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At least 397 records · Page 22Linked to original sources
PubMed2001

Use of ultrasonographic guidance in interventional musculoskeletal procedures: a review from a single institution.

We have evaluated the utility of ultrasonographic guidance for intervention in the musculoskeletal system. All interventional musculoskeletal procedures using ultrasonographic guidance performed at our institution from July 1998 through November 1999 were reviewed. Examinations were performed using either a linear or curved phased array transducer, based on depth and local geometry. The choice of needle was likewise optimized for specific anatomic conditions. One hundred ninety-five procedures were performed on 167 patients from July 1998 through November 1999. Thirty-one procedures had magnetic resonance correlation within 6 months beforehand. Excluding large-joint aspirations and injections, we found that 180 of the procedures were more readily performed using ultrasonography than any other imaging modality. These included therapeutic injections into tendon sheaths (biceps, flexor digitorum longus, posterior tibial, and iliopsoas), Morton's neuromas, plantar fascia, wrist ganglia, and tarsal tunnel cysts; peritendinous hamstring injections; and synovial cyst and muscle biopsies. In all cases, the target of interest was identified easily with ultrasonography, and needle position was documented readily. Also in all cases, aspiration or medication delivery to the site of interest was observed during real time and was documented on postprocedure images of the area. No significant complications (e.g., bleeding, infection, and neurovascular compromise) were encountered during or immediately after any procedure. Ultrasonography is a readily available imaging modality useful for guiding interventional procedures in the musculoskeletal system. The ability to document exact needle placement in real time confirms accurate placement of therapeutic injections, fluid aspiration, and soft tissue biopsies.

Adolescent↗
PubMedDate not supplied

Pathologic morphology of the dislocated proximal femur in children with cerebral palsy.

We describe the gross and microscopic anatomic changes in the hip that result from the deforming forces in children with neuromuscular imbalance. Twelve dislocated proximal femora that had been resected from children with spastic diplegia or tetraplegia were evaluated with respect to their gross, microscopic, and radiographic structure. The epiphyses were wedge shaped with deformation of the femoral head apparent in all cases. In addition to a severe loss of articular cartilage, a furrowed erosion of epiphyseal bone suggested a sustained, blunt, band-like force across the surface of the hip where it opposed the acetabular labrum. The underlying physis of the capital femur was irregular with aberrant histologic structure, whereas that of the lesser trochanter was hypertrophic and angulated in a superior and anterior direction. A significant degree of valgus was not noticeable in most specimens. In summary, the spastic adductor and iliopsoas, responsible for the changes in the lesser trochanter, work in conjunction with the hip flexor and internal rotator muscles to subluxate the proximal femur. In the process, the superior rim of the acetabulum and capsule causes focal deformation of the superolateral femoral head, creating a fulcrum upon which the hip then progressively subluxates. The indentation locks the femoral head at the lateral acetabular margin, preventing complete dislocation, but leading to bone pain consequent to cartilage erosion.

Adolescent↗
PubMed2006

Mechanical energetic contributions from individual muscles and elastic prosthetic feet during symmetric unilateral transtibial amputee walking: a theoretical study.

Energy storage and return (ESAR) foot-ankle prostheses have been developed in an effort to improve gait performance in lower-limb amputees. However, little is known about their effectiveness in providing the body segment mechanical energetics normally provided by the ankle muscles. The objective of this theoretical study was to use muscle-actuated forward dynamics simulations of unilateral transtibial amputee and non-amputee walking to identify the contributions of ESAR prostheses to trunk support, forward propulsion and leg swing initiation and how individual muscles must compensate in order to produce a normal, symmetric gait pattern. The simulation analysis revealed the ESAR prosthesis provided the necessary trunk support, but it could not provide the net trunk forward propulsion normally provided by the plantar flexors and leg swing initiation normally provided by the biarticular gastrocnemius. To compensate, the residual leg gluteus maximus and rectus femoris delivered increased energy to the trunk for forward propulsion in early stance and late stance into pre-swing, respectively, while the residual iliopsoas delivered increased energy to the leg in pre- and early swing to help initiate swing. In the intact leg, the soleus, gluteus maximus and rectus femoris delivered increased energy to the trunk for forward propulsion in the first half of stance, while the iliopsoas increased the leg energy it delivered in pre- and early swing. Thus, the energy stored and released by the ESAR prosthesis combined with these muscle compensations was able to produce a normal, symmetric gait pattern, although various neuromuscular and musculoskeletal constraints may make such a pattern non-optimal.

Amputation, Surgical↗
PubMed2005

Pitfalls in the use of acetabular reinforcement rings in total hip revision.

INTRODUCTION: For the reconstruction of acetabular bone defects different types of acetabular reinforcement rings are being used. In clinical practice, these implants showed to some extent good long-term results. In the present work pitfalls and complications after the implantation of acetabular reinforcement rings as well as possible solutions are being discussed. MATERIAL AND METHODS: In the first case recurrent dislocation was caused by the malposition of the acetabular component with an impingement of the protruding bone cement and the anterior edge of the acetabular ring as well as muscle insufficiency as a result of the shortening of the leg length. The second case revealed an impingement of the iliopsoas tendon due to a protruding acetabular reinforcement ring. During revision, bone cement was used to smoothen the protruding anterior edge of the acetabular reconstruction ring in order to obtain a relieved sliding of the tendon. Furthermore, we report on the case of a delayed neuropathy of the sciatic nerve after reconstruction of the acetabulum with an acetabular reinforcement ring. RESULTS: Intraoperatively an impingement of the sciatic nerve at the protruding dorsal edge of the acetabular reinforcement ring and the surrounding scar tissue was found. In a further case an aseptic loosening of an acetabular reinforcement ring caused the formation of an excessive granuloma with a large intrapelvic portion. The granuloma led to persisting senso-motoric deficits of the femoral nerve. In summary, based on these clinical cases possible pitfalls, associated with the use of acetabular reinforcement rings, are shown. The mal-positioning and the intra-operative re-shaping of the implant by the surgeon are pointed out as the substantial factors for the occurrence of an impingement phenomenon and total hip instability. Furthermore, in case of an adequate orientation of the cemented polyethylene insert an improper position of the acetabular ring which results in protruding edges has to be considered as a cause of a prosthetic impingement. CONCLUSION: The cases presented emphasize the necessity of prevention of such pitfalls intra-operatively as well as accurate analysis of implant failures. Furthermore, they suggest explicit preoperative planning before deciding on the strategy of revision surgery of acetabular reinforcement rings.

Acetabulum↗
PubMed1999

Variation of rotation moment arms with hip flexion.

Excessive flexion and internal rotation of the hip is a common gait abnormality among individuals with cerebral palsy. The purpose of this study was to examine the influence of hip flexion on the rotational moment arms of the hip muscles. We hypothesized that flexion of the hip would increase internal rotation moment arms and decrease external rotation moment arms of the primary hip rotators. To test this hypothesis we measured rotational moment arms of the gluteus maximus (six compartments), gluteus medius (four compartments), gluteus minimus (three compartments) iliopsoas, piriformis, quadratus femoris, obturator internus, and obturator externus. Moment arms were measured at hip flexion angles of 0, 20, 45, 60, and 90 degrees in four cadavers. A three-dimensional computer model of the hip muscles was developed and compared to the experimental measurements. The experimental results and the computer model showed that the internal rotation moment arms of some muscles increase with flexion; the external rotation moment arms of other muscles decrease, and some muscles switch from external rotation to internal rotation as the hip is flexed. This trend toward internal rotation with hip flexion was apparent in 15 of the 18 muscle compartments we examined, suggesting that excessive hip flexion may exacerbate internal rotation of the hip. The gluteus maximus was found to have a large capacity for external rotation. Enhancing the activation of the gluteus maximus, a muscle that is frequently underactive in persons with cerebral palsy, may help correct excessive flexion and internal rotation of the hip.

Biomechanical Phenomena↗
PubMed1978

Pelvic displacement osteotomy in young myelodysplastic patients with dislocatable hips.

This prospective study of the role that pelvic displacement osteotomy may have in the management of dislocatable hips in patients with myelomeningocele defines the technical points to be considered and gives preliminary results for ten hips in eight children. The procedure may salvage failed posterior iliopsoas transfers or, in patients not operated on previously, it may limit cephalad displacement of the femoral head. Both control of muscle imbalance and improvement of acetabular contour appear essential to a high rate of success in these patients. Eight of ten hips in this series were stable upon short-term review. All patients were less than 7 years of age.

Acetabulum↗