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At least 649 records · Page 36Linked to original sources
PubMed1999

Frey syndrome: treatment with temporoparietal fascia flap interposition.

There is a 10% to 48% reported incidence of clinically significant gustatory sweating after parotid surgery or injury. Various medical and surgical treatments have been used in the attempt to treat this socially embarrassing condition. These treatments are not always effective and often have unwanted risks and adverse effects. They also do not address the post-parotidectomy defect. Prevention of Frey syndrome and correction of the postoperative contour deformity after parotidectomy have recently been achieved by interposition of temporoparietal fascia flap between the parotid gland and the cheek skin flap at the time of parotidectomy. This article presents the first report (to our knowledge) of an established case of Frey syndrome being treated with temporoparietal fascia flap interposition.

Follow-Up Studies↗
PubMed1996

Hippocampal NPY neurons project to the fascia dentata in organotypic cultures.

The distribution of neuropeptide Y immunoreactive (NPY-ir) neurons in organotypic cultures of hippocampi from neonates was compared to that seen in adult rats. In addition to the known NPY-ir neurons in the hippocampus proper and in the hilus of the fascia dentata, isolated, large, multipolar, NPY-ir neurons were observed in the subiculum and in areas CA1 and CA3. Their axons projected into stratum radiatum of the hippocampus proper and into the molecular layers and hilus of the fascia dentata where they branched profusely. These NPY-ir neurons were regularly distributed throughout the septo temporal extent of the hippocampus and were present in both neonates and adult hippocampi. The hilar NPY-ir neurons have always been considered the source of the NPY-ir plexus in the outer molecular layer of the dentate gyrus. However, our results show that there is also a contribution from the NPY-ir neurons in the hippocampus proper.

Animals↗
PubMed1988

Scanning electron microscope study of elastic fibers of the loose connective tissue (superficial fascia) in the rat.

A combination of intravascular resin injection and formic acid incubation was utilized to study the three-dimensional arrangement of the elastic fibers in the loose connective tissue (superficial fascia) of the rat limb by scanning electron microscopy (SEM). The cast of the microvasculature served as a scaffolding for the otherwise collapsible connective tissue. SEM study demonstrated that the elastic fibers did not form an anastomosing network but were arranged in multiple layers. The fibers in each layer lay parallel to each other but were oriented differently from the fibers in the layers on either side, thereby producing a meshwork. Each individual fiber was composed of a small bundle of discrete fibrils. Some of these component fibrils separated from the parent fiber and united with other fibers, thus producing branching. The elastic fiber either decreased or grew in size by the respective sharing or joining of these component fibrils with neighboring fibers in their respective layers. Interconnections between elastic fibers of different layers were rare. These findings may provide a morphological explanation for the characteristic function of the superficial fascia, which allows the skin and underlying muscles to have a rapid and extensive alteration in their relative positions.

Animals↗
PubMed2001

The lacrimal fascia redefined.

It has been commonly accepted that the lacrimal fascia is an intact septum, composed of connective tissue, that separates the orbital cavity into a large compartment, which contains the eyeball, and a small compartment, which contains the lacrimal sac and nasolacrimal duct. the septum, however, is not necessarily always intact. We found a circular or oval opening in the lacrimal fascia in 37 of 52 specimens (71.2%) examined. The opening, which we shall refer to as the lacrimal fascial foramen, was located at variable levels in the lacrimal fossa. The lacrimal fascial foramen was buried in fatty tissue through which passed a branch of either the inferior palpebral artery or the infraorbital artery and a vein of the nasolacrimal duct. The clinical implications of the lacrimal fascial foramen in obstruction of the nasolacrimal duct are discussed.

Aged↗
PubMed2002

Abnormal positioning of granule cells alters afferent fiber distribution in the mouse fascia dentata: morphologic evidence from reeler, apolipoprotein E receptor 2-, and very low density lipoprotein receptor knockout mice.

The fascia dentata of the hippocampal formation is characterized by the nonoverlapping and lamina-specific termination of afferent fibers: entorhinal fibers terminate in the outer molecular layer and commissural/associational fibers terminate in the inner molecular layer. It has been proposed that this fiber lamination depends on the presence of the correct postsynaptic partner at the time of fiber ingrowth during development. Pioneer neurons that guide afferent fibers to their correct layers as well as signals located on granule cells have both been implicated. To study the role of granule cells for the lamina-specific ingrowth of afferents, the cyto- and fiberarchitecture of three mouse mutants (very low density lipoprotein receptor knockout mouse, apolipoprotein E receptor 2 knockout mouse, and reeler mouse) that show different degrees of granule cell migration defects were analyzed. Anterograde tracing with Phaseolus vulgaris-leucoagglutinin was used to visualize the afferent fiber systems, and immunohistochemistry was used to determine the position of their putative target cells. In controls, granule cells are packed in a single layer. This laminar organization is mildly altered in very low density lipoprotein receptor knockout mice, moderately disturbed in apolipoprotein E receptor 2 knockout mice, and severely disrupted in reeler mice. These changes in granule cell distribution are mirrored by the distribution of commissural fibers. In contrast, changes in granule cell distribution do not severely affect the laminar termination of entorhinal fibers. These data provide further evidence for a role of granule cells in the laminar termination of commissural/associational afferents to the fascia dentata.

Afferent Pathways↗
PubMed1983

Commissural inhibition and facilitation of granule cell discharge in fascia dentata.

Stimulation of the contralateral hippocampus in the hilar region had a marked effect on granule cell excitability in the fascia dentata. The primary effect was to block the population spike that otherwise occurred in response to perforant path stimulation. In contrast, the size the excitatory post-synaptic potential component of the perforant path-evoked field potential was only slightly reduced. The population spike diminution began at short latency (3.5 msec), beginning at about 1.0 msec after the onset of the slow component of the potential evoked by the contralateral stimulus. The completeness and duration of this population spike diminution depended on the contralateral stimulus intensity. The maximum duration was less than 40 msec in unanesthetized rats and more than 100 msec in rats under pentobarbital anaesthesia. Bicuculline did not diminish the field potential evoked by the contralateral stimulus but it did prevent the stimulus from blocking the perforant path population spike and, instead, permitted a weak facilitation of the population spike. The normal reduction of the population spike was not mediated by recurrent inhibition, secondary to granule cell activation, since it occurred whether or not the granule cells were inhibited at the time of contralateral stimulation. These results imply that the initial main effect on fascia dentata granule cells of activity in the contralateral hilus is a gamma-aminobutyric-acid-mediated inhibition. This effect most probably involves commissural excitation of local inhibitory interneurons. The direct excitatory action of commissural fibers on granule cells, by comparison, is very weak.

Anesthesia, General↗
PubMed1984

Cellular and connective organization of slice cultures of the rat hippocampus and fascia dentata.

This study examined the cellular and connective organization of hippocampal tissue taken from 6-8-day-old rats and cultured by the roller tube technique for 3-6 weeks. In the cultures containing the fascia dentata and the hippocampus proper (CA1, CA3, CA4) the main cell and neuropil layers were organotypically organized when observed in ordinary cell stains. The normal distribution of smaller cell populations of AChE-positive neurons and somatostatin-reactive neurons was demonstrated by histochemical and immunohistochemical methods. Both cell types were mainly confined to str. oriens of CA3 and CA1 and the dentate hilus (CA4). Individual dentate granule cells and hippocampal pyramidal cells were injected with lucifer yellow and HRP, revealing great stability of the dendritic patterns of these cells in the culture condition. The same was found for the axonal branching and termination of HRP-filled mossy fibers arising from an HRP-injected granule cell. The preservation of organotypic afferent patterns in the cultures was also shown by Timm staining of the terminal distribution of the mossy fiber system. Mossy fiber terminals, with characteristic ultrastructural features verified in the electron microscope, were thus found in the hilus (CA4) and along the CA3 pyramidal cell layer onto the CA3-CA1 transition. Depending on the amount of dentate tissue relative to CA3 the terminals could stop before reaching CA1 (small fascia dentata) or take up additional intra and infrapyramidal locations along CA3 (small CA3). In cultures with a gap in the CA3 pyramidal cell layer some mossy fiber terminals were found in contact with the CA3 pyramidal cells beyond the gap. In all cultures there was an aberrant projection of supragranular mossy fibers. This projection is analogous to the one known from lesion and transplant studies to form in the absence of the entorhinal perforant path input to the dentate molecular layer. Also, in accordance with these studies the Timm staining pattern of the outer parts of the dentate molecular layer and the entire molecular layer of the hippocampus was altered corresponding to the spread of afferents normally confined to the inner zone of the dentate and str. radiatum of CA3 and CA1. Possibly as a consequence of the lack of normal targets for projections from CA1, this subfield contained an unusually dense Timm staining suggestive of autoinnervation.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetylcholinesterase↗
PubMed1991

Neuropeptide Y (NPY)-immunoreactive neurons in the primate fascia dentata; occasional coexistence with calcium-binding proteins: a light and electron microscopic study.

Neuropeptide Y (NPY)-containing neurons are known to be highly vulnerable following sustained electrical stimulation in rats and in humans suffering from temporal lobe epilepsy. This has been related to a strong excitatory input. In contrast, there is evidence that neurons containing calcium-binding proteins exhibit a high resistance under experimental seizure and hypoxia conditions. The aim of this study was to determine the coexistence of NPY and calcium-binding proteins in inhibitory neurons of the primate fascia dentata and their synaptic connections. Vibratome sections of hippocampi of African green monkeys (Cercopithecus aethiops) were immunostained with antibodies against NPY, PARV, and CB. A quantitative coexistence study was performed for NPY and PARV on consecutive semithin sections. In contrast to the rodent hippocampus, NPY-immunoreactive neurons were found exclusively in the hilus of fascia dentata with horizontally oriented dendrites which did not extend into the granular and molecular layer. Conversely, PARV-immunoreactive neurons were also present in the granular and inner molecular layer and extended their dendrites far out in the molecular layer and the hilus. Axon terminals immunoreactive for NPY were mostly concentrated in the middle and outer molecular layer and the hilar region and were rare in the granular layer. PARV-immunoreactive boutons were basically restricted to the granular layer where they formed typical baskets. The antibody against calbindin stained almost exclusively granule cells. Coexistence of NPY- and PARV-immunoreactivity was found only in hilar neurons and was rare (9 out of 152 cells analyzed). These results suggest that most NPY-immunoreactive neurons do not contain calcium-binding proteins. NPY-containing neurons exhibited ultrastructural characteristics as described for inhibitory neurons. Their dendrites were only sparsely contacted by mostly asymmetric synaptic terminals, including a very small number of mossy fiber axon terminals. In turn, numerous NPY-immunoreactive axon terminals formed symmetric synapses with spines and dendritic shafts of unlabeled neurons in the middle and outer molecular layer, whereas no contact with granule cell bodies was evident. Thus, we conclude that the vulnerability of NPY-containing inhibitory neurons may be due more to the lack of calcium-binding proteins than to a strong excitatory innervation. As their axons may contribute to the inhibitory control of the major excitatory input from the entorhinal cortex, their loss following overstimulation may play a role in perpetuating hippocampal seizure activity.

Animals↗
PubMed1991

Effects of prenatal protein deprivation on postnatal development of granule cells in the fascia dentata.

The effect of prenatal protein deprivation on the postnatal development of granule cells in the fascia dentata in the rat was studied at 15, 30, 90, and 220 days of age. The granule cells showed a significant reduction in cell size, decreased number of synaptic spines throughout their dendritic extent, and reduced complexity of dendritic branching in the outer two-thirds of the molecular layer. All of these deficits were present at 15 days and persisted throughout the study (220 days). The least deficits in synaptic spine density occurred at 90 days and in dendritic branching at 30 days. Partial restitution of earlier, more severe deficits was associated primarily with maturational events occurring in the protein deprived rats, whereas later increases in deficits were related primarily to a failure of the protein deprived rats to keep pace with neuronal development occurring in the controls. The present results are similar to those noted in our previous study in this journal of the effect of a low protein diet (8% casein) on these neurons that extended from pregnancy until the time of sacrifice at 30, 90, and 220 days of age (Cintra et al., '90; 532:271-277). Taken together, these two studies suggest that the postnatal adaptation of the granule cells to prenatal protein deprivation is primarily due to events that occur during pregnancy and that the site of predilection for the deficit is their dendrites in the outer two-thirds of the molecular layer of the fascia dentata.

Aging↗
PubMed1993

GABAergic innervation of the rat fascia dentata: a novel type of interneuron in the granule cell layer with extensive axonal arborization in the molecular layer.

By using the combined Golgi/electron microscopy (EM) technique and postembedding immunocytochemistry for gamma-aminobutyric acid (GABA), we describe a novel type of local circuit neuron in the rat fascia dentata that gives rise to an axon profusely ramifying in the dentate molecular layer. The relatively small ovoid cell body (long axis 12-15 microns) is located directly underneath the granular layer. From both poles of the cell body dendritic processes emerge that enter the molecular layer and hilar region, respectively. The apical dendrites traverse the granular layer, invade the molecular layer, and branch in the same way as granule cell dendrites. Some branches reach the hippocampal fissure. Thus, the apical dendrites of these neurons may receive a similar input pattern as the granule cells. The dendrites are smooth, occasionally bearing varicosities. A few spines are regularly observed. The axon originates from the apical dendrite and traverses the molecular layer horizontally for up to 500 microns. It gives off numerous collaterals that are distributed throughout the entire width of the molecular layer and only rarely enter the granule cell layer. Electron microscopy of the cell body of gold-toned neurons revealed the well-known fine-structural characteristics of nonpyramidal neurons, i.e., an indented nucleus with nuclear inclusions and large aggregations of endoplasmic reticulum. Apical as well as basal dendrites are densely covered with presynaptic boutons, mainly forming asymmetric synapses. The axon terminals of these cells form symmetric synapses with dendritic shafts and, to a lesser extent, with spines. These symmetric synapses, together with the results of our GABA postembedding immunocytochemical study, suggest that this cell is a GABAergic inhibitory neuron that almost exclusively innervates the dentate molecular layer. Together with data from the literature on dentate axoaxonic cells (which innervate the axon initial segments of the granule cells) and GABAergic basket cells (which innervate the granule cell somata and proximal dendrites in the granular layer), the present results indicate that there is a lamination of the GABAergic innervation of the fascia dentata corresponding to the well-known segregated termination of entorhinal and commissural afferents to this region.

Animals↗
PubMed2006

NG2 upregulation in the denervated rat fascia dentata following unilateral entorhinal cortex lesion.

The chondroitin sulfate proteoglycan NG2 is a component of the glial scar following brain injury. Because of its growth inhibiting properties, it has been suggested to impede axonal regeneration. To study whether NG2 could also regulate axonal growth in denervated brain areas, changes in NG2 were studied in the rat fascia dentata following entorhinal deafferentation and were correlated with the post-lesional sprouting response. Laser microdissection was employed to selectively harvest the denervated molecular layer and combined with quantitative RT-PCR to measure changes in NG2 mRNA (6 h, 12 h, 2 days, 4 days, 7 days post-lesion). This revealed increases of NG2 mRNA at day 2 (2.5-fold) and day 4 (2-fold) post-lesion. Immunocytochemistry was used to detect changes in NG2 protein (1 days, 4 days, 7 days, 10 days, 14 days, 30 days, 6 months post-lesion). NG2 staining was increased in the denervated outer molecular layer at day 1 post-lesion, reached a maximum 10 days post-lesion, and returned to control levels thereafter. Electron microscopy revealed NG2 immunoprecipitate on glial surfaces and in the extracellular matrix around neuronal profiles, indicating that NG2 is secreted following denervation. Double labeling of NG2-immunopositive cells with markers for astrocytes, microglia/macrophages, and mature oligodendrocytes suggested that NG2 cells are a distinct glial subpopulation before and after entorhinal deafferentation. BrdU labeling revealed that some of the NG2-positive cells are generated post-lesion. Taken together, our data revealed a layer-specific upregulation of NG2 in the denervated fascia dentata that coincides with the sprouting response. This suggests that NG2 could regulate lesion-induced axonal growth in denervated areas of the brain.

Acetylcholinesterase↗
PubMed2003

Comparison of commissural sprouting in the mouse and rat fascia dentata after entorhinal cortex lesion.

Reactive axonal sprouting occurs in the fascia dentata after entorhinal cortex lesion. This sprouting process has been described extensively in the rat, and plasticity-associated molecules have been identified that might be involved in its regulation. To demonstrate causal relationships between these candidate molecules and the axonal reorganization process, it is reasonable to analyze knockout and transgenic animals after entorhinal cortex lesion, and because gene knockouts are primarily generated in mice, it is necessary to characterize the sprouting response after entorhinal cortex lesion in this species. In the present study, Phaseolus vulgaris-leucoagglutinin (PHAL) tracing was used to analyze the commissural projection to the inner molecular layer in mice with longstanding entorhinal lesions. Because the commissural projection to the fascia dentata is neurochemically heterogeneous, PHAL tracing was combined with immunocytochemistry for calretinin, a marker for commissural/associational mossy cell axons. Using both techniques singly as well as in combination (double-immunofluorescence) at the light or electron microscopic level, it could be shown that in response to entorhinal lesion mossy cell axons leave the main commissural fiber plexus, invade the denervated middle molecular layer, and form asymmetric synapses within the denervated zone. Thus, the commissural sprouting response in mice has a considerable translaminar component. This is in contrast to the layer-specific commissural sprouting observed in rats, in which the overwhelming majority of mossy cell axons remain within their home territory. These data demonstrate an important species difference in the commissural/associational sprouting response between rats and mice that needs to be taken into account in future studies.

Animals↗
PubMed1994

Microglial and astroglial reactions to anterograde axonal degeneration: a histochemical and immunocytochemical study of the adult rat fascia dentata after entorhinal perforant path lesions.

The reaction of microglial and a stroglial cells to anterograde axonal degeneration was studied in the fascia dentata of adult rats at various timepoints after removal of the entorhinal perforant path projection. Microglial cells were identified by histochemical staining for nucleoside diphosphatase (NDPase) at light and electron microscopical levels. Astroglial cells were stained immunocytochemically for glial fibrillary acidic protein (GFAP). Activated astroglial cells and some microglial cells also stained immunocytochemically for the intermediate filament protein vimentin. Phagocytotic activity was detected by histochemical staining for acid phosphatase. The postlesional connective reorganization of the cholinergic septohippocampal projection was monitored by histochemical staining for acetylcholinesterase. Twenty-four hours after entorhinal cortex ablation, microglial cells in the perforant path zones of the fascia dentata and the adjacent neuropil reacted by shortening and coarsening of processes and an increase in NDPase reactivity. These changes occurred prior to a noticeable increase in GFAP immunoreactivity and hypertrophy of astroglial cells (first evident on postlesional day 2) or sprouting of cholinergic septohippocampal fibres (first evident on day 3). There was evidence of an early, local proliferation of microglial cells in the denervated perforant path zones and migration into these zones of microglial cells from adjacent intact areas. The specific accumulation of strongly stained microglial cells within the denervated parts of the dentate molecular layer persisted for at least 4 weeks, while the astroglial reaction subsided at 3 weeks. The results demonstrate an early activation of microglial cells by axonal degeneration, and indicate that these cells may play a pivotal, inductive role in the subsequent glial and neural events.

5'-Nucleotidase↗
PubMed1986

Pick body-like inclusions in the dentate fascia of the hippocampus in Alzheimer's disease.

Pick body-like inclusions are described in the granular neurons of the dentate fascia in Alzheimer's disease. The inclusions are round, argyrophilic and stained by thioflavine-S. Immunocytochemically they contain antigenic determinants of neurofilaments and of Alzheimer neurofibrillary tangles. Ultrastructurally they are composed primarily of 15-18 nm straight filaments similar to the neurofibrillary pathology of progressive supranuclear palsy and Pick's disease. The dentate fascia inclusions, as well as cerebellar plaques but not amyloid angiopathy, are found most frequently in association with severe neurofibrillary degeneration.

Aged↗
PubMed1991

Basket cells in the monkey fascia dentata: a Golgi/electron microscopic study.

This study describes non-granule cells in the fascia dentata of rhesus monkeys and baboons. Their cell bodies are located in the molecular layer and at the hilar border of the granular layer. They are called basket cells since their axons give rise to collaterals that branch in the close vicinity of the parent cell body and form symmetric synapses with dendrites and cell bodies of granule cells. These neurons are further classified with regard to the shape and location of their cell bodies and the orientation of their dendrites. Basket cells in the molecular layer are mainly bipolar with dendrites oriented perpendicular to the granular layer. These dendrites are densely innervated by presynaptic boutons forming asymmetric synapses. We have rarely observed molecular layer basket cells with dendrites traversing the granular layer and invading the hilus. We thus conclude that these cells are mainly activated by extrinsic afferents terminating in the molecular layer. Basket cells at the hilar border display pyramidal, fusiform or multipolar cell bodies that give rise to apical dendrites traversing the molecular layer and basal dendrites invading the hilar region. Large boutons establish asymmetric synapses with identified basal dendrites of these neurons. The dendrites of all types of basket cell are smooth, i.e. they had few or no spines. Many of them display varicosities. Cell counts in Cresyl Violet-stained sections revealed a ratio of basket cells to granule cells of 1:500. Essentially, the types of basket cell in the monkey fascia dentata are similar to those described previously for the rat. This contrasts sharply to our recent findings for pyramidal neurons and granule cells of the monkey hippocampus which showed an increased complexity and variability when compared with rodents. These data do not support the hypothesis that only local circuit neurons evolve in phylogeny.

Animals↗
PubMed1975

[Studies concerning the usefulness of catgut, PGA and polyester for abdominal fascia closure (author's transl)].

The abdominal fascia incisions of 133 rabbits were closed either with plain gut, chromic gut, PGA or polyester threads. The breaking strength of the wounds were determined tensiometrically at different time intervals and the tissue was examined histologically. For a three-week period the strength of the abdominal wall depends significantly on the intactness of the threads. PGA produces minimal inflammatory reactions, but loses its strength after a fortnight. Since longitudinal incisions are endangered by severe muscle pull, this material cannot be recommended because of the possibility of wound disruption and the formation of hernias. The loss of strength of catgut plain and catgut chromic starts later. Catgut causes inflammatory reactions within the wound area leading to loss of strength of the sutured tissue. Thus incisions of the abdominal fascia should not be closed with catgut. The non-resorbable suture material polyester shows satisfactory strength and minimal tissue reaction. As long as there is no synthetic suture material with mild tissue reaction and late resorption the fascial closure should be sutured with polyester.

Abdominal Muscles↗
PubMed1988

Differentiation of granule cells in relation to GABAergic neurons in the rat fascia dentata. Combined Golgi/EM and immunocytochemical studies.

Golgi impregnation was used to study the dendritic differentiation of granule cells in the rat fascia dentata. The impregnated granule cells were gold-toned allowing for a fine structural study of the same identified neurons and of the input synapses onto their cell bodies and dendrites. Due to the long postnatal formation of these cells it was possible to describe a sequence of maturational stages coexisting on the same postnatal day (P5). Characteristic features of the dendritic development of granule cells were i) occurrence of varicose swellings along the dendrites, ii) growth cones on dendritic tips, iii) transient formation of basal dendrites, and iv) progressive development of dendritic spines. Incoming synapses on the differentiating granule cells were mainly found on dendritic shafts. Their membrane specializations were symmetric. At least some of these symmetric synapses were GABAergic because immunostaining of Vibratome sections from the same postnatal stage (P5) demonstrated a well-developed GABAergic axon plexus in the fascia dentata (antibodies against glutamate decarboxylase (GAD), the GABA synthesizing enzyme). Electron microscopy of the immunostained axon plexus revealed numerous GABAergic terminals that formed symmetric synaptic contacts, mainly on shafts of differentiating dendrites but also on cell bodies of granule cells. Our results thus indicate that the plexus of inhibitory GABAergic axons is already well developed at a stage when the target neurons, the granule cells, are still being formed.

Animals↗
PubMed1997

[Raising a radial flap with primary wound closure by prefabrication of split skin fascia flaps].

A disadvantage of the radial forearm flap is the removal of skin from a functionally important and aesthetically exposed region. To minimize the donor site morbidity with this flap, we have thus far used a two-phase procedure for intraoral defect coverage in 15 patients: In a first step, a 0.5-mm split thickness skin graft is transplanted to the forearm fascia and settles there over a period of 2 weeks. In step two, the prefabricated fascial-split thickness skin graft can be raised with complete preservation of the forearm skin and microsurgically transferred like a conventional radial forearm flap. We have obtained the following results with this procedure: (1) All skin grafts took completely on the forearm fascia. (2) Prefabricated fascial-split thickness skin flaps could be raised like conventional radial forearm flaps. (3) The very thin and moldable flaps were excellently suited for intraoral lining and showed complication-free healing. We conclude that tension-free, primary closure of the donor site can be achieved with minimal aesthetic and functional impairment.

Forearm↗