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Biomedical subjects

M A Keenan

Publications and source records attributed to M A Keenan.

At least 19 recordsLinked to original sources
PubMed2000

The relation between lower extremity strength and shoulder overuse symptoms: a model based on polio survivors.

OBJECTIVE: To determine the relation between lower extremity weakness and shoulder overuse symptoms among polio survivors. We predicted that individuals with moderate weakness in their leg extensor muscles would use their arms to help compensate for this weakness and would be at high risk for developing symptoms of shoulder overuse. DESIGN: A cohort study of polio survivors recruited from the Einstein-Moss Postpolio Management Program (Philadelphia), the community, and the surrounding region. SETTING: A research laboratory at Moss Rehabilitation Research Institute, Philadelphia, PA. PARTICIPANTS: One hundred ninety-four polio survivors. Demographic and medical history data, symptom data, and strength data were obtained for each. MAIN OUTCOME MEASURES: Presence or absence of shoulder symptoms and ratings of pain by visual analogue scale were recorded. Strength was measured using a hand-held dynamometer and manual muscle testing. RESULTS: Shoulder symptoms could be grouped into two distinct clusters based on the type of testing used for assessment. Symptoms elicited by palpation were present in 26% of the subjects and were strongly related to knee extensor strength and weight. These symptoms were more common among women than men (42% and 10%, respectively). Symptoms elicited by resistance tests were present in 33% of the subjects and were seen with equal frequency in both sexes. These symptoms were also related to lower extremity strength, but the specific relationship was not as clear as for the palpation-related symptoms. CONCLUSIONS: Lower extremity weakness predisposes individuals to shoulder overuse symptoms. Sex and body weight are contributing factors. These results may be generalized to other populations with lower extremity weakness, including the elderly.

Adult↗
PubMed2000

Changes in strength over time among polio survivors.

OBJECTIVE: To study changes in the strength of different muscle groups in polio survivors over a period of approximately 9 months. DESIGN: Longitudinal study. SETTING: Moss Rehabilitation Research Institute. PARTICIPANTS: One hundred twenty subjects (57 men, 63 women) were studied on three occasions, each 3 to 5 months apart. Subjects were recruited through the Einstein-Moss Post-Polio Management Program. newspaper advertisements, and polio support groups. MAIN OUTCOME MEASURES: Isometric strength of 30 muscle groups (16 in upper extremities, 14 in lower extremities) was measured, using a hand-held dynamometer. RESULTS: Data were analyzed in two separate groups: upper-extremity muscles and lower-extremity muscles. Results for the upper-extremity muscles revealed evidence of a significant deterioration in strength. The amount of deterioration differed among muscles and increased with age. There was also evidence of deterioration in strength in the flexor muscles in the ankle, hip, and knee. However, the rate of deterioration in these muscles was not strongly related to age, time since polio, gender, symptom status, or history of residual weakness. CONCLUSIONS: Strength is deteriorating among polio survivors at a rate higher than that associated with normal aging. This deterioration is not occurring in the extensor, or so-called "weight-bearing" muscles, but is occurring in many of the upper-extremity muscle groups and in the flexor muscles in the lower extremities.

Adult↗
PubMed1999

Improving calf muscle strength in patients with spastic equinovarus deformity by transfer of the long toe flexors to the Os calcis.

The split tibialis anterior tendon transfer (SPLATT), Achilles tendon lengthening, and toe flexor release are proven and effective procedures for correcting a spastic equinovarus deformity of the foot. Paresis is a prominent feature of upper motoneuron syndrome. Lengthening the Achilles tendon, although necessary to correct the equinus, further weakens the gastrocnemius-soleus muscle group. The calf paresis commonly results in the need for an ankle-foot orthosis (AFO) during ambulation. Previous studies have shown that despite the correction of the equinovarus deformity, only one third of patients were able to ambulate without an AFO. The need for continued use of an AFO was because of insufficient calf strength to stabilize the tibia during late stance when the body mass is anterior to the ankle joint. This study prospectively evaluated the results of transfer of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) to the os calcis in 30 patients. The transfer was done in an effort to augment the strength of the gastrocnemius-soleus muscle complex. Twenty-five patients in group I (the control group) underwent SPLATT, Achilles tendon lengthening, and toe flexor release. Thirty patients in group II (the study group) underwent the identical procedures plus the additional FHL and FDL transfer to the os calcis. Postoperatively, the varus and toe flexion deformities were corrected in all feet. In group II, two feet had a mild residual equinus that did not interfere with ambulation. Of the 11 patients who were not independent community ambulators in group I, 7 (64%) improved ambulatory status by at least one level after surgery. Of the 15 patients who were not independent community ambulators in group II, 14 (93%) improved ambulatory status by at least one level after surgery. In group I, 10 of 25 (40%) of the patients were brace free at follow-up. In group II, 21 of 30 (70%) were brace free at follow-up (c2, P =.025). These results indicate that the addition of an FHL and FDL transfer to the os calcis at the time of SPLATT, Achilles tendon lengthening, and toe flexor release improves calf strength and allows greater increase in function and less reliance on orthotics.

Achilles Tendon↗
PubMed1998

Volkmann's ischemic contracture of the upper extremity.

Upper extremity deformity of ischemic contracture usually includes elbow flexion, forearm pronation, wrist flexion, thumb flexion and adduction, digital metacarpophalangeal joint extension, and interphalangeal joint flexion. Treatment of mild contractures consists of either nonoperative management with a comprehensive rehabilitation program (to increase range of motion and strenght) or operative management consisting of infarct excision or tendon lengthening. Treatment of moderate-to-severe contractures consists of release of secondary nerve compression, treatment of contractures (with tendon lengthening or recession), tendon or free-tissue transfers to restore lost function, and/or salvage procedures for the severely contracted or neglected extremity.

Arm↗
PubMed1996

Correction of severe spastic flexion contractures in the nonfunctional hand.

The superficialis to profundus transfer has been a time-honored treatment of spasticity in nonfunctional hands, but it does not address the many associated problems. Fourteen patients were treated with 15 procedures (1 bilateral) designed to relieve severe flexion contractures of the hand and wrist over a 3-year period with a single-stage comprehensive surgical correction consisting of superficialis to profundus transfer, wrist flexor release, flexor pollicis longus lengthening, wrist arthrodesis, carpal tunnel release, and ulnar motor branch neurectomy or intrinsic release. For all, nonoperative treatment had failed or there were chronic skin problems. The follow-up period averaged 1 year. In 13 of 15 patients, there was wrist fusion after the index procedure, with 1 patient requiring replating and another uniting after prolonged casting. Two patients had a residual claw hand with only partial correction of a thumb-in-palm deformity. All preoperative hygiene problems and infections resolved. The comprehensive protocol allowed correction of severe contractures of the hand and wrist by a single operation with improved care and appearance of the hand.

Arthrodesis↗
PubMed1993

Skin surface pressures under short leg casts.

Electronic sensors were used to measure skin surface pressures beneath plaster and fiberglass short leg casts. Pressures were recorded after casting, univalving, bivalving, and spreading of casts. Fiberglass resulted in significantly higher pressures than plaster. Beneficial effects of bivalving and cast spreading are confirmed by significant pressure drops. Application of casts by different orthopaedic surgeons and technologists showed pressure differences due to operator technique. However, fiberglass pressures again proved to be significantly greater than those caused by plaster. Excessive pressure beneath casts can cause skin ulceration, and results confirm the need for extreme care, especially when using fiberglass. It is suggested that plaster is safer than fiberglass when significant extremity swelling is likely or when a patient's skin is more vulnerable to breakdown.

Calcium Sulfate↗
PubMed1992

Deep-venous thrombosis of the upper extremity after traumatic brain injury.

Deep-venous thrombosis (DVT) of the lower extremity occurs frequently in a variety of patients, including those with traumatic brain injury (TBI), during their rehabilitation. Thrombosis of the major veins of the upper extremity is believed to be relatively rare, although it has increased in recent years due to the routine use of indwelling percutaneous central venous catheters. Upper extremity pain and swelling in a TBI patient is commonly attributed to heterotopic ossification, reflex sympathetic dystrophy, or occult fracture. Clinicians may not consider DVT in the differential diagnosis. No longer regarded as a benign disorder, we report the successful outcome in a 27-year-old with TBI who developed an upper extremity DVT after subclavian catheterization. The diagnostic findings, as well as treatment recommendations are reviewed.

Adult↗
PubMed1991

Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis.

To investigate the cause of valgus deformity of the hindfoot in patients who have rheumatoid arthritis and to characterize the effects of the deformity on gait, two groups of patients were evaluated clinically, radiographically, and with gait analysis in the laboratory. Group 1 consisted of seven patients who had seropositive rheumatoid arthritis and normal alignment of the feet and Group 2, of ten patients who had rheumatoid arthritis and valgus deformity of the hindfoot. In Group 2, the disease was of longer duration and the feet were more painful than in Group 1. There was no evidence of muscular imbalance, equinus contracture, valgus deformity of the tibiotalar joint, or isolated deficiency of the tibialis posterior (such as weakness, tenosynovitis, or rupture of the tendon) that could have contributed to the development of the valgus deformity. In the patients who had valgus deformity, quantitated electromyography demonstrated that the intensity and duration of activity of the tibialis posterior was significantly increased, apparently in an effort to support the collapsing longitudinal arch of the foot. Gait studies revealed decreases in velocity, stride length, and single-limb-support time, as well as delayed heel-rise in both groups, but the decreases were more marked in the patients who had valgus deformity. The results of this study suggest that valgus deformity of the hindfoot in rheumatoid patients results from exaggerated pronation forces on the weakened and inflamed subtalar joint. These forces are caused by alterations in gait secondary to symmetrical muscular weakness and the effort of the patient to minimize pain in the feet. Radiographs also suggested an association between the valgus deformity of the feet and valgus deformity of the knees in patients who have rheumatoid arthritis.

Adult↗
PubMed1990

Carpal tunnel syndrome secondary to wrist and finger flexor spasticity.

Ten patients with spastic wrist flexion deformities secondary to traumatic brain injury were evaluated for carpal tunnel syndrome. The angle of wrist flexion deformity averaged 75 degrees (range, 58 to 115 degrees). Nerve conduction studies demonstrated prolonged median motor and/or sensory latencies in all patients. Preoperative wick catheter measurements of carpal tunnel pressures in eight patients averaged 11 mm Hg in the resting position, 21 mm Hg in maximal wrist flexion, and 15 mm Hg in maximal extension. Each patient had carpal tunnel release with simultaneous wrist and finger flexor tendon releases or lengthenings. At surgery nine of the median nerves were constricted at the proximal edge of the transverse carpal ligament. The presence of normal carpal tunnel pressures and impingement of the median nerve at the proximal edge of the transverse carpal ligament indicates that the chronically flexed posture of the wrist resulted in median nerve compression, and this condition may be aggravated by underlying pressure from the spastic finger flexors.

Adolescent↗
PubMed1990

Percutaneous phenol block of the musculocutaneous nerve to control elbow flexor spasticity.

Twenty-three extremities in 17 brain-injured adults were prospectively studied to evaluate the effectiveness of percutaneous phenol blocks of the musculocutaneous nerve in controlling spasticity of the biceps and brachialis muscles. Twenty-one (93%) of the extremities improved after the initial injection. The mean resting position decreased from 120 degrees of flexion to 69 degrees. Elbow range of motion increased an average of 53 degrees. There were no complications. Two patients did not respond to the initial injection and required repeat nerve blocks. Concomitant phenol motor point block of the brachioradialis muscle further improved elbow motion. The mean duration of the block was 5 months. Follow-up averaged 21 months. This study indicates that percutaneous phenol injection of the musculocutaneous nerve provides reliable, temporary relief of spasticity in patients with potential for further neurologic improvement.

Adolescent↗
PubMed1990

Dynamic electromyography to assess elbow spasticity.

Control of elbow motion was evaluated in 45 extremities of adults with spasticity resulting from traumatic brain injury with use of dynamic electromyography. Simultaneous recording of elbow motion was obtained using a double parallelogram goniometer. Thirty-four male and 9 female patients were studied. Mean elbow flexion was 85 degrees and mean extension was 20 degrees. The average time of elbow flexion was 1.8 seconds. Extension time was prolonged to a mean of 4.0 seconds. Dynamic electromyography revealed a consistent pattern of muscle activity. Severe spasticity was noted in the brachioradialis muscle. Moderate spasticity was present in the biceps and only mild spasticity was seen in the brachialis muscle. Normal phasic muscle activity was the rule in the triceps. All patients had active elbow flexion, but the flexor spasticity limited smooth extension. Elbow flexor spasticity, especially of the brachioradialis and biceps muscles, commonly interferes with hand placement. Lengthening of the biceps and brachialis tendons combined with release of the brachioradialis enhances elbow motion and improves hand placement.

Adolescent↗
PubMed1990

Acquired limb loss in patients with traumatic brain injury.

The outcome associated with long-term prosthetic use was evaluated in 12 patients who had a dual disability of severe traumatic brain injury and an extremity amputation. The incidence and nature of complications after limb loss was also reviewed. The 12 patients sustained 15 extremity amputations. Lower extremity amputations were the most common disability. Fifty percent of the patients had at least one postoperative complication after amputation. All patients (100%) had at least one complication documented on rehabilitation admission. No patient was using a prosthesis at the time of rehabilitation admission. At discharge six patients were able to use a prosthesis. Only one patient was considered independent. Patient follow-up averaged 28.6 months. At long-term follow-up six patients were using a prosthesis. Four were considered independent. One-third of the total group was considered able to use the prosthesis independently in the community. Of the lower extremity amputated population, only 40% became ambulatory. This is considerably less than can be expected to become ambulatory if there was no amputation. All three upper extremity amputees did not use a prosthesis. All efforts should be directed at salvaging a limb threatened by amputation after survival of traumatic brain injury. Early transfer to a facility specializing in traumatic brain injury rehabilitation may decrease complications, reduce total hospitalization and improve overall functional ability.

Adolescent↗
PubMed1990

The treatment of spastic planovalgus foot deformity in the neurologically impaired adult.

The surgical correction of 14 feet with spastic planovalgus in the neurologically impaired adult is reviewed. Evaluation of the patterns of lower extremity muscle activity preoperatively by dynamic EMG showed overactivity of the peroneus longus. A new gait pattern which has not been previously reported was observed. This "combination foot" deformity, noted in six patients, consists of equinovarus in swing, and planovalgus in stance during the gait cycle. The remaining eight patients exhibited planovalgus in swing and stance. Transfer of the peroneus longus tendon to either the cuboid or navicular was performed in seven (50%) patients. Release of the peroneus longus was performed in four (29%) patients. Two patients had Z-lengthening of the peroneus longus, and tenodesis of the peroneus longus to posterior tibialis was performed in one patient. The mean postoperative follow-up time was 34.6 months. All feet were plantigrade. Ten (71%) feet were balanced. Four (29%) feet were improved. There were no failures or complications. Thirteen patients were able to ambulate independently after surgery and one patient continued to require only stand-by-assistance secondary to balance problems. No patient decreased in ambulation level. Seven (64%) of the 11 patients who required bracing, preoperatively became brace free. Peroneus longus was found to be the major deforming force in spastic planovalgus. Release, transfer, or tenodesis of the peroneus longus is effective in correcting planovalgus.

Adult↗