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At least 649 records · Page 36Linked to original sources
PubMed2005

Expression of SERCA2a is not regulated by calcineurin or upon mechanical unloading in skeletal muscle regeneration.

This study investigates to what extent the expression of the slow myosin heavy chain (MyHCI) isoform and the slow type sarcoplasmic reticulum Ca2+ ATPase (SERCA2a) isoform are co-regulated in fibers of regenerating skeletal soleus muscle. Both overexpression of cain, a calcineurin inhibitor, or partial tenotomy prevented the expression of MyHCI but left SERCA2a expression unaffected in fibers of regenerating soleus muscles. These data complement those from different experimental models and clearly show that the expression of MyHCI and SERCA2a--the major proteins mediating, respectively, the slow type of contraction and relaxation--are not coregulated in regenerating soleus muscle.

Animals↗
PubMed2005

An irreducible variant of intertrochanteric fractures: a technique for open reduction.

We report five cases of intertrochanteric fractures that needed open reduction after failed closed reduction techniques. In all cases the shaft fragment included the lesser trochanter, and there was a long spike on the head-neck fragment. This was evident clinically as the proximal shaft, pulled by the iliopsoas tendon, produced a swelling in front of the hip joint. Radiographically, the fracture was minimally comminuted. The anteroposterior view revealed upward riding of the shaft fragment, while lateral view showed the femoral shaft in front of the head and neck. We describe a three-step technique, which was applied for open reduction in these unusual cases. With the patient supine on a standard operating table, the fracture site was exposed. The limb was placed in full adduction and external rotation to slacken the iliopsoas tendon. A Hohmann retractor was then passed medial to the shaft and behind the fractured surface of the sunken femoral neck, levering it anteriorly. Traction in abduction and internal rotation was applied to complete the reduction. Additional iliopsoas tenotomy was performed in two patients. All cases were fixed with a dynamic hip screw and all fractures united uneventfully.

Aged↗
PubMed2004

Rectus muscle orbital wall fixation: a reversible profound weakening procedure.

INTRODUCTION: Surgical treatment of third nerve palsy, sensory exotropia and strabismus secondary to anomalous innervation of the rectus muscles, frequently require large rectus muscle recessions in an attempt to maintain alignment in the primary position and reduce the effects of misinnervation. The aim of this study was to describe and evaluate the results of inactivation of a rectus muscle by its attachment to the adjacent orbital wall. METHODS: Seven subjects diagnosed with third-nerve palsy (three cases), Duane syndrome (two cases), sensory exotropia (one case), and congenital aberrant innervation of vertical rectus muscles (one case) underwent rectus muscle inactivation by orbital wall fixation. The rectus muscle was disinserted from the globe and reattached to the adjacent orbital periosteum using non-absorbable sutures. This surgery was performed on the lateral rectus muscle in six subjects, and surgery was performed on both ipsilateral vertical rectus muscles in one. RESULTS: Postoperatively four of six patients were aligned within 12 prism diopters of orthotropia in primary position. All patients had improvement of the anomalous head posture. In Duane syndrome, lateral rectus inactivation markedly reduced co-contraction and globe retraction. No overcorrections resulted. CONCLUSION: A rectus muscle may be functionally inactivated when its insertion is attached to the orbital periosteum. Advantages of this procedure over extirpation and free tenotomy include permanent disinsertion of the muscle from globe and reversibility.

Adult↗
PubMed2005

Vocal process avulsion.

Vocal process avulsion is a rare complication of intubation or external laryngeal trauma that can cause significant dysphonia. The vocal process develops independently from the body of the arytenoid cartilage, which results in a fusion plane that is vulnerable to trauma. The findings of vocal process avulsion may be subtle, and the relationship of the vocal process to the body of the arytenoid cartilage must be examined closely. Stroboscopy is critical in the evaluation. We describe three cases of vocal process avulsion encountered by the senior author (R.T.S.) over the last 5 years and discuss our approaches to evaluation and treatment. All cases were repaired endoscopically. However, we used three different techniques. These include chemical tenotomy with botulinum toxin, closed reduction with fat injection, and open reduction via cordotomy.

Adipose Tissue↗
PubMed2005

Comparative study of the efficacy of the topical application of hydrocortisone, therapeutic ultrasound and phonophoresis on the tissue repair process in rat tendons.

The purpose of this study was to compare the treatment efficacy of topical application of hydrocortisone, therapeutic ultrasound (US) and phonophoresis on the rat's Achilles tendon (tendo calcaneus) repair process after tenotomy. The two treated groups with US were made in a pulsed mode. The irradiation of US was performed at a frequency of 1 MHz and an intensity of 0.5 W/cm2 (SATA), for 5 min each session. The tendons were analyzed using the polarized light microscopy. The results showed that the treated group with the topical application of hydrocortisone has not been delivered transdermally and that the molecule of collagen responds to the ultrasonic stimulation. The treatment with phonophoresis was the more efficient method. These findings allow us to conclude that the US stimulates the acceleration of tissue repair processes and induces the transdermal delivery of hydrocortisone in a therapeutic concentration on the tendon.

Achilles Tendon↗
PubMedDate not supplied

Aqueous vascular endothelial growth factor increases in anterior segment ischemia in rabbits.

Both long posterior ciliary arteries were occluded or the three extraocular muscles were tenotomized to produce anterior segment ischemia in rabbits, and the aqueous levels of vascular endothelial growth factor (VEGF) were measured. The occlusion of both long posterior ciliary arteries led to clinical and histological anterior segment ischemia in varying degrees. The aqueous VEGF levels increased significantly compared with controls on all days examined (Mann-Whitney U test: day 1, P = 0.0039; day 4, P = 0.0065; day 7, P = 0.0039; day 14, P = 0.0104), while the levels at days 7 and 14 decreased significantly compared with those at day 4 (Wilcoxon signed-rank test; day 4 to day 7 and day 4 to day 14, P = 0.0464). In contrast, tenotomy of the three extraocular muscles resulted in no histological changes. The VEGF levels increased significantly compared with controls at day 1 and day 4 decreased significantly compared with those at day 1 (Wilcoxon signed-rank test, P = 0.0499). Aqueous VEGF levels represent the severity of anterior segment ischemia and could be used as an indicator for the extent of ischemia.

Animals↗
PubMed1999

Muscle as a collagen fiber reinforced composite: a review of force transmission in muscle and whole limb.

Even though no direct physiologic evidence proving that myo-tendinous junctions at the end of myofibers are sites of force transmission is available, these locations are accepted to support this function, because its specialized morphology resembles that of load-bearing membranes in structure and location: Its design is fit for force transmission of force exerted by myofibers to tendinous fibrous material. Shearing of the interface between these structures is thought to be stronger than direct tensile transmission. On the basis of morphological studies of 'in-series fibered muscle' and biomechanical modeling it has been argued previously that force could also be transmitted laterally from the tapered ends of myofibers onto in series myofiber via the intramuscular connective tissue component. Shearing of the interfaces between myofibers is hypothesized to be the mechanisms of transmission. The interfaces are made up of basal membranes of both myofibers and their common endomysium. The issue of lateral force transmission from myofibers has not been addressed for whole muscle, in which myofibers are attached at both ends to tendinous aponeuroses, nor is any direct experimental evidence available about possible functional importance of this phenomenon in whole muscle. The primary objective of this presentation is to review available literature on myo-tendinous and myo-fascial force transmission, present evidence from experiments involving tenotomy, fasciatomy and aponeurotomy regarding its importance and consider implications for our thinking about muscle(s) and movement.

Animals↗
PubMed1994

Lacuna magna in 6 boys with post-void bleeding and dysuria: alternative approach to treatment.

Six boys from 8 to 17 years old presented with blood dripping from the meatus at the termination of urination, spotting of blood on underwear and/or distal penile dysuria. Repeat urinalyses and cultures were negative, and evaluation included a voiding cystourethrogram. Diagnosis was lacuna magna in the area of the fossa navicularis, which was confirmed by cystoscopy. Each patient was treated endoscopically using a pediatric resectoscope and right-angle wire electrode. The value was incised with the cutting current and the base of the diverticulum was fulgurated. We find that this method of treatment is preferable to incision with tenotomy scissors.

Adolescent↗
PubMed2006

[Congenital club foot: treatment in childhood, outcome and problems in adulthood].

PURPOSE OF THE SYMPOSIUM: Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to re-align the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. MANAGEMENT OF CONGENITAL CLUBFOOT IN CHILDREN: Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. OUTCOME IN ADULTHOOD: There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree under-correction is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. CONCLUSION: A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; under-correction is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.

Adult↗
PubMed2005

Treatment for diabetic foot ulcers.

People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both. The initiating injury may be from acute mechanical or thermal trauma or from repetitively or continuously applied mechanical stress. Patients with clinically significant limb ischaemia should be assessed by a vascular surgeon to determine the need for angioplasty, stenting, or femorodistal bypass. When infection complicates a foot ulcer, the combination can be limb or life-threatening. Infection is defined clinically, but wound cultures reveal the causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and should aim to cure the infection, not to heal the wound. Alleviation of the mechanical load on ulcers (off-loading) should always be a part of treatment. Neuropathic ulcers typically heal in 6 weeks with total contact casting, because it effectively relieves pressure at the ulcer site and enforces patient compliance. The success of other approaches to off-loading similarly depends on the patients' adherence to the effectiveness of pressure relief. Surgery to heal ulcers and prevent recurrence can include tenotomy, tendon lengthening, reconstruction, or removal of bony prominences. However, these procedures may result in secondary ulceration and other complications. Ulcer recurrence rates are high, but appropriate education for patients, the provision of posthealing footwear, and regular foot care can reduce rates of re-ulceration.

Amputation, Surgical↗
PubMed1999

Late diagnosis of congenital dislocation of the hip and presence of a screening programme: South Australian population-based study.

BACKGROUND: The Medical Research Council Working Party on Congenital Dislocation of the Hip have reported an ascertainment-adjusted incidence of a first operative procedure for congenital dislocation of the hip (CDH) of 0.78 per 1000 livebirths, which is similar to the incidence of CDH before the start of the UK screening programme. The report showed that CDH had not been detected by routine screening before age 3 months in 70% of children reported to the national orthopaedic surveillance scheme. This report raised concerns about the merit of screening at birth for CDH. We aimed to find out the incidence of an operative procedure for CDH in the first 5 years of life among children born in South Australia between 1988 and 1993, and the proportion of these patients that were detected at age 3 months or older. METHODS: The state's database for inpatient separations between January, 1988, and April, 1998 was searched. Case records were examined for the age and circumstances of diagnosis, and type of operative procedures. Prevalence rates of CDH were obtained from the South Australian Birth Defects Register, which receives notifications from a statutory perinatal data collection of birth defects detected at birth and subsequent voluntary notifications for children up to age 5 years. FINDINGS: Of the 55 children born in South Australia between 1988 and 1993 identified as having non-teratological CDH and operative procedures, only 22 (40%) had been diagnosed at age 3 months or older. 18 had an open reduction of the hip joint or osteotomy, or both, and the remainder had arthrograms, closed reductions, and/or tenotomy. The prevalence of non-teratological CDH in children was 7.74 per 1000 livebirths. The incidence of surgery for CDH in the first 5 years of life was 0.46 per 1000 livebirths (95% CI 0.34-0.59) and only 0.19 per 1000 livebirths (0.11-0.26) for those diagnosed late (age 3 months or older). These children diagnosed late represented 2.4% of all known cases of CDH. INTERPRETATION: Only 2.4% of known cases of CDH in children born in South Australia had been detected late and required surgery. These results show that a screening programme for CDH can be successful, contrary to the findings of the UK Medical Research Council Working Party.

Child, Preschool↗
PubMed1990

A primate model of anterior segment ischemia after strabismus surgery. The role of the conjunctival circulation.

Fornix conjunctival incisions in strabismus surgery may provide partial protection against anterior segment ischemia by preserving the perilimbal conjunctival-Tenon's circulation, which is disrupted with limbal conjunctival incisions. Six adult cynomolgus monkeys underwent tenotomies of three or four rectus muscles by making limbal conjunctival incisions in one eye and fornix incisions in the other. Iris fluorescein angiography and slit-lamp biomicroscopy were used to monitor changes. The eyes that had limbal incisions exhibited more severe anterior segment ischemic changes than the eyes that had fornix incisions in every instance of four rectus muscle surgery.

Animals↗
PubMed1991

Incomitant dissociated vertical deviation and superior oblique overaction.

When superior oblique overaction coexists with dissociated vertical deviation, it may produce a pattern of disparity in the amount of dissociated vertical deviation in different horizontal gaze fields, which the authors have termed incomitance. Seven patients with the constellation of esotropia, bilateral superior oblique overaction, "A"-pattern, and incomitant dissociated vertical deviation are presented. In each case, a distinctive incomitant pattern of dissociated vertical deviation was noted in which dissociated vertical deviation was least in adduction, moderate in primary position, and greatest in abduction. Four patients underwent asymmetric superior rectus recessions and partial tenotomy of the superior oblique tendons at their insertions as the initial treatment for their incomitant dissociated vertical deviation. Recognition of such a pattern of incomitant dissociated vertical deviation is important in choosing appropriate surgical management.

Child↗
PubMed2002

Gravitational unloading effects on muscle fiber size, phenotype and myonuclear number.

The effects of gravitational unloading with or without intact neural activity and/or tension development on myosin heavy chain (MHC) composition, cross-sectional area (CSA), number of myonuclei, and myonuclear domain (cytoplasmic volume per myonucleus ratio) in single fibers of both slow and fast muscles of rat hindlimbs are reviewed briefly. The atrophic response to unloading is generally graded as follows: slow extensors > fast extensors > fast flexors. Reduction of CSA is usually greater in the most predominant fiber type of that muscle. The percentage of fibers expressing fast MHC isoforms increases in unloaded slow but not fast muscles. Myonuclear number per mm of fiber length and myonuclear domain is decreased in the fibers of the unloaded predominantly slow soleus muscle, but not in the predominantly fast plantaris. Decreases in myonuclear number and domain, however, are observed in plantaris fibers when tenotomy, denervation, or both are combined with hindlimb unloading. All of these results are consistent with the view that a major factor for fiber atrophy is an inhibition or reduction of loading of the hindlimbs. These data also indicate that predominantly slow muscles are more responsive to unloading than predominantly fast muscles.

Animals↗
PubMed2001

The effect of therapeutic ultrasound on repair of the achilles tendon (tendo calcaneus) of the rat.

The purpose of this study was to evaluate the effects of therapeutic ultrasound (US) on the healing process in the Achilles tendon (Tendo calcaneus) of Wistar rats after tenotomy. Sonication was performed at a frequency of 1 MHz, an intensity of 0.5 W/cm(2) (SATA), for 5 min, over a period of 14 consecutive days in two modalities (n = 15); in both continuous and pulsed modes. The control group was divided into tenotomized, mock-sonicated and nontenotomized tendons (n = 15). On the 15th postoperative day, the tendons were removed and analyzed by using the polarized light microscopy, with the purpose of detecting and measuring the organization of collagen fibers through birefringence. The results showed a high birefringence for the tendons treated using the pulsed mode (p < 0.001), revealing the best organization and aggregation of collagen bundles. Sonication in the continuous mode induced a decrease (p = 0.047) in the ability to quicken the healing process. These findings suggest that US therapy is beneficial in the early healing process of tendons when the pulsed mode is used.

Achilles Tendon↗
PubMed1990

Intratendinous fibroma of flexor tendon.

Fibroma of the tendon sheath is a benign lesion usually found in contact with tendon sheath or on the epitenon layer. This case report describes the intratendinous location not previously described. Impairment of flexor tendon excursion is relieved by longitudinal tenotomy and tumor excision.

Child↗
PubMed2003

Evaluation of collagen fiber maturation and ordering in regenerating tendons employing H-1 double quantum filtered NMR spectroscopy.

It is difficult to monitor the chronic stage of the healing process of ruptured tendons employing the present diagnostic modes. However, the results of this study have shown that 1H double quantum filtered (DQF) NMR spectroscopy is sensitive to the later stages of the healing process. Regenerated tendons of rabbits were dissected and measured at the end of the acute phase (three weeks), the subacute phase (nine weeks), and the chronic phase (13 and 18 weeks after tenotomy). Four parameters were determined by 1H DQF NMR spectroscopy: (a) the maximum signal intensity (h(max)) relative to the single quantum spectrum, (b) the creation time of the maximum signal intensity (tau(max)), (c) the decay time from the maximum signal intensity to a value half of that intensity (tau(1/2)) and (d) the residual dipolar splitting of water (delta), representing the order of the collagen fibers. The values of h(max), tau(max), tau(1/2), and delta of the intact Achilles tendons were 11.3+/-1.0%, 0.48+/-0.03 ms, 0.67+/-0.04 ms and 732+/-62 Hz (mean +/- SEM, n=6), respectively. In the regenerating tendon, h(max) increased from 0.41+/-0.12% at three weeks to 7.07+/-0.77% at 18 weeks, tau(max) decreased from 1.88+/-0.31 ms at three weeks to 0.72+/-0.04 ms at 18 weeks, tau(1/2) decreased from 11.6+/-1.8 ms at 3 weeks to 1.48+/-0.16 ms at 18 weeks, and delta increased from 129+/-8 Hz at three weeks to 414+/-29 Hz at 18 weeks. We have concluded that reordering of collagen fibers proceeds continuously even in the chronic stage of healing. Thus, the 1H DQF NMR spectroscopy is a useful non-invasive technique to evaluate the reconstruction and the order of collagen fibers in regenerating tendon. It is also suggested that tau(1/2) and h(max) are most useful for in vivo DQF NMR spectroscopy and imaging, respectively, in combination with tau(max).

Achilles Tendon↗
PubMedDate not supplied

Arthroscopic release of shoulder contracture secondary to birth palsy: an early report on findings and surgical technique.

PURPOSE: Internal rotation contractures are common in children with external rotation weakness secondary to brachial plexus birth palsy. Surgical release of the contracture, with or without latissimus dorsi transfer, is an established treatment through a variety of open methods. This article describes an arthroscopic method of contracture release in this patient population. TYPE OF STUDY: New surgical technique. METHODS: Forty-one children with contractures, ranging in age from 8 months to 12 years (mean, 3.5 years), underwent arthroscopic release of the shoulder with a 2.7-mm arthroscope used for visualization. The release consisted of a subscapularis tenotomy and release of the anterior capsular ligaments. Eighteen children underwent a subscapularis release as an isolated procedure. Twenty-three of the children also underwent latissimus dorsi transfer. RESULTS: Arthroscopic release was successful in achieving at least 45 degrees of passive external rotation at surgery in all but one case. This case was in the oldest child, a 12-year-old with severe deformity, who needed an open release. No other complications were noted. Glenohumeral deformity was common. The primary contracted elements were the subscapularis and the anterior capsular ligaments. CONCLUSIONS: Arthroscopic contracture release was effective in the restoration of passive external rotation in children with internal rotation contractures secondary to birth palsy.

Arthroscopy↗