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PubMed1977

[3H]inositol incorporation into phosphatidyl-inositol in work-induced growth of rat muscle.

Unilateral tenotomy of the gastrocnemius muscle in normal rats caused rapid hyptertrophy of the soleus and plantaris muscles. The phospholipid content of hypertrophied muscles increased; the increase was proportional to the extent of hypertrophy and was distributed proportionally among the major phospholipid components. During the growth process, the hypertrophying muscles incorporated [3H]inositol into phosphatidyl-inositol more rapidly than did the contralateral, control limb muscles. The increased incorporation was evident 2 h after the operation and cannot be explained solely by an increased uptake of [3H]inositol. After growth had ceased, the incorporation of [3H]inositol into phosphatidyl-inositol gradually returned toward control levels. The increase in incorporation after tenotomy was prevented by simultaneous spinal section to abolish activity in the tenotomized limb muscles. By contrast, in rats that had been forced to swim for prolonged periods of time, there was no increased incorporation of [3H]inositol into phosphatidyl-inositol. It is concluded that the increased incorporation of [3H]inositol into phosphatidyl-inositol is related to increased muscle activity sufficient to produce compensatory hypertrophy.

Adaptation, Physiological↗
PubMed1980

Experimental strabismus in the kitten.

1. We have examined the relative roles of visual and nonvisual input to striate cortex cells in causing the breakdown of binocularity produced by brief periods of visual-axis misalignment in kittens. 2. In the first study, the binocularity of single neurons recorded from the striate cortex was assessed in kittens reared with either surgical or optical strabismus. Surgical strabismus was induced by performing a unilateral medial rectus tenotomy, and optical strabismus by means of goggles that held prisms of equal power before the two eyes with their bases oriented in opposite directions. The loss of functional binocular connections was of comparable severity in these two groups of kittens. Control kittens, reared wearing goggles containing prisms whose bases were oriented in the same direction, showed normal levels of binocularity. 3. In the second experiment, normal kittens were given a surgical strabismus at around 1 mo of age and kept in total darkness for 2 days, 2 wk, or 4 wk. Cortical binocularity was normal in these kittens. 4. Finally, a group of kittens was reared in the illuminated colony with a symmetric surgical strabismus (bilateral medial rectus tenotomy). These kittens suffered a severe loss in cortical binocularity that was comparable to that seen in control kittens reared with asymmetric (unilateral) strabismus. 5. We conclude that altered visual input caused by misregister of the images falling in the two eyes is necessary and almost certainly sufficient to cause breakdown of cortical binocularity in kittens exposed to brief periods of divergent strabismus and that, when strabismus is induced surgically, this loss of binocularity is not dependent on the symmetry of the surgical manipulation; we thus find no evidence for a special role of afferents from the extraocular muscles in producing this effect.

Animals↗
PubMed1995

Involvement of cochlear efferent pathways in protective effects elicited with binaural loud sound exposure in cats.

1. Studies in guinea pigs have shown that the crossed olivocochlear efferent [crossed olivocochlear bundle (OCB)] pathways can reduce the cochlear neural desensitization caused by loud sounds. In one experimental paradigm, binaural loud sound exposure produced less damage than did monaural exposure, and various tests confirmed that this could be attributed to the OCB. In contrast, a study in cats has shown no such protection from the OCB for binaural exposures. There are some methodological differences between the cat and guinea pig studies that could account for the difference. The present study was carried out to determine whether two factors, namely anesthetic or exposure frequency, could account for the difference. Experiments were carried out in cats using barbiturate anesthesia, as in the guinea pig experiments. 2. Using a unilateral middle ear muscle (MEM) tenotomy, it was confirmed that under Nembutal anesthesia the MEM did not affect the threshold losses to monaural or binaural exposure. However, comparing results for monaural versus binaural 11-kHz exposures, there were significantly less threshold losses to the binaural exposure, independent of the presence of the MEM. No such difference between monaural and binaural exposures was seen for 3-kHz exposures. 3. By employing unilateral surgical strategies such as MEM tenotomy and/or various brain stem incisions, it was confirmed that the protection with binaural compared with monaural 11-kHz exposure was due specifically to the OCB. In unilaterally deefferented animals, binaural 11-kHz exposure always produced lower threshold losses on the OCB-intact side than on the OCB-cut side, regardless of the status of the MEM. Brain stem cuts that affected other rostrally or laterally located structures but not the OCB produced similar threshold losses bilaterally after binaural exposure, and the losses were comparable with the protected levels seen in other cases with intact OCB and binaural exposure. These data confirmed that when using an exposure frequency very similar to that used in the guinea pig experiments, a protective OCB effect could be demonstrated in cats, as previously seen in guinea pigs. The MEMs appeared to be inactive in barbiturate-anesthetized animals and were not activated by 3-, 7-, or 11-kHz exposures at 100 dB SPL for 10 min. The companion manuscript demonstrates this same effect across a wider range of exposures.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed2006

Combined gaze-angle and vergence variation in infantile nystagmus: two therapies that improve the high-visual-acuity field and methods to measure it.

PURPOSE: To investigate the convergence-induced waveform and high-acuity-field improvements resulting from different therapies in two subjects with infantile nystagmus (IN) that was damped by convergence and to report a new finding in one of the subjects. METHODS: Infrared reflection was used to measure eye movements during fixation of targets at different gaze and convergence angles and the expanded nystagmus acuity function (NAFX) to evaluate the IN waveform's foveation quality at all fixation points. RESULTS: Recordings demonstrated that, at far, both subjects exhibited classic nulls (high NAFX values) with NAFX reduction at gaze angles lateral to the null. S1 was treated with prisms and S2 with surgery. When converged at near or at far with base-out prisms (S1) or after bimedial recession and bilateral tenotomy surgery (S2), NAFX was higher at both the null and lateral gaze angles; the null region was broadened. The longest foveation domain (gaze angles where the NAFX is within 10% of its peak) at near was three times wider than at far for S1 and two times wider after than before surgery for S2. The therapeutic improvement domain (gaze angles where the posttherapy NAFX is higher than pretherapy) was even broader. At fixed gaze angles in the central 20 degrees of gaze, S1's NAFX variation with vergence exhibited hysteresis, higher during divergence than convergence; S2 exhibited no hysteresis after surgery. CONCLUSIONS: Damping IN by means of convergence, induced either surgically or with prisms, broadened the range of gaze angles with higher foveation quality, mimicking the null-broadening effects of tenotomy. The discovery of vergence hysteresis may reflect pulley movement and might allow higher acuity, if a near point is transiently fixated just before a far target. The acuity domains provide new and more comprehensive evaluations of both pre- and posttherapy visual function than do primary-position acuity measurements, suggesting that high-visual-acuity fields should be included in clinical measures of visual function in nystagmus.

Adolescent↗
PubMed2004

Surgical correction of internal coxa saltans: a 20-year consecutive study.

PURPOSE: To report the complications associated with surgical correction of internal snapping hip. STUDY DESIGN: Retrospective review. METHODS: A review of 92 cases of internal coxa saltans (12 bilateral) from 1982 to 2002 was performed to identify complications following primary surgical correction. An inguinal approach was used for iliopsoas tendon fractional lengthening. The average follow-up time per patient was 5.4 years. RESULTS: A total of 40 complications occurred in 32 patients. Complications included persistent hip pain (n = 6), sensory deficit (n = 8), and hip flexor weakness persisting longer than 1 month (n = 3). Additionally, painful bursa formation (n = 1), hematoma requiring reexploration (n = 1), and superficial infection (n = 1) were noted. Some patients developed recurrent snapping after a 3-month snapping-free interval (n = 9), and some patients never had complete resolution of snapping and were considered failures (n = 11). Of these failures/recurrences, 8 patients had a second tenotomy with 4 failures. Two had a third tenotomy, with 1 failure. CONCLUSIONS: In this series, primary iliopsoas tendon lengthening in patients with internal coxa saltans was without any complication in only 60% of patients; however, overall patient satisfaction was 89%.

Adolescent↗
PubMed2006

Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization.

BACKGROUND: Postoperative subscapularis muscle insufficiency after open shoulder stabilization procedures represents an unrecognized condition. HYPOTHESIS: Primary and revision open shoulder stabilization using the inverted L-shaped tenotomy approach impairs subscapularis muscle recovery and affects final clinical outcome. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-five patients who underwent primary (group 1: n = 13; mean age, 36.5 years; follow-up, 48 months) or revision (group 2: n = 12; mean age, 34.2 years; follow-up, 52 months) open shoulder stabilization procedures were followed up clinically (clinical subscapularis tests and signs, Constant score, and Rowe score) and by magnetic resonance imaging (tendon integrity, defined muscle diameters, and signal intensity analysis [ratio infraspinatus/upper subscapularis muscle and infraspinatus/lower subscapularis muscle]). A third group (group 0) of 12 healthy volunteers served as a control. RESULTS: Clinical signs for subscapularis muscle insufficiency were present in 53.8% of cases in group 1 and 91.6% of cases in group 2. There were no significant differences between groups with regard to Constant and Rowe scores (P > .05). On magnetic resonance imaging, no complete tendon ruptures were found. The mean vertical diameter of the subscapularis muscle and the mean transverse diameter of the upper subscapularis muscle portion were significantly greater in group 0 than in group 1 and greater in group 1 than in group 2 (P < .05). The mean transverse diameter of the lower subscapularis muscle was comparable in all groups (P > .05). The signal intensity analysis revealed the infraspinatus/upper subscapularis muscle ratio was greater in group 0 than in group 1 and greater in group 1 than in group 2 (P < .05). The infraspinatus/lower subscapularis muscle ratio was lower in group 0 than in groups 1 and 2 (P < .05). CONCLUSION: Open shoulder stabilization using an inverted L-shaped tenotomy approach may lead to atrophy and fatty infiltration, particularly of the upper part of the subscapularis muscle, resulting in postoperative subscapularis muscle insufficiency. Revision procedures using the same approach may further compromise clinical subscapularis muscle function and structure. The lower portion of the subscapularis muscle seems to have a compensating effect that may, in addition to a meticulous capsulolabral reconstruction, account for the uncompromised overall clinical outcome.

Adult↗
PubMedDate not supplied

Adductor tendinitis and musculus rectus abdominis tendopathy.

Groin injuries are becoming more common today in soccer. Conservative treatment consisting of rest, physiotherapy, and medication yields favorable results in only 38% of the long-standing lesions. Operative treatment is indicated in selected cases. Better knowledge of the underlying pathology and a more accurate initial conservative treatment directed to the ethiopathogenesis could solve many of the problems. However, in our experience a simple subcutaneous adductor tenotomy and/or a rectus abdominis tenotomy in combination with a fasciaplasty was done successfully in 75 of 81 patients. There was no loss of power in this group of patients as measured and compared with a control group.

Abdominal Muscles↗
PubMed1993

Bunion correction using proximal Chevron osteotomy.

Fifty-one cases of moderate to severe bunion deformity with hallux valgus and metatarsus primus varus in 43 patients were treated by bunionectomy, proximal Chevron metatarsal osteotomy, lateral capsulotomy, adductor tenotomy, and lashing of first and second metatarsals together. The hallux valgus angle improved an average of 19 degrees from 33 degrees (mean) preoperatively to 14 degrees (mean) postoperatively. The intermetatarsal angle improved an average of 7.3 degrees from an average of 14 degrees preoperatively to an average of 6 degrees postoperatively. The position of the sesamoids was realigned to beneath the first metatarsal head and the metatarsal length remained essentially unchanged. Union occurred in 9 weeks (mean). No malunions occurred. Foot score profiles revealed a significant improvement in subjective evaluation from 69/100 preoperatively to 83/100 postoperatively with respect to pain, deformity, motion, disability, and cosmesis. Seventy-eight percent of patients had a good to excellent result. Improved subjective evaluations indicated that proximal Chevron osteotomy combined with bunionectomy, capsulotomy, tenotomy, and metatarsal lashing provides a reliable method with respect to stability, technical ease, low complication, and satisfactory surgical outcome for correction of moderate and severe bunion deformity, both as a primary and revision procedure.

Adolescent↗
PubMed1994

Treatment of the atypical lesser toe deformity with basal hemiphalangectomy.

Eighty-six lesser toe basal hemiphalangectomies were performed in 52 patients. The surgical technique included an oblique dorsal incision, resection of 8 mm of bone, and an extensor tenotomy. Minimum follow-up was 2 years (range 2-6/1/2 years). Sixty percent of the patients had total relief of pain. Twenty-nine percent stated that they would not have the surgery again, and we categorized these patients as dissatisfied. An extensor tenotomy increased the satisfaction rate and was found to decrease the radiographic sagittal angulation of the toe. The preoperative diagnosis was significant to the outcome of the surgery. Patients with metatarsophalangeal joint synovitis and rheumatoid toe deformities had high rates of satisfaction; those with transverse deviation, metatarsalgia, and hammertoes with metatarsophalangeal joint subluxation/dislocation had lower rates of satisfaction. Seventy percent of the dissatisfied patients were dissatisfied because of persistent flexion deformity of the PIP joint or pain under the metatarsal head. We now add a PIP fusion if any flexion deformity, even a mild deformity, is present at the PIP joint and a plantar metatarsal condylectomy for metatarsalgia.

Adult↗
PubMed1995

Treatment of symptomatic hammertoe with a proximal interphalangeal joint arthrodesis.

This study examined 76 consecutive patients (100 feet) treated by a single surgeon for both flexible and rigid hammertoes with a PIP arthrodesis using custom-machined drills, a peg cutter, and hole cutter, combined with an extensor tenotomy and dorsal capsulotomy. Forty-eight percent of patients were defined as satisfied without reservation, 37% were defined as satisfied with reservations, and 15% were defined as dissatisfied. The incidence of radiographic fusion was 95% (130/137 toes). The most common reasons for either reservation or dissatisfaction included incomplete pain relief, residual toe angulation, and prolonged shoe wear restriction in the postoperative period. Based upon the results of this study, the authors suggest that when using a peg and socket arthrodesis for hammertoe correction (1) there is a 95% rate of radiographic fusion, (2) patients over 65 years old be alerted to a diminished rate of satisfaction, and (3) a distal flexor tenotomy be considered in patients with a preoperative DIP flexion contracture.

Adult↗
PubMed1999

Open versus closed repair of the Achilles tendon: an experimental animal study.

This experimental animal study compared the healing patterns between open and closed treatments of Achilles tendon tenotomies. Twenty-four male New Zealand rabbits underwent tenotomy of the left Achilles tendon and were randomized into two groups, treated with either open surgical repair or closed management. After the death of the animal, the retrieved tendons were submitted for biomechanical and histological testing. The total elongation of the open treatment group was 9.5+/-1.0 mm compared with 21.2+/-3.4 mm for the closed treatment group (P = 0.008), and the regain of stiffness was 67.4+/-2.0% and 48.9+/-5.3%, respectively (P = 0.132). Histological evaluation demonstrated similar healing patterns in both groups.

Achilles Tendon↗
PubMed1986

Avascular necrosis in congenital hip dislocation. The significance of splintage.

Avascular necrosis is an iatrogenic complication of the treatment of congenital dislocation of the hip. In order to assess the incidence of this and other complications, we have reviewed a consecutive series of 211 children treated at some stage with the modified Denis Browne splint used in Adelaide. In 173 children treated with this splint alone for 238 subluxed or dislocated hips which were stable when reduced, six hips (2.5%) developed radiographic avascular necrosis, though there was progressive growth deformity in only one. There was a much higher incidence among cases treated for unstable reduction by tenotomy, plaster spica and then the splint, 20 of 33 hips (60.6%) showing radiographic signs, though only one led to progressive abnormality. Of seven patients treated by adductor tenotomy and the splint no case of avascular necrosis was encountered. In the whole series the incidence of significant long-term growth disturbance in children treated in this splint was 0.7%. The great majority of our cases of avascular necrosis were attributable to manipulation and plaster, not to the subsequent use of a splint.

Casts, Surgical↗
PubMed1988

Stabilisation of the hip in myelomeningocele. Comparison of posterior iliopsoas transfer and varus-rotation osteotomy.

Patients with myelomeningocele who had had surgery to stabilise the hip were reviewed; the results of the 106 operations in 88 patients were assessed. In the earlier part of the series there were 55 children who had 64 iliopsoas transfers; later in the series 33 children had 42 varus-rotation osteotomies combined with adductor tenotomy, anterior obturator neurectomy and psoas division. The technical results of both operations were satisfactory: following iliopsoas transfer only 19% of the hips were either dislocated or subluxated; the corresponding figure for the osteotomy was 12%. Thus varus-rotation osteotomy with psoas division, adductor tenotomy and anterior obturator neurectomy was at least as effective in stabilising the hip as iliopsoas transfer. Nevertheless 80% of the latter and 61% of the osteotomy patients relied on wheelchairs for mobility.

Child↗
PubMed1992

Closed division of the flexor tendon sheath for trigger finger.

Closed tenotomy was used to treat triggering of the fingers and thumb in 54 patients. In 56 digits the method was successful; in seven it was a simple matter to proceed to open tenotomy. With experience, the closed procedure can be completed within minutes without risk of damaging the digital nerves.

Adult↗
PubMed2006

The role of the Pirani scoring system in the management of club foot by the Ponseti method.

The Pirani scoring system, together with the Ponseti method of club foot management, was assessed for its predictive value. The data on 70 idiopathic club feet successfully treated by the Ponseti method and scored by Pirani's system between February 2002 and May 2004 were analysed. There was a significant positive correlation between the initial Pirani score and number of casts required to correct the deformity. A foot scoring 4 or more is likely to require at least four casts, and one scoring less than 4 will require three or fewer. A foot with a hindfoot score of 2.5 or 3 has a 72% chance of requiring a tenotomy. The Pirani scoring system is reliable, quick, and easy to use, and provides a good forecast about the likely treatment for an individual foot but a low score does not exclude the possibility that a tenotomy may be required.

Achilles Tendon↗
PubMed2006

Early results of a physiotherapist-delivered Ponseti service for the management of idiopathic congenital talipes equinovarus foot deformity.

We studied 24 children (40 feet) to demonstrate that a physiotherapist-delivered Ponseti service is as successful as a medically-led programme in obtaining correction of an idiopathic congenital talipes equinovarus deformity. The median Pirani score at the start of treatment was 5.5 (mean 4.75; 2 to 6). A Pirani score of > or =5 predicted the need for tenotomy (p < 0.01). Of the 40 feet studied, 39 (97.5%) achieved correction of deformity. The remaining foot required surgical correction. A total of 25 (62.5%) of the feet underwent an Achilles tenotomy, which was performed by a surgeon in the physiotherapy clinic. There was full compliance with the foot abduction orthoses in 36 (90%) feet. Continuity of care was assured, as one practitioner was responsible for all patient contact. This was rated highly by the patient satisfaction survey. We believe that the Ponseti technique is suitable for use by non-medical personnel, but a holistic approach and good continuity of care are essential to the success of the programme.

Achilles Tendon↗
PubMed1993

Scanning electron microscopy of tenotomized soleus muscles of the rat.

The effects of tenotomy on the surface morphology of muscle fibers including myotendinous junctions in the rat soleus muscle were studied by scanning electron microscopy (SEM). Using potassium hydroxide (KOH) and collagenase, the extracellular materials were successfully removed to expose the surface of muscle fibers. When the soleus muscle was tenotomized at both proximal and distal ends, virtually all muscle fibers showed marked alterations of the fiber surface characterized by the formation of numerous transverse grooves and folds along their length. Narrow longitudinal grooves and folds of the sarcolemma were also observed. At myotendinous junctions, the fiber ends showed an over-all rounded shape with several short sarcoplasmic processes, indicating that the processes were significantly retracted. These changes were clearly recognizable at 5 days after tenotomy, and most apparent at one week. Thin-section electron microscopy of the same SEM samples demonstrated that such folding of the sarcolemma was not directly related to the sarcomere pattern of the underlying myofibrils, suggesting that, once formed, the folds and grooves were retained for a certain period of time. At 2 and 3 weeks the surface morphology of the fibers underwent a recovery process of restoring the smooth surface on which the cross-striations of the underlying myofibrils were seen. At the fiber ends, sarcoplasmic processes regrew into slender, wavy and short forms. Such sarcoplasmic processes were greater in number and more elaborate than those in the control muscle. At 5 and 6 weeks the fiber surface resumed an almost normal morphology, except that the sarcoplasmic processes at the fiber end were still shorter and more numerous than those in the control. These observations support our previous results obtained by thin-section electron microscopy that the myotendinous junction undergoes a series of morphological changes of collapse and regrowth of the sarcoplasmic processes, reflecting changes in the underlying myofibrils. In conclusion, the changes in the surface morphology of tenotomized muscle fibers were well correlated chronologically to those of myofibrils such as the central core lesion.

Animals↗
PubMed2001

Formation of unique vacuoles in tenotomized rat soleus muscle fibers.

The formation of unique vacuoles in tenotomized rat soleus muscle fibers was examined by light and electron microscopy. After tenotomy at both proximal and distal tendons, virtually all muscle fibers underwent characteristic degenerative changes with a disorganization of myofibrils called the central core lesion, but eventually recovered. At 3 days after tenotomy, some muscle fibers showed small vacuoles in the sarcoplasm of the end segments, which were larger in diameter and paler in staining than those of the control fibers in light microscopy. At 5 days, more fibers formed larger vacuoles together with the extensive disorganization of myofibrils. Such vacuole formation was more conspicuous in the distal end than in the proximal end. At 1 week the myofibrillar disorganization was most extensive in the central areas, and vacuoles were considerably enlarged in some fibers to occupy most of the sarcoplasm near the fiber ends. Vacuoles decreased in number and size with time and could rarely be seen at 4 weeks postoperative. In thin-section electron microscopy, the early forms of vacuoles were often connected with the T-system tubules. The limiting membrane of such vacuoles possessed many caveolae, some of which appeared to be continuous with the T-system networks. The vacuole membrane was closely associated with the sarcoplasmic reticulum to form dyadic connections. In later stages, the vacuole membrane was lined in part with the basal lamina. From these findings, it can be concluded that the vacuoles are sarcolemmal in nature and derived from the T-system. The significances of the vacuole formation are discussed with special reference to the mechanism and fate of the vacuoles and their clinical implications.

Animals↗