By T. Sivert. Saint Norbert College. 2017.

In a subsequent study order minipress 2 mg with mastercard, 70 ral pathways responsible for the pain have been patients with chronic neuromatous knee pain poorly understood purchase 2 mg minipress free shipping. However, recent anatomical following total knee arthroplasty, trauma, or studies detailing these neural pathways have osteotomy had selective denervation with a facilitated our understanding of the sensory good to excellent outcome in 86% with a mean mechanisms responsible for pain around the follow-up of 24 months. Anatomic Basis for Selective Unfortunately, there are only scattered reports in the literature describing these conditions and Denervation the appropriate treatments. There are currently seven surgically identifiable Denervation for chronic joint pain was ini- sensory nerves around the knee joint (Figure tially described in 1958. This is retinacular nerve, and the medial and anterior because both sensory and motor nerves were cutaneous nerves of the thigh. Thus, for many years, denervation was vation to the lateral aspect of the knee includes not considered a reasonable option. However, the tibiofibular branch of the peroneal nerve, the with the advent of selective denervation, the lateral retinacular nerve, and the lateral femoral untoward sequellae have been eliminated cutaneous nerve. The medial and lateral retinac- because only the specific sensory nerves are ular nerves provide sensation to the knee joint excised. It is important to realize, however, that The anatomical location and paths of these selective denervation is primarily directed at nerves is generally constant; however, varia- patients with neuromatous pain. It is not rec- tions and anomalies can occur especially in the ommended for chronic pain resulting from a setting of prior operative procedures. These nerves are located just distal to the 363 364 Clinical Cases Commented Anterior Cutaneous n. An illustration demonstrating the course and cutaneous territories of the seven surgically identifiable nerves about the knee. Technique of Selective Denervation Initial Consultation A critical component in the management of At the initial consultation, patients are thor- patients with chronic knee pain is to differentiate oughly questioned regarding the mechanism pain of neuromatous versus nonneuromatous responsible for the knee pain. In general, neuromatous knee pain is ondary to chronic disease states such as arthritis characterized as sharp and localized whereas or chondromalacia as well as acute events such as nonneuromatous knee pain is dull and diffuse.

Number of lesions: & less than 5 & over 5 and less than 10 & over 10 and less than 20 & over 20 3 generic minipress 1 mg with visa. Depressed: & superficial (up to 1 mm underneath the cutaneous surface) & medium (1 to 3 mm underneath the cutaneous surface) & profound (over 3 mm underneath the cutaneous surface) b cheap minipress 2 mg mastercard. Elevated: & discrete elevation (up to 1 mm over the cutaneous surface) & moderate elevation (1 to 3 mm over the cutaneous surface) & severe elevation (over 3 mm over the cutaneous surface) 28 & HEXSEL ET AL. Localized fat: & Yes & No Localization: ______________________________________________________________ Thickness by skinfold plicometry: ____________________________________________ b. Flaccidity: & Yes & No & unapparent (only evidenced by the distension test) & apparent (noticeable without the distension test) & slight (does not determine relief alterations) & moderate (determines relief alterations classified as cellulite degree II) & severe (determines relief alterations classified as cellulite degree III) 5. Surgical sequelae: & Absent & Present Localization: ______________________________________________________________ b. Scars: & Absent & Present Localization: ______________________________________________________________ c. Other: ___________________________________________________________________ 3 Anatom y of Cellulite and the Interstitial atrix Pier Antonio Bacci University of Siena, Siena, Italy and Cosmetic Pathologies Center, Arezzo, Italy & INTRODUCTION The understanding of the structure and function of the interstitial (or extracellular) matrix constitutes a relatively recent conceptual revolution. Sergio Curri, was the first to study and describe the clinical relevance of this microvascular-tissue unit (1). The human body is characterized by the presence of rigid fasciae and especially deep muscular fasciae that start from the base of the cranium and continue to the ankles and metatarsus promoting various physiological functions: vascular, neurophysiologic, and orthopedic. Cellulite is a degenerative and evo- lutional affect on subcutaneous tissue. The authors describe cellulite from a histomorpho- logically point of view, defining it as a PEFS: ‘‘panniculopatia edematofibrosclerotica (edematofibrosclerotic dermo-lipodermic pathology)’’ (2).