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Muscle function studies in amputated lathyritic rats.

This study is presented to compare two methods of evaluating changes in muscle function after amputation of the left leg at the knee. Rats were fed a 50% Lathyrus odoratus diet, which causes exostoses to develop at sites of attachment of certain muscles. The rats were on the experiment for 3, 6, or 9 weeks. Muscles of rats killed at 6 weeks were weighed to determine whether atrophy or hypertrophy had occurred. Sizes of exostoses were evaluated subjectively at each time period. The left adductor longus and quadratus femoris muscles underwent considerable atrophy and their exostoses were smaller than on the right side. The left iliopsoas increased in weight and had the larger exostosis. However, the left pectineus increased in weight but had the smaller exostosis. It is concluded that changes in muscle weights and changes in sizes of exostoses both reflect changes in muscle function, but because the two methods respond by different mechanisms, the results do not always agree.

Amputation, Surgical↗

Computed tomography and magnetic resonance imaging of affected muscle in childhood acid alpha-glucosidase deficiency: a case report.

A 13-year-old boy with the juvenile type of acid alpha-glucosidase deficiency is presented. Muscle CT scans performed before muscle biopsy revealed high image density over the entire rectus femoris, and partial high density over the iliopsoas, adductor magnus and tibialis anterior. MRI of the rectus femoris in the transaxial plane showed high image intensity over the entire length of the muscle in both T1- and T2-weighted images. A biopsy revealed a surprising histological difference between the rectus femoris, which showed pronounced vacuolar myopathy with excessive glycogen, and the vastus lateralis, in which deposition of glycogen was minimal and the CT image indicated a normal muscle density. The findings in this case suggest that CT scanning and MRI are useful in recognizing muscle involvement in acid alpha-glucosidase deficiency, which is characterized by images of increased density compared to normal muscle, presumably because excessive deposition of glycogen and lysosomal membranes cause high X-ray absorption on CT and high signal intensity on MRI.

Adolescent↗

[Bursa iliopectinea--size and morphology].

The size of the iliopsoas bursa is usually larger than its size described in textbooks of anatomy. Proximally the synovial bursa lies on the pectineal eminence of the superior pubic ramus, passes across the front of the capsule of the hip joint and extends distally downwards almost as far as to the lesser trochanter. Only the tendon of the psoas major muscle is normally an immediate relation to the bursa. In 13% of all cases the iliopsoas bursa is partly separated by a septum into 2 cavities. Here the tendon of the psoas major muscle passes over the medial chamber and the tendon of the iliac muscle runs over the lateral chamber. With regard to modern diagnostic techniques (computer tomography, magnetic resonance-tomography) the results are significant for the differential diagnosis of inflammatory processes in hip joints.

Aged↗

Evaluation of the influence of muscle deactivation on other muscles and joints during gait motion.

When any muscle in the human musculoskeletal system is damaged, other muscles and ligaments tend to compensate for the role of the damaged muscle by exerting extra effort. It is beneficial to clarify how the roles of the damaged muscles are compensated by other parts of the musculoskeletal system from the following points of view: From a clinical point of view, it will be possible to know how the abnormal muscle and joint forces caused by the acute compensations lead to further physical damage to the musculoskeletal system. From the viewpoint of rehabilitation, it will be possible to know how the role of the damaged muscle can be compensated by extra training of the other muscles. A method to evaluate the influence of muscle deactivation on other muscles and joints is proposed in this report. Methodology based on inverse dynamics and static optimization, which is applicable to arbitrary motion was used in this study. The evaluation method was applied to gait motion to obtain matrices representing (1) the dependence of muscle force compensation and (2) the change to bone-on-bone contact forces. These matrices make it possible to evaluate the effects of deactivation of one of the muscles of the musculoskeletal system on the forces exerted by other muscles as well as the change to the bone-on-bone forces when the musculoskeletal system is performing the same motion. Through observation of this matrix, it was found that deactivation of a muscle often results in increment/decrement of force developed by muscles with completely different primary functions and bone-on-bone contact force in different parts of the body. For example, deactivation of the iliopsoas leads to a large reduction in force by the soleus. The results suggest that acute deactivation of a muscle can result in damage to another part of the body. The results also suggest that the whole musculoskeletal system must go through extra retraining in the case of damage to certain muscles.

Adaptation, Physiological↗

Adaptive control for backward quadrupedal walking. II. Hindlimb muscle synergies.

1. To compare the basic hindlimb synergies for backward (BWD) and forward (FWD) walking, electromyograms (EMG) were recorded from selected flexor and extensor muscles of the hip, knee, and ankle joints from four cats trained to perform both forms of walking at a moderate walking speed (0.6 m/s). For each muscle, EMG measurements included burst duration, burst latencies referenced to the time of paw contact or paw off, and integrated burst amplitudes. To relate patterns of muscle activity to various phases of the step cycle, EMG records were synchronized with kinematic data obtained by digitizing high-speed ciné film. 2. Hindlimb EMG data indicate that BWD walking in the cat was characterized by reciprocal flexor and extensor synergies similar to those for FWD walking, with flexors active during swing and extensors active during stance. Although the underlying synergies were similar, temporal parameters (burst latencies and durations) and amplitude levels for specific muscles were different for BWD and FWD walking. 3. For both directions, iliopsoas (IP) and semitendinosus (ST) were active as the hip and knee joints flexed at the onset of swing. For BWD walking, IP activity decreased early, and ST activity continued as the hip extended and the knee flexed. For FWD walking, in contrast, ST activity ceased early, and IP activity continued as the hip flexed and the knee extended. For both directions, tibialis anterior (TA) was active throughout swing as the ankle flexed and then extended. A second ST burst occurred at the end of swing for FWD walking as hip flexion and knee extension slowed for paw contact. 4. For both directions, knee extensor (vastus lateralis, VL) activity began at paw contact. Ankle extensor (lateral gastrocnemius, LG) activity began during midswing for BWD walking but just before paw contact for FWD walking. At the ankle joint, flexion during the E2 phase (yield) of stance was minimal or absent for BWD walking, and ankle extension during BWD stance was accompanied by a ramp increase in LG-EMG activity. At the knee joint, the yield was also small (or absent) for BWD walking, and increased VL-EMG amplitudes were associated with the increased range of knee extension for BWD stance. 5. Although the uniarticular hip extensor (anterior biceps femoris, ABF) was active during stance for both directions, the hip flexed during BWD stance and extended during FWD stance.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Physiological↗

Magnetic resonance signal alterations in the acute onset of heterotopic ossification in patients with spinal cord injury.

The purpose of our study was to evaluate magnetic resonance (MR) signal characteristics of acutely forming heterotopic ossification (HO) in paralyzed patients. Fourteen patients with spinal cord injury (female n=2, male n=12, mean age 38.3 years) and acute onset of radiographically proven HO had contrast-enhanced 1.5-T MRI within 13.4+/-18.3 days of clinical onset of symptoms. MR signal alterations of affected muscles, fascia, subcutaneous tissue, skin and adjacent bone were evaluated. A diffuse T2-hyperintense signal of multiple muscle groups was seen in all patients (bilateral in 12) involving quadriceps (n=13, 93%), adductors (n=13, 93%) and iliopsoas (n=12, 86%) with contrast enhancement in n=11 (79%), n=8 (57%) and n=8 (57%) patients. All patients had nonenhancing areas (mean size 2 x 3.5 x 5.8 cm) within diffusely enhancing muscles. HO formation occurred around these nonenhancing areas in four patients with computed tomography follow-up. Other MR findings included fascial edema (n=14, 100%), fascial enhancement (n=13, 93%), subcutaneous edema (n=13, 93%), subcutaneous enhancement (n=12, 86%), bone marrow edema (n=5, 36%), and joint effusion (n=12, 86%). MRI reveals mostly bilateral edema and enhancement of muscles, fascia and subcutaneous tissue during acute onset of HO. HO develops in the periphery of well-defined areas of no enhancement.

Adolescent↗

The adult hip: an anatomic study. Part II: the soft-tissue landmarks.

A comprehensive anatomic, pathologic, and radiographic study was undertaken to define reliable soft-tissue landmarks about the hip. Methodology included an analysis of 300 "normal" adult hip radiographs, tissue maceration, cadaveric intra-articular injection studies and review of selected clinical cases. Results, when applied to clinical situations, indicate: (a) The iliopsoas and "capsular" fat planes are poor indicators of small to moderate amounts of intra-articular fluid in the adult. (b) The "capsular" fat plane is not associated with the joint capsule, but in fact is a fat plane between two muscle bundles anterior to the articulation. (c) Distinct soft-tissue planes are available for dissemination of fluid from the hip joint. These include the iliopsoas bursa, which may distend in association with articular disease, and the fat plane of the obturator externus muscle.

Hip↗

Surgical prevention of paralytic dislocation of the hip in cerebral palsy.

Paralytic dislocation of the hip in cerebral palsy may be prevented by soft tissue surgery and the results of two procedures are reported. Twenty hips were treated by adductor tenotomy alone and this was unsuccessful in every case. An alternative method was carried out in 42 hips in 25 patients. The procedure combined adductor tenotomy with release of the hip muscles including iliac crest resection, tenotomy of the rectus femoris, recession of the iliopsoas and, when necessary, either release or transposition of the knee flexors. This was much more successful in decreasing migration of the femoral head.

Adolescent↗

[Compartment syndrome of the pelvis].

In the pelvic region three major compartments (gluteus medius-minimus, gluteus maximus and iliopsoas) can be distinguished from the smaller compartment of the tensor fasciae latae muscle. Pelvic compartment syndromes are rare. A clear history of trauma is often lacking. Association with drug and alcohol abuse is common as well as an association with the widespread use of anticoagulant therapy. From 1982 to 1988 six acute buttock compartment syndromes were treated in the Trauma Department of Hannover Medical School. In five patients fasciotomy of the gluteal compartment was performed. Two patients with a compartment syndrome secondary to necrotising fasciitis died of septic multiple organ failure. The mean follow-up of the four other patients was 29 months (7-48 months). Three of these four patients revealed a decrease of gluteal muscle volume. Ergometric tests showed a decrease in gluteal muscle strength in all patients.

Adolescent↗

Influence of head constraint and muscle forces on the strain distribution within the intact femur.

The aim of this study was to analyse the influence of muscle action and a horizontally constrained femoral head on the strain distribution within the intact femur. The strain distribution was measured for three loading configurations: joint reaction force only, joint reaction force plus abductors, and joint reaction force plus the abductors, vastus lateralis and iliopsoas. In each case the strains were recorded from 20 uniaxial strain gauges placed on the medial, lateral, anterior and posterior aspects of the proximal femur. Application of the abductor muscle force produced a marginal decrease in the strain levels on all aspects of the femur as compared with the joint reaction force alone. This is in contrast with previous studies which have simulated an unconstrained femoral head. The inclusion of vastus lateralis and iliopsoas further reduced the strain levels. A horizontally constrained femoral head produces smaller variation in the strain levels when muscle forces are applied. In vivo data, demonstrating negligible movement of the femoral head in one-legged stance, support the results of this study and suggest that in the absence of comprehensive muscle force data, a constrained femoral head may provide a more physiologically relevant loading condition.

Elasticity↗

The pelvic compartment syndrome.

In the pelvic region three major compartments (gluteus medius-minimus compartment, gluteus maximus compartment, and iliopsoas compartment) can be distinguished from the smaller compartment of the tensor fasciae latae muscle. Pelvic compartment syndromes are rare. A clear history of trauma is often lacking. Association with drug and alcohol abuse is common, as is the association with the widespread use of anticoagulant therapy. From 1982 to 1990 six patients with acute buttock compartment syndrome were treated in the Department of Trauma Surgery of Hannover Medical School. In five patients fasciotomy of the gluteal compartment was performed. Two patients with a compartment syndrome secondary to necrotizing fasciitis died of septic multiple organ failure. The mean follow-up of the four other patients was 29 months (7-48 months). Three of these four patients revealed a decrease of gluteal muscle volume. Ergometric tests showed a decrease in gluteal muscle force in all patients.

Adolescent↗

Paralytic hip instability in poliomyelitis.

A retrospective study was made of the results of surgical treatment of subluxation or dislocation of the hip in patients who had suffered from poliomyelitis. Good results were achieved in 46% and satisfactory results in 24%. The key factors for success are muscle balance, the femoral neck-shaft and anteversion angles, and the acetabular geometry. Iliopsoas transfer can augment the hip abductor power by an average of one MRC grade. Varus derotation femoral osteotomy is important to re-establish a normal neck-shaft angle and anteversion. The results of pelvic osteotomy are variable and the importance of a posterior acetabular defect is emphasised.

Acetabulum↗