Effects of two different degrees of lateral-wedge insoles on unilateral lower extremity load-bearing line in patients with medial knee osteoarthritis.

OBJECTIVE: The aim of this study is to assess the effect of 5 and 10° lateral-wedge insoles on unilateral lower extremity load carrying line in patients with medial knee osteoarthritis using the L.A.S.A.R. posture alignment system. PATIENTS AND METHODS: Twenty subjects (10 females and 10 males, mean age 67.7 ± 5.4 years (range: 58-78) with bilateral medial knee osteoarthritis were included in the study. The laser line projected on the person by the L.A.S.A.R. posture alignment system showed joint load carrying line. The location of the joint load carrying line in static standing with one foot on the force plate was assessed with barefoot, and 5° and 10° lateral-wedge insoles. Displacement of the load carrying line was measured using a ruler placed tangentially to the patella at the level of joint line. RESULTS: The load carrying lines measured with 5° and 10° lateral-wedge insoles were significantly laterally located compared to that without wearing insole (p < 0.001). 10° lateral-wedge insole caused a significant more lateral shifting of the load carrying line than 5° lateral-wedge insole (p < 0.001). CONCLUSION: Both wedge insoles was effective in moving of the unilateral lower extremity load carrying line to the lateral. Lateral wedged insoles are biomechanically effective and reduce loading of the medial compartment in patients with medial knee osteoarthritis.

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees.

OBJECTIVES: The purpose of this study was to identify psychiatric symptoms by comparing male patients with traumatic leg amputations (LAs) with healthy controls and to determine the association between these psychiatric symptoms and phantom pain and prosthesis use characteristics. METHODS: One hundred four volunteers, 51 LA patients (group 1) and 53 healthy controls (group 2) were included. Demographic data including age, height, weight, time since amputation, duration of prosthesis use, and Satisfaction with Prosthesis Questionnaire scores were recorded. Phantom pain was measured a visual analog scale (VAS). Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory. Correlations were determined between time since amputation, duration of prosthesis use and satisfaction with prosthesis questionnaire scores and psychiatric scale scores. RESULTS: Amputee patients had higher phobic anxiety, state anxiety, trait anxiety and sleep disturbance scores (p<0.05) than the controls. No difference was determined in terms of psychiatric symptoms between the phantom pain and no phantom pain groups (p>0.05). There were significant negative correlations between time since amputation, duration of prosthesis use, duration of daily prosthesis use, and satisfaction with prosthesis questionnaire scores and psychiatric symptoms. CONCLUSIONS: Apart from anxiety (state, trait or phobic) and disturbed sleep, other psychiatric symptoms in amputee patients undergoing lengthy prosthetic rehabilitation may not differ from those of healthy controls. The presence and severity of phantom pain appear to be unrelated to general psychiatric symptomatology. Length of time since amputation, length of prosthesis use, daily length of prosthesis use and prosthesis satisfaction are negatively correlated with general psychiatric symptoms. These characteristics must be borne in mind in psychiatric and prosthetic rehabilitation.

The effect of nonsurgical periodontal treatment on serum and saliva chitotriosidase activities in patients with periodontitis and coronary artery disease.

BACKGROUND: Plasma chitotriosidase activity, which is a marker of macrophage activation, has been reported to increase in inflammatory conditions and atherosclerosis. Chronic periodontitis has likely an important role in the development of coronary artery disease. In this study, we aimed to analyze the effect of chronic periodontitis on salivary and plasma chitotriosidase activities in patients with or without coronary atherosclerosis. METHODS: Fifty subjects were divided into four groups as controls (n=13), periodontitis (n=11), coronary artery disease (n=13), and periodontitis + coronary artery disease (n=13). Plasma and saliva chitotriosidase activities were measured by a fluorimetric method in all groups before the nonsurgical treatment of periodontitis and 5 weeks posttreatment in periodontitis groups. RESULTS: Salivary chitotriosidase activity was decreased after nonsurgical periodontal treatment in patients having periodontitis with or without coronary atherosclerosis. However, plasma activities remained unchanged. CONCLUSION: Although this study has some limitations like small sample size and short study duration, it can suggest that salivary chitotriosidase can have the potential to be used as a very useful and practical marker to evaluate the success of the periodontal treatment and/or host response. KEY FINDING: Salivary chitotriosidase can be used as a marker for the evaluation of the success of the periodontal treatment and/or host response.

Nerve block of articular branches of the obturator and femoral nerves for the treatment of hip joint pain.

OBJECTIVES: The aim of this retrospective study was to investigate the effectiveness of the nerve block of articular branches of obturator and femoral nerves in patients with intractable pain due to hip osteoarthritis. MATERIAL AND METHOD: Twenty patients (8 female and 12 male; with a mean age 53.5 years) were retrospectively identified who had received nerve block of articular branches of obturator and femoral nerves for chronic hip joint pain due to hip osteoarthritis. The outcome measures (visual analogue pain scale, the level of patient satisfaction with nerve block, reduction rate of NSAID using) were assessed before the treatment and at the 1st and 3rd months after injection. RESULTS: Mean reduction in hip joint pain while walking and at night between the baseline and 1st month, and between the baseline and 3rd month were statistically significant (p< 0.05). At the 1st and 3rd months after treatment, the reduction rates of NSAID using were almost 67% and 71%; respectively. At the 1st and 3rd months after treatment, the level of patient satisfaction with nerve block were 73.00 ± 21.23 mm and 73.50 ± 18.14 mm; respectively. CONCLUSION: We found that nerve blocks of articular branches of obturator and femoral nerves were effective in short- and mid-term for reducing chronic hip joint pain.

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial.

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.

Quality of life and functionality after lower limb amputations: comparison between uni- vs. bilateral amputee patients.

BACKGROUND: It is difficult for the lower limb amputee patients to adapt to their new lifestyles. OBJECTIVE: To compare the life quality and functionality of patients with bilateral vs. unilateral lower extremity amputations. STUDY DESIGN: Cross-sectional study. METHODS: Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis Questionnaire (SAT-PRO), Amputee Body Image Scale. (ABIS), Houghton Scale (HS), six-minute walk test (6MWT), and 10-metre walk test (10 MWT) were performed. RESULTS: Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups. There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain). The unilateral amputee group had significantly better scores than the bilateral amputee group in terms of HS, 6MWT and 10 MWT. CONCLUSION: Physical capacity of bilateral lower extremity amputee patients is lower than the unilateral amputee patients; satisfaction with prosthesis and body image are not related with the amputation level; and the life quality and satisfaction with prostheses are increased in parallel with the use of the prostheses. Clinical relevance Although differences exist between the groups, in terms of quality of life and functionality, patients can reach an acceptable life standard with good rehabilitation and a suitable prosthesis.

Influence of adapted sports on quality of life and life satisfaction in sport participants and non-sport participants with physical disabilities.

BACKGROUND: The lack of controlled trials in the relationship between participation in adapted sports, and quality of life (QoL) and life satisfaction in people with physical disabilities encouraged us to consider conducting this study. OBJECTIVE: The aim of this study was to compare the QoL and life satisfaction scores between people with physical disabilities who participated in adapted sports and those who did not participate in any adapted sports. METHODS: This cross-sectional controlled study included 60 individuals with physical disabilities (paraplegia and amputee). Participants were divided into two groups based on sports participation and non-sports participation. Group one included 30 disabled elite athletes who participated in adapted sports. The control group included 30 disabled individuals not involved in any adapted sports. We compared scores on the World Health Organization Quality-of-Life Scale (WHOQoL-BREF) and the Satisfaction With Life Scale (SWLS) between the two groups. Participation in the community and QoL was examined as a reflection of participant's priority on sports participation. RESULTS: We found that WHOQoL-BREF physical, psychological, and social domain scores were significantly higher in group one than in the control group (p < 0.05), whereas environment domain scores were similar (p = 0.13). Moreover, SWLS scores were significantly higher in group one than in the control group (p < 0.05). CONCLUSIONS: These results showed that people with physical disabilities who participated in adapted sports had significantly higher QoL and life satisfaction scores compared to people with physical disabilities not involved in any adapted sports.

Effects of exercise continued until anaerobic threshold on balance performance in male basketball players.

The objective of the present study was to determine the effects of exercise continued until the anaerobic threshold on balance performance in basketball players. Twelve male basketball players (age = 20.92 ± 2.81 years, body height = 192.72 ± 7.61 cm, body mass = 88.09 ± 8.41 kg, training experience = 7.17 ± 3.10 years) volunteered to participate in this study. A Kinesthetic Ability Trainer (KAT 2000 stabilometer) was used to measure the balance performance. Balance tests consisted of static tests on dominant, nondominant and double leg stance. The Bruce Protocol was performed by means of a treadmill. The exercise protocol was terminated when the subject passed the anaerobic threshold. After the exercise protocol, balance measurements were immediately repeated. Statistical differences between pre and post-exercise for dominant, nondominant and double leg stance were determined by the paired samples t-test according to the results of the test of normality. The post-exercise balance score on the dominant leg was significantly higher than pre-exercise (t = -2.758, p < 0.05). No differences existed between pre- and post-exercise in the balance scores of the nondominant leg after the exercise protocol (t = 0.428, p > 0.05). A significant difference was found between pre and post-exercise balance scores in the double leg stance (t = -2.354, p < 0.05). The main finding of this study was that an incremental exercise continued until the anaerobic threshold decreased balance performance on the dominant leg in basketball players, but did not alter it in the nondominant leg.

Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial.

OBJECTIVE: To determine which injection technique was effective for patients with hemiplegic shoulder pain. DESIGN: Randomized prospective double-blind study. SETTING: Brain Injury Rehabilitation Unit. INTERVENTION: Patients with hemiplegic shoulder pain were recruited over a 12-month period and all were hospitalized in our clinic. Intra-articular steroid injection or suprascapular nerve block was performed on all patients. MAIN MEASURES: Range of motion values at the moment that pain started (range of motion A) and passive maximum range of motion values (range of motion B) were recorded. Pain intensity levels (visual analogue scale) at these two range of motion values (pain A and pain B) were also taken. Evaluations were made before the injection, and 1 hour, one week and one month after the injection. RESULTS: Twenty-six patients were enrolled in the study, the mean age was 61.53 ± 10.30 years. The mean time since injury was 8.69 ± 15.71 months. The aetiology was ischaemic in 16 (61%) patients. Intra-articular steroid injection was performed in 11 (42 %) patients, and suprascapular nerve block in 15 (57%) patients. Range of motion A and range of motion B were changed statistically in repeated measures. There were important differences in repeated measures of pain intensity levels at these two range of motion values (P < 0.05). However, no significant differences were determined in all measurements between intra-articular steroid injection and suprascapular nerve block groups (P > 0.05). CONCLUSIONS: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.

Effect of autonomic dysfunction on p-wave dispersion in patients with chronic spinal cord injury.

OBJECTIVE: To provide information about the effect of autonomic dysfunction on P-wave dispersion, as a predictor of atrial fibrillation, in patients with spinal cord injury. DESIGN: Thirty patients with chronic traumatic spinal cord injury and 27 healthy controls were included in this study. The initial assessment of the patients included routine physical examination and evaluation of 12-lead electrocardiography. In the patient group, blood pressure and electrocardiography recordings were obtained during urodynamic assessment. The measurements of the P-wave duration were performed manually by two blinded investigators. P-wave dispersion was calculated as the difference between maximum P-wave duration and minimum P-wave duration. P-wave dispersion values of resting electrocardiography recordings in control and study groups were compared. In the patient group, subgroup analyses were also performed according to the injury level and severity and existence of autonomic dysfunction in examinations. RESULTS: P-wave dispersion values were greater in patients with spinal cord injury than in healthy controls. There was statistically significant difference between P-wave dispersion values of the patients with and without autonomic dysfunction. P-wave dispersion values at initial sensation of vesical filling were greater than those of the resting state in the patients without autonomic dysfunction. CONCLUSIONS: Our findings indicate that P-wave dispersion increases significantly in chronic spinal cord injured patients with autonomic dysfunction. This finding suggests a tendency for atrial fibrillation occurrence in patients with spinal cord injury, which may cause further cerebrovascular complications in this special subset of patients by creating a thromboembolic milieu.

Energy expenditure of walking with prostheses: comparison of three amputation levels.

Amputee patients spend more energy during walking than able-bodied persons. It is generally accepted that more proximal amputation is associated with more energy need. However, the picture is not clear, especially for partial foot amputees. The purpose of this study was to compare the energy consumption of walking in traumatic unilateral amputees with three different amputation levels (trans-femoral, trans-tibial and partial foot amputations). Sixty-four male unilateral traumatic amputees participated in this study. Energy expenditure during walking was measured for four different speed and slope combinations: 1.5 km/h and 0 degrees slope, 3 km/h and 0 degrees slope, 1.5 km/h and 5 degrees slope, 3 km/h and 5 degrees slope. Mean O(2) consumption (ml/kg/min) of the last 2 min of each 5-min session was calculated. In all four combinations, energy expenditure of trans-tibial amputees was the lowest, and energy expenditure of trans-femoral amputees was the highest. Statistical significance, however, could not be obtained for the differences among the groups. In conclusion, walking of partial foot amputees does not seem to be more energy efficient than that of higher level amputees.

Muscle strength and bone mineral density in mine victims with transtibial amputation.

The aims of this study were to: (i) Determine if there were significant bone mineral density and muscle strength differences between intact and amputated limbs, and (ii) investigate the possible relationship between local bone loss and muscle strength in transtibial amputees. Fifteen male veterans with traumatic unilateral transtibial amputations who ranged in age from 18-45 years were included in this prospective study. Lower limb muscle strength was measured with an isokinetic dynamometer. Dual energy X-ray absorptiometry was used to determine bone mineral density of the femur and tibia. The bone mineral density values of the femur and tibia were found significantly decreased on the amputated side. Significant decreases (p < 0.001) in strength of the quadriceps and hamstrings were observed in the amputated limb. There was a weak correlation between quadriceps strength and total femur bone mineral density (p = 0.048, r = 0.518) on the amputated limb. Transtibial amputees are prone to bone mineral loss and muscle strength decrease on the amputated side. Our results also indicate that muscle strength itself might not be of decisive importance for bone mass in transtibial amputees.

Evaluation of the patellar tendon in transtibial amputees: a preliminary sonographic study.

This study aimed to provide sonographic imaging of the patellar tendon (PT) - one of the main weight bearing structures for prosthetic use - in transtibial amputees. Thirteen males, who had been under follow-up for unilateral traumatic transtibial amputations, were enrolled. After physical examination of the limb, pain was evaluated by visual analogue scale and Leeds Assessment of Neuropathic Symptoms and Signs. Sonographic evaluations were performed by using a linear array probe (Aloka UST-5524-7.5 MHz) on both sides. Measurements pertaining to the contralateral limbs were taken as controls. In three subjects (23.1%), two with a silicone liner and one with a pelite liner, cortical irregularities were detected at the tibial insertion of the PT on the amputated sides. PTs were found to be thicker on the amputated sides when compared with those of the contralateral sides (p = 0.03), and this increase in thickness correlated with disease duration (r = 0.67, p = 0.01). Overall, our preliminary results imply that after transtibial amputation, PTs of the amputated sides tend to become thicker by time. These findings need to be complemented with future studies. In this regard, sonography seems to be promising for imaging the soft tissue problems of the stump.

Comparison of quality of life and functionality in patients with traumatic unilateral below knee amputation and salvage surgery.

The aim of this study was to compare the functionality during daily activities and quality of life of patients with transtibial amputation vs. salvage surgery after severe lower limb trauma. Ten patients with unilateral below knee amputation and nine patients with salvage surgery after severe lower limb trauma were enrolled. Functional Ambulation Scale (FAS), Visual Analogue Scale (VAS), Short Form 36 (SF-36) Energy Expenditure Index (EEI), 6-Minute Walking Test (6MWT) and 10-Meter Walking Test (10MWT) were used for the evaluation of subjects. Patients in the salvage group were also evaluated radiologically with Graves' radiological assessment method and Freiburg ankle scoring system. All patients were classified as grade 5 according to FAS. All SF-36 subgroup values were higher in the amputation group whereas only those of general health and vitality reached statistical significance (p < 0.05). The visual analogue scale (VAS) has been used to assess the efficacy of pain management. Mean VAS scores were found to be statistically higher in the salvage group (p < 0.005). Reoperation rates were one in 10 amputee and six in nine salvage patients. Mean Freiburg ankle scores of the patients in the salvage group were 55.33 +/- 15.51 which was consistent with moderate functionality. According to Graves' radiological assessment; four patients had grade 3 degeneration, four had grade 2 and one had grade 1 degeneration in the ankle joints. Mean EEI values, 6-MWT and 10-MWT results were not significantly different between the groups (p values > 0.05). Although amputation still remains as the last resort both for patients and the physicians, our results demonstrated that reoperation rates, quality of life (general health and vitality) and pain scores were better in amputee patients.

Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions.

This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time period from start of pain symptoms to neuroma surgery was 7.8 months. All clinically proven neuromas were surgically resected. In the mean follow-up of 2.8 years, all patients were satisfied with the end results and all were free of any pain symptoms. Painful stump with clinical diagnostic findings of neuroma described above may be regarded as neuroma without requiring any further imaging modalities and is an indication for surgery if conservative measures fail.

Does standing protect bone density in patients with chronic spinal cord injury?

BACKGROUND/OBJECTIVE: To compare the t-scores of proximal femur and lumbar spine of patients with spinal cord injury (SCI) with different levels of weight bearing. METHODS: Cross-sectional study comparing 3 groups of patients with SCI: patients with daily standing times of more than 1 hour, patients with daily standing times of less than 1 hour, and nonstanding patients. Seventy-one patients with chronic SCI were recruited. They were assigned to 1 of 3 groups according to their reported daily standing time. The bone density of lumbar and proximal femoral regions was measured with dual-energy x-ray absorptiometry. RESULTS: The 3 groups were similar in terms of demographics and clinical variables. No significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups. However, the patients in the group that stood more than 1 hour daily had a slight tendency to have higher t-scores than those in the control group. CONCLUSIONS: There was no significant difference among the 3 groups. However, standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization.

Osteoporosis: A factor on residual limb pain in traumatic trans-tibial amputations.

Residual limb pain is defined as a painful sensation or feeling from the remaining part of the leg. Aggressive bone edge, bone spur formation, neuroma, abscess or bursitis are common causes of residual limb pain. On the other hand, regional osteoporosis on femur and tibia is an inevitable consequence in patients with lower limb amputations. The etiology of bone loss is uncertain but it is likely to be a local phenomenon in lower limb amputees. Altered gait pattern, decreased weight load, disuse atrophy and lack of muscular action at the limb seem to be important causal factors in the development of both local and generalized osteoporosis. The aims of this study are: (i) To determine if there is significant bone mineral density (BMD) difference at proximal tibias and femurs between intact and amputated limbs, (ii) to investigate the factors affecting bone loss in these areas and (iii) to investigate the possible relationship between residual limb pain and local bone loss. The 36 men who participated in this study had amputations due to land-mine injuries. Dual energy X-ray absorptiometry was used to determine BMD of the proximal femur and proximal tibia. The non-amputated limb was used as a control for the amputated side. BMD values on the amputated side were significantly lower than non-amputated side. In addition, BMD values on the amputated limbs with residual limb pain were significantly less than in those without residual limb pain. Insufficient mechanical loading leads to bone loss in patients with trans-tibial amputations. Furthermore, bone loss at tibia may be a cause of residual limb pain. However, this needs to be confirmed with more specific studies in the future.

Sectional neuroanatomy of the middle thoracic spine (t5-t8) and chest.

This is the third in a series of articles on the spine. The first reviewed the anatomy of the neck. The second reviewed the upper thoracic spine and chest (T1-T4). A fourth article is planned for the lower thoracic spine. Procedures in the midthoracic spine include chest tube placement, trigger point injections, chemodenervation with botulinum toxin, video-assisted thoroscopic surgery, and spinal injections. Complications include pneumothorax, hemothorax, diaphragmatic irritation, sympathetic trunk irritation, postthoracotomy pain, and intradural abscesses. This article provides anatomically accurate schematics of innervations of the middle thoracic chest and spine (T5-T8) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the middle thoracic chest and spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the middle thoracic chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.

Effect of penile vibratory stimulation on spasticity in men with spinal cord injury.

OBJECTIVE: Penile vibratory stimulation is the first treatment option for anejaculation in men with spinal cord injury. It has been postulated that it also has an antispasticity effect. The purpose of this study was to determine the effect of penile vibratory stimulation on spasticity in patients with spinal cord injury. DESIGN: Ten male patients with spinal cord injury were included in the study. They were examined at the baseline and 3, 6, 24, and 48 hrs later. After their baseline examination, they performed penile vibratory stimulation. The outcome variables were spasticity (Ashworth scale), spasm frequency, spasm severity, painful spasms, plantar stimulation response, deep tendon reflexes, clonus, and effect on function. RESULTS: Ashworth grade showed a statistically significant decrease at hour 3 and hour 6 examinations (P = 0.001 and P = 0.03, respectively, with Tukey test). The patients showed a tendency toward having less frequent and less severe spasms throughout the study; however, it did not reach to a significant level. Similarly, clonus showed a nonsignificant decrease during follow-up examinations. The other variables did not change considerably. CONCLUSIONS: Penile vibratory stimulation may contribute to the relief of the spasticity in men with spinal cord injury. In treating spasticity, all the factors that increase or decrease the tone should be considered.

Sectional neuroanatomy of the upper thoracic spine and chest.

This is the second in a series of articles on the spine. The first reviewed the anatomy of the neck. Subsequent articles are planned to cover the anatomy of the middle and lower thoracic spine. Procedures and trauma of the upper thoracic spine and chest are fraught with potentially serious complications. Hemothorax, pneumothorax, nerve damage, pulmonary collapse, and thoracic aortic aneurysm are included in the list. This article provides anatomically accurate schematics of innervation of the upper thoracic chest and spine that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the upper chest and spine were drawn as they appear in imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the upper chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.