흉요근막과 관련된 만성요통에 대한 논문(근골격계 초음파와 관련된 논문)

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흉요근막, 근골격초음파, 만성요통.

재미있는 논문일듯.. 읽자.. 얼릉

흉요건막의 피하조직과 외층에 감각신경이 많이 분포하고 있음. sp-positive 자유신경종말이 특히 이 층에 많이 있음. 

두터운 감각신경지배때문에 흉요건막은 하부요통에 중요한 역할을 할 것임. 

다른 논문.

Neuroscience. 2011 Oct 27;194:302-8. Epub 2011 Aug 2.

Sensory innervation of the thoracolumbar fascia in rats and humans.

Tesarz J, Hoheisel U, Wiedenhofer B, Mense S.

Source

Department of General Internal and Psychosomatic Medicine, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.

Abstract

The available data on the innervation of the thoracolumbar fascia (TLF) are inconsistent and partly contradictory. Therefore, the role of the fascia as a potential source of pain in the low back is difficult to assess. In the present study, a quantitative eval‎uation of calcitonin gene-related peptide (CGRP) and substance P (SP)-containing free nerve endings was performed in the rat TLF. 

A preliminary non-quantitative eval‎uation was also performed in specimens of the human TLF. The data show that the TLF is a densely innervated tissue with marked differences in the distribution of the nerve endings over the fascial layers. In the rat, we distinguished three layers: (1) Outer layer (transversely oriented collagen fibers adjacent to the subcutaneous tissue), (2) middle layer (massive collagen fiber bundles oriented obliquely to the animal's long axis), and (3) inner layer (loose connective tissue covering the paraspinal muscles). 

The subcutaneous tissue and the outer layer showed a particularly dense innervation with sensory fibers. SP-positive free nerve endings-which are assumed to be nociceptive-were exclusively found in these layers. Because of its dense sensory innervation, including presumably nociceptive fibers, the TLF may play an important role in low back pain.

흉요건막의 피하조직과 외층에 감각신경이 많이 분포하고 있음. sp-positive 자유신경종말이 특히 이 층에 많이 있음. 

두터운 감각신경지배때문에 흉요건막은 하부요통에 중요한 역할을 할 것임. 

 Reduced thoracolumbar fascia shear strain in human chronic .pdf

Abstract

Background: The role played by the thoracolumbar fascia in chronic low back pain (LBP) is poorly understood.

The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP).

Methods: We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In

each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive

trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound

probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement

within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived

from this displacement data. Additional measures included standard range of motion and physical performance

eval‎uations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity.

Results: Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4%

± 3.1% vs. 70.2% ± 3.6% respectively, p < .01). There was no evidence that this difference was sex-specific (group

by sex interaction p = .09), although overall, males had significantly lower shear strain than females (p = .02).

Significant correlations were found in male subjects between thoracolumbar fascia shear strain and the following

variables: perimuscular connective tissue thickness (r = -0.45, p <.001), echogenicity (r = -0.28, p < .05), trunk flexion

range of motion (r = 0.36, p < .01), trunk extension range of motion (r = 0.41, p < .01), repeated forward bend task

duration (r = -0.54, p < .0001) and repeated sit-to-stand task duration (r = -0.45, p < .001).

Conclusion: Thoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This

reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective

tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may

also play a role in altered connective tissue function.

Reduced thoracolumbar fascia shear strain in human chronic .pdf

Background

The thoracolumbar fascia plays an important role in transferring forces among trunk muscles and the spine

[1]. An important feature of this complex fascial structure is that it is composed of several layers of dense

connective tissue separated by layers of “loose” areolar connective tissue that allow adjacent dense layers to

glide past one another [2]. Independent motion of adjacent connective tissue layers is particularly relevant

in structures such as the thoracolumbar fascia in which the dense layers correspond to the aponeuroses of muscles

with different directions of pull: in this case, longitudinal (for latissimus dorsi, serratus posterior and

erector spinae) vs. transverse (for internal/external obliques and latissimus dorsi).

Although the thoracolumbar fascia has been the subject of recent attention as a potential pain-generating structure in the back [3-6], its role in low back pain(LBP) pathophysiology is poorly understood. In a previous study using ultrasound, we found that human subjects with chronic LBP of more than 12 months duration had increased thickness and echogenicity of the perimuscular connective tissues forming the thoracolumbar

fascia in the low back [6]. 

Abnormal connective tissue structure may be a predisposing factor for LBP, or a consequence of injury and/or changes in movement patterns occurring as a result of chronic pain. A potentially important consequence of injury may

be fibrosis and adhesions, causing loss of independent motion of adjacent connective tissue layers which could further restrict body movements. Therefore, quantification of tissue mobility within the thoracolumbar fascia would be an important next step to investigate connective tissue pathophysiological alterations that may play a role in LBP.

Ultrasound elasticity imaging is a computational technique utilizing cross correlation methods to quantify tissue

motion based on a series of ultrasound images acquired in rapid succession. In this study, we used a novel application of ultrasound elastography in which the relative mobility of layers within the thoracolumbar fascia was quantified in humans during passive trunk flexion induced by a motorized articulated table. Based on our previous findings of abnormal connective tissue structure in chronic LBP [6], we hypothesized that this relative motion would be reduced on average in a group of human subjects with chronic LBP of greater than 12 months duration compared with control subjects without

low back pain (No-LBP). In addition, we compared thoracolumbar connective tissue motion to clinical tests commonly used during physical therapy to eval‎uate trunk range of motion and physical performance in LBP

assessment.

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그림이 멋지네요 ㅎㅎㅎ

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흉요건막의 피하조직과 외층에 감각신경이 많이 분포하고 있음. sp-positive 자유신경종말이 특히 이 층에 많이 있음.

두터운 감각신경지배때문에 흉요건막은 하부요통에 중요한 역할을 할 것임.