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PubMed1997

Organization of lumbosacral motoneuronal cell groups innervating hindlimb, pelvic floor, and axial muscles in the cat.

In a study on descending pathways from the nucleus retroambiguus (NRA) to hindlimb motoneurons (see accompanying paper), it appeared impossible, using data from the literature, to precisely determine which muscles were innervated by the motoneurons receiving the NRA fibers. This lack of data made it necessary to produce a detailed map of the lumbosacral motoneuronal cell groups in the cat. Therefore, 50 different muscles or muscle compartments of hindlimb, pelvic floor and lower back were injected with horseradish peroxidase (HRP) in 135 cases. The respective muscles were divided into ten groups: I, sartorius and iliopsoas; II, quadriceps; III, adductors; IV, hamstrings; V, gluteal and other proximal muscles of the hip; VI, posterior compartment of the distal hindlimb; VII, anterior compartment of the distal hindlimb; VIII, long flexors and intrinsic muscles of the foot; IX, pelvic floor muscles; and X, extensors of the lower back and tail. The L4-S2 segments were cut and incubated, and labeled motoneurons were counted and plotted. A new method was developed that made it possible, despite variations in size and segmental organization between the different cases, to compare the results of different cases. The results show that the spatial interrelationship between the hindlimb and pelvic floor lumbosacral motoneuronal cell groups remains constant. This finding enabled the authors to compose an accurate overall map of the location of lumbosacral motoneuronal cell groups. The general distribution of the motoneuronal cell groups is also discussed in respect to their dorsoventral, mediolateral, and rostrocaudal position within the lumbosacral ventral horn.

Animals↗

PubMed2001

Proprioceptive modulation of hip flexor activity during the swing phase of locomotion in decerebrate cats.

This study examined the influence of proprioceptive input from hip flexor muscles on the activity in hip flexors during the swing phase of walking in the decerebrate cat. One hindlimb was partially denervated to remove cutaneous input and afferent input from most other hindlimb muscles. Perturbations to hip movement were applied either by 1) manual resistance or assistance to swing or by 2) resistance to hip flexion using a device that blocked hip flexion but allowed leg extension. Electromyographic recordings were made from the iliopsoas (IP), sartorius, and medial gastrocnemius muscles. When the hip was manually assisted into flexion, there was a reduction in hip flexor burst activity. Conversely, when hip flexion was manually resisted or mechanically blocked during swing, the duration and amplitude of hip flexor activity was increased. We also found some specificity in the role of afferents from individual hip flexor muscles in the modulation of flexor burst activity. If the IP muscle was detached from its insertion, little change in the response to blocking flexion was observed. Specific activation of IP afferent fibers by stretching the muscle also did not greatly affect flexor activity. On the other hand, if conduction in the sartorius nerves was blocked, there was a diminished response to blocking hip flexion. The increase in duration of the flexor bursts still occurred, but this increase was consistently lower than that observed when the sartorius nerves were intact. From these results we propose that during swing, feedback from hip flexor muscle afferents, particularly those from the sartorius muscles, enhances flexor activity. In addition, if we delayed the onset of flexor activity in the contralateral hindlimb, blocking hip flexion often resulted in the prolongation of ipsilateral flexor activity for long periods of time, further revealing the reinforcing effects of flexor afferent feedback on flexor activity. This effect was not seen if conduction in the sartorius nerves was blocked. In conclusion, we have found that hip flexor activity during locomotion can be strongly modulated by modifying proprioceptive feedback from the hip flexor muscles.

Animals↗

PubMed1993

[A case of carbamazepine-induced lupus with myositis].

This is the report with muscle disorder associated carbamazepine (CBZ)-induced lupus. A 39-year-old female had been treated with CBZ 400 mg per day for 2 years because of complex partial seizure. In November, 1992 laboratory studies showed elevation of serum CK, IgG and titers of antinuclear antibody. Physical examination on admission revealed muscle weakness of neck flexors and iliopsoas but no rash or arthralgia. The electromyography showed myogenic change in the right biceps. CBZ was discontinued and replaced by zonisamide. Prednisolone 40 mg daily was started and the patient steadily improved. In the literature, there have been a few cases with muscle symptoms in CBZ-induced lupus, but muscle involvement with highly elevated CK associated with CBZ-induced lupus has not been reported.

Adult↗

PubMed1990

[Computed tomography of skeletal muscles in myotonic muscular dystrophy].

The computed tomography (CT) of skeletal muscles was performed on 12 patients with myotonic muscular dystrophy (MyD). We have sliced at seven levels; those are 1. neck level-at the level of thyroid cartilage 2. shoulder girdle level-at the level of upper edge of sternum 3. upper arm level-at the level of middle of upper arm 4. abdominal level-at the level of L3 vertebra 5. pelvic girdle level-at the level of middle inguinal ligament 6. thigh level-at the level of middle of thigh 7. lower leg level-at the maximum size level of lower leg. The characteristic changes of MyD are; the sternocleidomastoid muscles are most severely affected, and the paravertebral and straight abdominal muscles also tend to be severely atrophied with lower CT density. Concerning thigh levels, the deeply located muscles and muscles for extension are predominantly affected. At the lower leg levels, the calf muscles are severely affected. The muscles of levator scapulae, trapezius, psoas major, iliopsoas, gluteus, and tibialis posterior tend to be preserved. In the tight, the compensatory hypertrophy is observed often in the rectus femoris muscles and rarely in the gracilis muscles with the involvements of the agonist muscles. It might be also important to examine the changes of muscles as a whole and to know the grade of atrophy for planning the life style. The CT examination would be recommended by this standpoint.

Adult↗

PubMed1989

Inclusion body myositis. Observations in 40 patients.

Inclusion body myositis (IBM) was suspected on light microscopic grounds in 48 of 170 consecutive patients with inflammatory myopathies. One or more vacuoles containing membranous material, groups of atrophic fibres, and an autoaggressive endomysial inflammatory exudate occurred in 100, 96 and 92% of the muscle specimens. All three of these features were present in 88% of the specimens. Electron microscopy confirmed the presence of filamentous inclusions in 40 of 43 patients. The inclusions are typically near vacuoles and a minimum of three vacuolated fibres must be scrutinized to detect them with confidence. There is no electromyographic pattern that can reliably distinguish IBM from other inflammatory myopathies. The typical clinical features in the patients diagnosed by histological criteria as IBM were: insidious onset after age 50 yrs with painless, proximal lower extremity weakness; slow but relentless progression with selectively severe involvement of quadriceps, iliopsoas, tibialis anterior, biceps and triceps muscles; relatively early depression of the knee reflexes; and a normal or mildly elevated serum creatine kinase level. The male: female ratio was 3:1. Distal weakness occurred in about 50%, but only in 35% was it as great or greater than proximal weakness. Significant associated illnesses include other autoimmune disorders (15%), diabetes mellitus (20%), and diffuse peripheral neuropathy (18%). Prednisone treatment at dose levels frequently effective in polymyositis failed to prevent disease progression in those patients observed for 2 or more years. Our findings support the notion that IBM is a distinct entity in which a set of pathological features is associated with a constellation of clinical findings.

Adult↗

PubMed2003

Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome.

OBJECTIVE: Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. METHODS: We retrospectively reviewed the records of 38 patients who underwent laminectomy and lateral mass plating for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament between January 1994 and November 2001. Seventy-six percent of patients had spondylosis, 18% had ossification of the posterior longitudinal ligament, and 5% had both. Clinical presentation included upper extremity sensory complaints (89%), gait difficulty (70%), and hand use deterioration (67%). Spasticity was present in 83%, and weakness of one or more muscle groups was seen in 79%. Spinal cord signal abnormality on sagittal T2-weighted magnetic resonance imaging (MRI) was seen in 68%. Neurological evaluation was performed using a modification of the Japanese Orthopedic Association Scale for functional assessment of myelopathy, the Cooper Scale for separate evaluation of upper and lower extremity motor function, and a five-point scale for evaluation of strength in individual muscle groups. Lateral cervical spine x-rays were analyzed using a curvature index to determine maintenance of alignment. Each surgically decompressed level was graded on a four-point scale using axial MRI to assess the adequacy of decompression. Late follow-up was conducted by telephone interview. RESULTS: Laminectomy was performed at a mean 4.6 levels. Follow-up was obtained at a mean of 30.2 months after the procedure. The score on the modified Japanese Orthopedic Association scale improved in 97% of patients from a mean of 12.9 preoperatively to 15.58 postoperatively (P < 0.0001). In the upper extremities, function measured by the Cooper Scale improved from 1.8 to 0.7 (P < 0.0001), and in the lower extremities, function improved from 1.0 to 0.4 (P < 0.0002). There was a statistically significant improvement in strength in the triceps (P < 0.0001), iliopsoas (P < 0.0002), and hand intrinsic muscles (P < 0.0001). X-rays obtained at a mean of 5.9 months after surgery revealed no change in spinal alignment as measured by the curvature index. There was a decrease in the mean preoperative compression grade from 2.46 preoperatively to 0.16 postoperatively (P < 0.0001). There was no correlation between neurological outcome and the presence of spinal cord signal change on T2-weighted MRI scans, patient age, duration of symptoms, or preoperative medical comorbidity. CONCLUSION: Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.

Adult↗

PubMed1997

Lumbosacral plexus compression by fetus: an unusual cause of radiculopathy during teenage pregnancy.

A case is reported of a lumbosacral plexus compression by the fetus in a young 34-weeks pregnant woman, who had low-back pain and progressive muscular weakness of the leg. Neurological examination showed a grade IV motor weakness of the iliopsoas, quadriceps femoris and biceps femoris muscles. Mechanical stretch manoeuvers were negative. Electromyography revealed denervation activity in L4 and L5 muscles. Lumbosacral plexus radiculopathy was diagnosed. Although fetal compression appears to be an uncommon cause of lumbosacral radiculopathy during teenage pregnancy, both neurosurgeons and obstetricians should be aware of the possibility.

Adolescent↗

PubMed2002

An unusual case of electromyographic recorded myokymic potentials: a case report.

Abnormal spontaneous potentials, specifically myokymia, can occur from various causes. We present the case of a 64-year-old woman with a 12-month history of left leg weakness and difficulty descending stairs. The patients' medical history was significant for breast carcinoma (no node involvement), hypercholesterolemia, and vitamin B(12) deficiency. She previously had a modified radical mastectomy and received chemotherapy (5-flurouracil, methotrexate, Cytoxan [cyclophosphamide]), but received no radiation. She took simvastatin for hypercholesterolemia and received vitamin B(12) injections for her B(12) deficiency. She initially noticed her symptoms when she began taking simvastatin, and they were exacerbated when her dose was increased from 10 to 20mg/d. Electrodiagnostic studies were performed twice at a 6-month interval. Nerve conduction studies were normal, but the initial needle electromyography showed significant myokymic discharges in bilateral iliopsoas, adductor magnus, and left deltoid muscles. The second electromyograph had similar findings, except for the absence of myokymic discharges in the left deltoid muscle. The possible origins of these myokymic discharges are discussed.

Action Potentials↗

PubMed2003

A rare case of Salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.

We report the case of a 16-year-old female who was ultimately diagnosed with Salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.

Abscess↗

PubMed1984

Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan.

Results of animal experiments and then of clinical study of newborn infants suggested that the main mechanical factor causing hip dislocation is prolonged tension on the hamstrings and iliopsoas and that each of these muscles has a synergistic effect in the production of hip dislocation during the perinatal period. It was, therefore, presumed that the high incidence of congenital dislocation of the hip (CDH) in Japan might be due mainly to the Japanese tradition of forcibly maintaining the legs of infants in an extended position with a "swathing diaper." The incidence of CDH in Japanese infants prior to 1965 was as high as 1.1%-3.5%. In an attempt to reduce the incidence of CDH, examination of newborns was performed on a national scale. However, early screening methods for hip abnormalities were not adequately reliable in Japan to allow identification of conditions that would later become CDH. In 1975 a national campaign to avoid prolonged extension of the hips and knees of infants during the early postnatal period was initiated. As a result, there has been a remarkable reduction in the incidence of CDH in infants, to less than 0.2%.

Animals↗

PubMed1982

Operant control and cat locomotion.

An operant conditioning history can produce highly uniform kinematic performances by cats on a motor-driven treadmill, but in the present work there was additional stimulus control such that the animals moved smoothly backward or forward on the belt, "startled," or reached for a food tray at the front of the chamber. The resulting responses were filmed and EMG records were taken from VL (vastus lateralis, a knee extensor) or IP (iliopsoas, a hip flexor) or both muscles. Both ipsilateral and bilateral responses were observed, and sometimes the change was restricted to just one portion of the VL or IP activity, showing precise moment-to-moment control. Forelimb reaching caused an early VL burst prior to touchdown, which may help understanding of extensor bursts that "anticipate" the contact of a limb. In other cases, an absence of control of hindlimb events was the major finding. No evidence was gained for vestibular or neck reflexes, since there was no response to large isolated head or neck excursions. Also, an animal might complete a full hindlimb step without any VL activity. It was concluded that acquired stimulus control could bring about marked separations of functional subdivisions of the step cycle.

Animals↗

PubMed2004

Ultrastructural evidence for a direct excitatory pathway from the nucleus retroambiguus to lateral longissimus and quadratus lumborum motoneurons in the female golden hamster.

During mating, the female golden hamster displays a stereotyped specific receptive posture, characterized by lordosis of the back, elevation of the tail, and extension of the legs. Muscles involved in this posture are thought to be iliopsoas, cutaneus trunci, lateral longissimus (LL), and quadratus lumborum (QL). Lesion studies in rats suggest that mating behavior is controlled by the mesencephalic periaqueductal gray (PAG). The PAG does not project directly to the motoneurons innervating the muscles involved in mating, but is thought to make use of the nucleus retroambiguus (NRA) as relay. The NRA is located ventrolaterally in the most caudal medulla, and projects directly to iliopsoas and cutaneus trunci motoneuronal cell groups. The question is whether this is also true for LL and QL muscles. Retrograde HRP tracing experiments revealed that LL and QL motoneurons are located medially in the ventral horn of the T12-L6 and T13-L4 segments, respectively. A subsequent ultrastructural study combined wheatgerm agglutinin-conjugated horseradish peroxidase injections in the NRA with cholera-toxin B-subunit injections in LL and QL muscles. The results revealed monosynaptic contacts between anterogradely labeled NRA-fiber terminals with retrogradely labeled dendrites of both LL and QL motoneurons. Almost all these terminals had asymmetrical synapses and contained spherical vesicles, suggesting an excitatory function of this NRA-motoneuronal pathway. These results correspond with the hypothesis that in hamster the PAG-NRA-motoneuronal projection not only involves motoneurons of iliopsoas and cutaneus trunci but also of LL and QL.

Animals↗

PubMed1981

A surgical technique for hip disarticulation.

Hip disarticulation is usually elected for malignant bony and soft tissue tumors below the lesser trochanter of the femur. The operation is performed with the patient in a posterolateral position; in the first phase of the procedure the surgeon stands anterior to the patient. After incision of the skin and division of the femoral vessels and nerve, muscles of the anterior thigh are transected off the pelvic bone from lateral to medial starting with the sartorius and finishing with the adductor magnus. Muscles are divided at their origin except for the iliopsoas and obturator externus which are divided at their insertion on the lesser trochanter of the femur. The quadratus femoris muscle is identified and preserved, then the flexor muscles are transected at their site of origin from the ischial tuberosity. During the next phase the surgeon is posterior to the patient, and the pelvis is rotated from the posterolateral to the anterolateral position. After completion of the skin incision, the gluteal fascia, tensor fascia lata, and the gluteus maximus muscles are divided and dissected free of their posterior attachments to expose the muscles inserting by way of a common tendon onto the greater trochanter. These muscles are then transected at their insertion on the bone. The posterior aspect of the joint capsule is then exposed and transected. Finally, the sciatic nerve is divided and allowed to retract beneath the piriformis muscle. To close the wound the preserved muscles are approximated over the joint capsule and the gluteal fascia secured to the inguinal ligament over suction drains. The skin is closed with interrupted sutures.

Disarticulation↗

PubMed1999

Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression.

OBJECTIVES: We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms and functional results in patients with cervical spondylotic myelopathy who underwent anterior decompressive operations. Additionally, we sought to determine which findings had predictive value for surgical outcome. METHODS: We retrospectively reviewed the records of 76 patients with cervical spondylotic myelopathy caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion performed by one surgeon. The patients were evaluated postoperatively by office visits and/or telephone interviews. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. RESULTS: The most common preoperative symptoms were deterioration of hand use (75%), upper extremity sensory complaints (82.9%), and gait difficulties (80.3%). In the upper extremities, preoperative weakness was most common in the hand intrinsic muscles (56.6%) and triceps (28.9%), and in the lower extremities, preoperative weakness was most common in the iliopsoas (38.8%) and quadriceps (26.3%). In the lower extremities, individual muscle groups had strength improvement rates from 79.1 to 88.1 %; somewhat higher rates, from 81.3 to 90.9%, were observed in the upper extremities. When evaluated by using the Cooper myelopathy scale, lower extremity functional improvement occurred in 46.7% of the patients and upper extremity functional improvement in 75.4%. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale, was noted in 79.7% of the patients who had abnormal scores preoperatively. CONCLUSION: Strength improved at rates of approximately 80 to 90% in individual muscle groups after anterior cervical decompression. However, fewer than half of all patients experienced functional improvement in the lower extremities, a discrepancy that was probably caused by persistent spasticity rather than muscle weakness. Postoperative dysfunction in the upper extremities was caused by residual weakness as well as sensory loss. Recurrent symptomatic spondylosis at unoperated levels was calculated to occur at an incidence of 2% per year.

Adult↗

PubMed1989

[Critical observation of selected exercises of power training in relation to prevention of postural damage and physical handicaps].

Prevention of and compensation for muscular weaknesses in postural disorders and physical disability are priority tasks of physiotherapy. A range of typical exercises are therefore being used to strengthen weakened groups of muscles, some of them traditionally already included in school sports. Most therapy concepts primarily focus on muscle strengthening, without taking into consideration that it is crucial to redress muscular imbalances by stretching contracted muscle groups as well. Based on this experience, the effectiveness of several specifically modified exercises was tested, derived from the usual range of physiotherapy activities in strengthening very commonly weakened muscle groups, i.e. the abdominal, gluteal, sacrospinalis and shoulder-blade affixing musculature. To increase exercise effectiveness, training machines were used in addition. Stretching exercises were carried out initially, in terms of passive stretching with isometric pre-tension. The following muscle groups were stretched: rectus femoris m., iliopsoas m., pectoralis m., and lumbar sacrospinalis m. Altogether, 64 patients between age 16 and 27 were examined following training therapy, 58 patients presented pure postural disorders, 6 had slight cerebral movement disorders. Two almost equal study groups were formed, one (31 patients) receiving only gymnastic exercises, the other (33 patients) using training machines. The muscular situation was tested after 6 months by means of Janda's semiquantitative muscle-testing. For further objective assessment of therapy outcome, Neugebauer's 'back-index' was determined. Muscular harmony and spinal balance were found to have significantly improved in the second group who had used the training machines. A slight reduction of muscle spasticity in addition was found in the patients with cerebral movement disorders.

Adult↗

PubMed1980

Radicular innervation of hindlimb muscles of the rat.

In 20 adult rats under Nembutal anaesthesia ventral spinal roots L1-S1 were stimulated in turn and electromyographic responses were recorded from various hindlimb muscles; in addition, the motor and sensory radicular supply of the main hindlimb nerves was examined by their stimulation and recording from ventral and dorsal roots. After averaging the results of individual experiments, the following radicular innervation of different functional muscle groups was found: L2-L5 for hip flexors (iliopsoas), thigh adductors (pectineus, anterior gracilis, adductor magnus) and knee extensors (quadriceps femoris), L3-L6 for hip extensors (gluteal muscles), L3-L5 for knee flexors (biceps femoris, semitendinosus) and ankle flexors (anterior tibial) and L4-L5 for ankle extensors (triceps surae). The femoral nerve is supplied by L2-L5, the obturator nerve by L2-L4, the peroneal nerve by L4-L5 and the tibial nerve by L4-L6 spinal roots. Comparison of the ventral and dorsal roots which supplied a given nerve revealed that the radicular distribution of the afferent fibres in the nerve matched that of the efferent fibres. These results are, in general, in accordance with anatomical data in the literature. However, the radicular supply of some hindlimb muscles in the rat was found to be somewhat more extensive, when evaluated electrophysiologically, than that reported on the basis of anatomical dissection.

Animals↗

PubMed1995

[Iliopsoas tendinitis in athletes. Diagnosis and treatment].

Iliopsoas tendinitis is a common injury in sport. Despite of this there are only a few articles in the literature that deal with these injuries. The changes in the inflamed tendons and muscles have been difficult to determine objectively. The modernization of ultrasound devices has improved the methods of examination and made it possible to diagnose objective changes in the tendons and muscles. Recommendations for the treatment of acute and chronic iliopsoas tendinitis are given.

Adult↗

PubMed1986

Psoas muscle disorders: MR imaging.

Nineteen patients with evidence of psoas and iliopsoas abnormalities on computed tomographic (CT) scans (12 with metastases, three with lymphoma, two with hematoma, and two with abscess) were examined with magnetic resonance (MR) imaging. The abnormal psoas could be identified on both T1- and T2-weighted spin-echo images, although T2-weighted sequences provided better contrast. The psoas muscle can be affected by one of three mechanisms: total replacement, lateral displacement, or medial displacement. In four patients in whom the CT study showed apparent enlargement of a psoas muscle, subsequent MR imaging examinations demonstrated that the psoas muscle was compressed and displaced laterally by a paraspinal mass. MR images provided better contrast between the normal and abnormal psoas than CT scans in nine cases; MR images were inferior to CT scans in two cases because calcifications (one case) and air bubbles within an abscess (one case) were not detectable.

Abscess↗