Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.007
Brazilian Journal of Anesthesiology
Original Investigation

Location of motor branches of tibialis posterior muscle and its relation in treatment of spastic equinovarus foot: a cadaveric study

Localização dos ramos motores do músculo tibial posterior e sua relação no tratamento do pé equinovaro espástico: estudo em cadáver

Zheng-Yu Gao, Lei Li, Jian-Fang Song, Wei Chen, Peng Ma, Ji-Xia Wu

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Abstract

Background and objectives
Nerve block or neurolysis is an important approach in the treatment of spastic equinovarus foot. To illustrate the accurate location of the nerve branch to the tibialis posterior muscle (TP) in clinical practice, 21 adult cadavers were dissected and 14 complete both lower limb specimens were obtained. A total of 28 lower limbs were included.

Methods
We measured the length of the motor branch nerve (LM) of the tibialis posterior muscle, the length of the fibula (LF), the vertical distance (D1) from the midpoint of LM to the fibula tip as well as the horizontal distance (D2) from the midpoint of LM to the inner edge of the fibula.

Results
The LM was higher (35.74 ± 7.28 mm) in male than in female (30.40 ± 6.88 mm) specimens but there was no significant correlation between LM and gender (p >  0.05). Additionally, among male specimens, the LM on the right side was longer than that on the left (p ≤  0.05) while among female specimens, the D1 on the left side was longer than that on the right (p ≤  0.05). The LF in male specimen was significantly longer than that in female (p ≤  0.05). The midpoint of the nerve to the motor branch of the tibialis posterior muscle was about 50 mm distal to the fibular head and 10 mm at the inner edge of the fibula.

Conclusion
Using this coordinate, the midpoint of the nerve branch to the TP could be accurately located.

Keywords

Tibial nerve,  Posterior tibial tendon dysfunction,  TARP syndrome

Resumo

Justificativa e objetivos: O bloqueio do nervo ou neurólise é uma abordagem importante no tratamento do pé equinovaro espástico. Para ilustrar a localização precisa do ramo nervoso para o músculo tibial posterior (TP) na prática clínica, 21 cadáveres adultos foram dissecados e 14 espécimes completos de ambos os membros inferiores foram obtidos. Um total de 28 membros inferiores foram incluídos. Métodos: Medimos o comprimento do nervo do ramo motor (RM) do músculo tibial posterior, o comprimento da fíbula (CF), a distância vertical (D1) do ponto médio do RM até a ponta da fíbula, bem como a distância horizontal (D2) do ponto médio de RM até a borda interna da fíbula. Resultados: O RM foi maior (35,74 ± 7,28 mm) no sexo masculino do que no feminino (30,40 ± 6,88 mm), mas não houve correlação significativa entre o RM e o sexo (p > 0,05). Além disso, entre os machos, o LM do lado direito foi maior que o esquerdo (p ≤ 0,05) enquanto entre os espécimes femininos, o D1 do lado esquerdo foi maior que o do direito (p ≤ 0,05). O CF no espécime masculino foi significativamente maior do que no feminino (p ≤ 0,05). O ponto médio do nervo para o ramo motor do músculo tibial posterior foi cerca de 50 mm distal à cabeça da fíbula e 10 mm na borda interna da fíbula. Conclusão: Utilizando esta coordenada, o ponto médio do ramo nervoso para o TP pôde ser localizado com precisão.

Palavras-chave

Nervo tibial; Disfunção do tendão tibial posterior; Síndrome TARP

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