• The Journal of Korean Medicine
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• v.26 no.1 s.61
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• pp.11-17
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• 2005

This study was carried out to identify the components of the human heart meridian muscle, the regional muscle group being divided into outer, middle, and inner layers. The inner parts of the body surface were opened widely to demonstrate muscles, nerves, blood vessels and to expose the inner structure of the heart meridian muscle in the order of layers. We obtained the following results; $\cdot$ The heart meridian muscle is composed of muscles, nerves and blood vessels. $\cdot$ In human anatomy, the difference between terms is present (that is, between nerves or blood vessels which control the meridian muscle and those which pass near by). $\cdot$ The inner composition of the heart meridian muscle in the human arm is as follows: 1) Muscle H-l: latissimus dorsi muscle tendon, teres major muscle, coracobrachialis muscle H-2: biceps brachialis muscle, triceps brachialis muscle, brachialis muscle H-3: pronator teres muscle and brachialis muscle H-4: palmar carpal ligament and flexor ulnaris tendon H-5: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficialis tendon, flexor digitorum profundus tendon H-6: palmar carpal ligament & flexor retinaculum, flexor carpi ulnaris tendon H-7: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficial is tendon, flexor digitorum profundus tendon H-8: palmar aponeurosis, 4th lumbrical muscle, dorsal & palmar interrosseous muscle H-9: dorsal fascia, radiad of extensor digiti minimi tendon & extensor digitorum tendon 2) Blood vessel H-1: axillary artery, posterior circumflex humeral artery H-2: basilic vein, brachial artery H-3: basilic vein, inferior ulnar collateral artery, brachial artery H-4: ulnar artery H-5: ulnar artery H-6: ulnar artery H-7: ulnar artery H-8: palmar digital artery H-9: dorsal digital vein, the dorsal branch of palmar digital artery 3) Nerve H-1: medial antebrachial cutaneous nerve, median n., ulnar n., radial n., musculocutaneous n., axillary nerve H-2: median nerve, ulnar n., medial antebrachial cutaneous n., the branch of muscular cutaneous nerve H-3: median nerve, medial antebrachial cutaneous nerve H-4: medial antebrachial cutaneous nerve, ulnar nerve H-5: ulnar nerve H-6: ulnar nerve H-7: ulnar nerve H-8: superficial branch of ulnar nerve H-9: dorsal digital branch of ulnar nerve.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.242-246
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• 2000

Radiofrequency medial branch neurotomy is an effective way of controlling pain in the posterior compartment of the spine such as the facet joint, and the interspinous ligament. However, it is difficult to determine the exact location of the medial branch. Up until now we have relied on sensory response provoked by 50 Hz stimulation. The responses elicited using this method are quite subjective and can originate from sources other than the medial branch such as the periosteum, the intermediate or lateral branch. We need a confirmed indicator to locate the medial branch reliably. We applied 2 Hz stimulation under 0.4 volts to locate the medial branch and elicited a motor response. Twitching of multifidus and muscles around the SI joint was observed. The observation of these muscles provides a much more reliable method for confirmation of the medial branch. We have treated 45 chronic nonspecific low back pain patients using radiofrequency medial branch neurotomy with this method of confirming the medial branch.

• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.90-94
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• 2023

Objective : Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. Methods : A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. Results : There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. Conclusion : In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

• Korean Journal of Veterinary Research
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• v.38 no.3
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• pp.474-487
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• 1998

The present study was undertaken to investigate the morphological characteristics of trigeminal nerve in the Korean native goat by macroscopic methods. Trigeminal nerve was originated from the lateral side of pons, and extended shortly forward to form trigeminal ganglion at the opening of oval foramen. Thereafter this nerve was divided into maxillary, mandibular and ophthalmic nerve. Ophthalmic nerve gave off the zygomaticotemporal branch, frontal nerve, frontal sinus branch, and was continued as the nasociliary nerve. Maxillary nerve gave rise to the zygomaticofacial branch, accessory zygomaticofacial branch, communicating branch with oculomotor nerve, pterygopalatine nerve, caudal superior alveolar branch, malar branch and was continued as the infraorbital nerve. Mandibular nerve was divided into the masseteric nerve, buccal nerve, lateral pterygoid nerve, medial pterygoid nerve, nerve to tensor tympani m., auriculotemporal nerve, and furnished the inferior alveolar nerve and lingual nerve as terminal branches. The course and distribution of the trigeminal nerve in the Korean native goat appeared to be similar to that in other small ruminants such as sheep and goat. But the main differences from other small ruminants were as follows : 1. There was no accessory branch of the major palatine nerve. 2. The caudal superior alveolar branch was directly branched from the maxillary nerve. 3. The communicating branch with oculomotor nerve was originated from maxillary nerve or common trunk with zygomaticofacial branch. 4. The malar branch arose from the maxillary nerve at the rostral to the origin of the caudal superior alveolar branch. 5. The inferior alveolar nerve originated in a common trunk with the lingual nerve. 6. The mylohyoid nerve arose at the origin of the inferior alveolar nerve. 7. The zygomaticotemporal branch was single fascicle, and gave off lacrimal nerve and cornual branch. 8. The base of horn was provided by the cornual branches of zygomaticotemporal branch and infratrochlear nerve of nasociliary nerve.

• Annals of Clinical Neurophysiology
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• v.12 no.1
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• pp.16-20
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• 2010

Background: The medial plantar nerve (MPN) is a distal branch of the posterior tibial nerve, and various methods of nerve conduction study for MPN have been introduced so far. Hemmi et al described a new method (Hemmi's method) for recording medial plantar sensory nerve action potentials (SNAPs), which is considered as a simple and reliable method for measuring medial plantar SNAPs. This study was aimed to establish the normal values for the MPN conduction study among Koreans and to compare the sensitivities of three different methods for MPN conduction study (Hemmi, Oh, and Saeed's method) in detecting evidence of peripheral neuropathy among diabetic patients. Methods: In 27 healthy subjects, MPN conduction study using Hemmi's method was performed and normal values were calculated. In 54 diabetic patients who showed normal routine nerve conduction studies, three different methods for MPN conduction study were performed and diagnostic sensitivity of each method were compared. Results: In normal subjects, the mean medial plantar SNAP amplitude and conduction velocities measured by Hemmi's method were $4.3{\pm}1.0$ uV and $38.3{\pm}6.8$ m/s respectively. Among 54 patients with diabetes who showed normal routine nerve conduction studies, medial plantar SNAP was not obtainable in 28, 31, and 6 patients by Hemmi, Oh and Saeed's method respectively. Conclusions: In terms of the diagnostic sensitivity for detecting diabetic neuropathy, there had been no significant statistical difference between three different methods. Our study suggested that MPN conduction study using Hemmi's method is simple and useful screening test for early diabetic neuropathy, and is comparable with Oh's method.

• The Korean Journal of Pain
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• v.27 no.2
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• pp.133-138
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• 2014

Background: The precise knowledge of anatomy and the region of transverse process (TP) and superior articular processes (AP) and their distance from the skin are important in blocking and treating lumbar facet syndrome. Evaluation of these anatomic distances from 3rd and 5th lumbar vertebrae in both sides and in different body mass index (BMI) in healthy volunteers might improve knowledge of ultrasound (US) lumbar medial branch nerve blocks (LMBB). Methods: Bilateral US in the 3rd and 5th lumbar vertebrae of 64 volunteers carried out and the distance between skin to TP and skin to AP was measured. These distances were compared on both sides and in different BMI groups. The analysis was done using SPSS 11. Analysis of variance was used to compare the means at three vertebral levels (L3-L5) and different BMI groups. P values less than 0.05 were considered statistically significant. The paired t-test was used to compare the mean distance between skin to TP and skin to AP on both sides. Results: The distance between skin to TP and skin to AP of 3rd vertebrae to 5th vertebrae was increased in both right and left sides (P < 0.001) from up to down. The mean distance from skin to TP were greater on the left side compared to the right in all three vertebral levels from L3 to L5 (P values 0.014, 0.024, and 0.006 respectively). The mean distance from skin to TP and the skin to AP was statistically significant in different BMI groups (P < 0.001). Conclusions: We found many anatomic distances which may increase awareness of US guided LMBB.

• The Journal of Korean Medicine
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• v.30 no.3
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• pp.15-27
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• 2009

Objective : This study was carried to identify the anatomical component of BMM (Foot Taeyang Meridian Muscle in the human truncus), and further to help the accurate application to real acupunctuation. Methods: The human truncus was stripped off in order to demonstrate muscles, nerves and other components, and to display the internal structure of the BMM, dividing into outer, middle, and inner parts. Results: The BMM in the human truncus is composed of muscles, nerves, ligaments etc. The internal composition of the BMM in the human truncus is as follows: 1. Muscle A. Outer layer: medial palpebral ligament, orbicularis oculi, frontalis, galea aponeurotica, occipitalis, trapezius, latissimus dorsi, thoracolumbar fascia, gluteus maximus. B. Middle layer: frontalis, semispinalis capitis, rhomboideus minor, serratus posterior superior, splenius cervicis, rhomboideus major, latissimus dorsi, serratus posterior inferior, levator ani. C. Inner layer: medial rectus, superior oblique, rectus capitis, spinalis, rotatores thoracis, longissimus, longissimus muscle tendon, longissimus muscle tendon, multifidus, rotatores lumbaris, lateral intertransversi, iliolumbaris, posterior sacroiliac ligament, iliocostalis, sacrotuberous ligament, sacrospinous ligament. 2. Nerve A. Outer layer: infratrochlear nerve, supraorbital n., supratrochlear n., temporal branch of facial n., auriculotemporal n., branch of greater occipital n., 3rd occipital n., dorsal ramus of 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th thoracic n., dorsal ramus of 1st, 2nd, 3rd, 4th, 5th lumbar n., dorsal ramus of 1st, 2nd, 3rd, 4th, 5th sacral n. B. Middle layer: accessory nerve, anicoccygeal n. C. Inner layer: branch of ophthalmic nerve, trochlear n., greater occipital n., coccygeal n., Conclusions : This study shows that BMM is composed of the muscle and the related nerves and there are some differences from already established studies from the viewpoint of constituent elements of BMM at the truncus, and also in aspect of substantial assay method. In human anatomy, there are some conceptional differences between terms (that is, nerves which control muscles of BMM and those which pass near by BMM).

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.267-269
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• 2012

Traumatic brachial plexus injuries can be devastating, causing partial to total denervation of the muscles of the upper extremities. Surgical reconstruction can restore motor and/or sensory function following nerve injuries. Direct nerve-to-nerve transfers can provide a closer nerve source to the target muscle, thereby enhancing the quality and rate of recovery. Restoration of elbow flexion is the primary goal for patients with brachial plexus injuries. A 4-year-old right-hand-dominant male sustained a fracture of the left scapula in a car accident. He was treated conservatively. After the accident, he presented with motor weakness of the left upper extremity. Shoulder abduction was grade 3 and elbow flexor was grade 0. Hand function was intact. Nerve conduction studies and an electromyogram were performed, which revealed left lateral and posterior cord brachial plexopathy with axonotmesis. He was admitted to Rehabilitation Medicine and treated. However, marked neurological dysfunction in the left upper extremity was still observed. Six months after trauma, under general anesthesia with the patient in the supine position, the brachial plexus was explored through infraclavicular and supraclavicular incisions. Each terminal branch was confirmed by electrophysiology. Avulsion of the C5 roots and absence of usable stump proximally were confirmed intraoperatively. Under a microscope, neurotization from the musculocutaneous nerve to two medial pectoral nerves was performed with nylon 8-0. Physical treatment and electrostimulation started 2 weeks postoperatively. At a 3-month postoperative visit, evidence of reinnervation of the elbow flexors was observed. At his last follow-up, 2 years following trauma, the patient had recovered Medical Research Council (MRC) grade 4+ elbow flexors. We propose that neurotization from medial pectoral nerves to musculocutaneous nerve can be used successfully to restore elbow flexion in patients with brachial plexus injuries.

• Korean Journal of Acupuncture
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• v.22 no.1
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• pp.67-74
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• 2005

Objectives : This study was carried to identify the component of the Pericardium Meridian Muscle in human. Methods : The regional muscle group was divided into outer, middle, and inner layer. The inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and to expose the inner structure of the Pericardium Meridian Muscle in the order of layers. Results We obtained the results as follows; He Perfcardium Meridian Muscle composed of the muscles, nerves and blood vessels. In human anatomy, it is present the difference between terms (that is, nerves or blood vessels which control the muscle of the Pericardium Meridian Muscle and those which pass near by the Pericardium Meridian Muscle). The inner composition of the Pericardium Meridian Muscle in human is as follows ; 1) Muscle P-1 : pectoralis major and minor muscles, intercostalis muscle(m.) P-2 : space between biceps brachialis m. heads. P-3 : tendon of biceps brachialis and brachialis m. P-4 : space between flexor carpi radialis m. and palmaris longus m. tendon(tend.), flexor digitorum superficialis m., flexor digitorum profundus m. P-5 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum superficialis m., flexor digitorum profundus m. tend. P-6 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum profundus m. tend., pronator quadratus m. H-7 : palmar carpal ligament, flexor retinaculum, radiad of flexor digitorum superficialis m. tend., ulnad of flexor pollicis longus tend. radiad of flexor digitorum profundus m. tend. H-8 : palmar carpal ligament, space between flexor digitorum superficialis m. tends., adductor follicis n., palmar interosseous m. H-9 : radiad of extensor tend. insertion. 2) Blood vessel P-1 : lateral cutaneous branch of 4th. intercostal artery, pectoral br. of Ihoracoacrornial art., 4th. intercostal artery(art) P-3 : intermediate basilic vein(v.), brachial art. P4 : intermediate antebrachial v., anterior interosseous art. P-5 : intermediate antebrarhial v., anterior interosseous art. P-6 : intermediate antebrachial v., anterior interosseous art. P-7 : intermediate antebrachial v., palmar carpal br. of radial art., anterior interosseous art. P-8 : superficial palmar arterial arch, palmar metacarpal art. P-9 : dorsal br. of palmar digital art. 3) Nerve P-1 : lateral cutaneous branch of 4th. intercostal nerve, medial pectoral nerve, 4th. intercostal nerve(n.) P-2 : lateral antebrachial cutaneous n. P-3 : medial antebrachial cutaneous n., median n. musrulocutaneous n. P-4 : medial antebrachial cutaneous n., anterior interosseous n. median n. P-5 : median n., anterior interosseous n. P-6 : median n., anterior interosseous n. P-7 : palmar br. of median n., median n., anterior interosseous n. P-8 : palmar br. of median n., palmar digital br. of median n., br. of median n., deep br. of ulnar n. P-9 : dorsal br. of palmar digital branch of median n. Conclusions : This study shows some differences from already established study on meridian Muscle.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.137-142
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• 2010

Purpose: Tumor ablation and traumatic intractable ulceration of the plantar surface of the foot results in skin and soft tissue defects of the weight-bearing sole. Simple skin grafting is not sufficient for reconstruction of the weight-bearing areas. Instead, the island medial plantar flap (instep flap) and distally-based island medial plantar flap was used for proper reconstruction of the weight bearing area. However, there are some disadvantages. In particular, an island medial plantar flap has a short pedicle limiting the mobility of the flap and the distally-based island medial plantar flap is based on a very small vessel. We investigated whether good results could be obtained using a reverse island medial plantar flap based on the lateral plantar vessel as a solution to the above limitations. Methods: Three patients with malignant melanoma were cared for in our tertiary hospital. The tumors involved the lateral forefoot, the postero-lateral heel, and the medial forefoot area. We designed and harvested the flap from the medial plantar area, dissected the lateral and medial plantar artery and vena comitans, and clamped and cut the vessel 1 cm proximal to the branch from the posterior tibial artery and vena comitans. The medial plantar nerve fascicles of these flaps anastomosed to the sural nerve, the 5th interdigital nerve, and the 1st interdigital nerve of each lesion. The donor sites were covered with skin grafting. Results: The mean age of the 3 subjects was 64.7 years (range, 57 - 70 years). Histologically, all cases were lentiginous malignant melanomas. The average size of the lesion was $5.3\;cm^2$. The average size of the flap was $33.1\;cm^2$. The flap color and circulation were intact during the early postoperative period. There was no evidence of flap necrosis, hematomas or infection. All patients had a normal gait after the surgery. Sensory return progressively improved. Conclusion: Use of an island medial plantar flap based on the lateral plantar vessel to the variable weight-bearing sole is a simple but useful procedure for the reconstruction of any difficult lesion of the weight-bearing sole.