molecular Biology ,030304 developmental biology ,Biotechnology - Published
- 2019
50. A 3D Anatomical Investigation of the Suprascapular Nerve: A Needle Placement Study for Radiofrequency Denervation of the Glenohumeral Joint
- Author
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Philip Peng, John A Tran, and Anne Agur
- Subjects
business.industry ,Radiofrequency denervation ,Genetics ,Needle placement ,Medicine ,Anatomy ,Suprascapular nerve ,business ,Molecular Biology ,Biochemistry ,Joint (geology) ,Biotechnology - Published
- 2019
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