Another (Internal) Epineurium: Beyond the Anatomical Barriers of Nerves

Reina, Miguel Ángel; Boezaart, André P.; Tubbs, R. Shane; Zasimovich, Yury; Fernández‐Domínguez, Manuel; Fernández, Paloma; Sala‐Blanch, Xavier

doi:10.1002/ca.23442

Cited by 30 publications

(22 citation statements)

References 19 publications

(21 reference statements)

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“…Recent findings revealed that intraneural fat, deep to the epineurium, is in fact in direct contact with another interlaced collagen fiber membrane surrounding the perineurium 3. Between this collagen fiber membrane and the perineurium are no adipocytes (figure 1).…”

mentioning

confidence: 98%

“…Between this collagen fiber membrane and the perineurium are no adipocytes (figure 1). 3 (This collagen fiber membrane is unnamed presently. Although we inappropriately named it ‘internal epineurium’ in our article, we would like to suggest ‘circumfascicular collagen fiber layer’ because INTernal EPIneurium is a contradiction in terms.)…”

mentioning

confidence: 99%

“…However, dispersed collagen fibers had been described in the extrafascicular tissue between adipocytes. Interestingly, the perineurium of most fascicles has its own covering of this collagen fiber layer, which has microscopic characteristics similar to those of the epineurium surrounding the nerve 3. The circumneurium, epineurium, and circumfascicular collagen fiber layer are formed by the same connective tissue type, and all three are networks of interlaced collagen fibers 3…”

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confidence: 99%

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Yet another perineural layer: so what?

Reina

Boezaart

Nin

et al. 2019

Reg Anesth Pain Med

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confidence: 98%

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confidence: 99%

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confidence: 99%

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Yet another perineural layer: so what?

Reina

Boezaart

Nin

et al. 2019

Reg Anesth Pain Med

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“…The incidence of nerve swelling was high when compared with studies focusing on other nerve blocks 15–17. Differences in definition criteria and limited ultrasound resolution to distinguish different components of the nerve anatomy18 could explain this finding.…”

Section: Discussionmentioning

confidence: 89%

Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial

Dieguez-Garcia¹,

López-Álvarez

Juncal

et al. 2020

Reg Anesth Pain Med

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Background and objectivesCircumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block than non-circumferential (NC) spread.MethodsWe randomized 124 patients undergoing open carpal tunnel syndrome surgery to receive C or NC spread ultrasound-guided median and ulnar nerve blocks. The primary outcome was the proportion of patients who developed complete sensory block measured at 5, 15 and 30 min. The loss of cold sensation was graded as: 0 (complete block), 1 (incomplete block), or 2 (no block). Secondary outcomes included motor block, nerve swelling and adverse events.ResultsIn group C, complete sensory block at 5 min was 2.4 (95% CI 1.0 to 5.7; p=0.04) times more frequent in the median nerve and 3.0 (95% CI 1.2 to 7.2; p=0.01) times more frequent in the ulnar nerve compared with group C. However, at 15 and 30 min, it was similar between groups. Complete motor block was more frequent in group C than in group NC for both the median nerve: 1.5 (95% CI 1.1 to 2.2; p<0.01) at 15 min, 1.1 (95% CI 1.0 to 1.2; p=0.02) at 30 min, and the ulnar nerve: 1.7 (95% CI 1.2 to 2.6; p<0.01) at 15 min, 1.2 (95% CI 1.0 to 1.4; p<0.01) at 30 min. The incidence of nerve swelling and adverse effects was similar between groups.ConclusionsC spread around the median and ulnar nerves at the level of the antecubital fossa generates more complete sensory and motor blocks compared with NC spread.Trial registration numberEudraCT 2011-002608-34 and NCT01603680

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“…The epineurium, in its internal portion, contains vessels and adipose tissue and envelops the branches of the nerve; the endoneurium is a connective tissue sheath, which has the task of covering the axon, while the perineurium covers and holds together several axon bundles. Perineurium together with endoneurium constitutes a blood-nerve barrier [39]. The number of files varies from 1 to 200, depending on the size of the nerve; the arrangement of the bundles may also vary according to the function of the nerve.…”

Section: Clinical Reflectionsmentioning

confidence: 99%

The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 2

Bordoni¹

2020

Cureus

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The main objective of the osteopath and that of osteopathic manipulative medicine (OMM) is to create space between the different tissues. The sliding capacity of the various tissue layers and between the different body components, up to the possibility of movement between cells is the salutogenic stimulus to allow the circulation of fluids, the biochemical exchange, and the adequate management of the multiple internal and external stimuli that perturb the body living. Movement is allowed by space and space is life. In this second part, the exposure of the anatomical neurological relationships of the five diaphragms continues, highlighting the relationships of the thoracic outlet, the respiratory diaphragm, and the pelvic floor. Finally, there will be clinical reflections to further corroborate the existence of the anatomical continuum and to lay the scientific foundations for an OMM approach to body diaphragms.

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Another (Internal) Epineurium: Beyond the Anatomical Barriers of Nerves

Abstract: identified several fat-containing concentric compartments. Those compartments were limited by collagen fiber layers that were also similar to the epineurium. Clin.

Cited by 30 publications

References 19 publications

Yet another perineural layer: so what?

Yet another perineural layer: so what?

Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial

The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 2

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