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Background Radiofrequency ablation is a common non-opioid treatment to manage chronic knee pain. The inferior medial genicular nerve is conventionally targeted. It has been suggested that the infrapatellar branch (saphenous nerve) should also be targeted. There is controversy regarding the contribution of the infrapatellar branch to the innervation of the knee joint capsule. Objective (1) Identify the frequency of the branching pattern(s) of the infrapatellar branch in three-dimensional (3D); (2) Assess spatial relationships of branches of infrapatellar branch to the inferior medial genicular nerve; (3) Determine if capturing infrapatellar branch could result in additional benefit to the existing protocol. Design Anatomical study. Methods The infrapatellar branch and inferior medial genicular nerve were serially dissected, digitized, and modelled in 3D in 7 specimens (mean age 91.3 ± 6.5; 2F/5M) and their relationship documented. The spatial relationship of the nerves was used to assess the anatomical efficacy of including the infrapatellar branch in the protocol. Results The infrapatellar branch is most frequently a cutaneous nerve. This nerve was variable and found to be unbranched or have 2-3 branches and in all specimens was located superficial to the branches of inferior medial genicular nerve. When the infrapatellar branch (1) coursed more distally, the strip lesion would not capture the infrapatellar branch but would capture inferior medial genicular nerve consistently; (2) overlapped with the inferior medial genicular nerve, the strip lesion would capture both nerves. Conclusions Proposed protocol targeting the infrapatellar branch is likely to capture the inferior medial genicular consistently regardless of the anatomical variation of the infrapatellar branch. [ABSTRACT FROM AUTHOR]

Background: Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. Methods: We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as ≤75% agreement and weak consensus as 50%-74% agreement. Results: A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. Conclusions We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and committee included a member of the executive committee in addition to three other members selected based on their track record of academic output content expertize in upper and lower limb nerve blocks (JG, APerlas, and AT). A panel of international experts were invited as collaborators, based on previously published criteria, to participate. We replicated a methodology used in a previous study, which is reported in detail elsewhere, and reported in detail in online supplemental appendix 1. In brief, a modified three-round Delphi approach was used, with two rounds of electronic questionnaires and a third round-table discussion round. [ABSTRACT FROM AUTHOR]

Several studies have shown that cognitive integration of basic and clinical sciences supports diagnostic reasoning in novices; however, there has been limited exploration of the ways in which educators can translate this model of mental activity into sound instructional strategies. The use of "self-explanation" during learning has the potential to promote and support the development of integrated knowledge by encouraging novices to elaborate on the causal relationship between clinical features and basic science mechanisms. To explore the effect of this strategy, we compared diagnostic efficacy of teaching students (n = 71) the clinical features of four musculoskeletal pathologies using either (1) integrated causal basic science descriptions (BaSci group); (2) integrated causal basic science descriptions combined with self-explanation prompts (SE group); (3) basic science mechanisms segregated from the clinical features (SG group). All participants completed a diagnostic accuracy test immediately after learning and 1-week later. The results showed that the BaSci group performed significantly better compared to the SE (p = 0.019) and SG groups (p = 0.004); however, no difference was observed between the SE and SG groups (p = 0.91). We hypothesize that the structure of the self-explanation task may not have supported the development of a holistic conceptual understanding of each disease. These findings suggest that integration strategies need to be carefully structured and applied in ways that support the holistic story created by integrated basic science instruction in order to foster conceptual coherence and to capitalize on the benefits of cognition integration.

Spasticity of flexor digitorum profundus is frequently managed with botulinum toxin injections. Knowledge of the 3D morphology and intramuscular innervation of the digital bellies of flexor digitorum profundus is necessary to optimize the injections. The purpose of this study was to digitize and model in 3D the contractile and connective tissue elements of flexor digitorum profundus to determine muscle morphology, model and map the intramuscular innervation and propose sites for botulinum toxin injection. Fiber bundles (FBs)/aponeuroses and intramuscular nerve branches were dissected and digitized in 12 formalin embalmed cadaveric specimens. Cartesian coordinate data were reconstructed into 3D models as in situ to visualize and compare the muscle morphology and intramuscular innervation patterns of the bellies of flexor digitorum profundus. The 3rd, 4th and 5th digital bellies were superficial to the 2nd digital belly and located adjacent to each other in all specimens. Each digital belly had distinct intramuscular innervation patterns. The 2nd digital belly received intramuscular branches from the anterior interosseus nerve (AIN). The superior half of the 3rd digital belly was innervated intramuscularly by the ulnar nerve (n = 4) or by both the anterior interosseus and ulnar nerves (n = 1). The inferior half of the belly received dual innervation from the anterior interosseus and ulnar nerves in 2 specimens, or exclusively from the AIN (n = 2) or the ulnar nerve (n = 1). The 4th digital belly was innervated by intramuscular branches of the ulnar nerve. One main branch, after coursing through the 4th digital belly, entered the lateral aspect of the 5th digital belly and arborized intramuscularly. The morphology of the FBs, aponeuroses and intramuscular innervation of the digital bellies of FDP were mapped and modelled volumetrically in 3D as in situ. Previous studies were not volumetric nor identified the course of the intramuscular nerve branches within each digital belly. Based on the intramuscular innervation of each of the digital bellies, one possible optimized botulinum toxin injection location was proposed. This injection location, at the junction of the superior and middle thirds of the forearm, would be located in dense nerve terminal zones of the anterior interosseus and ulnar nerves. Future anatomical and clinical investigations are necessary to evaluate the efficacy of these anatomical findings in the management of spasticity. [ABSTRACT FROM AUTHOR]

Background Lumbar medial branch radiofrequency ablation (RFA) is a common intervention to manage chronic axial low back pain originating from the facet joints. A more parasagittal approach targeting the posterior half of the lateral neck of superior articular process (SAP) was previously proposed. However, specific needle angles to achieve parallel placement at this target site have not been investigated. Objective To quantify and compare the needle angles, on posterior and lateral views, to achieve parallel placement of electrodes along the medial branch at the posterior half of the lateral neck of SAP at each lumbar vertebral level (L1–L5) and sacrum. Design Osteological Study Methods Twelve disarticulated lumbosacral spines (n  = 72 individual bones) were used in this study. Needles were placed along the periosteum of the posterior half of the lateral neck of SAP, bilaterally and photographed. Mean needle angles for each vertebral level (L1–L5) and sacrum were quantified, and statistical differences were analyzed. Results The posterior view provided the degrees of lateral displacement from the parasagittal plane (abduction angle), while the lateral view provided the degrees of declination (cranial-to-caudal angle) of the needle. Mean needle angles at each level varied, ranging from 5.63 ± 5.76° to 14.50 ± 14.24° (abduction angle, posterior view) and 40.17 ± 7.32° to 64.10 ± 9.73° (cranial-to-caudal angle, lateral view). In posterior view, a < 10-degree needle angle interval was most frequently identified (57.0% of needle placements). In lateral view, the 40–50-degree (L1–L2), 50–60-degree (L3–L5), and 60–70-degree (sacrum) needle angle intervals occurred most frequently (54.2%, 50.0%, and 41.7% of needle placements, respectively). Conclusions Targeting the posterior half of the lateral neck of SAP required <10-degree angulation from parasagittal plane in majority of cases. However, variability of needle angles suggests a standard "one-size-fits-all" approach may not be the optimal technique. [ABSTRACT FROM AUTHOR]

To address the need for more clinical anatomy training in residency education, many postgraduate programs have implemented structured anatomy courses into their curriculum. Consensus often does not exist on specific content and level of detail of the content that should be included in such curricula. This article describes the use of the Delphi method to identify clinically relevant content to incorporate in a musculoskeletal anatomy curriculum for Physical Medicine and Rehabilitation (PM&R) residents. A two round modified Delphi involving PM&R experts was used to establish the curricular content. The anatomical structures and clinical conditions presented to the expert group were compiled using multiple sources: clinical musculoskeletal anatomy cases from the PM&R residency program at the University of Toronto; consultation with PM&R experts; and textbooks. In each round, experts rated the importance of each curricular item to PM&R residency education using a five-point Likert scale. Internal consistency (Cronbach's alpha) was used to determine consensus at the end of each round and agreement scores were used as an outcome measure to determine the content to include in the curriculum. The overall internal consistency in both rounds was 0.99. A total of 37 physicists from across Canada participated and the overall response rate over two rounds was 97%. The initial curricular list consisted of 361 items. After the second iteration, the list was reduced by 44%. By using a national consensus method we were able to objectively determine the relevant anatomical structures and clinical musculoskeletal conditions important in daily PM&R practice.

Background Clinical outcomes following lumbar medial branch radiofrequency ablation (RFA) have been inconsistent. One possible reason is less-than-optimal placement of the electrode along the medial branch at the lateral neck of superior articular process (SAP). Needle angles that define optimal placement (i.e. parallel to the medial branch) may be helpful for consistent technical performance of RFA. Despite its importance, there is a lack of anatomical studies that quantify RFA needle placement angles. Objective To quantify and compare needle angles to achieve parallel placement along the medial branch as it courses on the middle two-quarters of the lateral neck of the SAP at the L1–L5 vertebrae. Design Osteological Study. Methods Ten lumbar vertebral columns were used in this study. Needles were placed along the periosteum of the middle two-quarters of the lateral neck of SAP. Mean needle angles for L1–L5 were quantified and compared using posterior (n = 100) and lateral (n = 100) photographs. Results Mean needle angles varied ranging from 29.29 ± 17.82° to 47.22 ± 16.27° lateral to the parasagittal plane (posterior view) and 33.53 ± 10.23° to 49.19 ± 10.69° caudal to the superior vertebral endplate (lateral view). Significant differences in mean angles were found between: L1/L3 (P  = .008), L1/L4 (P  = .003), and L1/L5 (P  = .040) in the posterior view and L1/L3 (P  = .042), L1/L4 (P  < .001), L1/L5 (P  < .001), L2/L4 (P  = .004), and L2/L5 (P  = .004) in lateral view. Conclusions Variability of needle angles suggest a standard "one-size-fits-all" approach may not be the optimal technique. Future research is necessary to determine optimal patient-specific needle angles from a more detailed and granular analysis of fluoroscopic landmarks. [ABSTRACT FROM AUTHOR]

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<0.01]. Race/ethnicity (B=0.05, SE=0.01, β=0.42, p<0.008) and self-efficacy for learning and performance (B=0.02, SE=0.01, β=0.39, p<0.01), remained significantly related to course grade. Conclusion: Self-efficacy for learning and performance and ethnicity are factors that determine academic success and could be utilized in DPT programs to aid in the development of teaching strategies to support students. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: The motivational behavior of self-efficacy for learning and performance was correlated with academic success in Doctor of Physical Therapy (DPT) students taking clinical anatomy, the first foundational course in the program. Students' motivation strategies have been reported to be important factors in academic success, however, these strategies have not been investigated in DPT students. Therefore, the purpose of this study was to determine if course grade in clinical anatomy was correlated with the motivation subscales of the Motivated Strategies for Learning Questionnaire (MSLQ). Materials and Methods: The MSLQ was administered to 33 first-year DPT students who consented to participate in the study. Correlation (Pearson r zero order) between the subscales and final course grade in clinical anatomy were determined. Results: Self-efficacy for learning and performance was correlated with course grade (r(31)=.44, p<.05), while intrinsic and extrinsic goal orientation, task value, control of learning beliefs, and test anxiety, were poorlycorrelated. Conclusions:The results of the current study, indicating that self-efficacy for learning and performance is correlated with academic success, could be utilized in DPT programs to broaden admission processes, and aid in the development of remedial curricular and teaching strategies to support students identified with poor selfefficacy for learning and performance. [ABSTRACT FROM AUTHOR]

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 whether a treatment group provided with current standard treatment plus the proposed "Three-dimensional Shoulder Pain Alignment" mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone. Methods: In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory). Results: Compared to controls (n = 10) the treatment group (n = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction (p < 0.05; Hedges g > 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86). Conclusions: The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment. Although three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management. The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement. The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain. [ABSTRACT FROM AUTHOR]

Purpose: Altered three-dimensional (3D) joint kinematics can contribute to shoulder pathology, including post-stroke shoulder pain. Reliable assessment methods enable comparative studies between asymptomatic shoulders of healthy subjects and painful shoulders of post-stroke subjects, and could inform treatment planning for post-stroke shoulder pain. The study purpose was to establish intra-rater test–retest reliability and within-subject repeatability of a palpation/digitization protocol, which assesses 3D clavicular/scapular/humeral rotations, in asymptomatic and painful post-stroke shoulders. Methods: Repeated measurements of 3D clavicular/scapular/humeral joint/segment rotations were obtained using palpation/digitization in 32 asymptomatic and six painful post-stroke shoulders during four reaching postures (rest/flexion/abduction/external rotation). Intra-class correlation coefficients (ICCs), standard error of the measurement and 95% confidence intervals were calculated. Results: All ICC values indicated high to very high test–retest reliability (≥0.70), with lower reliability for scapular anterior/posterior tilt during external rotation in asymptomatic subjects, and scapular medial/lateral rotation, humeral horizontal abduction/adduction and axial rotation during abduction in post-stroke subjects. All standard error of measurement values demonstrated within-subject repeatability error ≤5° for all clavicular/scapular/humeral joint/segment rotations (asymptomatic ≤3.75°; post-stroke ≤5.0°), except for humeral axial rotation (asymptomatic ≤5°; post-stroke ≤15°). Conclusions: This noninvasive, clinically feasible palpation/digitization protocol was reliable and repeatable in asymptomatic shoulders, and in a smaller sample of painful post-stroke shoulders. In the clinical setting, a reliable and repeatable noninvasive method for assessment of three-dimensional (3D) clavicular/scapular/humeral joint orientation and range of motion (ROM) is currently required. The established reliability and repeatability of this proposed palpation/digitization protocol will enable comparative 3D ROM studies between asymptomatic and post-stroke shoulders, which will further inform treatment planning. Intra-rater test–retest repeatability, which is measured by the standard error of the measure, indicates the range of error associated with a single test measure. Therefore, clinicians can use the standard error of the measure to determine the "true" differences between pre-treatment and post-treatment test scores. [ABSTRACT FROM AUTHOR]

Background and Objectives: The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule.Methods: Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified.Results: The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level.Conclusions: The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this cadaveric study was to determine the pattern of anterior hip capsule innervation and the associated bony landmarks for image-guided radiofrequency denervation.Methods: Thirteen hemipelvises were dissected to identify innervation of the anterior hip capsule. The femoral (FN), obturator (ON), and accessory obturator (AON) nerves were traced distally, and branches supplying the anterior capsule documented. The relationships of the branches to bony landmarks potentially visible with ultrasound were identified.Results: The anterior hip capsule received innervation from the FNs and ONs in all specimens and the AON in 7 of 13 specimens. High branches of the FN (originating above the inguinal ligament) were found exclusively in 12 specimens and passed between the anterior inferior iliac spine and the iliopubic eminence. The ONs were innervated exclusively by high branches (proximal to the division), by low branches (from the posterior branch), and by both in 4, 5, and 4 specimens, respectively. The most consistent landmark was the inferomedial acetabulum (radiographic "teardrop"). When present, the AON coursed over the iliopubic eminence before innervating the anterior hip capsule.Conclusions: Branches of the FNs and ONs consistently provided innervation to the anterior hip capsule. The AON also contributed innervation in many specimens. The relationship of the articular branches from these 3 nerves to the inferomedial acetabulum and the space between the anterior inferior iliac spine and iliopubic eminence may suggest potential sites for radiofrequency ablation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this systematic review was to determine the effect of trunk restraint (TR) training on post-stroke compensatory trunk movements during functional reach, and to identify functional gains of TR within the context of the International Classification of Functioning, Disability and Health (ICF). Methods: Six databases were searched prior to 20 February 2013. Randomized control trials (RCTs) comparing the effects of a post-stroke reaching intervention with and without TR in the adult post-stroke population were included in this review. Data related to study inclusion/exclusion criteria, methodology, study participants and between-group outcomes ( p < 0.05) were extracted. All outcomes were categorized according to functional domains defined within the ICF. Results: Five RCTs met the inclusion criteria. TR groups demonstrated significant between-group differences ( p < 0.05) for decreased compensatory trunk displacement (4/5 RCTs), increased elbow extension (3/5 RCTs) and increased shoulder flexion (2/5 RCTs). All significant between-group differences fell within the Body Structure/Function domain of the ICF. Conclusions: Trunk restraint is a simple, cost-effective technique that may help to reduce compensatory trunk/shoulder/elbow movements in the post-stroke adult population. Synthesis of study outcomes also highlights applications of TR to clinical practice and areas for further research. [ABSTRACT FROM AUTHOR]

Physiological cross-sectional area (PCSA) is used to compare force-producing capabilities of muscles. A limitation of PCSA is that it cannot be measured directly from a specimen, as there is usually no area within the muscle traversed by all fibres. Traditionally, a formula requiring averaged architectural parameters has been used. The purpose of this paper is to describe the development of a fibre bundle element (FBE) method to calculate PCSA from digitised fibre bundle data of five architecturally distinct muscles and compare the FBE and PCSA formula. An FBE method was developed that used a serially arranged set of cylinders as the volumetric representation of each fibre bundle, and PCSA was computed as the summation of the cross-sectional area of each FBE. Four of five muscles had significantly different PCSA between FBE and formula methods. The FBE method provides an approach that considers architectural variances while minimising the need for averaged architectural parameters. [ABSTRACT FROM AUTHOR]

Introduction: The cost, high resource demands, and psychological significance of in-person cadaveric labs are barriers to their use. Computer-assisted instruction (CAI) of gross anatomy is widely available as an alternative option. However, student engagement, reflections, and expectations of learning anatomy with CAI instead of in-person labs may influence their learning experience and outcomes. Purpose: To evaluate students' critical self-reflection and perceptions of learning using online self-guided anatomy modules with video-based pro-section CAI. Methods: A prospective observational cross-sectional study was conducted with first-year occupational therapy students who received anatomy education using CAI involving online self-guided anatomy modules with video-based pro-section instruction. Critical self-reflection was measured using Kember's Critical Self-Reflection Questionnaire scores and open-ended comments. Paired analysis of self-reported Kember nonreflective and reflective actions was conducted followed by quantitative (correlation, Student t -tests) and qualitative (directed content analysis) exploration of factors associated with critical self-reflection. Results: Of the 126 students enrolled in the study, 97 consented and completed the study. The students' Kember Understanding (U) subscale mean score was significantly higher than the Habitual Action (HA), Reflection, and Critical Self-Reflection subscales. The largest effect size was found between the U and HA subscales (ds = 1.3, 95% CI [1.0, 1.5]). Academic outcomes (anatomy quiz sum score, term grade) did not correlate with the Kember scores. Overall, students felt that video-based anatomy pro-section CAI was best used in a supplementary manner and opportunities for hands-on learning of anatomy were needed. Conclusion: Video-based anatomy pro-section CAI helped students understand anatomy but did not readily engage students in critical self-reflection. Strategic course and curriculum design with integrated and hands-on learning opportunities are needed to optimize student anatomy learning experience and academic outcomes while using this type of CAI. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound-guided peripheral nerve block and radiofrequency ablation have been developed for pain management in various joints including the hip, knee and shoulder, but not the elbow. Precise three-dimensional (3D) localization of the articular branches and landmarks visible on ultrasound are needed. The objectives of this anatomical study were to determine the presence, course, frequency, landmarks and areas innervated by the articular branches supplying the posterior elbow joint., Methods: In 12 upper extremity specimens, articular branches to the posterior elbow joint were dissected from brachial plexus to termination. Origin, course, frequency, capsular distribution and landmarks were documented. Data were reconstructed into 3D models and a 3D frequency map to visualize spatial relationships between the articular branches, capsule and landmarks., Results: The superior part of the posterior capsule was innervated by the ulnar collateral nerve (92%) and lateral branch to triceps (100%). The lateral part was supplied by the nerve to anconeus (100%) and, when present, branch to extensor carpi ulnaris (58%). The medial part was supplied by the ulnar nerve through direct branches (92%) and branches to forearm flexors (100%). The medial and posterior antebrachial cutaneous nerves supplied the medial and lateral epicondylar areas, respectively (100%, 83%). Common landmarks included the epicondyles, olecranon, olecranon fossa, and margins of triceps., Conclusions: The 3D data of the articular branches supplying the posterior elbow joint provide an anatomical basis for the development of peripheral nerve block and radiofrequency ablation protocols to treat elbow joint pain. Further anatomical and clinical studies are necessary to identify target sites and evaluate the proposed landmarks in vivo., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To address the learning needs of student Occupational Therapists with diverse academic backgrounds, educators must understand the factors that influence anatomy academic outcomes. Purpose: To compare anatomy learning outcomes of students with and without previous anatomy coursework over time and on higher- versus lower-order thinking skills. Method: An observational cohort study was conducted with entry-level occupational therapy students. Anatomy quizzes, were designed using the Blooming Anatomy Tool, were administered progressively throughout the term. Grades and thinking skills were compared between groups. Findings: At the start of term, students with anatomy coursework fared better than those without; the difference between groups was no longer present in the last four quizzes of the term. In general, students had lower grades on higher-order assessments; this did not differ between groups. Conclusion: Students without anatomy coursework achieved similar assessment outcomes as their peers; however, lower grades at the start of the term indicate that there was an adjustment period to anatomy learning., Competing Interests: Declaration of Conflicting InterestsThe authors report there are no competing interests to declare. This research study was presented as an oral scientific presentation at the Canadian Association of Occupational Therapists Annual Meeting on Friday, May 3, 2024, in Halifax, Nova Scotia.

Purpose: Irreversible facial paralysis results in significant functional impairment. The motor nerve to the masseter is a reconstructive option, but despite its clinical importance, there are few parametric anatomic studies of the masseteric nerve. The purpose of this study was to investigate the extra- and intramuscular innervation of the masseter in 3D to determine the relationship of the nerve to the muscle heads and identify landmarks to aid identification., Materials and Methods: The nerve was dissected throughout its entire course in eight formalin-embalmed cadaveric specimens (mean age 84.9 ± 12.2 years). The nerve was digitized at 1-2 mm intervals using a MicroScribe™ digitizer and modeled in 3D in Autodesk® Maya®., Results: Two or three extramuscular nerves were found to enter the deep head (DH) of the masseter: one main "primary" nerve (n = 8) and one (n = 4) or two (n = 4) smaller primary nerve(s). The main primary nerve supplied both the deep and superficial heads, whereas the smaller primary nerve(s) only supplied the DH. Surgical landmarks for masseter nerve localization were quantified., Conclusions: Comprehensive mapping of the innervation of the masseter muscle throughout its volume revealed neural partitioning that could provide a basis for safety planning for muscle flaps and donor nerve identification and explain why masseter functional loss is not incurred by donor nerve sacrifice. Quantified landmarks correlate to previous studies and support the constant anatomy of this nerve. Our results provide a basis to optimize surgical approaches for donor nerve and muscle flap surgery., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Ultrasound 2-D shear wave elastography (US 2D-SWE) is a non-invasive, cost-effective tool for quantifying tissue stiffness. Amidst growing interest in US 2D-SWE for musculoskeletal research, it has been recommended that shear wave velocity (SWV) should be reported instead of elastic moduli to avoid introducing unwanted error into the data. This scoping review examined the evolving use of US 2D-SWE to measure SWV in skeletal muscle and identified strengths and weaknesses to guide future research. We searched electronic databases and key review reference lists to identify articles published between January 2000 and May 2021. Two reviewers assessed the eligibility of records during title/abstract and full-text screening, and one reviewer extracted and coded the data. Sixty-six studies met the eligibility criteria, of which 58 were published in 2017 or later. We found a striking lack of consensus regarding the effects of age and sex on skeletal muscle SWV, and widely variable reliability values. Substantial differences in methodology between studies suggest a pressing need for developing standardized, validated scanning protocols. This scoping review illustrates the breadth of application for US 2D-SWE in musculoskeletal research, and the data synthesis exposed several notable inconsistencies and gaps in current literature that warrant consideration in future studies., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2023 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Objective: Rotator interval (RI) corticosteroid injections are used to alleviate pain associated with adhesive capsulitis, though the pattern of injectate spread remains unclear. The purpose of this anatomical study was to assess the staining patterns of intra-articular, intracapsular/extrasynovial, and pericapsular structures of the glenohumeral joint following medial-to-lateral and lateral-to-medial RI injections., Design: Ten cadaveric specimens were injected with a methylene blue dye injectate: five using a medial-to-lateral RI injection technique and five using a lateral-to-medial RI injection technique. Serial dissection was performed to assess the staining of intra-articular, intracapsular/extrasynovial, and pericapsular structures. The frequency of capture and degree of staining were compared between injection groups., Results: The lateral-to-medial injection resulted in the capture of all intra-articular; intracapsular/extrasynovial; and pericapsular structures, whereas the medial-to-lateral injection did not consistently stain all structures. Intracapsular/extrasynovial structures (superior glenohumeral ligament and the long head of biceps tendon) were more darkly stained in the lateral-to-medial group, and pericapsular structures (supraspinatus tendon and coracohumeral ligament) were more darkly stained in the medial-to-lateral group., Conclusion: The frequency of capture and degree of staining of intra-articular, intracapsular/extrasynovial, and pericapsular structures of the glenohumeral joint differed between medial-to-lateral and lateral-to-medial RI injection techniques, which may influence outcomes in pain management for adhesive capsulitis., Competing Interests: Dr. Anne Agur is an Anatomy Faculty with the Allergen Academy of Excellence. Dr. Philip Peng received equipment support from SonoSite Fujifilm Canada. Partial results of this study were presented by Benjamin Kozlowski in an abstract at the American Association for Clinical Anatomist (AACA) Virtual Conference 2021., (© 2022 The Authors.)