The relation between thoracic paraspinal tissues and pressure sensitivity measured by a digital algometer (original) (raw)
Segmental paraspinal tissue texture change has been proposed to be an important diagnostic sign of intervertebral somatic dysfunction. The nature and existence of these regions is speculative. The aim of this study was to examine whether deep, medial, paraspinal regions identified as having abnormal texture by palpation are confirmed as being more sensitive to pressure measured by a digital algometer. An osteopath examined the thoracic regions of 32 subjects (26 asymptomatic, six with mild thoracic symptoms) to detect an abnormal to palpation and tender (AbPT) site in each individual. Three non-tender and normal to palpation (NT) regions (immediately above, below and opposite the AbPT site) were also located. A digital pressure
Waveform characteristics in thoracic paravertebral space: a prospective observational study v1
2023
Background: With increased use of thoracic block (TPVB) in thoracic surgery, many faced the challenge of locating the thoracic paravertebral space (TPVS) ultrasonographically. This observational study aimed to investigate the waveform characteristics and pressure value within the TPVS in Anesthetized patients with controlled ventilation. Methods: Fifty patients scheduled for elective lung surgery were enrolled. After conduction of Anesthesia, all patients underwent TPVB at T4/5 and T6/7 using transverse, in-plane ultrasound guidance. A pressure transducer system with a desktop monitor was connected to the needle hub to measure pressure values and waveform characteristics in three locations: the paraspinal muscles, immediately behind the superior costotransverse ligament, and within the TPVS. Next, 15 mL of 0.33% bupivacaine was injected into each desired TPVS. After completion of the surgery, the extent of dermatomal blockade and the pain score was assessed in all patients. Results: Ninety-eight typical regular respiratory waveforms with a mean pressure of ≤ 25 mmHg were detected in the TPVS of fty patients. The sensitivity of the combined ultrasound and pressure waveform measurement technique to identify the TPVS was 95.45% (95% con dence interval, 84.527-99.445) . Nontypical respiratory waveforms were present in two patients. Factors interfering with the TPVS waveform characteristics were previous thoracic surgery and chronic pleural in ammation. Monitoring of the pressure value and waveform characteristics is a simple and reliable strategy to identify the needle tip in the TPVS. The appearance of the respiratory waveform ensures that the end of the needle aperture is within the TPVS.
Measurement of maximal expiratory pressure: effect of holding the lips
Thorax, 1992
Background Minor differences in technique may account for the wide range of published normal values of maximum expiratory and inspiratory pressures. The effects of holding the lips while the subject performed a maximal expiratory pressure manoeuvre were investigated in this study. Methods Maximum static expiratory pressures (PEmax) obtained with a cylindrical tube by means of lip compression by the subject and technician aided compression were compared in 20 men (mean age 27 years) and 20 women (mean age 28 years). Results Technician aided lip compression was associated with higher maximum expiratory pressure than compression by the subject in both men (195 v 110 cm H20) and women (134 v 80 cm H20). Conclusion Compression of the lips and corners of the mouth should be performed by a trained technician for maximum expiratory pressure measurements when a cylindrical mouthpiece is used. (Thorax 1992;47:961-963) Measurement of maximum expiratory pressures PEmax under static conditions provides quantitative information about expiratory muscle function and is a useful measure of this in various pulmonary and neuromuscular disorders."A Large variations in PEmax are reported in normal subjects.'5 One possible explanation for this variation is that different laboratories use different measuring techniques.' 3 8 Black and Hyatt suggest the use of a large, rigid circular mouthpiece with an adequate seal around the lips but it is often difficult to prevent leakage during expiration. We compared PEmax in a group of normal subjects-firstly, with the subjects holding their lips to the tube and then with help from the technician.
Comparison of three protocols for measuring the maximal respiratory pressures
Fisioterapia em Movimento, 2015
Introduction To avoid the selection of submaximal efforts during the assessment of maximal inspiratory and expiratory pressures (MIP and MEP), some reproducibility criteria have been suggested. Criteria that stand out are those proposed by the American Thoracic Society (ATS) and European Respiratory Society (ERS) and by the Brazilian Thoracic Association (BTA). However, no studies were found that compared these criteria or assessed the combination of both protocols. Objectives To assess the pressure values selected and the number of maneuvers required to achieve maximum performance using the reproducibility criteria proposed by the ATS/ERS, the BTA and the present study. Materials and method 113 healthy subjects (43.04 ± 16.94 years) from both genders were assessed according to the criteria proposed by the ATS/ERS, BTA and the present study. Descriptive statistics were used for analysis, followed by ANOVA for repeated measures and post hoc LSD or by Friedman test and post hoc Wilcox...
The Electromyographic Activity of Thoracic Paraspinal Muscles Identified as Abnormal with Palpation
J Manip Physiol Ther, 2007
Objective: The aim of this study was to compare the electromyographic (EMG) activity of deep muscles in the thoracic paravertebral gutter (PVG) detected as abnormal to palpation (AbPT) and reported as tender by the subject with muscles underlying nontender (NT), normal to palpation sites under various experimental conditions. Methods: Twelve subjects (mean age, 25.42 years; range, 22-43 years) participated in this study. Fine-wire, bipolar intramuscular electrodes were inserted, under real-time ultrasonic guidance, into the deep paravertebral muscle mass underlying 1 AbPT and 2 NT sites (1 segment above and below the AbPT site) in the thoracic PVG regions. Electromyographic activity was recorded under the following conditions: resting prone, prone active trunk extension, application of pressure (300 kPa) to adjacent spinous processes, resting seated, passive and active seated trunk rotation, and supporting 2-kg weights in outstretched arms. Results: Mean EMG activity was highest at the AbPT site, relative to NT sites, under all conditions, with a significant between-group effect of site (F 2,31 = 4.13, P = .03) and large between-group effect size (D 2 = 0.21). There was also a trend for lower percentage change from baseline resting at the AbPT sites, relative to the NT sites, in response to the demand of other conditions. There were large variations in EMG activity within and between individuals, and large SDs accompanied the mean values of EMG activity in all cases. Conclusion: Increased motor activity may be a contributing factor to tissue changes in the PVG detected with palpation. However, caution must be used when interpreting these results because of the large variations, small sample size, and issues associated with EMG normalization.
Non-pulmonary factors strongly influence the stress index
Intensive Care Medicine, 2011
Purpose: A quantitative measure of the airway pressure-time tracing during passive inflation [stress index (SI)] has been suggested as an indicator of tidal lung recruitment and/or overinflation. If reliable, this simple index could help guide positive end-expiratory pressure (PEEP) and tidal volume selection. The compartment surrounding the lungs should impact airway pressure and could, therefore, affect SI validity. To explore the possibility, we determined SI in a swine model of pleural effusion (PLEF). Methods: Unilateral PLEF was simulated by instilling fluid (13 ml/kg-moderate, 26 ml/ kg-large) into the right pleural space of five anesthetized, paralyzed, mechanically ventilated pigs. Animals were ventilated with constant flow ventilation: tidal volume (V T ) 9 ml/kg, f set to end-tidal CO 2 (ETCO 2 ) of 30-40 mmHg, inspiratory to expiratory ratio (I/E) 1:2, PEEP 1 or 10 cmH 2 O. Respiratory system mechanics and computed tomography (CT) were acquired at end-inspiration and end-expiration to determine % tidal recruitment and overinflation. Results: Prior to PLEF instillation, SI values derived at PEEP = 1 and 10 cmH 2 O were 0.90 and 1.22, respectively. Moderate PLEF increased these SI values to 1.06 and 1.24 and large PLEF further increased SI to 1.23 and 1.27 despite extensive tidal recruitment and negligible overdistention by CT. The initial half of the tidal pressure curve produced SI values (range 0.82-1.17) that were significantly lower than those of the second half (0.98-1.37). Conclusions: In the presence of pleural fluid, SI indicated overinflation when virtually none was present and tidal lung recruitment predominated. When the extrapulmonary environment is abnormal, caregivers are advised to interpret the SI with caution.
2001
La respiration est un phenomene vital qui implique une synergie entre diverses structures anatomiques qui constituent le thorax. La physiologie articulaire reste un parent pauvre de la physiologie et la litterature concernant la quantification de la cinematique 3D des articulations du thorax durant le mouvement respiratoire est rare. Ce travail se concentre sur le developpement et l'application d'une methodologie permettant de repondre a cet objectif. La methode developpee combine le traitement de donnees tomodensitometriques realisees a trois volumes pulmonaires differents et des techniques d'infographies. Les amplitudes (ROMs) et axes de mouvements (axe helicoidaux moyen, AHMs) ont ete obtenus au niveau des articulations costo-vertebrales de 12 sujets asymptomatiques. En resume, les amplitudes diminuent graduellement dans les etages inferieurs ; le volume pulmonaire et l'etage costal influencent significativement les amplitudes costales ; l'orientation des AHMs...
Predicted normal values for maximal respiratory pressures in caucasian adults and children
ABsTRAcr Maximal respiratory pressures at the mouth (PEm. and PI,M.) have been measured in 370 normal caucasian children and adults. Age, height, and weight were recorded for all subjects and incorporated in a stepwise multiple regression analysis to determine prediction equations for the maximal respiratory pressures in the children and adults for both sexes. In men Pi,. and PEmax were significantly correlated only with age (p < 0-001 and < 0-035 respectively), whereas in women they were correlated with height (p < 0-035 and < 0-03). In both boys and girls PN., was related to weight (p < 0-0001 and <0-01 respectively) and PEma. to age (p < 0-001 for both). The values for PImax and PEmax in adults were lower than in previously reported series, but in children the values obtained were similar to those reported for several smaller series. In recent years interest has been rekindled in methods for measurement of respiratory muscle function in patients with neuromuscular disease. One of the simplest non-invasive measurements is that of maximal pressures, generated at the mouth, after full inspiration and full expiration-that is, maximal expiratory pressure (PE,,,C) and maximal inspiratory pressure (PI n). These pressures have been measured with a mercury manometer' and by pressure gauges.2 Normal values for adults have been collected by Ringqvist3 and Black and Hyatt2 and measurements in patients with neuromuscular disease and obstructive lung disease have also been reported.4 5 Inkley et a!6 studied a group of 38 American boys with Duchenne muscular dystrophy and compared the results with values from 66 normal schoolboys (aged 6-14 years), and Cerretelli et aP studied a small group of 12 year old children. As part of the investigation of patients with neuromuscular disease we measured PE,.l, and Pimax in a group of normal subjects and noted a wide range of normal values from these pressures in published reports. In addition, since there are limited data on PIn,,,, and PE,,, values in children, a larger and more comprehensive group of normal subjects was studied in an attempt to determine normal values for British caucasian adults and children. The age range of our subjects was 7-70 years.