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Cesar Fernandezdelaspenas - One of the best experts on this subject based on the ideXlab platform.
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muscle trigger points pressure pain threshold and cervical range of motion in patients with high level of disability related to acute whiplash injury
Journal of Orthopaedic & Sports Physical Therapy, 2012Co-Authors: Antonio Manuel Fernandezperez, Carmen Villaverdegutierrez, Aurora Morasanchez, Cristina Alonsoblanco, Michele Sterling, Cesar FernandezdelaspenasAbstract:Study Design Cross-sectional cohort study. Objective To analyze the differences in the prevalence of trigger points (TrPs) between patients with acute whiplash-associated disorders (WADs) and healthy controls, and to determine if widespread pressure hypersensitivity and reduced cervical range of motion are related to the presence of TrPs in patients with acute WADs. Background The relationship between active TrPs and central sensitization is not well understood in patients with acute WADs. Methods Twenty individuals with a high level of disability related to acute WAD and 20 age- and sex-matched controls participated in the study. TrPs in the temporalis, masseter, upper trapezius, levator scapulae, sternocleidomastoid, suboccipital, and Scalene Muscles were examined. TrPs are defined as hypersensitive spots in a palpable taut band, producing a local twitch response and referred pain when palpated. Pressure pain threshold (PPT) was assessed bilaterally over the C5–6 zygapophyseal joints, second metacarpal,...
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referred pain from myofascial trigger points in head neck shoulder and arm Muscles reproduces pain symptoms in blue collar manual and white collar office workers
The Clinical Journal of Pain, 2012Co-Authors: Cesar Fernandezdelaspenas, Ricardo Ortegasantiago, Christian Grobli, Christine Stebler Fischer, Daniel Boesch, Philippe Froidevaux, Lilian Stocker, Richard Weissmann, Javier GonzaleziglesiasAbstract:Objective: To describe the prevalence and referred pain area of trigger points (TrPs) in blue-collar (manual) and white-collar (office) workers, and to analyze if the referred pain pattern elicited from TrPs completely reproduces the overall spontaneous pain pattern. Methods: Sixteen (62% women) blue-collar and 19 (75% women) white-collar workers were included in this study. TrPs in the temporalis, masseter, upper trapezius, sternocleidomastoid, splenius capitis, oblique capitis inferior, levator scapulae, Scalene, pectoralis major, deltoid, infraspinatus, extensor carpi radialis brevis and longus, extensor digitorum communis, and supinator Muscles were examined bilaterally (hyper-sensible tender spot within a palpable taut band, local twitch response with snapping palpation, and elicited referred pain pattern with palpation) by experienced assessors blinded to the participants’ condition. TrPs were considered active when the local and referred pain reproduced any symptom and the patient recognized the pain as familiar. The referred pain areas were drawn on anatomic maps, digitized, and measured. Results: Blue-collar workers had a mean of 6 (SD: 3) active and 10 (SD: 5) latent TrPs, whereas white-collar workers had a mean of 6 (SD: 4) active and 11 (SD: 6) latent TrPs (P>0.548). No significant differences in the distribution of active and latent TrPs in the analyzed Muscles between groups were found. Active TrPs in the upper trapezius, infraspinatus, levator scapulae, and extensor carpi radialis brevis Muscles were the most prevalent in both groups. Significant differences in referred pain areas between Muscles (P<0.001) were found; pectoralis major, infraspinatus, upper trapezius, and Scalene Muscles showed the largest referred pain areas (P<0.01), whereas the temporalis, masseter, and splenius capitis Muscles showed the smallest (P<0.05). The combination of the referred pain from TrPs reproduced the overall clinical pain area in all participants. Conclusions: Blue-collar and white-collar workers exhibited a similar number of TrPs in the upper quadrant musculature. The referred pain elicited by active TrPs reproduced the overall pain pattern. The distribution of TrPs was not significantly different between groups. Clinicians should examine for the presence of muscle TrPs in blue-collar and white-collar workers.
Francois Hug - One of the best experts on this subject based on the ideXlab platform.
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Scalene muscle activity during progressive inspiratory loading under pressure support ventilation in normal humans
Respiratory Physiology & Neurobiology, 2008Co-Authors: Linda Chiti, Giuseppina Biondi, Capucine Morelotpanzini, Mathieu Raux, Thomas Similowski, Francois HugAbstract:We hypothesized that (1) in healthy humans subjected to intermittent positive pressure non-invasive ventilation, changes in the ventilator trigger sensitivity would be associated with increased Scalene activity, (2) if properly processed - through inspiratory phase-locked averaging - surface electromyograms (EMG) of the Scalenes would reliably detect and quantify this, (3) there would be a correlation between dyspnea and Scalene EMG. Surface and intramuscular EMG activity of Scalene Muscles were measured in 10 subjects. They breathed quietly through a face mask for 10min and then were connected to a mechanical ventilator. Recordings were performed during three 15-min epochs where the subjects breathed against an increasingly negative pressure trigger (-5%, -10% and -15% of maximal inspiratory pressure). With increasing values of the inspiratory trigger, inspiratory efforts, dyspnea and the Scalene activity increased significantly. The Scalene EMG activity level was correlated with the esophageal pressure time product and with dyspnea intensity. Inspiration-adjusted surface EMG averaging could be useful to detect small increases of the Scalene Muscles activity during mechanical ventilation.
Sharon L Hammond - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of thoracic outlet syndrome
Journal of Vascular Surgery, 2007Co-Authors: Richard J Sanders, Sharon L Hammond, Neal M RaoAbstract:Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred Scalene Muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90 degrees in external rotation, which usually brings on symptoms within 60 seconds.
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diagnosis of thoracic outlet syndrome
Journal of Vascular Surgery, 2007Co-Authors: Richard J Sanders, Sharon L HammondAbstract:Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred Scalene Muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90° in external rotation, which usually brings on symptoms within 60 seconds.
Vincent W S Chan - One of the best experts on this subject based on the ideXlab platform.
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refining the ultrasound guided interScalene brachial plexus block the superior trunk approach
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2014Co-Authors: David Burckettst Laurent, Vincent W S Chan, Ki Jinn ChinAbstract:Purpose The conventional ultrasound-guided interScalene block targets the C5 and C6 nerve roots at approximately the level of the cricoid cartilage where they lie in the groove between the anterior and middle Scalene Muscles. This technique, although effective at providing regional anesthesia of the shoulder, is associated with risks of phrenic nerve palsy, injury to the dorsal scapular and long thoracic nerves, and long-term postoperative neurologic symptoms. In this case report, we describe the ultrasound-guided superior trunk block. This procedure targets the C5 and C6 components of the brachial plexus more distally after they unite into the superior trunk but before the suprascapular nerve branches off.
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applying ultrasound imaging to interScalene brachial plexus block
Regional Anesthesia and Pain Medicine, 2003Co-Authors: Vincent W S ChanAbstract:Abstract Objective: Previous studies have examined ultrasound-assisted brachial plexus blocks, but few have applied this imaging technology to the interScalene region. We report a case of interScalene brachial plexus block using ultrasound guidance to show the clinical usefulness of this technology. Case Report: A nerve stimulator-guided interScalene block was attempted for arthroscopic shoulder surgery but failed. Subsequent nerve localization was accomplished by ultrasound imaging using a high-frequency probe (5-12 MHz) and the Philips ATL HDI 5000 unit. Ultrasound showed nerves between the Scalene Muscles, block needle movement at the time of advancement, and local anesthetic spread during injection. InterScalene block was successful after 1 attempt of nerve localization and needle placement. Conclusions: Advanced ultrasound technology is useful for nerve localization and can generate brachial plexus images of high resolution in the interScalene groove, guide block needle placement and advancement in real time to targeted nerves, and assess adequacy of local anesthetic spread at the time of injection. Ultrasound imaging guidance can potentially improve success during interScalene brachial plexus block.
Richard J Sanders - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of thoracic outlet syndrome
Journal of Vascular Surgery, 2007Co-Authors: Richard J Sanders, Sharon L Hammond, Neal M RaoAbstract:Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred Scalene Muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90 degrees in external rotation, which usually brings on symptoms within 60 seconds.
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diagnosis of thoracic outlet syndrome
Journal of Vascular Surgery, 2007Co-Authors: Richard J Sanders, Sharon L HammondAbstract:Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred Scalene Muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90° in external rotation, which usually brings on symptoms within 60 seconds.
