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Keiichi Akita - One of the best experts on this subject based on the ideXlab platform.

  • functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Ryuzo Arai, Takashi Nakamura, Tomoyuki Mochizuki, Kumiko Yamaguchi, Hiroyuki Sugaya, Masahiko Kobayashi, Keiichi Akita
    Abstract:

    Background Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon. Material and methods Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied. Results Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament. Conclusion To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior Insertion Point of the subscapularis from behind the ligament may be necessary. Level of Evidence Basic Science

  • functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Ryuzo Arai, Takashi Nakamura, Tomoyuki Mochizuki, Kumiko Yamaguchi, Hiroyuki Sugaya, Masahiko Kobayashi, Keiichi Akita
    Abstract:

    Background Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon. Material and methods Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied. Results Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament. Conclusion To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior Insertion Point of the subscapularis from behind the ligament may be necessary. Level of Evidence Basic Science

Takashi Nakamura - One of the best experts on this subject based on the ideXlab platform.

  • advantages of the paraspinal muscle splitting approach in comparison with conventional midline approach for s1 pedicle screw placement
    Spine, 2010
    Co-Authors: Masato Ota, Masashi Neo, Shunsuke Fujibayashi, Mitsuru Takemoto, Takashi Nakamura
    Abstract:

    Study design A retrospective comparative study of the S1 pedicle screw (S1PS) position obtained using 2 surgical approaches. Objective To determine whether the paraspinal approach leads to more medially oriented placement of the S1PS compared with the midline approach. Summary of background data To obtain a stronger as well as safer fixation of the S1PS, medially oriented screw placement is very important. However, no study has recommended a surgical approach to achieve this object. Methods The positions of 32 screws placed by the midline approach and 34 screws placed by the paraspinal approach were compared using postoperative computed tomography. The location of the bilateral common iliac veins (CIV) in relation to the S1PS tips was also analyzed to evaluate their safety. Results There was no statistical difference in screw Insertion Point regardless of the approach employed. However, in the paraspinal group the S1PS were placed with significantly greater medial direction and with longer screws. In addition, they pierced the anterior sacral cortex closer to the midline compared with the midline approach. Four left screws in the midline approach group made contact with the left CIV, whereas no screw in the paraspinal approach group lay adjacent to the CIV. Conclusion Our results demonstrate that the paraspinal approach for S1PS placement may be superior to the midline approach in terms of the medially oriented screw placement that is biomechanically stronger and less risky for the CIV.

  • functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Ryuzo Arai, Takashi Nakamura, Tomoyuki Mochizuki, Kumiko Yamaguchi, Hiroyuki Sugaya, Masahiko Kobayashi, Keiichi Akita
    Abstract:

    Background Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon. Material and methods Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied. Results Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament. Conclusion To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior Insertion Point of the subscapularis from behind the ligament may be necessary. Level of Evidence Basic Science

  • functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Ryuzo Arai, Takashi Nakamura, Tomoyuki Mochizuki, Kumiko Yamaguchi, Hiroyuki Sugaya, Masahiko Kobayashi, Keiichi Akita
    Abstract:

    Background Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon. Material and methods Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied. Results Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament. Conclusion To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior Insertion Point of the subscapularis from behind the ligament may be necessary. Level of Evidence Basic Science

Cristian Arzola - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound estimates for midline epidural punctures in the obese parturient paramedian sagittal oblique is comparable to transverse median plane
    Anesthesia & Analgesia, 2013
    Co-Authors: Jagpaul S Sahota, Mrinalini Balki, Jose C A Carvalho, Niall Fanning, Cristian Arzola
    Abstract:

    BACKGROUND: Spinal ultrasound (US) in the transverse median (TM) plane underestimates the distance to the epidural space in obese pregnant women, most likely because of compression of the subcutaneous tissue during the assessment, often required to compensate for poor visibility. We tested whether scanning in the paramedian sagittal oblique (PSO) plane compared with the TM plane resulted in a more precise estimate of the actual skin-epidural space measurement in this population. METHODS: We recruited obese (World Health Organization classes I, II, and III) pregnant women at term requesting labor epidural analgesia or combined spinal-epidural anesthesia for cesarean delivery. US imaging was performed with a 5-2 MHz curved array probe to identify the Insertion Point and to estimate the distance from the skin to the epidural space (US-estimated depth, UD) in the PSO and TM planes. The measurements were performed with the least possible compression of the subcutaneous tissue by the US probe. All punctures were performed via the midline approach. An anesthesiologist performed the epidural/combined spinal-epidural procedure at the predetermined Insertion Point, and marked the actual needle distance from the skin to the epidural space (needle depth, ND). Bland-Altman analysis was used to determine the differences and 95% limits of agreement between US depth and ND. RESULTS: We studied 60 women. The mean (SD) body mass index was 39.6 (7.9) kg/m2 (range 30.4–66.2 kg/m2). The US estimate in the PSO and TM planes, and the actual ND were 6.5 (1.2) cm, 6.5 (1.1) cm, and 6.6 (1.3) cm, respectively. The Bland-Altman analysis showed a mean difference of 0.05 cm and 95% limits of agreement of ±1 cm. The quality of imaging was rated as good in the PSO and TM planes in 86.7% and 68.3%, respectively (P = 0.028). CONCLUSION: The estimates of the US-determined distance to the epidural space in the PSO are comparable to those in the TM plane. The ability to use both estimates interchangeably for midline punctures may prove useful in patients presenting with poor visibility in the TM plane.

  • ultrasound imaging of the thoracic spine in paramedian sagittal oblique plane the correlation between estimated and actual depth to the epidural space
    Regional Anesthesia and Pain Medicine, 2011
    Co-Authors: Aliya Salman, Cristian Arzola, Uma Tharmaratnam, Mrinalini Balki
    Abstract:

    Background: Ultrasound (US) imaging of the spine has been shown to be a reliable tool to facilitate lumbar epidural needle placement; however, its feasibility in thoracic epidural placement is still unknown. The objective of this study was to assess the accuracy and reliability of prepuncture US imaging in the paramedian sagittal oblique plane to estimate the depth to the epidural space and optimum Insertion Point for guiding epidural needle placement at the mid-low thoracic level. Methods: This prospective study included 35 healthy adult patients who requested thoracic epidural analgesia before their upper abdominal surgeries. Ultrasound imaging was done in the paramedian sagittal oblique plane at the desired thoracic level to identify the intervertebral space, the distance from the skin to the epidural space (US depth [UD]) and the needle Insertion Point. Subsequently, a staff anesthesiologist located the epidural space through the predetermined Insertion Point and marked the actual distance from the skin to the epidural space (needle depth [ND]) on the needle with a sterile marker. The agreement between the UD and the ND was calculated using the Pearson and concordance correlation coefficients and Bland-Altman analysis with 95% limits of agreement. Results: The average patient age was 56 (SD, 14) years, and body mass index was 28 (SD, 6) kg/m2. The precision of the agreement between UD and ND estimated by Pearson correlation coefficient was 0.75, and the accuracy was 0.80, whereas the concordance correlation coefficient was 0.60 (confidence interval, 0.43-0.78). The mean UD and ND were 4.3 (SD, 0.96) and 5.0 (SD, 1.2) cm, respectively. The Bland-Altman analysis showed a mean difference of −0.71 cm (95% limits of agreement, 0.8 to −2.2 cm). There was a significant direct correlation of the ND with the body mass index (r2 = 0.27, P = 0.008). The mean number of attempts was 1 (p25-p75 = 1-2), and the epidural space was identified with 2 or less redirections in 88% of the cases. Conclusions: We found a good correlation between the US-estimated distance to the epidural space and the actual measured needle distance in our patients. We suggest that our proposed prepuncture US method, using the paramedian sagittal oblique approach, can be a useful guide to facilitate the placement of epidural needles at mid-low thoracic levels. A randomized controlled trial is necessary to confirm the utility of prepuncture US in thoracic epidural placement.

  • ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals
    Anesthesia & Analgesia, 2007
    Co-Authors: Cristian Arzola, Sharon Davies, Ayman Rofaeel, Jose C A Carvalho
    Abstract:

    BACKGROUND: Ultrasound imaging of the spine has recently been proposed to facilitate identification of the epidural space. In this study, we assessed the accuracy and precision of the transverse approach, using a “single-screen” method, to facilitate labor epidurals. METHODS: We enrolled 61 patients requesting labor epidurals. Ultrasound imaging (transverse approach, 2–5 MHz curved array probe) identified the midline, the intervertebral space, and the distance from the skin to the epidural space (ultrasound depth/UD). During the epidural puncture, we recorded the success of the Insertion Point, and measured the distance to the epidural space to the nearest half-centimeter of the marked Tuohy needle (needle depth/ND). We calculated the agreement between UD and ND by the concordance correlation coefficient and Bland–Altman analysis with 95% limits of agreement. RESULTS: The average maternal age was 33 4.6 yr, body mass index 29.7 4.8, UD 4.66 0.68 cm, and ND 4.65 0.72 cm. The success of the Insertion Point was 91.8%, with no need to redirect the needle in 73.8% of the patients. The concordance correlation coefficient between UD and ND was 0.881 (95% CI 0.820–0.942). The 95% limits of agreement were 0.666 to 0.687 cm. CONCLUSIONS: We found a good level of success in the ultrasound-determined Insertion Point, and very good agreement between UD and ND. This suggests that our proposed ultrasound single-screen method, using the transverse approach, can be a reliable guide to facilitate labor epidural Insertion. (Anesth Analg 2007;104:1188‐92)

Mrinalini Balki - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound estimates for midline epidural punctures in the obese parturient paramedian sagittal oblique is comparable to transverse median plane
    Anesthesia & Analgesia, 2013
    Co-Authors: Jagpaul S Sahota, Mrinalini Balki, Jose C A Carvalho, Niall Fanning, Cristian Arzola
    Abstract:

    BACKGROUND: Spinal ultrasound (US) in the transverse median (TM) plane underestimates the distance to the epidural space in obese pregnant women, most likely because of compression of the subcutaneous tissue during the assessment, often required to compensate for poor visibility. We tested whether scanning in the paramedian sagittal oblique (PSO) plane compared with the TM plane resulted in a more precise estimate of the actual skin-epidural space measurement in this population. METHODS: We recruited obese (World Health Organization classes I, II, and III) pregnant women at term requesting labor epidural analgesia or combined spinal-epidural anesthesia for cesarean delivery. US imaging was performed with a 5-2 MHz curved array probe to identify the Insertion Point and to estimate the distance from the skin to the epidural space (US-estimated depth, UD) in the PSO and TM planes. The measurements were performed with the least possible compression of the subcutaneous tissue by the US probe. All punctures were performed via the midline approach. An anesthesiologist performed the epidural/combined spinal-epidural procedure at the predetermined Insertion Point, and marked the actual needle distance from the skin to the epidural space (needle depth, ND). Bland-Altman analysis was used to determine the differences and 95% limits of agreement between US depth and ND. RESULTS: We studied 60 women. The mean (SD) body mass index was 39.6 (7.9) kg/m2 (range 30.4–66.2 kg/m2). The US estimate in the PSO and TM planes, and the actual ND were 6.5 (1.2) cm, 6.5 (1.1) cm, and 6.6 (1.3) cm, respectively. The Bland-Altman analysis showed a mean difference of 0.05 cm and 95% limits of agreement of ±1 cm. The quality of imaging was rated as good in the PSO and TM planes in 86.7% and 68.3%, respectively (P = 0.028). CONCLUSION: The estimates of the US-determined distance to the epidural space in the PSO are comparable to those in the TM plane. The ability to use both estimates interchangeably for midline punctures may prove useful in patients presenting with poor visibility in the TM plane.

  • ultrasound imaging of the thoracic spine in paramedian sagittal oblique plane the correlation between estimated and actual depth to the epidural space
    Regional Anesthesia and Pain Medicine, 2011
    Co-Authors: Aliya Salman, Cristian Arzola, Uma Tharmaratnam, Mrinalini Balki
    Abstract:

    Background: Ultrasound (US) imaging of the spine has been shown to be a reliable tool to facilitate lumbar epidural needle placement; however, its feasibility in thoracic epidural placement is still unknown. The objective of this study was to assess the accuracy and reliability of prepuncture US imaging in the paramedian sagittal oblique plane to estimate the depth to the epidural space and optimum Insertion Point for guiding epidural needle placement at the mid-low thoracic level. Methods: This prospective study included 35 healthy adult patients who requested thoracic epidural analgesia before their upper abdominal surgeries. Ultrasound imaging was done in the paramedian sagittal oblique plane at the desired thoracic level to identify the intervertebral space, the distance from the skin to the epidural space (US depth [UD]) and the needle Insertion Point. Subsequently, a staff anesthesiologist located the epidural space through the predetermined Insertion Point and marked the actual distance from the skin to the epidural space (needle depth [ND]) on the needle with a sterile marker. The agreement between the UD and the ND was calculated using the Pearson and concordance correlation coefficients and Bland-Altman analysis with 95% limits of agreement. Results: The average patient age was 56 (SD, 14) years, and body mass index was 28 (SD, 6) kg/m2. The precision of the agreement between UD and ND estimated by Pearson correlation coefficient was 0.75, and the accuracy was 0.80, whereas the concordance correlation coefficient was 0.60 (confidence interval, 0.43-0.78). The mean UD and ND were 4.3 (SD, 0.96) and 5.0 (SD, 1.2) cm, respectively. The Bland-Altman analysis showed a mean difference of −0.71 cm (95% limits of agreement, 0.8 to −2.2 cm). There was a significant direct correlation of the ND with the body mass index (r2 = 0.27, P = 0.008). The mean number of attempts was 1 (p25-p75 = 1-2), and the epidural space was identified with 2 or less redirections in 88% of the cases. Conclusions: We found a good correlation between the US-estimated distance to the epidural space and the actual measured needle distance in our patients. We suggest that our proposed prepuncture US method, using the paramedian sagittal oblique approach, can be a useful guide to facilitate the placement of epidural needles at mid-low thoracic levels. A randomized controlled trial is necessary to confirm the utility of prepuncture US in thoracic epidural placement.

  • ultrasound imaging of the lumbar spine in the transverse plane the correlation between estimated and actual depth to the epidural space in obese parturients
    Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, 2009
    Co-Authors: Mrinalini Balki, Yung Lee, Stephen H Halpern, Jose C A Carvalho
    Abstract:

    BACKGROUND: Prepuncture lumbar ultrasound scanning is a reliable tool to facilitate labor epidural needle placement in nonobese parturients. In this study, we assessed prepuncture lumbar ultrasound scanning as a tool for estimating the depth to the epidural space and determining the optimal Insertion Point in obese parturients. METHODS: We studied 46 obese parturients, with prepregnancy body mass index (BMI) >30 kg/m 2 , requesting labor epidural analgesia. Ultrasound imaging was done by one of the investigators to identify the midline, the intervertebral space, and the distance from the skin to the epidural space (ultrasound depth, UD) at the level of L3-4. Subsequently, an anesthesiologist blinded to the UD located the epidural space through the predetermined Insertion Point and marked the actual distance from the skin to the epidural space (needle depth, ND) on the needle with a sterile marker. The agreement between the UD and the ND was calculated using the Pearson correlation coefficient and a paired t-test. Bland-Altman analysis was used to determine the 95% limits of agreement between the UD and the ND. RESULTS: The prepregnancy BMI ranged from 30 to 79 kg/m 2 , and the BMI at delivery was 33-86 kg/m 2 . The Pearson correlation coefficient between the UD and the ND was 0.85 (95% confidence interval: 0.75-0.91), and the concordance correlation coefficient was 0.79 (95% confidence interval: 0.71-0.88). The mean (±SD) ND and UD were 6.6 ± 1.0 cm and 6.3 ± 0.8 cm, respectively (difference = 0.3 cm, P = 0.002). The 95% limits of agreement were 1.3 cm to ―0.7 cm. Epidural needle placement using the predetermined Insertion Point was done without reInsertion at a different puncture site in 76.1% of parturients and without redirection in 67.4%. CONCLUSIONS: We found a strong correlation between the ultrasound-estimated distance to the epidural space and the actual measured needle distance in obese parturients. We suggest that prepuncture lumbar ultrasound may be a useful guide to facilitate the placement of epidural needles in obese parturients.

Ryuzo Arai - One of the best experts on this subject based on the ideXlab platform.

  • functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Ryuzo Arai, Takashi Nakamura, Tomoyuki Mochizuki, Kumiko Yamaguchi, Hiroyuki Sugaya, Masahiko Kobayashi, Keiichi Akita
    Abstract:

    Background Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon. Material and methods Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied. Results Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament. Conclusion To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior Insertion Point of the subscapularis from behind the ligament may be necessary. Level of Evidence Basic Science

  • functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon
    Journal of Shoulder and Elbow Surgery, 2010
    Co-Authors: Ryuzo Arai, Takashi Nakamura, Tomoyuki Mochizuki, Kumiko Yamaguchi, Hiroyuki Sugaya, Masahiko Kobayashi, Keiichi Akita
    Abstract:

    Background Various findings in the lateral rotator interval to support the long head of the biceps tendon have been reported. The purpose of this study was to clarify the functional anatomy regarding the stabilization of the biceps tendon. Material and methods Twenty embalmed shoulders were used for anatomic study, and 5 specimens of the anterosuperior part of the glenohumeral joint were histologically studied. Results Anatomically, the most superior part of the subscapularis tendon was attached to the upper margin of the lesser tuberosity and extended as a thin tendinous slip to the fovea capitis of the humerus. The superior glenohumeral ligament ran spirally along the biceps tendon. Histologically, the superior glenohumeral ligament was attached to the tendinous slip. There was no clear boundary between the superior glenohumeral and coracohumeral ligament. Conclusion To keep the biceps tendon in place and stabilized, tension in the superior glenohumeral ligament and the buttress support of the most superior Insertion Point of the subscapularis from behind the ligament may be necessary. Level of Evidence Basic Science