A Novel Technical Protocol for Improved Capture of the Genicular Nerves by Radiofrequency Ablation

Pain Medicine ◽  
2019 ◽  
Vol 20 (11) ◽  
pp. 2208-2212 ◽  
Author(s):  
Aaron Conger ◽  
Daniel M Cushman ◽  
Kortnie Walker ◽  
Russell Petersen ◽  
David R Walega ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Anatomic Variation ◽  
Vastus Lateralis ◽  
Tendon Injury ◽  
Sensory Nerves ◽  
Sensory Innervation ◽  
Vastus Intermedius ◽  
Technical Report ◽  
Sensory Denervation ◽  
Anterior Knee

Abstract Background Fluoroscopically guided cooled genicular nerve radiofrequency ablation (RFA) is an increasingly performed procedure for chronic, refractory knee pain due to osteoarthritis. Traditionally, partial sensory denervation has been accomplished through ablation of the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies have demonstrated additional sensory nerves and significant anatomic variation that impact current protocols. Objective We describe an updated cooled genicular nerve radiofrequency ablation protocol that accounts for varied nerve location of the superomedial, superolateral, and inferomedial genicular nerves, as well as capture of the terminal articular branches of the nerves to the vastus intermedius, vastus lateralis, and vastus medialis. Furthermore, we describe an adjusted technique for inferomedial genicular nerve capture that mitigates the risk of pes anserine tendon injury. Design Technical report and brief literature review. Methods Cadaveric studies relating to the sensory innervation of the anterior knee joint were reviewed, and a more accurate and comprehensive cooled genicular nerve radiofrequency ablation (CRFA) protocol is proposed. Conclusions Based on recent, rigorous anatomic dissections of the knee, the proposed genicular nerve CRFA protocol will provide more complete sensory denervation and potentially improve clinical outcomes. Prospective studies will be needed to confirm the hypothesis that this protocol will result in improved effectiveness and safety of genicular nerve RFA.

Sympathetic but not sensory denervation stimulates white adipocyte proliferation

2006 ◽  
Vol 291 (6) ◽  
pp. R1630-R1637 ◽  
Author(s):  
Michelle T. Foster ◽  
Timothy J. Bartness
Keyword(s):  
Sensory Nerve ◽  
Sympathetic Nerves ◽  
Cell Number ◽  
Sensory Nerves ◽  
Sensory Innervation ◽  
Fat Cell ◽  
Protein Marker ◽  
White Adipocyte ◽  
Sensory Denervation

White adipocyte proliferation is a hallmark of obesity, but it largely remains a mechanistic mystery. We and others previously demonstrated that surgical denervation of white adipose tissue (WAT) triggers increases in fat cell number, but it is unknown whether this was due to preadipocyte proliferation or maturation of existing preadipocytes that allowed them to be counted. In addition, surgical denervation severs not only sympathetic but also sensory innervation of WAT. Therefore, we tested whether sympathetic WAT denervation triggers adipocyte proliferation using 5-bromo-2′-deoxyuridine (BrdU) as a marker of proliferation and quantified BrdU-immunoreactive (ir) cells that were colabeled with AD-3-ir, an adipocyte-specific membrane protein marker. The unilateral denervation model was used for all experiments where Siberian hamster inguinal WAT (IWAT) was unilaterally denervated, the contralateral pad was sham denervated serving as a within-animal control, and then BrdU was injected systemically for 6 days. When IWAT was surgically denervated, severing both sympathetic and sensory nerves, tyrosine hydroxylase (TH)-ir, a sympathetic nerve marker, and calcitonin gene-related peptide (CGRP)-ir, a sensory nerve marker, were significantly decreased, and BrdU+AD-3-ir adipocytes were increased ∼300%. When IWAT was selectively sensory denervated via local microinjections of capsaicin, a sensory nerve-specific toxin, CGRP-ir, but not TH-ir, was decreased, and BrdU+AD-3-ir adipocytes were unchanged. When IWAT was selectively sympathetically denervated via local microinjections of 6-hydroxy-dopamine, a catecholaminergic-specific toxin, TH-ir, but not CGRP-ir, was significantly decreased, and BrdU+AD-3-ir adipocytes were increased ∼400%. Collectively, these data provide the first direct evidence that sympathetic nerves inhibit white adipocyte proliferation in vivo.

scholarly journals Prevalence of the additional head of quadriceps femoris in the South Indian population: a cadaveric and radiological study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Femina Sam ◽  
Madhavi Kandagaddala ◽  
Ivan James Prithishkumar ◽  
Koyeli Mary Mahata ◽  
Mahasampath Gowri ◽  
...  
Keyword(s):  
Indian Population ◽  
Vastus Lateralis ◽  
Femoral Nerve ◽  
Quadriceps Femoris ◽  
Lower Limbs ◽  
South Indian Population ◽  
The South ◽  
South Indian ◽  
Circumflex Femoral Artery ◽  
Vastus Intermedius

AbstractQuadriceps femoris is an extensor muscle in the anterior compartment of thigh and is traditionally taught to be composed of four heads. Recently, there is an increased interest in the occurrence of an additional muscle head of quadriceps femoris. But scientific knowledge regarding its incidence is lacking in the South Indian population. This study was done to confirm the presence of the additional head by routine anatomic dissection and radiological imaging techniques. Forty-one formalin fixed human cadaveric lower limbs were dissected and the morphology of the additional head was noted. Retrospective analysis of 88 MRI images of patients was done. The additional muscle head was present in 43.9% of the cadaveric lower limbs and was consistently located between the vastus lateralis and vastus intermedius. It originated from variable portions of the greater trochanter, intertrochanteric line, lateral lip of linea aspera and lateral surface of the shaft of femur and inserted either as a muscle belly or as an aponeurosis into the vastus intermedius (55.6%), vastus lateralis (22.2%) or directly into the base of the patella. It received its vascular supply from branches of the lateral circumflex femoral artery and was innervated by branches from the posterior division of the femoral nerve. In addition, the additional muscle head was identified by MRI and its incidence was reported to be 30.68% for the first time in living subjects. The result of this study provides additional information in understanding the morphology of the quadriceps femoris muscle.

120 Genicular Nerve Radio-Frequency Ablation in The Treatment of Anterior Knee Pain in Patients with Osteoarthritis of The Knee Joint: Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Farrugia ◽  
C Tinning
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Comparative Studies ◽  
Primary Outcome ◽  
Final Analysis ◽  
Primary Outcome Measure ◽  
Sensory Innervation ◽  
Osteoarthritis Of The Knee ◽  
Pain Scores ◽  
Anterior Knee

Abstract Anterior knee pain is one of the main symptoms in osteoarthritis, resulting from the rich sensory innervation of its capsule. Pain control can be difficult to achieve, with non-responders to conservative and medical therapy often requiring a total knee replacement. Radiofrequency ablation (RFA) is a novel technique that could be beneficial in managing anterior knee pain by targeting the genicular nerves around the knee; however, its routine use is not included in current guidelines. A literature search identified fifty-two results, which underwent screening using a study protocol and the final literature sources, of varying levels of evidence, underwent critical appraisal and analysis. The primary outcome included the significant improvement of pain scores from baseline, against their respective control treatments. The ten studies included in the final analysis consisted of seven comparative studies and three non-comparative studies. Literature showed significant improvement in their mean pain scores, all meeting the primary outcome measure. Most studies also showed significant improvement from the control treatments used. Current literature shows evidence that genicular nerve RFA is an effective and safe treatment modality in the management of anterior knee pain secondary to osteoarthritis. However, the literature available is limited and further comparative studies are required.

scholarly journals Renal sensory and sympathetic nerves reinnervate the kidney in a similar time-dependent fashion after renal denervation in rats

2013 ◽  
Vol 304 (8) ◽  
pp. R675-R682 ◽  
Author(s):  
Jan Mulder ◽  
Tomas Hökfelt ◽  
Mark M. Knuepfer ◽  
Ulla C. Kopp
Keyword(s):  
Substance P ◽  
Optical Density ◽  
Renal Denervation ◽  
Time Course ◽  
Sympathetic Nerves ◽  
Sensory Nerves ◽  
Sensory Innervation ◽  
Multiple Time ◽  
Sensory Reinnervation ◽  
Renal Sympathetic

Efferent renal sympathetic nerves reinnervate the kidney after renal denervation in animals and humans. Therefore, the long-term reduction in arterial pressure following renal denervation in drug-resistant hypertensive patients has been attributed to lack of afferent renal sensory reinnervation. However, afferent sensory reinnervation of any organ, including the kidney, is an understudied question. Therefore, we analyzed the time course of sympathetic and sensory reinnervation at multiple time points (1, 4, and 5 days and 1, 2, 3, 4, 6, 9, and 12 wk) after renal denervation in normal Sprague-Dawley rats. Sympathetic and sensory innervation in the innervated and contralateral denervated kidney was determined as optical density (ImageJ) of the sympathetic and sensory nerves identified by immunohistochemistry using antibodies against markers for sympathetic nerves [neuropeptide Y (NPY) and tyrosine hydroxylase (TH)] and sensory nerves [substance P and calcitonin gene-related peptide (CGRP)]. In denervated kidneys, the optical density of NPY-immunoreactive (ir) fibers in the renal cortex and substance P-ir fibers in the pelvic wall was 6, 39, and 100% and 8, 47, and 100%, respectively, of that in the contralateral innervated kidney at 4 days, 4 wk, and 12 wk after denervation. Linear regression analysis of the optical density of the ratio of the denervated/innervated kidney versus time yielded similar intercept and slope values for NPY-ir, TH-ir, substance P-ir, and CGRP-ir fibers (all R2 > 0.76). In conclusion, in normotensive rats, reinnervation of the renal sensory nerves occurs over the same time course as reinnervation of the renal sympathetic nerves, both being complete at 9 to 12 wk following renal denervation.

Muscle-specific atrophy of the quadriceps femoris with aging

2001 ◽  
Vol 90 (6) ◽  
pp. 2070-2074 ◽  
Author(s):  
T. A. Trappe ◽  
D. M. Lindquist ◽  
J. A. Carrithers
Keyword(s):  
Vastus Lateralis ◽  
Rectus Femoris ◽  
Quadriceps Femoris ◽  
Aging Research ◽  
Cross Sectional ◽  
Men And Women ◽  
Younger Women ◽  
Vastus Intermedius ◽  
Aging Men ◽  
Old Men

We examined the size of the four muscles of the quadriceps femoris in young and old men and women to assess whether the vastus lateralis is an appropriate surrogate for the quadriceps femoris in human studies of aging skeletal muscle. Ten young (24 ± 2 yr) and ten old (79 ± 7 yr) sedentary individuals underwent magnetic resonance imaging of the quadriceps femoris after 60 min of supine rest. Volume (cm3) and average cross-sectional area (CSA, cm2) of the rectus femoris (RF), vastus lateralis (VL), vastus intermedius (VI), vastus medialis (VM), and the total quadriceps femoris were decreased ( P < 0.05) in older compared with younger women and men. However, percentage of the total quadriceps femoris taken up by each muscle was similar ( P > 0.05) between young and old (RF: 10 ± 0.3 vs. 11 ± 0.4; VL: 33 ± 1 vs. 33 ± 1; VI: 31 ± 1 vs. 31 ± 0.4; VM: 26 ± 1 vs. 25 ± 1%). These results suggest that each of the four muscles of the quadriceps femoris atrophy similarly in aging men and women. Our data support the use of vastus lateralis tissue to represent the quadriceps femoris muscle in aging research.

Muscle blood flow during exercise in sedentary and trained hypothyroid rats

1995 ◽  
Vol 269 (6) ◽  
pp. H1949-H1954 ◽  
Author(s):  
R. M. McAllister ◽  
M. D. Delp ◽  
K. A. Thayer ◽  
M. H. Laughlin
Keyword(s):  
Skeletal Muscle ◽  
Blood Flow ◽  
Citrate Synthase ◽  
Vastus Lateralis ◽  
Muscle Blood Flow ◽  
Treadmill Running ◽  
Exercise Intolerance ◽  
Vastus Lateralis Muscle ◽  
Blood Flows ◽  
Vastus Intermedius

Hypothyroidism is characterized by exercise intolerance. We hypothesized that active muscle blood flow during in vivo exercise is inadequate in the hypothyroid state. Additionally, we hypothesized that endurance exercise training would restore normal blood flow during acute exercise. To test these hypotheses, rats were made hypothyroid (Hypo) over 3-4 mo with propylthiouracil. A subset of Hypo rats was trained (THypo) on a treadmill at 30 m/min (15% grade) for 60 min/day 5 days/wk over 10-15 wk. Hypothyroidism was evidenced by approximately 80% reductions in plasma triiodothyronine levels in Hypo and THypo and by 40-50% reductions in citrate synthase activities in high oxidative muscles in Hypo compared with euthyroid (Eut) rats. Training efficacy was indicated by increased (25-100%) citrate synthase activities in muscles of THypo vs. Hypo. Regional blood flows were determined by the radiolabeled microsphere method before exercise and at 1-2 min of treadmill running at 15 m/min (0% grade). Preexercise muscle blood flows were generally similar among groups. During exercise, however, flows were lower in Hypo than in Eut for high oxidative muscles such as the red section of vastus lateralis [277 +/- 24 and 153 +/- 13 (SE) ml.min-1.100 g-1 for Eut and Hypo, respectively; P < 0.01] and vastus intermedius (317 +/- 32 and 187 +/- 20 ml.min-1.100 g-1 for Eut and Hypo, respectively; P < 0.01) muscles. Training (THypo) did not normalize these flows (168 +/- 24 and 181 +/- 24 ml.min-1.100 g-1 for red section of vastus lateralis and vastus intermedius muscles, respectively). Blood flows to low oxidative muscle, such as the white section of vastus lateralis muscle, were similar among groups (21 +/- 5, 25 +/- 4, and 34 +/- 7 ml.min-1.100 g-1 for Eut, Hypo, and THypo, respectively; P = NS). These findings indicate that hypothyroidism is associated with reduced blood flow to skeletal muscle during exercise, suggesting that impaired delivery of nutrients to and/or removal of metabolites from skeletal muscle contributes to the poor exercise tolerance characteristic of hypothyroidism.

scholarly journals Endocannabinoids in Bladder Sensory Mechanisms in Health and Diseases

2021 ◽  
Vol 12 ◽  
Author(s):  
Stewart Christie ◽  
Simon Brookes ◽  
Vladimir Zagorodnyuk
Keyword(s):  
Overactive Bladder ◽  
Sensory Neurons ◽  
Cannabinoid Receptors ◽  
Cannabinoid Receptor ◽  
Endocannabinoid System ◽  
Sensory Nerves ◽  
Sensory Innervation ◽  
Bladder Function ◽  
Painful Bladder ◽  
Bladder Diseases

The recent surge in research on cannabinoids may have been fueled by changes in legislation in several jurisdictions, and by approval for the use of cannabinoids for treatment of some chronic diseases. Endocannabinoids act largely, but not exclusively on cannabinoid receptors 1 and 2 (CBR1 and CBR2) which are expressed in the bladder mainly by the urothelium and the axons and endings of motor and sensory neurons. A growing body of evidence suggests that endocannabinoid system constitutively downregulates sensory bladder function during urine storage and micturition, under normal physiological conditions. Similarly, exogenous cannabinoid agonists have potent modulatory effects, as do inhibitors of endocannabinoid inactivation. Results suggest a high potential of cannabinoids to therapeutically ameliorate lower urinary tract symptoms in overactive bladder and painful bladder syndromes. At least part of this may be mediated via effects on sensory nerves, although actions on efferent nerves complicate interpretation. The sensory innervation of bladder is complex with at least eight classes identified. There is a large gap in our knowledge of the effects of endocannabinoids and synthetic agonists on different classes of bladder sensory neurons. Future studies are needed to reveal the action of selective cannabinoid receptor 2 agonists and/or peripherally restricted synthetic cannabinoid receptor 1 agonists on bladder sensory neurons in animal models of bladder diseases. There is significant potential for these novel therapeutics which are devoid of central nervous system psychotropic actions, and which may avoid many of the side effects of current treatments for overactive bladder and painful bladder syndromes.

scholarly journals Intra- and inter-muscular differences in the cross-sectional area of the quadriceps muscles assessed by extended field-of-view ultrasonography

2020 ◽  
Vol 22 (2) ◽  
pp. 152 ◽  
Author(s):  
Chrysostomos Sahinis ◽  
Eleftherios Kellis ◽  
Nikiforos Galanis ◽  
Konstantinos Dafkou ◽  
Athanasios Ellinoudis
Keyword(s):  
Vastus Lateralis ◽  
Intraclass Correlation ◽  
Cross Sectional Area ◽  
Field Of View ◽  
Cost Evaluation ◽  
Sectional Area ◽  
Cross Sectional ◽  
Vastus Intermedius ◽  
Extended Field ◽  
Extended Field Of View

Aim: Τo examine the inter- and intra-muscular differences in the anatomical cross-sectional area (CSA) of the quadricep muscles, using extended - field of view (EFOV) ultrasonography (US).Material and methods: Panoramic transverse US images of the thigh were acquired from 10 young participants at five different locations across the thigh, in two sessions, spaced a week apart. The CSA of the vastus medialis (VM), rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL) and tensor vastus intermedius (TVI) was quantified.Results: The intraclass correlation coefficients ranged from 0.75 to 0.97 and the standard error of measurement ranged from 0.78% to 6.61%, indicating high test-retest reliability. Analysis of the variance indicated that among the 5 quadriceps muscles the VL and the RF displayed the greater CSA proximally, the VI medially and the VM distally across the thigh (p <0.05). No differences in the quadriceps CSA measured with and without including the TVI were found (p >0.05).Conclusions: The EFOV US technique provides transverse scans of the quadriceps muscle in vivo and allowed a reliable and non-invasive determination of CSA at a low cost. Evaluation of CSA along the thigh largely depends on the measurement site. Future studies that examine the quadriceps CSA using EFOV after any form of intervention should consider changes of at least 6.5% as meaningful.

Re-innervation of axolotl limbs - II. Sensory nerves

1975 ◽  
Vol 190 (1098) ◽  
pp. 59-75 ◽  
Keyword(s):  
Tactile Stimulation ◽  
Receptive Fields ◽  
Sensory Information ◽  
Extracellular Recording ◽  
Sensory Nerves ◽  
Sensory Innervation ◽  
Contralateral Limb ◽  
Innervation Patterns ◽  
Control Limb ◽  
Left And Right

Segmental sensory receptive fields in axolotl hindlimb skin were mapped during extracellular recording of nerve responses to light tactile stimulation. Normally, cutaneous sensory innervation patterns for a given pair of left and right hindlimbs were similar, but there was variability among animals. Individual cutaneous fibres innervated a solitary receptive field whose borders were sharply defined. When spinal nerves were crushed or cut and allowed to regrow the receptive fields re-established were similar to those on the normal contralateral limb. However, many single cutaneous fibres innervated multiple receptive fields. After cutting and interchanging the two major limb nerve branches, regenerating cutaneous nerves tended to innervate skin toward which they were directed, and receptive fields did not resemble the patterns on the control limb skin. This contrasts with the results following the same operations on the motor innervation where patterns of re-innervation do resemble the control. Regenerating cutaneous fibres apparently cannot relocate their respective original cutaneous addresses, but readily re-innervate foreign skin areas. Nerves regenerating after a crush or cut appear to follow mechanical and/or biochemical orienting clues within the nerve trunks for restoration of typical innervation patterns. It is not known how the axolotl central nervous system copes with cutaneous sensory information from mislocated nerve terminals.

Whole-body Vibration Attenuates Pyroptosis-Mediated Inflammation but Accelerates Progression of Intervertebral Disc Degeneration

2020 ◽  
Author(s):  
Fang-da Fu ◽  
Sai Yao ◽  
Zhi-tao Sun ◽  
Cheng-cong Zhou ◽  
Huan Yu ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Whole Body Vibration ◽  
Sensory Nerves ◽  
Sensory Innervation ◽  
Whole Body ◽  
Body Vibration ◽  
Pharmaceutical Therapy ◽  
The Matrix ◽  
Matrix Metabolism ◽  
Ivd Degeneration

Abstract Background Whole body vibration (WBV) is a non-pharmaceutical therapy that has been widely incorporated into clinical practice for musculoskeletal disorders, including low back pain (LBP). Intervertebral disc (IVD) degeneration (IVDD) is clinically associated with LBP and is known as the main cause for LBP. However, cumulative evidence also suggested WBV might have an adverse impact on IVDs. Moreover, previous studies have been focusing on the effects of WBV on healthy mice, rather than those suffering from IVDD. Thus, uncertainties still exist concerning the effects of WBV on IVDs undergoing IVDD. This study was aiming to evaluate the effects of WBV intervention on the development and progression of IVDD mouse model induced by lumbar spine instability (LSI) surgery. Methods LSI surgery, by resecting the lumbar 3 rd -5 th spinous processes along with the supraspinous and interspinous ligaments, was conducted in 10-week-old male mice which then received WBV treatment (1 h per day, 5 days per week, at 3 Hz with peak acceleration at 0.4 g) or sham treatment. The progression of IVDD was evaluated by MRI, μCT and histological analyses after WBV treatment. The matrix metabolism, distribution of sensory nerves, pyroptosis in IVDs tissues were determined by immunohistological analysis or real-time PCR. The apoptosis of IVD cells was detected by TUNEL assay. Results LSI surgery was successful in producing IVDD modeling. WBV caused decreases in IVD height and annulus fibrosus (AF) score, as well as increased numbers of apoptotic cells in IVD tissues. WBV contributed to sensory innervation into AF and upregulation of Adamts5 and MMP3 expression in IVDD mice received LSI surgery. In addition, WBV treatment triggered earlier activation of Wnt/β-catenin signaling in IVDD mice with WBV treatment compared with those without WBV treatment. Unexpectedly, WBV significantly attenuated Caspase-1 and IL-1β expression in AF. Conclusions Collectively, our findings demonstrate that WBV treatment may worsen the development of ongoing IVDD. Decrease of IL-1β expression after WBV intervention may partially account for patient self-reported pain relief after WBV treatment in some previous trials. This study may help us better understand the effects of WBV intervention on patients experiencing LBP resulting from the degeneration of lumbar IVDs.

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