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PubMed1983

Partial selective denervation in spastic palsies (hyponeurotization).

Treating spastic palsies is a difficult problem. Hyponeurotization is a technique in which peripheral nerves are partially and selectively denervated to diminish spasm in muscles, hence reducing spasticity and tenseness so inimical to movement. Hyponeurotization can be performed in all spastic patients who are capable of cooperating. It should be avoided in cases of athetosis and brain impairment. Partial denervation is employed to reduce spasm; tenotomies, tendon lengthening, and myoectomy are employed to increase length in retracted muscles. Secondary surgery is usually required to further correct the spasm after the "adoption" phenomenon is complete. The results with hyponeurotization have been good in a high percentage of cases in which the surgery strictly adhered to basic principles.

Humans↗

PubMed2004

Enhanced neuromuscular transmission efficacy in overloaded rat plantaris muscle.

To better understand the effect of muscle hypertrophy on the physiological properties of transmitter release, we investigated neuromuscular transmission (NMT) efficacy in overloaded rat plantaris muscle in situ. In the overload group, following bilateral tenotomy of plantaris synergists, rats were confined to wheel-cages. Age-matched rats in the control group were confined to plastic cages. During the terminal experiment, muscle action potentials were blocked using micro-conotoxin, and full-sized endplate potentials (EPPs) were recorded at 25, 50, and 75 HZ to determine their amplitude rundown. Quantal contents for the control and overload groups were 37.0 and 74.3, respectively (P <0.01). There was a significant group difference in EPP amplitude rundown at all frequencies examined, with increased rundown occurring in the overload group (P < 0.01). Cumulative quantal release was 139% and 153% higher in the overload group at 25 and 50 HZ, respectively (P < 0.05). Together, these data suggest the safety factor for NMT is increased by neuromuscular overload. Furthermore, these findings support and supplement previously reported activity-dependent improvements in NMT efficacy that are probably mediated via presynaptic adaptations.

Action Potentials↗

PubMedDate not supplied

"Snapping bottom": subluxation of the tendon of the long head of the biceps femoris muscle.

Subluxation of the tendon of origin of the long head of the biceps femoris muscle (or snapping bottom) is a rare, previously unreported degeneration of the tendinous attachments of the muscle at the ischial tuberosity. It occurs in a patient who wears out this attachment through a lifetime of hyperflexion hip movements, such as are required in bending to reach the floor. The snapping of the tendon across its point of origin causes pain and swelling in the buttock. In the older nonathlete, if conservative measures fail, the treatment of choice is simple tenotomy. The condition should not be confused with weaver's bottom (ischiogluteal bursitis), even though it may be a cause for that bursitis.

Aged↗

PubMed1988

Adaptation of skeletal muscle to immobilization in a shortened position.

This study determined the morphological changes and adaptations that occur following immobilization of rat soleus and gastrocnemius muscles when the ankle joint is placed in complete plantar flexion for 2, 5, 7, 14, 21, and 28 days by means of plaster casts. Previous studies of such shortened muscles have shown that the number of sarcomeres in series is reduced, but how the sarcomeres are reduced has not been determined. We observed that the fibers in the mid-belly region of the muscles demonstrated a progressive degenerative process over the first few weeks. Myofibrils across the entire width of the affected fibers underwent dissolution. However, by 4 weeks new myofibrils were being formed, and sarcomere lengths appeared normal. Portions of the fibers near the tendon underwent segmental necrosis. These findings are similar to the response of the soleus and gastrocnemius muscles to tenotomy and are clinically relevant to orthopedic procedures that maintain muscles in shortened conditions for prolonged periods.

Adaptation, Physiological↗

PubMed1992

Active muscle length reduction progressively damages soleus in hindlimb-suspended rabbits.

This study describes the morphologic changes in rabbit soleus muscle following hindlimb suspension (HS) for 1 to 4 weeks (group A); or following HS with hindfeet passively dorsiflexed, by means of an elastic band, for 1 to 2 weeks (group B). In the latter, elastic band use allowed phasic contractions of foot extensor muscles against resistance and prevented 35% chronic soleus shortening, which occurred in group A animals. In group A, the soleus revealed progressive muscle atrophy and myofibrillar damage. Myofibrils underwent dissolution, muscle regeneration was ineffective, and adipose tissue developed from about 2-week suspension onward. Conversely, passive dorsiflexion of unloaded hindfeet was essential in maintaining mass and structural muscle integrity in the soleus of group B. It is hereby demonstrated that HS-induced soleus damage in the rabbit is progressive, and can be prevented, avoiding long-term shortening of soleus and its phasic unloaded contractions. Soleus sensitivity to unloading conditions, such as HS, tenotomy, and hypogravity, may depend on the particular physiology of this tonic antigravity muscle, engaged mainly in developing long-lasting isometric contractions in a stretched length.

Animals↗

PubMed1993

Cartilage and bone formation in repairing Achilles tendons within diffusion chambers: evidence for tendon-cartilage and cartilage-bone conversion in vivo.

Rodent Achilles tendons were subjected to midpoint tenotomy and allowed to recover for various times in situ before the operated tissue was removed, placed into a Millipore diffusion chamber, and inserted intraperitoneally into syngeneic hosts. Diffusion chambers were then removed at weekly intervals, such that the total time after the operation (i.e., time allowed to recover in situ plus time within the diffusion chamber) was up to 8 weeks, and examined histologically. Ectopic cartilage was produced within the diffusion chamber after a total of 4 weeks but only if the first 2 weeks of recovery were in situ. With increasing time, calcified cartilage, osteoid, and bone were also observed. Overall, the evidence suggests that the cartilage forms via a direct conversion from tendon tissue and that the bone may form as a result of differentiative changes of hypertrophic chondrocytes.

Achilles Tendon↗

PubMed1986

Club-foot through the centuries.

This is a study of the history of club-foot from ancient times up to the present. It embraces not only the clinical aspects of the deformity but also its social implications, particularly of its early history when the attitude of society towards the lame and crippled in general and to foot deformities in particular is discussed. Relevant references from Greek mythology and also from the Old Testament are quoted. A close study is made of the old Chinese custom of foot-binding which produced club-foot like deformities which became a symbol of social standing. Inevitably, like most other medical conditions, club-foot has been well described by Hippocrates and it is a sobering thought that his concepts of causation and his principles of treatment are as valid today as they were 2300 years ago. This paper also briefly describes club-foot in history and art. Encouraged by society's compassionate approach towards the cripple, famous painters of the 17th century produced sympathetic portraits of the deformed and the club-footed. Well-known personalities who suffered from club-foot, such as Lord Byron and Sir Walter Scott, are mentioned and it is shown how the deformity affected them. The saga of the physician and surgeon W.J. Little, himself afflicted by club-foot, is unfolded. His life was dedicated to the study and relief of his own deformity and later he devoted his efforts towards the cure of his fellow sufferers. W.J. Little has done so much for the advancement of orthopaedic surgery that Sir Robert Jones called him the father of orthopaedic surgery; yet at heart W.J. Little was a physician! Another physician, Nicholas André, deserves the title of father of orthopaedic surgery. He coined the word 'orthopaedia' and laid down the principles of preventing and correcting deformities and he detailed the conservative management of club-foot. The treatment of the deformity came into the hands of bone setters and instrument makers and it was almost beneath the dignity of a surgeon to treat it. Yet, with the advent of tenotomy, popularised by Little, surgical treatment of the condition increased, aided by the development of antiseptic and aseptic technique and anaesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1990

[Effect of a calcium inhibitor, verapamil, on the development of heterotopic ossifications. An experimental study in rats].

After division of the tendo achilles in rats heterotopic bone forms in the muscle and in the tendon stumps. Tenotomy was performed in 26 male rats. Thirteen received Verapamil (36 mm/Kg) for six days per week for five months, and the remainder were not given this drug. The onset of heterotopic ossification was monitored by monthly x-rays. After five months the animals were killed and the sectioned tendons examined microscopically. The radiographs had shown that the amount of ossification was less in rats treated with Verapamil. This was confirmed at microscopy, but examination of the sections under polarised light showed that the ratio of lamellar to woven bone was the same in the two groups. Verapamil appeared to reduce the amount of heterotopic bone formation but did not influence the substitution of woven by lamellar bone.

Achilles Tendon↗

PubMed1995

Palliative operations for painful old Perthes' disease.

Thirty-one adults with painful old Perthes' disease were treated by subcutaneous adductor tenotomy and cheilectomy of the femoral head with the aim of increasing abduction and rotation of the hip. In addition, multiple drilling was carried out to decompress the femoral head, and muscle-pedicle bone grafting to improve the circulation and repair the necrotic bone. Follow up was from 38 to 120 months. Pain was relieved in every case and movement improved in most. There were 14 excellent, 12 good, 4 fair and one poor result.

Adolescent↗

PubMed1981

Connective tissue changes in surgically overloaded muscle.

The effects of overload on the connective tissue component of the soleus muscle of the rat have been investigated. Three weeks after tenotomy of its synergistic muscles the soleus underwent considerable increase in weight. This was shown to have resulted from an increase in size of the predominant fibre type. Whilst occasional groups of fibres appeared to have resulted from the splitting of large single fibres, there was not significant increase in the number of fibres in cross-section of the muscle belly. The connective tissue content of the overloaded muscles was investigated using both histological and biochemical techniques. It was found that muscle fibre hypertrophy was accompanied by an increase in the connective tissue component. Furthermore, there was an increase in the proportion of collagen to muscle fibre tissue.

Animals↗

PubMed1985

Convergent strabismic amblyopia in cats.

Experiments were carried out to determine the effects of different types of experimental strabismus on the acuities of retinal ganglion cells. Six kittens were raised from twenty-one days of age with an esotropia surgically induced by myectomy of the lateral rectus muscle and a large portion of the superior oblique muscle. The results are compared with those, previously reported, from five other cats also made esotropic, but by tenotomy of the lateral rectus. All animals tested behaviourally were amblyopic in the strabismic eye. For square wave gratings, the visual acuities were 1.0 to 2.5 cyc/deg through the strabismic eye compared with 6.0 to 7.5 cyc/deg through the non-deviating eye. The cut-off spatial frequencies were determined for 132 brisk sustained cells from five of the myectomized strabismic cats. There was a loss of approximately 20% in cut-off spatial frequency when compared with both normal and tenotomized cats. A correlate of the physiologically observed difference between the tenotomized cats and the myectomized cats was also found in the morphology of cells in the lateral geniculate nucleus. The tenotomized cats showed no evidence of cell shrinkage in laminae receiving a projection from the amblyopic eye whereas in the myectomized cats large differences were observed in cell cross-sectional areas between laminae receiving input from the amblyopic eye and those receiving input from the non-deviating eye. Together, these findings indicate that the presence of a neural deficit in the retina of strabismic cats is associated with the actual removal of extra-ocular muscle and probably has little to do with the optical quality of images arriving at the retina.

Accommodation, Ocular↗

PubMed1984

Contracture of the adductor pollicis and the first dorsal interosseous muscles.

Trauma, infection, local injections and even acupuncture may cause fibrosis of the muscles of the first web space of the hand, leading to severe malposition and loss of function of the thumb and index finger. The authors present the anatomical basis for the deformity and the results of surgical treatment by tenotomy or tendon lengthening in 120 hands in 79 patients. Operation produced an excellent result in the majority of cases and the outcome was independent of the severity of the deformity or the duration of the condition.

Adolescent↗

PubMed1985

The anatomy of the dysplastic hip in cerebral palsy related to prognosis and treatment.

The development of dysplasia of the hip in cerebral palsy has been studied in 292 hips in children. The rate of migration of the hip has been defined, and gave a very early indication of the prognosis for the dysplasia. A close relationship was also found between the early radiographic changes and the functional locomotor anatomy. By reviewing the initial radiographs the need for early treatment and its adaptation to the future locomotor potential of the child can be assessed. Treatment is usually by musculotendinous releases and is especially effective in early recentering of the femoral head, but this method is ineffective in correcting bone dysplasia, particularly acetabular obliquity, which starts at around the age of 30 months. It is preferable to anticipate its development by early tenotomies which are much better tolerated than pelvic osteotomy in spastic children.

Cerebral Palsy↗

PubMed1985

Effect of work-induced hypertrophy on muscle glucose metabolism in lean and obese mice.

The effect of work-induced hypertrophy (without any concomitant change in circulating parameters) on skeletal muscle metabolism was studied in lean mice and in gold-thioglucose-obese mice. Soleus muscle was functionally overloaded in one leg by tenotomy of gastrocnemius muscle 4 days before muscle isolation, muscle in the other leg being used as control. Basal deoxyglucose uptake and glycolysis were markedly increased in overloaded muscles compared with control muscles, together with a ten-fold increase in fructose 2-6 bisphosphate content. In the presence of maximally effective insulin concentrations, deoxyglucose uptake and glycolysis were identical in overloaded and control muscles of lean mice, while the effects of overload and insulin were partly additive in muscles of gold-thioglucose-obese mice. The sensitivity to insulin and insulin binding to muscles were not modified in overloaded muscles. Insulin-stimulated glycogenogenesis was decreased by about 50% probably due to a lower amount of glycogen synthase in overloaded than in control muscles. Thus, in muscles of gold-thioglucose-obese mice work-induced hypertrophy increased the response to maximal insulin concentrations without modifying the altered insulin sensitivity and decreased insulin binding.

Animals↗

PubMed1980

Capillary density of tenotomized skeletal muscles. II. Observations on human muscles after spontaneous rupture of tendon.

Alterations in the capillary density of the M. biceps brachii was studied in 20 cases during 2 months after spontaneous rupture of the tendon. The fiber typing was done using succinic dehydrogenase and myofibrillar ATP-ase at pH 9.4 for the staining, the capillaries were visualized with alkaline phosphatase and PAS reactions, and in each case 1,000 muscle fibers with their capillaries were estimated. In the intact muscles the capillary count ranged from 1,500 to 1,910 (mean 1,740) per 1,000 fibers. During the 1st month following the rupture the decrease in the capillary count of the muscle occurred rapidly, being after 4-7, 8-10, and 18-29 days 36%, 52%, and 66%, respectively, as compared to the contralateral muscles. After 2 months a decrease of approx. 70% was found in the amount of capillaries compared with the contralateral muscles. The obliteration of the capillaries was particularly pronounced in the amount of anastomoses. These results indicate that the capillary supply of the human M. biceps brachii decreases enormously during the 1st month after a tenotomy.

Adult↗

PubMed1997

Diagnostic and therapeutic strategies for the operative treatment of radiohumeral epicondylopathy.

We examined the extent and effect of an assumed neuromuscular transmission disorder by performing a prospective clinical study on 75 patients with therapy-resistant radiohumeral epicondylopathy. Before operating, we diagnosed with electromyography an increased rate of polyphasic potentials of the long wrist extensors as well as a prolonged motor latency of the respective muscles. Disordered neuromuscular recruitment combined with a reduced maximum strength and elasticity corresponding to the suspected damage to the distal part of the motor neuron could be proven. Both effects were significantly reversible (P < 0.001) through operative intervention. We found a significant correlation (> 0.90) between the normalization of the motor latency and increased strength. Subgroups were formed according to different preoperative diagnostic efforts and differing radicality regarding the type of soft-tissue operation performed; thus, the clinical validity of the findings diagnosed in the anatomical/ electrophysiological part of the study was additionally examined. The failure rate varied between 10% and 30%, depending on the radicality of the tenotomy, which could be interpreted as a general indication for a complete extensor carpi radialis brevis tendon release. In this connection it is remarkable that the clinical result of electromyographically localized damage in the area between the epicondyle and arcade of Frohse could not be improved through open neurolysis. Dealing with strictures located on the proximal side of the epicondyle on the other hand, this technique seems to play an important role in the recurrence prophylaxis.

Activities of Daily Living↗

PubMed1984

Delayed diagnosis of a spontaneous atlanto-axial rotatory dislocation.

Without any known specific cause a 3-year-old boy developed a torticollis. Although the symptoms were treated immediately there was no improvement. Four months later X-rays showed that the dens-atlas distance was enlarged. In spite of this, he was treated by tenotomy and intensive physiotherapy, but the torticollis remained. Two years later a tomogram and a CT showed a complete rotatory dislocation between atlas and axis. At this stage it was impossible to treat the original cause. Physiotherapy was continued to improve the position of the head.

Atlanto-Axial Joint↗

PubMed1986

The influence of indomethacin on tendon healing. A biomechanical and biochemical study.

The influence of indomethacin on the biomechanical and biochemical properties of tendons during their healing was investigated. In 68 New Zealand White rabbits a transverse tenotomy followed by repair with a criss-cross suture was performed in the plantaris longus tendon of the left hind limb. The leg was immobilized for 4 weeks postoperatively in a long-leg plastic splint. Half of the animals were treated with indomethacin, 10 mg/kg/day orally, and the other half with placebo. After 4, 8, and 16 weeks of treatment the animals were killed and biomechanical and biochemical parameters were measured. After 16 weeks there was a significant increase in tensile strength in the indomethacin group. There were only small biochemical differences between the groups. However, there was a slight but significant decrease in the amount of soluble collagen in the indomethacin group. This may indicate a higher degree of cross-linkage following indomethacin treatment, which might explain the increased tensile strength.

Animals↗