[Study on compensatory muscular hypertrophy after tenotomy of the synergists].
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Fifty-five patients who, in a twenty-eight-year period, had been managed with a biterminal open release because of congenital muscular torticollis, were re-examined at an average of fifteen years and a minimum of five years after the operation. Forty-eight patients reported no functional or cosmetic impairment. Palpable soft-tissue strands remained in twenty-nine patients, but bending toward the untreated side was limited more than 10 degrees in only one patient. The rate of recurrence was 2 per cent. Facial asymmetry improved or resolved in more than one-half of the patients. We recommend that biterminal release be performed at the age of three to five years in all patients who do not respond to non-operative treatment.
Tenotomized turtle muscles exhibited some changes similar to those found in mammalian tenotomized muscles. These changes included presence of small rounded and angulated fibres with high oxidative reaction, acute necrosis of fibres with degenerative changes, perivascular cellular reaction, phagocytosis and the atrophy of all 3 types of fibres. In contrast to mammalian tenotomized muscles, no decrease in PAS positive material and phosphorylase activity was noticeable. Also, the central core fibres and nemaline rods were absent in tenotomized turtle muscles.
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This manuscript describes a clinical entity caused by hyperextension of the interphalangeal joint of the hallux and a corrective procedure performed percutaneously through a 3-mm. incision. A discussion of local anatomy, patient selection, and contraindications is included. Proper pre-operative assessment is stressed.
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