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At least 667 records · Page 37Linked to original sources
PubMed1990

[Resection of the central slip in treatment of longstanding mallet fingers (Fowler's technique). Apropos of 8 cases].

Tenotomy of the central slip of the extensor retinaculum over the proximal interphalangeal region was performed in 8 cases longstanding, flexible mallet fingers. This technique gave 6 excellent results, with one complete correction of the PIP and DIP deformities, and 2 partial results (residual distal defects of 5 and 10 degrees) without any reduction in flexion and without any complications, in particular no boutonnière syndrome. The two incomplete results were observed in two patients in whom the preoperative DIP deformities exceeded 50 degrees, a value which the authors consider to be the limit for the choice of this method. This simple (no postoperative immobilisation) technique is reliable in precise indications which are discussed here. It should take its place together with tenodermodeses and more ambitious but more complicated reconstructions such as reconstruction of the spiral retinacular ligament described by Littler.

Adult↗
PubMed1983

[Selective microsurgical denervation in spastic paralysis].

Denervation, provosed at the turn of the century and abandoned because of inconstant results, has again been taken up in principle, but with a notable change in technique. It is necessary to do a careful examination of the muscles that are to be denervated (of the median and ulnar nerves) and to determine the nature of the spasticity. The incision, longer than in the original technique, allows a better view of the median and ulnar nerves. The nerve branches to each muscle are thus easily identified, and by electric stimulation during the operation one judges how much denervation to subject the muscles to while taking into account the phenomenon of the take-over of the denervated muscles by the remaining nerve fibers. Part of the nerve branches are then sectioned under microscopic control near the muscle, taking care to cauterize the proximal stump. It may be necessary to do associated tenotomies or capsulotomies. This method gives good results if the technique and the contraindications, (athetosis, chorea and cerebral deficits) are respected. It must be emphasized that the results depend on the degree of denervation, which is hardly quantifiable, and is subject to the operator's experience.

Arm↗
PubMed1989

[A surgical correction method for spastic "thumb in the palm"].

Spastic flexus-adductus thumb considerably decreases the function of the hand because of the loss of muscular control and the predominant adduction retraction of the thumb. The authors propose a new surgical technique of unipolar tenotomy of the adductor pollicis and first interosseous dorsalis muscles, which are then sutured end-to-end forming a single elongated adductor muscle. These two muscles act synergistically as they are innervated by the same branch of the ulnar nerve. In this way, two pathological muscles are transformed into a single functional muscle. The preservation of the insertion of the adductor pollicis prevents hyperextension of the metacarpophalangeal joint. The authors used this technique in nine patients with a good functional and aesthetic result.

Child, Preschool↗
PubMed1997

Distal insertions of abductor pollicis longus muscle and arthritis of the first carpometacarpal joint in 104 dissections.

The different types of distal insertions of the tendons of the abductor pollicis longus muscle (APL) were studied in 104 cadaveric hands, and the appearance of the rhizarthrosis in the level of the basal joint of the thumb, as well, in a try to detect possible anatomical relationships. From the anatomical point of view, it was evident that the insertions of the APL muscle are usually multiple (95%), that the insertion to the base of the first metacarpal is constantly present, accompanied in 70% of the cases with an insertion to the trapezium. Finally, the accessory tendon to the thenar eminence was proved to be extremely frequent (42%). Rhizarthrosis has been found in 97% of the dissections. The lateral compartment of the joint surface appeared to be the most frequently affected with arthritis (71%) and probably the starting point of the lesion. But no correlation has been recorded between severe arthritis and any type of distal insertion of abductor pollicis longus muscle. Early tenotomy of some tendons, in order to prevent arthritis of the first CMC joint, cannot be recommended from this study.

Arthritis↗
PubMed1992

Cementless hip arthroplasty in diastrophic dysplasia.

Diastrophic dysplasia results in severe disproportionate growth failure, generalized joint dysplasia, and early osteoarthrosis of the hips. A total hip arthroplasty is often necessary in patients afflicted with diastrophic dysplasia by time they reach early middle age. During 1983-1988, total hip arthroplasties were performed on six women and four men (15 hips) with diastrophic dysplasia at the Orthopaedic Hospital of the Invalid Foundation. The mean age of the patients at the time of operation was 37 years and the mean height was 133 cm. A Lord endoprosthesis was used in nine hips and a Biomet endoprosthesis in six. Cementless fixation was used in all cases. Autogenous bone grafting to the acetabulum was performed in six hips. Simultaneous corrective osteotomy of the proximal femur and transposition of the greater trochanter was performed in three cases. Soft tissue release and tenotomies were performed in 10 hips. The average follow-up period was 5 years. Overall clinical results were good, with marked relief of pain and improvement of hip joint mobility. Aseptic loosening of the acetabular component was noted in two hips. As for complications, two femoral nerve paresis and two perioperative fractures of the proximal femur occurred, which all healed.

Adult↗
PubMed1999

Case report of malocclusion with abnormal head posture and TMJ symptoms.

Abnormal cervical muscle function can cause abnormal head posture, adversely affecting the development and morphology of the cervical spine and maxillofacial skeleton, which in turn leads to facial asymmetry and occlusal abnormality. There can be morphologic abnormalities of the mandibular fossa, condyle, ramus, and disk accompanying the imbalance of the cervical and masticatory muscles activities. Two normally growing Japanese female patients with Class II Division 1 malocclusion presented with TMJ symptoms and poor head posture as a result of abnormal sternocleidomastoid and trapezius cervical muscle activities. One patient underwent tenotomy of the two heads of the sternocleidomastoid muscle and the other patient did not. In addition to orthodontics, the 2 patients received physiotherapy of the cervical muscles during treatment. Both were treated with a functional appliance as a first step, followed by full multi-bracketed treatment to establish a stable form of occlusion and to improve facial esthetics with no head gear. This interdisciplinary treatment approach resulted in normalization of stomatognathic function, elimination of TMJ symptoms, and improvement of facial esthetics. In the growing patients, the significant response of the fossa, condyle, and ramus on the affected side during and after occlusal correction contributed to the improvement of cervical muscle activity. Based on the result, early occlusal improvement, combined with orthopedic surgery of the neck muscles or physiotherapy to achieve muscular balance of the neck and masticatory muscles, was found to be effective. Two patients illustrate the potential for promoting symmetric formation of the TMJ structures and normal jaw function, with favorable effects on posttreatment growth of the entire maxillofacial skeleton.

Birth Injuries↗
PubMed1999

Long-term results of silicone expander for moderate and severe Brown syndrome (Brown syndrome "plus").

BACKGROUND: The treatment of Brown syndrome has been undergoing an evolution toward more effective procedures with fewer operative interventions. Dr Kenneth Wright has introduced a procedure of superior oblique muscle tenotomy with a silicone expander to reduce the incidence of overcorrection. METHODS: There was a retrospective study of 20 eyes of 19 consecutive patients with moderate or severe Brown syndrome (Brown syndrome "plus"). Follow-up ranged from 12 to 72 months. The expander, which varies 6 to 10 mm in length, was placed in all patients in the tenotomized superior oblique muscle tendon 5 mm nasal to the nasal border of the superior rectus muscle using 7-0 or 8-0 Prolene suture without violating the inner layer of the intermuscular septum. The intermuscular septum was closed over the silicone expander. RESULTS: One hundred percent of patients had resolution of the down shoot in adduction and some or full ability to elevate the eye in adduction. Twenty percent of patients required reoperation (12.5% using 5-8 mm expanders) for overcorrection. Restriction of downgaze was not seen postoperatively. Patients often show an undercorrection 1 to 6 months postoperatively and improve or occasionally overcorrect at 1 to 2 years postoperatively. One patient with a 10-mm expander extruded the implant. DISCUSSION: Placement of a 5- to 8-mm silicone expander in the tenotomized superior oblique muscle tendon is an effective means of correcting Brown syndrome with a low rate of reoperation. Initial undercorrection should not discourage the surgeon because improvement may continue for up to 3 years. The goal of treatment should be to convert a moderate or severe Brown syndrome (Brown syndrome plus) to a mild Brown syndrome ("true" Brown syndrome). CONCLUSION: This technique reduces the need for either simultaneous or subsequent inferior oblique muscle weakening and represents an advance in the treatment of Brown syndrome.

Adolescent↗
PubMed2002

[Reorientation osteotomy of the trapezial saddle].

At its early stage, the thumb TM osteo-arthritis is occasionally painful during some activities and there are mainly radiological signs, only visible on specific views and with maximum amplitudes. They are the first metacarpal base imperfect reintegration in the trapezium saddle in ante-position and an increased slope angle of 140 degrees. So, the "slippery saddle" of the trapezium induces a metacarpal base subluxation. The goal of the proposed technique is to correct the orientation of the trapezial saddle. The slope angle must return to its normal value of about 125 degrees, thanks to an opening wedge osteotomy into the trapezium, completed with a bony wedge insertion. Proposed for the first time in 1983, and used only once by Dr. Heim, this technique was "rediscovered" recently and used on five patients in ten years. It is easy to do, the only complication being two post-operative radial nerve sensitive branch neuromas. In six cases on seven, the pain disappeared, even if the osteo-arthritis was evolving for the two former cases. The functional recovery was total and the patients were satisfied in most of the cases. In spite of this short series, this technique is worth being used for the early stage of thumb osteo-arthritis, eventually combined with others techniques like tenotomy of the Abductor pollicis longus accessories or different types of ligamentoplasties. It is, in any case, more logical than the first metacarpal osteotomy.

Adult↗
PubMed1999

Histomorphometric assessment of bone changes in rats with type II collagen-induced arthritis.

Numerous studies have demonstrated bone loss in rats following immobilization by tenotomy or nerve sectioning and following ovariectomy. However, few experiments have focused on bone change in rats with arthritis. We investigated bone loss in the proximal tibia and lumbar vertebra in rats with type II collagen-induced arthritis, an experimental model of rheumatoid arthritis, using histomorphometry. Bone loss in the early phase after immunization reflected a significant increase in numbers of osteoclasts and temporarily decreased bone formation. In the proximal tibia, near an arthritic joint, osteoclast numbers associated with bone trabeculae were increased four times over control numbers 4 weeks after immunization. In the lumbar vertebra, where arthritis was not shown, recruitment of osteoclasts occurred later than in the proximal tibia. With time, in both the proximal tibia and lumbar vertebra bone resorption normalized, but bone formation rate and double-label surface by tetracycline, a parameter reflecting bone formation, were increased above control values. We conclude that differences between the proximal tibia and lumbar vertebra probably reflected resumption of function as well as distance from areas of inflammation. These findings indicate that collagen-induced arthritis in rats is a useful model not only of autoimmunity, but also of juxta-articular and generalized osteoporosis in rheumatoid arthritis.

Animals↗
PubMed1998

Cellular responses in exertion-induced skeletal muscle injury.

Muscle injury is a common result of muscle exertion caused by overload and over-activity. In this presentation, an attempt was made to discuss models of muscle injury which involve exertion but not excessive strain, although most functional activities of the extremities require some eccentric muscle actions. Muscle injury is characterized by cellular and extracellular matrix responses which appear to be common to all types of muscle trauma -- even in the absence of bleeding. Using tenotomy and functional over-load of the rat hindlimb muscles as examples, illustrations of several of these responses are presented and discussed.

Animals↗
PubMedDate not supplied

A study of the cellular response to orientated fibronectin material in healing extensor rat tendon.

3D orientated fibronectin (Fn) mats have been used as biocompatible and biodegradeable scaffolds to provide orientated cues using contact guidance for cell migration/adhesion and deposition of extracellular matrix. We have implanted Fn scaffolds in an established rat tendon(partial tenotomy) injury model to test its efficacy and monitor the early cellular and inflammatory response. Tendons were harvested at 0, 6 h, 1, 3, 5, 7 and 14 days for H&E, immunohistochemistry and TEM. Total cell counts within the window increased progressively with time with no significant differences between the Fn scaffolds and controls. CD45 (pan leukocyte) positive cell numbers peaked at 6 h and when expressed as a percentage of total cell counts as determined by H&E staining constituted 20% of the total cell number at 6 h but decreased to 5% of total number by 72 h. There were no significant differences in the inflammatory response between the control and implanted groups. Few CD44 (mesenchymal stem cell) positive cells identified had a surface location. A novel cell with long exaggerated cytoplasmic processes was identified by TEM. Our results show that the Fn scaffold did not degrade or elicit any untoward inflammatory response at the time points tested and has potential use in guiding the repair process.

Journal Article↗
PubMed2003

Effects of elastin-derived peptide on Achilles' tendon healing: an experimental study.

Different matrix macromolecules modulate the tendon healing process. Elastin contains sequences which exhibit chemotactic activity both in vitro and in vivo. We analyzed the effects of synthetic elastin-derived peptide Val-Gly-Val-Ala-Pro-Gly suspended in a gel solution on the healing process of Achilles' tendon in a rat model. A total tenotomy at the middle 3rd was performed in 32 rats. During the suture repair the gel with (Group A) or without (Group B) the elastin-derived peptide was applied to the tendon stumps. Four animals for each period and group were killed at 10, 30, 60 and 90 days after surgery. The scar tissue was processed for histochemical, immuno-histochemical and morphometric analysis. An improved healing process with increase in cellularity and vascularity, especially at the early stage of the Achilles' tendon healing process was observed in Group A compared to Group B. The fiber alignment was also positively influenced by the factor. Immunolabeling with HAM 56 and lisozyme revealed a stronger reaction for the presence of monocyte/macrophage in Group A vs Group B especially in early stages. Chondral metaplasia and endochondral ossification occurred in the healed tissue of both group at 60 and 90 days.

Journal Article↗
PubMed2002

Alteration in albumin level during modified muscular activity.

We have previously reported that albumin protein is increased in the atrophied muscle induced by hindlimb immobilization. The purpose of this study was to evaluate the effects of several disuse models on albumin protein and mRNA levels in mice skeletal muscle and to investigate whether the elevated amount of albumin returns to control level by muscular activity increased by hindlimb remobilization. Western blot analysis revealed that hindlimb immobilization, denervation, and tenotomy, except for hindlimb unloading, significantly increased albumin levels in soleus muscles by 2.1-, 1.9- and 2.0-fold, respectively (P < 0.001). Immunohistochemical analysis showed that albumin protein accumulates in the widened extracellular space. Reverse transcription-polymerase chain reaction (RT-PCR) assay revealed albumin gene expression to be downregulated in all disuse models relative to control level. During hindlimb remobilization, the amounts of albumin protein appeared to remain higher level after 3 and 7 days and had returned to control level after 14 days and muscle mass, the amounts of myosin heavy chain, and actin proteins seemed to restore control levels after 21 days. These results indicate that the amount of interstitial albumin protein may be modulated by muscular activity.

Albumins↗
PubMed1983

Synapse elimination in neonatal rat muscle is sensitive to pattern of muscle use.

The synaptic connections among the cells of the vertebrate nervous system undergo extensive rearrangements early in development. During their initial growth, neurones apparently form synaptic connections with an excessive number of targets, later retracting a portion of these synapses in establishing the adult neural circuits. Because of the profound effects which experience has upon the developing nervous system, a question of considerable interest has been the role which the functional use of these developing synapses might play in determining the final pattern of connectivity. At the neuromuscular junction the early changes in synaptic connections are well documented, and here questions about the importance of function can be relatively easily addressed. Mammalian skeletal muscle fibres experience a perinatal period of synapse elimination so that all but one of several synapses formed on each muscle fibre are lost. This synapse elimination is sensitive to alterations of neuromuscular use or activity. Reduction of muscle use by tenotomy or by paralysis of the muscle with drugs blocking nerve impulse conduction or neuromuscular transmission delays or even prevents synapse loss, while increased use produced by stimulation of the muscle nerve apparently accelerates the rate at which synapses are lost. I report here a further examination of the role of neuromuscular activity in synapse elimination. I show that chronic neuromuscular stimulation accelerates synapse elimination but that this acceleration is dependent on the temporal pattern in which the stimuli are presented: brief stimulus trains containing 100 Hz bursts of stimuli produce this acceleration whereas the same number of stimuli presented continuously at 1 Hz do not. Furthermore, the 100 Hz activity pattern which is effective in altering synapse elimination also alters two other muscle properties: the sensitivity of the muscle fibers to acetylcholine and the 'speed' of muscle contractions. These findings suggest that the ability of muscle fibres to maintain more than one nerve terminal, like other muscle properties, is sensitive to the pattern of muscle use rather than just the total amount of use.

Acetylcholine↗
PubMed2001

Active management in patients with ocular manifestations of myasthenia gravis.

PURPOSE: Myasthenia gravis can cause variable strabismus with disabling diplopia and/or poor cosmesis. A retrospective study of a group of patients with myasthenia gravis or 'myasthenia gravis like' syndromes was made. METHODS: The study group consisted of patients who had undergone botulinum toxin treatment and/or surgery for disabling diplopia, poor cosmesis or both. Surgical treatment was by conventional techniques including recess/resect, posterior fixation, superior oblique tenotomy and adjustable sutures. RESULTS: There were 9 patients in the study group (8 female, 1 male). Age at surgery ranged from 21 to 59 years (mean 46 years). Six were symptom-free following treatment. Two, although symptomatically improved, had occasional diplopia. One patient failed treatment and required an occlusive contact lens. CONCLUSIONS: The ocular manifestations of myasthenia gravis or 'myasthenia gravis like' syndromes may respond to surgery and/or botulinum toxin injection. Active intervention should be considered when deviations become stable. To our knowledge this is the first report of the use of botulinum toxin in such patients.

Adolescent↗
PubMed1977

Flexion and supination deformities of the elbow in tetraplegics.

Fixed flexion and supination deformities of the elbow occur occasionally in tetraplegics. The patients in whom this was seen were those who following injury had a neurological level at C5 and who subsequently developed radial wrist extension and brachioradialis function. They were generally patients who spent long hours with their elbows flexed and supinated. A simple effective method of biceps tenotomy and plaster correction is described. Recurrence of deformity was seen if the flexion supination posture was continued. Strength of elbow flexion was not reduced. Patients maintained correction if they refrained from poor elbow posture and wore a simple plastic splint. The procedure of correction is not difficult and because of its simplicity it can be repeated if deformity recurs.

Adult↗
PubMed2002

Comparison of sarcomere alterations after muscle contraction and tension loading in the rat soleus muscle.

Muscle contraction induced by 30 min of continuous nerve stimulation at 50 Hz resulted in sarcomere changes of the soleus muscle in the rat in our previous study. To further investigate the cause of sarcomere alterations, the sciatic nerve was electrically stimulated intermittently for 30 min. Nerve stimulation was also conducted after cutting the tendons of the soleus, gastrocnemius and plantaris muscles in order to prevent imposing tension on these muscles as a result to their own contractions. In addition, the muscles were pulled by weights via their tendons to load high tension for 30 min without nerve stimulation. Sarcomere alterations immediately after treatments were quantified by electron microscopy. The percentages of aberrant sarcomere areas of the soleus muscle were 25.7 +/- 16.4% (mean +/- SD) in the group of intermittent nerve stimulation with intact tendons and 21.1 +/- 35.4% in the group of tenotomy and continuous nerve stimulation, which were roughly equal to or more severe than the group of continuous nerve stimulation with intact tendons (18.8 +/- 15.8%) in our previous study. Sarcomere alterations consisted mainly of hypercontraction in these groups. Almost all sarcomere changes in the tension-loaded (pulled) soleus muscles were scarce myofilaments (1.7 +/- 1.0% by 600 g; 4.5 +/- 2.9% by 1200 g), and hypercontraction was not observed. These findings indicate that neither high tension nor a decrease of muscle blood flow during continuous contraction seems to be the primary cause of sarcomere alterations in the present study. There are probably other causes that produce aberrant sarcomeres.

Actin Cytoskeleton↗
PubMedDate not supplied

Matrix remodeling in healing rabbit Achilles tendon.

Biochemical, biomechanical and ultrastructural properties of the connective tissue matrix were investigated during the early remodeling phase of tissue repair in experimentally tenotomized and repaired rabbit Achilles tendons. Sterile surgical tenotomy was performed on the right Achilles tendons of 14 rabbits and allowed to heal for 15 days. The animals were euthanized and the Achilles tendons excised from both limbs. The left contralateral Achilles tendon of each rabbit was used as a control in the experiments. Prior to biochemical analysis, both intact and healing tendons were tested for their biomechanical integrity. The results revealed that the healing tendons had regained some of their physicochemical characteristics, but differed significantly from the intact left tendons. The healing tendons regained 48% tensile strength, 30% energy absorption, 20% tensile stress, and 14% Young's modulus of elasticity of intact tendons. In contrast, biochemical analysis showed that the healing tendons had 80% of the collagen and 60% of the collagen crosslinks (hydroxypyridinium) of normal tendons. Sequential extraction of collagen from the tissues yielded more soluble collagen in the healing tendons than intact tendons, suggesting either an increase in collagen synthesis and/or enhanced resorption of mature collagen in healing tendons compared to intact tendons. Electron microscopic studies revealed remarkable differences in the ultrastructure between intact and healing tendons. These observations could explain, in part, the connective tissue response to healing during the early phases of tissue remodeling.

Achilles Tendon↗