Superior oblique muscle

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Association of Superior Oblique Muscle Volumes with the Presence or Absence of the Trochlear Nerve on High Resolution MR Imaging in Congenital Superior Oblique Palsy

Association of Superior Oblique Muscle Volumes with the Presence or Absence of the Trochlear Nerve on High Resolution MR Imaging in Congenital Superior Oblique Palsy

A retrospective review of medical records was performed for 128 consecutive patients diagnosed with unilateral congenital SOP and 34 age-matched controls who had undergone thin-section MR imaging at the brain stem level at Seoul National University Bundang Hospital between August 2009 and June 2012. Patients were included if they showed the typical signs of congenital SOP, including apparent underdepression and overelevation in adduc- tion on the affected side, positive head tilt test results, large fu- sional amplitudes of vertical deviation, and a history or photo- graphic evidence of long-standing strabismus or anomalous head posture dating to infancy. Patients who had primary overaction of the inferior oblique muscle on the affected side, any evidence of acquired disease, a history of head or ocular trauma, or other potential causes, such as plagiocephaly, skew deviation, myasthe- nia gravis, or the ocular tilt reactions, were excluded. Subjects without strabismus and patients with simple horizontal strabis- mus without oblique muscle dysfunction were enrolled as the control group. Patient characteristics noted included sex, age at examination, and laterality of the paretic side. Approval to con- duct this study was obtained from the institutional review board of Seoul National University Bundang Hospital.
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Ciubotaru, Andreea
  

(2011):


	The Superior Oblique Posterior Tenectomy as therapy for Congenital Brown’s Syndrome.


Dissertation, LMU München: Medizinische Fakultät

Ciubotaru, Andreea (2011): The Superior Oblique Posterior Tenectomy as therapy for Congenital Brown’s Syndrome. Dissertation, LMU München: Medizinische Fakultät

The superior oblique muscle, the longest extraocular muscle, arises from the body of sphenoid bone above and medial to the optic canal just outside the tendinous ring. The muscle belly (30mm long) runs forward between the roof and medial wall of the orbital cavity and continues with a rounded tendon. The tendon passes through trochlea, a pulley of fibrocartilage that is attached to the trochlear fossa of the frontal bone. After emerging from the trochlea, the tendon bends downward, backward, and laterally, forming an angle of about 54° with the pretrochlear or direct portion of the muscle. After the posttrochlear or reflected part of the tendon passes under the superior rectus muscle, expands in a fan-shaped manner and inserts into the sclera posterior to the equator of the eyeball, forming a convex line of insertion.
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Analysis of surgical management of A-V pattern deviations.

Analysis of surgical management of A-V pattern deviations.

Most current authors believe that dysfunction of the oblique muscles play a major role in A-pattern. Based on the dysfunction of the abducting property (tertiary action) of obliques an A-V pattern would result. If a superior oblique muscle is paretic, the tertiary action i.e, abducting property is weakened which result in consequent increase in convergence in down gaze producing a V pattern. If the inferior oblique is weakened or superior oblique is overacting it would result in A-pattern in a similar position.

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Natural History and Treatment of Brown’s Syndrome: Long Term Experience

Natural History and Treatment of Brown’s Syndrome: Long Term Experience

Purpose: Brown’s Syndrome (BS) is a restrictive strabismus characterized by a limitation of elevation in adduction. Several etiologies have been described, usually involving the superior oblique muscle. Spontaneous improvement has been reported in several studies, so surgery is reserved for a minority of cases. Our purpose is to review the characteristics, natural history and treatment of this pathology and present the experience of the Instituto de Oftalmologia Dr. Gama Pinto (IOGP). Methods: A consecutive retrospective series of BS pa- tients seen at the Strabismus Department of IOGP between 1983 and 2014 was reviewed. All patients with complete clinical data were included in this study. The epidemiologic characteristics, clinical features, treatment, and clinical progression were reviewed. Results: Thirty-nine cases were selected, with a mean age at first diagnosis of 6.5 years. Of the thirty-nine cases, 6 were iatrogenic and the remainder idiopathic. Thirty-six cases were followed for a mean period of 6.1 years. Surgical intervention for BS was performed in 11 patients, using different approaches. Of these, 9 cases were considered suc- cessful. The remaining 25 cases were kept under observation without surgery, of which 17 showed spontaneous improvement and the other 7 remained unchanged. Conclusions: The surgical success rate was 82%, which demon- strates the good efficacy of the surgery despite the complexity and variety of pathophysiological mechanisms of the syndrome. In the patients kept under observation there was spontaneous improvement in 68%, confirming that a conservative approach seems to be adequate in most cases.
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Anatomy of Orbit.pdf

Anatomy of Orbit.pdf

Strike the center of the orbital roof with a chisel and hammer and crack the bone. Carefully remove the bony roof, leaving the periorbita (periosteum lining the orbit) intact. Identify the frontal branch of the ophthalmic nerve through the periorbita so that it is not destroyed when the periorbita is removed (Plates 86; 7.38). Locate the frontal nerve, trochlear nerve, superior oblique muscle, levator palpebrae superioris muscle and lacrimal nerve. Clean the frontal nerve and notice that it

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Histopathological and electron microscopic study for different grades of inferior oblique muscle overaction

Histopathological and electron microscopic study for different grades of inferior oblique muscle overaction

Histologically, EOMs, with a unique two-fiber system, differ from the other skeletal muscles. Resembling the usual skeletal muscle is the “fibrillenstruktur” fiber, which contains small, well-organized myofibrils surrounded by abundant sar- coplasm, large concentrations of mitochondria, and a nucleus that is usually situated peripherally. Each sarcomere has an orderly tubular (T) system. The unique striated muscle fiber found in the EOMs is the “felderstruktur” fiber, containing large, partially fused myofibrils embedded in scanty cyto- plasm, a virtual absence of concentrations of mitochondria, and a nucleus that is usually located centrally. The sarcom- eres are nearly devoid of a T system. Electron microscopy of both types of fibers reveals their histological differences. Light microscopy of a transverse section of an EOM shows the “fibrillenstruktur” fibers staining palely with regularly spaced myofibrils, while the “felderstruktur” fibers stain more densely, with irregularly clumped myofibrils. 6
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State of the Art: 3T Imaging of the Membranous Labyrinth

State of the Art: 3T Imaging of the Membranous Labyrinth

The semicircular ducts occupy ap- proximately one fourth of the cross-sec- tional area of the osseous canals but are of similar form, each with an ampullated end. They open by 5 orifices into the utri- cle, 1 opening being common to the posterior end of the su- perior duct and the superior end of the posterior duct (the common crus). In the ampullae, the wall is thickened, con- taining a fiddle-shaped transversely oriented complex of hair cells, the crista ampullaris. These sensory organs detect angu- lar (ie, rotational) acceleration. The superior and horizontal ampullae are innervated by the superior vestibular nerve, and the posterior ampulla is innervated by the posterior (singular) branch of the inferior vestibular nerve.
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Age and Gender Related Differences in Physical Functions of the Elderly Following One Year Regular Exercise Therapy

Age and Gender Related Differences in Physical Functions of the Elderly Following One Year Regular Exercise Therapy

A maintenance period is necessary to maintain good physical and mental functions throughout life, which can prevent recurrence, improve QOL, and extend life prognosis of the elderly [17]. In Japan, several policies have been implemented for the elderly, mainly in primary prevention. However, adequate studies have not been per- formed for the elderly during maintenance period, and its evidence related to physical functions is poor [13]. The elderly play sports and undergo exercise therapy in health promotion facilities (fitness clubs) and gymna- siums. However, because problems occur when transferring patient information from medical institutions to sports facilities, the management and manpower is limited to a few authorized incorporated non-profit organiza- tions [13]. In exercise therapy, sports, such as table tennis and soft tennis, and aerobic exercise, such as walking or bicycle ergometer, are employed for primary and secondary prevention of lifestyle-related diseases or during the maintenance period for the elderly [17]. It is suggested that the elderly during the maintenance period as well as the general elderly population can maintain physical functions by continuing exercise therapy [13] [16]. However, characteristics of their physical functions have not been completely examined for age and gend- er-related differences. According to previous studies [2] [18], physical functions of the elderly decrease with age. In general, males are superior in muscle strength, power, balance, and endurance, and females are superior in flexibility. The following was hypothesized in this study for physical functions of the elderly during the main- tenance period: their physical functions differ between sexes, males are superior to females in all the physical functions except flexibility, and the young-old elderly group is superior to the old-old elderly group in all the physical functions.
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Shape-from-Shading for Oblique Lighting with Accuracy Enhancement by Light Direction Optimization

Shape-from-Shading for Oblique Lighting with Accuracy Enhancement by Light Direction Optimization

In this paper, we present a novel shape-from-shading method, which uses neither adjusting parameters nor a pri- ori or additional information, and which appears more ac- curate for oblique light cases than the current methods. In this method, based on an application of the Jacobi iterative method to the consistency between the image and the re- flectance map, we introduce four surface normal approxima- tions and the resulting four iterative relations are combined as constraints to get an iterative relation. The methods us- ing viscosity solutions also use multiple depths at neighbor- ing grid points. Specifically, they use two gradients in each direction, but this results in spatially blurring shape recon- struction. On the other hand, we use four surface normals, which result in better shape through enhancement of stabil- ity. Then, the matrix that converts the shading information to the depth is modified so as to be uniform over the whole image region, making the iteration stable and, as a result, the resulting shape accurate. Then, in order to enhance the accu- racy, the light direction is optimized using two criteria based on the initial boundary value in the iteration and the rank of the converting matrix.
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The influence of fatigue and chronic low back pain on muscle recruitment patterns following an unexpected external perturbation

The influence of fatigue and chronic low back pain on muscle recruitment patterns following an unexpected external perturbation

Most studies about muscle onset timing following an external perturbation in CLBP individuals or fatigued subjects were only performed by evaluating the latency or amplitude of the onset, without analysing the rest of the muscle responses. To know the whole muscle behav- iour throughout the time could imply some important clinical considerations regarding treatment or prevention interventions in those populations. Moreover, to the au- thors’ knowledge, there are no studies in which mea- surements of muscle reactions following a perturbation are compared between CLBP patients and healthy con- trols and in which possible differences are compared with what happens when the healthy population is fa- tigued. CLBP patients and fatigued healthy subjects could experience similar neuromuscular strategies to at- tempt to protect the spine. Therefore, the current study had three objectives: a) to evaluate differences between healthy subjects and those suffering from CLBP in the sequence and amount of EMG muscle activity that occur after a perturbation during a functional position; b) to evaluate in an analogue way the effect of fatigue in healthy subjects and c) to evaluate similar compensatory
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<p>Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Technical Innovation and Presentation of Two Cases</p>

<p>Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Technical Innovation and Presentation of Two Cases</p>

compared with the hard bony cortex of vertebral body. The power Doppler was used while advancing the needle to avoid radicular artery puncture. The advancement of nee- dle was stopped when the patient felt electric-shock sensa- tion, suggesting irritation of the nerve root by the needle. The needle was redirected caudally as the root was slightly cranial to the IVD level. After the needle tip entered the IVD, the transducer was rotated back to the axial plane of lumbar spine and the needle tip was identi fi ed inside the IVD through the interlaminar space by using the poking technique. Another method to con fi rm whether the needle tip was positioned within the IVD was by placing the transducer in the paramedian sagittal oblique view for the interlaminar space (Figure 1D). The PRP was then injected to both the center and the periphery of the lumbar IVD until great resistance was felt (usually 3 – 4 mL) and the patient should feel the concordant pain during the injection. After the procedure was fi nished, the patient was suggested to keep lying on the table for 20 minutes. The patients were suggested to wear the brace immediately following the procedure.
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Fixation stability of the upward gaze in patients with myasthenia gravis: an eye-tracker study

Fixation stability of the upward gaze in patients with myasthenia gravis: an eye-tracker study

A total of 21 normal, healthy subjects (mean age=48.9±18.6 years, nine women) who had no strabismus or oculomotor abnormalities were included in the study as a control group. The MG group consisted of 10 patients with MG (mean age=54.7±16.5 years, six women) with diplopia (n=5) and without diplopia (n=5) at disease presenta- tion. These patients were diagnosed with MG based on the presence of antibodies in their serum (eight patients were acetylcholine receptor antibody positive, one was muscle-specific kinase antibody positive and one was seronegative), edrophonium test results (eight of nine patients tested positive and one patient was not tested) and repetitive nerve stimulation results (five of eight patients tested positive and two patients were not tested). The primary ocular deviations of the patients with MG without diplopia measured by APCT were orthophoria or slightly exophoria. In the patients with MG with diplopia, two patients exhibited exotropia: one was 45 prism diop- tres (PD) exotropic, the other was both 20 PD exotropic and 3 PD left hypertrophic. Another patient exhibited 14 PD right hypertropia, one exhibited 16 PD exophoria and one was orthophoric but presented with distur- bances of adduction and abduction in his right eye. The SO palsy group consisted of six patients with SO palsy with diplopia (mean age=53.5±16.3 years, four women). Patients with SO palsy in this study were unilateral palsy. This group consisted of patients with acquired SO palsy and patients with decompensated congenital SO palsy. They had awareness of diplopia in the upward gaze. Their ocular deviation measured by the synoptophore in the upward gaze was 3.5±5.22° of the horizontal devia- tion, 4.83±5.24° of the vertical deviation and 3.17±3.44° of the cyclodeviation.
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Anatomy of Motoneurones Innervating Mesothoracic Indirect Flight Muscles in the Silkmoth, Bombyx Mori

Anatomy of Motoneurones Innervating Mesothoracic Indirect Flight Muscles in the Silkmoth, Bombyx Mori

2 Arborization of the indirect flight motoneurones One remarkable feature is that the dendritic processes of dorsal longitudinal motoneurones, including that to the dorsal oblique muscle[r]

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A prospective study evaluating the use of polypropelene mesh
in emergency surgery of obstructed hernias

A prospective study evaluating the use of polypropelene mesh in emergency surgery of obstructed hernias

Technique: Simple herniotomy is done. The lower part of the conjoint tendon and upper surface of the inguinal ligament are carefully cleared off fat and areolar tissue. The muscle and tendon are lifted forwards on finger and 4 to 5 stitches are inserted at about one centimeter interval between conjoint tendon and the inguinal ligament at medial end of the canal, since it is the site of maximum recurrence. To make sure of closing the medial gap it is advised to take the first bite through the periosteum of the pubic bone. The stitches should be introduced at different depths into the inguinal ligament in order not to cause splitting of the inguinal ligament along the line o f suture. In placing sutures in the inguinal ligament, care should be taken not to inju re the external iliac vessels, which lie immediately deep to the inguinal ligament. Non- absorbable monofilament suture (prolene) is usually used but any other suture material of surgeon's choice can be used. It is particularly important that the stitches should not be too tight. Care should be taken not to include the iliohypoga stric nerve. The conjoint muscle should lie snugly around the internal ring. Care should be taken not to tie the suture under tension. The cord is placed over the strengthened posterior wall and external oblique aponeurosis, sutured with interrupted or continuous suture. The skin wound is sutured.
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A Study of Complications in Mesh Vs Non-Mesh Repair in inguinal hernias in Government Rajaji Hospital, Madurai

A Study of Complications in Mesh Vs Non-Mesh Repair in inguinal hernias in Government Rajaji Hospital, Madurai

They are anterior rami of lower six thoracic and first lumbar nerves. They pass between internal oblique and transversus abdominis muscle. The thoracic nerves are the lower five intercostals and sub costal nerves and first lumbar nerve is represented by ilio- hypo gastric and ilio-inguinal and genito-femoral nerve. They supply the skin of anterior abdominal wall, the muscles and parietal peritoneum. The lower six thoracic nerves supply the rectus muscle and pyramidalis. The ilio-inguinal nerve supply a portion of internal oblique muscle and accompanies the spermatic cord through external inguinal ring. It supplies the skin of medial thigh proximal to inguinal ligament, root of penis and upper anterior scrotum. In females, the nerve exits the external inguinal ring and supplies the mons pubis and labia majora. The genital branch of genito-femoral nerve exits the pelvis through the deep inguinal ring and continues with the spermatic cord supplying the cremastric muscle. It innervates the antero-lateral part of scrotal skin.
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Activity of three muscles associated with the uncinate processes of the
giant Canada goose Branta canadensis maximus

Activity of three muscles associated with the uncinate processes of the giant Canada goose Branta canadensis maximus

During breathing while standing, contraction of the appendicocostalis muscles appears to move the vertebral ribs cranially in a fixed plane and, in conjunction with the other inspiratory muscles, rotates the sternum ventrally. Phasic activity of the appendicocostalis increased when movements of the sternum were restricted by sitting. When sternal movements were restricted, expansion of the thoracic cavity was achieved by lateral flaring of the rib cage. The corresponding increase in EMG activity of the appendicocostalis muscle during sitting suggests this muscle may play a key role in facilitating this lateral flaring. The activity of the appendicocostalis muscles during locomotion is consistent with a dual respiratory and locomotor function, as indicated by the equally low correlation between breath and stride averages (Table·3). The activity of the appendicocostalis muscle was consistently larger during contralateral limb support suggesting the muscle may play some role in stabilising the forces exerted on the trunk during running.
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A COMPARATIVE EFFICACY BETWEEN STRENGTH AND STABILISATION TRAINING PROGRAMMES IN THE IMPROVEMENT OF TRUNK AND HIP MUSCLES ACTIVATIONS OF HEALTHY FEMALES SUBJECT: AN IMPLICATION FOR THE REHABILITATION PRACTITIONERS

A COMPARATIVE EFFICACY BETWEEN STRENGTH AND STABILISATION TRAINING PROGRAMMES IN THE IMPROVEMENT OF TRUNK AND HIP MUSCLES ACTIVATIONS OF HEALTHY FEMALES SUBJECT: AN IMPLICATION FOR THE REHABILITATION PRACTITIONERS

The results of the present study have demonstrated that the stabilisation training programme observed in the study iseffective in improving the muscles activations of the subjects within the five weeks training interventions period when compared to the training devised from the strength programme. The stabilisation intervention has appeared to be more effective in stimulating the rectus abdominis, external oblique, multifidus, gluteus maximus and gluteus medius muscles. Moreover, the study has shown that the utilisation of surface electromyography signals in detecting muscles activations is nontrivial as it permits the researchers to accurately identify the best intervention training programme that can enhance the activations of the trunk, hip and lumbar muscles amongst healthy female’s subjects. The results of the current study are expected to be valuable for the rehabilitation experts in determining the best training modality which would, in the long run, assist the female’s patients with a record of LBP.
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The effects of actuator selection on non-volitional postural responses to torso-based vibrotactile stimulation

The effects of actuator selection on non-volitional postural responses to torso-based vibrotactile stimulation

resulting from the lengthening of an abdominal muscle which is accompanied by skin stretch. Such responses also occur when vibration stimulates the muscle spindles [36,37]. Hence, the vibration-induced activity of cutane- ous receptors is likely interpreted as a skin stretch corre- sponding to proprioceptive information, as shown for distal joints [20]. The latency of the postural response for stimulation over the internal oblique and erector spi- nae locations is substantially greater than that of a reflex response, which is known to be less than 100 ms [38,39]; thus, a significant role of reflex contribution and muscle proprioception to changes in posture is ruled out. This hypothesis, discussed in detail in our previous study [24], is briefly outlined here.
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Surface coil MR imaging of orbital blowout fractures: a comparison with reformatted CT

Surface coil MR imaging of orbital blowout fractures: a comparison with reformatted CT

Then, additional images of other planes were obtained-an axial plane along the course of the medial rectus muscle in the case of the medial wall fracture and an oblique sagittal plane pa[r]

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Do the Extraocular Muscles in the Carp Compensate for Eye Displacements Induced by Respiratory Movements?

Do the Extraocular Muscles in the Carp Compensate for Eye Displacements Induced by Respiratory Movements?

EMG's in the superior rectus muscle can only be recorded during the nasal phase of the stretch, while the inferior muscle contracts in the temporal phase.. Both muscles remain inactive d[r]

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