{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:35:45Z","timestamp":1760142945182,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,20]],"date-time":"2024-01-20T00:00:00Z","timestamp":1705708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Internally rotated and adducted shoulder is a common posture in upper limb spasticity. Selective peripheral neurectomy is a useful and viable surgical technique to ameliorate spasticity, and the lateral pectoral nerve (LPN) could be a potential good target to manage shoulder spasticity presenting with internal rotation. However, there are some limitations related to this procedure, such as potential anatomical variability and the necessity of intraoperative surgical exploration to identify the target nerve requiring wide surgical incisions. This could result in higher post-surgical discomfort for the patient. Therefore, the aim of our study was to describe a modification of the traditional selective peripheral neurectomy procedure of the LPN through the perioperative ultrasound-guided marking of the target nerve with methylene blue. The details of the localization and marking procedure are described, as well as the surgical technique of peripheral selective neurectomy and the potential advantages in terms of nerve localization, surgical precision and patients\u2019 post-surgical discomfort. We suggest that the proposed modified procedure could be a valid technique to address some current limitations and move the surgical treatment of spasticity toward increasingly tailored management due to the ease of nerve identification, the possibility of handling potential anatomical variability and the resulting smaller surgical incisions.<\/jats:p>","DOI":"10.3390\/jpm14010116","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T03:50:22Z","timestamp":1705895422000},"page":"116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure"],"prefix":"10.3390","volume":"14","author":[{"given":"Paolo","family":"Zerbinati","sequence":"first","affiliation":[{"name":"Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Bemporad","sequence":"additional","affiliation":[{"name":"Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Massimiani","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7955-3369","authenticated-orcid":false,"given":"Edoardo","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3494-0287","authenticated-orcid":false,"given":"Davide","family":"Mazzoli","sequence":"additional","affiliation":[{"name":"Gait and Motion Analysis Laboratory, Sol et Salus Hospital, 47992 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2806-528X","authenticated-orcid":false,"given":"Davide","family":"Glorioso","sequence":"additional","affiliation":[{"name":"Neuro-Orthopedic Unit, Sol et Salus Hospital, 47922 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7375-9792","authenticated-orcid":false,"given":"Giuseppe","family":"della Vecchia","sequence":"additional","affiliation":[{"name":"Department of Women, Child, General and Specialistic Surgery, University of Campania \u201cL. Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3905-6154","authenticated-orcid":false,"given":"Antonio","family":"De Luca","sequence":"additional","affiliation":[{"name":"Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luciano Armanni, 5, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"De Blasiis","sequence":"additional","affiliation":[{"name":"Section of Human Anatomy, Department of Mental and Physical Health and Preventive Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Via Luciano Armanni, 5, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1046\/j.1468-1331.2002.0090s1003.x","article-title":"The Pathophysiology of Spasticity","volume":"9","author":"Sheean","year":"2002","journal-title":"Eur. 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