https://www.ijmhr.org/ijar.htm editor_anatomy@ijmhr.org
ISSN:       2321-4281 (E) 2321-8967 (P)

IJAR.2019.336

DOWNLOAD PDF
Table of Contents

Type of Article:  Original Research

Volume 7; Issue 4.3 (December 2019)

Page No.: 7176-7182

DOI: https://dx.doi.org/10.16965/ijar.2019.336

ANATOMICAL LOCALIZATION OF MOTOR ENTRY POINTS OF HAMSTRING MUSCLES – FOR NEUROLYSIS IN HAMSTRING SPASTICITY

Anju Mary Albert *1, Sunil J.Holla 2, Henry Prakash M 3, Ivan James Prithishkumar 4.

1 Assistant Professor, Department, Believers Church medical college, Thiruvalla, Kerala, India.

2 Retd. Professor, Department of Anatomy, CMC Vellore, Tamil Nadu, India.

3 Physical Medicine & Rehabilitation, Professor, Department of PMR, CMC Vellore, Tamil Nadu, India.

4 Professor, Department of Anatomy, CMC Vellore, Tamil Nadu, India.

Corresponding author: Dr. Anju Mary Albert, Assistant Professor, Department of Anatomy, Believers Church Medical College, Thiruvalla – 689103, Kerala, India. Phone : 8489073711 E-Mail: dranjubalu@gmail.com

ABSTRACT

Objectives: To study the motor entry points of hamstring muscles of lower limb and to suggest ideal sites for motor point procedures for treatment of spasticity in the above muscles.

Materials and Methods: The study was done after approval from Institutional Review Board. Sample size was estimated using Population mean-Absolute precision method. A total of 10 adult lower limbs were chosen. The nerve branches to hamstring muscles were dissected up to its motor entry point. Position of proximal and distal motor entry points were marked and following variables measured: a) The length of muscle; b)Number of motor entry points; c)The distance of proximal entry point (PEP) and distal entry point (DEP) from the origin of muscle; e)The position of PEP and DEP as a fraction of length of muscle; f) Ideal site of motor entry point injection; g) Ideal site of motor point injection expressed as a percentage of muscle length.

Results: The proximal and distal motor entry points of long head of Biceps Femoris were located at 35% and 51% of the total length of muscle. Most of the motor entry points of Semitendinosus were located between 43% and 48% of muscle length ie, in the third-fifth of total muscle length. Semimembranosus had its motor entry points located between 52% and 70% of the total muscle length ie, in the third-fifth and fourth-fifth of muscle length.

Conclusion: The interventions done for relief of spasticity will have the best outcomes if planned at the above mentioned areas of the respective muscles.

Key words: Motor entry point, Hamstring, Chemical neurolysis, Selective motor fasciculotomy, Spasticity.

REFERENCES

  1. Randall L. Braddom. Physical Medicine and Rehabilitation. 3rd ed. Philadelphia. Elsevier Saunders. 2011. 651-662 p.
  2. Won S-Y, Rha D-W, Kim H-S, Jung S-H, Park ES, Hu K-S, et al. Intramuscular nerve distribution pattern of the adductor longus and gracilis muscles demonstrated with Sihler staining: guidance for botulinum toxin injection. Muscle Nerve. 2012 Jul;46(1):80–5.
  3. Joel A.Delisa, Walter R Frontera, Bruce M.,Nicholas Walch, Lawrence R.Robinson. Delisa’s Physical Medicine and Rehabilitation. Principle’s and Practice. 5th ed. Philadelphia. Lippincott Williams and Wilkins. 2010. 1319-1337 p.
  4. Lee J-H, Lee B-N, An X, Chung R-H, Han S-H. Location of the motor entry point and intramuscular motor point of the tibialis posterior muscle: for effective motor point block. Clin Anat N Y N. 2011 Jan;24(1):91–6.
  5. Won S-Y, Rha D-W, Kim H-S, Jung S-H, Park ES, Hu K-S, et al. Intramuscular nerve distribution pattern of the adductor longus and gracilis muscles demonstrated with Sihler staining: guidance for botulinum toxin injection. Muscle Nerve. 2012 Jul;46(1):80–5.
  6. Deltombe T, Gustin T, Laloux P, De Cloedt P, De Wispelaere JF, Hanson P. [Selective fasicular neurotomy for spastic equinovarus foot deformity in cerebral palsy children]. Acta Orthop Belg. 2001 Feb;67(1):1–5.
  7. Puligopu AK, Purohit AK. Outcome of selective motor fasciculotomy in the treatment of upper limb spasticity. J Pediatr Neurosci. 2011 Oct;6(Suppl1):S118–25.
  8. Kwon J-Y, Kim J-S, Lee WI. Anatomic localization of motor points of hip adductors. Am J Phys Med Rehabil Assoc Acad Physiatr. 2009 Apr;88(4):336–41.
  9. Borodic GE, Ferrante R, Pearce LB, Smith K. Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections. Mov Disord Off J Mov Disord Soc. 1994 Jan;9(1):31–9.
  10. Van Campenhout A, Molenaers G. Localization of the motor endplate zone in human skeletal muscles of the lower limb: anatomical guidelines for injection with botulinum toxin. Dev Med Child Neurol. 2011 Feb;53(2):108–19.
  11. Shaari CM, Sanders I. Quantifying how location and dose of botulinum toxin injections affect muscle paralysis. Muscle Nerve. 1993 Sep;16(9):964–9.
  12. Purohit A, Reddy S, Puligopu A. Results of selective motor fasciculotomy in spastic upper limbs due to cerebral palsy (a review of 30 children and adults). Indian J Cereb Palsy. 2015;1(1):21.
  13. Maarrawi J, Mertens P, Luaute J, Vial C, Chardonnet N, Cosson M, et al. Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. J Neurosurg. 2006 Feb 1;104(2):215–25.
  14. Sara J.Cuccurullo. Physical Medicine and Rehabilitation Board Review. 2nd ed. United States of America. Demos Medical Publishing. 2010. 809-821 p.
  15. Seidel PM, Seidel GK, Gans BM, Dijkers M. Precise localization of the motor nerve branches to the hamstring muscles: an aid to the conduct of neurolytic procedures. Arch Phys Med Rehabil. 1996 Nov;77(11):1157–60.
  16. Botter A, Oprandi G, Lanfranco F, Allasia S, Maffiuletti NA, Minetto MA. Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning. Eur J Appl Physiol. 2011 Oct;111(10):2461–71.
  17. Woodley SJ, Mercer SR. Hamstring muscles: architecture and innervation. Cells Tissues Organs. 2005;179(3):125–41.
  18. An XC, Lee JH, Im S, Lee MS, Hwang K, Kim HW, et al. Anatomic localization of motor entry points and intramuscular nerve endings in the hamstring muscles. Surg Radiol Anat SRA. 2010 Jul;32(6):529–37.
  19. Berweck S, Heinen F. Treatment of cerebral palsy with botulinum toxin. Principles, Clinical practice, Atlas. 2nd ed. Child and Brain. Bonn. Berlin. 2003.
  20. Fheodoroff K, Schurch B, Heck G. Pocket atlas. Treatment of spasticity with botulinum toxin. 1st edn. Scherzingen, Switzerland: Saentis, 2005.

Cite this article: Anju Mary Albert, Sunil J.Holla, Henry Prakash M, Ivan James Prithishkumar. ANATOMICAL LOCALIZATION OF MOTOR ENTRY POINTS OF HAMSTRING MUSCLES – FOR NEUROLYSIS IN HAMSTRING SPASTICITY. Int J Anat Res 2019;7(4.3):7176-7182. DOI: 10.16965/ijar.2019.336