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At least 703 records · Page 39Linked to original sources
PubMed1999

Effect of infantile strabismus on visuomotor development in the squirrel monkey (Saimiri sciureus): optokinetic nystagmus, motion VEP and spatial sweep VEP.

PURPOSE: To determine whether squirrel monkeys made artificially strabismic in infancy had ocular fixation abnormalities, directional asymmetries of horizontal optokinetic nystagmus (OKN) and asymmetries of motion visually evoked potentials (MVEPs) similar to those of humans with infantile strabismus. METHODS: Esotropia was produced in a newborn squirrel monkey by surgical tenotomy of both lateral rectus muscles. The alignment and eye rotations of the monkey were examined longitudinally and VEP testing was performed at the age of one year. Visual acuity was measured using spatial frequency sweep VEPs (SSVEP) in response to grating stimulation. OKN was tested under conditions of monocular viewing using full-visual-field, vertically oriented, moving stripes. MVEPs in response to horizontal motion were recorded with the animal sedated to reduce the possibility of eye movement artifact. RESULTS: The artificially strabismic squirrel monkey displayed a constant, committant esotropic strabismus accompanied by latent nystagmus. Monocular SSVEP acuity was subnormal in one eye, consistent with mild monocular strabismic amblyopia. The monkey demonstrated asymmetric OKN favoring nasally-directed stimulus motion when viewing with either eye. Monocular MVEPs were also characterized by a horizontal asymmetry with a directional bias inverted 180 degrees between the right and the left eyes. The eye movements and MVEP asymmetries were similar to those observed in strabismic macaque monkeys and humans with early-onset strabismus. Neither the OKN asymmetry nor the MVEP asymmetry was evident in a normal squirrel or normal macaque monkey. CONCLUSION: The artificially strabismic squirrel monkey is an appropriate eye movement and VEP model for the study of neural mechanisms in human infantile strabismus.

Animals↗
PubMed2000

Late-diagnosed DDH: a prospective 11-year follow-up of 71 consecutive patients (75 hips).

I have prospectively studied 71 consecutive patients (75 hips) with late-diagnosed DDH (developmental dysplasia of the hip) treated uniformly with special reference to the development of the femoral head and the acetabulum. The age at the start of treatment was 10 (2-64) months. The follow-up time was 11 (6-18) years. After tenotomy and traction, closed reduction failed in 7 hips. These cases were treated by open reduction with or without Salter innominate osteotomy-in 2 hips femoral osteotomy was also done (shortening, varus and derotation). 1 hip subluxated and 1 re-dislocated after closed reduction. Avascular necrosis occurred in 4 hips and additional surgery was required in 12 hips--11 Salter osteotomies, 1 varus femoral osteotomy. In the first year after reduction, the acetabular angle improved rapidly--faster in the younger children. When treatment started between 12 and 22 months, the improvement was slower and the final outcome more unpredictable. The femoral head continued to grow irrespective of the age at reduction and became normal in almost all cases. Salter's innominate osteotomy stabilized hips after open reduction and gave excellent results in cases with an increasing acetabular angle. At the last re-examination, all but 2 patients were asymptomatic. Radiographically, 65 hips were rated Severin group I, 9 group II and 1 group III.

Age Factors↗
PubMed2005

The influence of ultrasound on the mechanical properties of healing tendons in rabbits.

BACKGROUND: Therapeutic ultrasound is commonly used for treatment of injuries to tendons, ligaments and joint capsules. Opinions still differ, however, as to the beneficial effects of ultrasound treatment of the above-mentioned conditions. METHODS: We studied the effect of various ultrasound intensities on the healing of tenotomized, sutured and immobilized Achilles tendons of adult rabbits. Different intensities of pulsating ultrasound (0, 50, 100, 200, 500, 750, 1000 and 2000 mW/cm2, frequency 3 MHz) were given over the healing tendons for 5 min daily, using a gel as the coupling agent between the ultrasound probe and the skin. Eleven days after the tenotomy, the healing tendons were analyzed in a materials testing machine. RESULTS: The extensibility of the healing tendons was greater after sonication at an intensity of 2000 mW/cm2 than after 50 mW/cm2. We found no significant effect on the load at rupture and normalized load at rupture of the ultrasound-treated healing tendons compared with mock-sonicated healing tendons. A gradual decline was observed, however, in the stiffness and collagen content of the healing tendons with increasing intensity of the ultrasound treatment. INTERPRETATION: The pulsating ultrasound treatment applied did not improve the mechanical properties of healing Achilles tendons at day 11 after the operation. On the other hand, a slight decline in stiffness was observed with increasing intensity of ultrasound treatment.

Achilles Tendon↗
PubMed1989

Infraspinatus muscle contracture in a working dog.

A five-year-old Border Collie bitch was presented to Massey University Small Animal Clinic, for examination of a right forelimb lameness of three months duration. The distal forelimb was deviated laterally, there was limited mobility of the shoulder joint, and the animal showed gait abnormalities. Marked atrophy of the infraspinatus, supraspinatus and deltoideus muscles were present. Contracture of the infraspinatus muscle caused the lameness, and tenotomy of the infraspinatus tendon resulted in restoration of a normal gait. Although the exact aetiology is unknown, several possibilities are discussed.

Journal Article↗
PubMed2001

Contractures in orthopaedic and neurological conditions: a review of causes and treatment.

PURPOSE: To examine the techniques used for the treatment of contracture in the context of current scientific knowledge of muscle. METHOD: Synthesis of data available from MEDLINE, RECAL, EMBASE, the Cochrane Library and relevant texts. RESULTS: The development of contractures through immobilisation, muscle weakness and spasticity is described. The effects of passive stretching, continuous passive movement, serial plastering, splinting, electrical stimulation, botulinum injections and surgical tenotomies in the treatment of contractures in persons with neurological and orthopaedic conditions are identified. The strengths and weaknesses of these modalities are discussed. CONCLUSION: Predisposing factors persist after treatment of contractures thus for treatment to be effective long-term management programmes need to be developed. New treatment techniques, used in series or combined, offer the prospect of improved management of contracture. Scientific and clinical research is needed to investigate the effect of contracture treatment.

Activities of Daily Living↗
PubMed1993

Physiological and pathological changes in levels of the two small stress proteins, HSP27 and alpha B crystallin, in rat hindlimb muscles.

The two small stress proteins, HSP27 and alpha B crystallin, are expressed widely in normal rat tissues and abundantly in skeletal muscle. In order to clarify the physiological significance of these stress proteins, the changes in their levels were determined immunochemically, in the slow-twitch soleus muscle and fast-twitch extensor digitorum longus muscle or rectus femoris muscle of growing rats, and in those of adult rats during denervation and tenotomy. HSP27 was quantitated by specific immunoassay, similar to that for alpha B crystallin, with antibodies raised in rabbits against purified rat HSP27. In adult rats, HSP27 was present at high levels in tissues composed of striated muscle, and it was present at much higher levels in the soleus muscle than in the rectus femoris or extensor digitorum longus muscle, as is alpha B crystallin. However, in rats of perinatal age (from prenatal day 2 to postnatal day 3), levels of HSP27 in the rectus femoris muscle were enhanced like those in the soleus muscle, reaching the maximum levels at postnatal day 3. Thereafter HSP27 in the fast-twitch muscle showed a steep decrease. The increase in alpha B crystallin in the hindlimb muscles was also observed in the perinatal period. However, alpha B crystallin concentrations in the soleus muscle of perinatal rats were as low as those in rectus femoris muscle. The transection of the sciatic nerve resulted in decreases in the levels of HSP27 and alpha B crystallin in the soleus muscle of adult rats, together with increases in the levels of the two proteins in the extensor digitorum longus muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1988

Management of spasticity.

The functional impairment due to spasticity must be carefully assessed before any treatment is considered. Therapeutic intervention is best individualized to a particular patient. Basic principles of treatment to ameliorate spastic hypertonia are: 1) avoid noxious stimuli and 2) provide frequent range of motion. Therapeutic exercise, cold or topical anesthesia may decrease reflex activity for short periods of time in order to facilitate minimal motor function. Casting and splinting techniques are extremely valuable to extend joint range diminished by hypertonicity. Baclofen, diazepam and dantrolene remain the three most commonly used pharmacologic agents in the treatment of spastic hypertonia. Baclofen is generally the drug of choice for spinal cord types of spasticity, while sodium dantrolene is the only agent which acts directly on muscle tissue. Phenytoin with chlorpromazine may be potentially useful if sedation does not limit their use. Tizanidine and ketazolam, not yet available in the United States, may be significant additions to the pharmacologic armamentarium. Intrathecal administration of antispastic medications allows high concentrations of drug near the site of action, which limits side effects. This form of treatment is the most exciting recent development in the treatment of spastic hypertonia. Peripheral electrical stimulation may have limited use in diminishing tone and facilitating paretic muscles. Dorsal column stimulation via electrodes within the spinal column was initially hailed as a therapeutic advance, but has subsequently been shown to be minimally effective. Phenol injections provide a valuable transition between short-term and long-term treatments and offer remediation of hypertonia in selected muscle groups. Tenotomies and tendon transfers offer significant benefit in carefully chosen patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Baclofen↗
PubMed2000

Acute and long-term effects on muscle force after intramuscular aponeurotic lengthening.

Intramuscular aponeurotic lengthening of muscles or intramuscular tenotomy involves bisecting the connective tissue fibers of the aponeurosis or tendon within the muscle belly. Because of its superficial location in the muscle, the aponeurosis may be bisected without damaging muscle fibers. Despite the existence of common operative methods for gaining length in short muscles, the effects on force and muscle function have not been studied. For this purpose animal experiments were performed. The medial gastrocnemius muscle of six male Wistar rats was lengthened by cutting the proximal aponeurosis at 50% of its length perpendicularly to the collagen fibers. The length gain was maintained by 3 days of cast immobilization at maximal dorsiflexion of the ankle. The long-term effect of the treatment was studied after 6 weeks and compared with 10 untreated controls and with six sham operated animals. The muscle was isolated in situ, and the force length characteristics were determined. In the untreated controls, the aponeurotomy was performed and the length force experiment was repeated to study the acute effects. The aponeurotic lengthening led acutely to a temporary loss of force because of an incomplete connection of the distal part of the muscle to the proximal insertion, but force recovered completely within 6 weeks. Although results from animal experiments cannot be transferred directly to humans, the principles of physiology are similar. Thus, for clinical use, aponeurotic lengthening should be considered if muscle force needs to be preserved. However, the drop of muscle force after surgery must be respected when mobilizing the patient during the postoperative rehabilitation program.

Animals↗
PubMedDate not supplied

Talectomy for clubfoot in arthrogryposis.

We reviewed the results of 101 talectomies in 56 patients with arthrogrypotic clubfeet. The average age at the time of surgery was 4.3 years and the mean follow-up was 6 years. Talectomy was performed as a primary procedure in 16 feet and as a salvage procedure in 85 feet that underwent other surgical procedures before talectomy. We graded our results as good when the foot was plantigrade, able to wear regular shoes, pain free, and, very important, patient satisfaction. We used a chi2 statistical test and, after comparing results with age <4 to >4 years at time of surgery, tendo Achilles tenotomy, time of casting, radiological complete excision of talus, and transcalcaneal pin placement, only the immobilization time needed to be statistically significant to achieve a good result. We conclude that feet must be individualized for treatment and that, after reduction of the calcaneus in the mortise, a short leg cast must be placed for 8 weeks to maintain position and alignment.

Achilles Tendon↗
PubMedDate not supplied

Nonoperative clubfoot treatment using the French physical therapy method.

Ninety-eight patients (142 clubfeet) treated nonoperatively by the French physical therapy method were reviewed to determine the effectiveness of this technique. All were 3 months old or less when treatment began and were rated for initial clubfoot severity using the Dimeglio scale (moderate, severe, very severe). Follow-up averaged 35 months (range 20-62 months). Forty-two percent of the feet needed no surgery to achieve a plantigrade position, 9% needed heelcord tenotomies, 29% needed posterior releases, and 20% needed comprehensive posteromedial releases. The Dimeglio scale was prognostic for outcomes, with moderate feet having the best results and very severe feet having the worst results. The French physical therapy method significantly reduced the need for operative intervention at the authors' institution.

Clubfoot↗
PubMed2001

Mechanical stimulation by external application of cyclic tensile strains does not effectively enhance bone healing.

OBJECTIVE: To determine whether an externally induced interfragmentary movement enhances the healing process of a fracture under flexible fixation. DESIGN: Randomized, prospective in vivo animal study with control group. Twenty-four skeletally mature Merino sheep were randomly assigned to six groups of four animals, which received cyclic interfragmentary movements of 0.2 and 0.8 millimeters and stimulation frequencies of 1, 5, and 10 Hertz, respectively. Twelve animals did not receive any externally applied stimulation and served as a control group. SETTING: Unrestricted stall activity with weight bearing reduced by tenotomy of the Achilles tendon. INTERVENTIONS: Osteotomy of the tibial diaphysis with three-millimeter gap width fixed with a six-pin, monolateral, double-bar external fixator. Interfragmentary movement of the osteotomy gap was externally induced by a motor-driven actuator unit. Five hundred cycles inducing nonuniform tensile strains within the gap were performed each day. MAIN OUTCOME MEASUREMENTS: Nine weeks after surgery, the animals were killed, and bone mineral density and callus cross-sectional area were measured with quantitative computed tomography. Callus projectional area was assessed by radiographs, and mechanical stability was determined with a three-point bending test. RESULTS: External stimulation with nonuniform cyclic tensile strains did slightly affect but not significantly enhance the fracture healing process. Varying the stimulation frequency had no influence on the healing process. The stimulation with 0.8 millimeter displacement magnitude resulted in a larger periosteal callus, but a decreased bone mineral density compared with the 0.2-millimeter displacement magnitude. The stimulation had no significant influence on the mechanical properties of the healing bone. CONCLUSIONS: Induced cyclic tensile strains did not produce a relevant enhancement of bone healing under flexible fixation.

Animals↗
PubMed1998

Biochemistry and biomechanics of healing tendon: Part I. Effects of rigid plaster casts and functional casts.

PURPOSE: Traditional treatment of surgically repaired Achilles tendons includes complete immobilization of the joint in rigid casts for 6 to 8 wk. We tested the use of functional polyurethane casts as an alternative to rigid plaster casts after experimental tenotomy and repair of the rabbit Achilles tendon. METHODS: After repair the limbs of 15 experimental rabbits were immobilized in a functional polyurethane cast for 15 d, while those of 14 controls were immobilized in traditional rigid plaster casts for the same period. RESULTS: Functional casting resulted in a 60% increase in total collagen in the neotendon compared with that in rigid casting (P < 0.05). Mature collagen cross-links declined 8% in the tendons with functional casts. The biomechanical parameters of the tendons changed with functional casting, showing a 20% increase in maximum load and 21% increase in maximum stress. CONCLUSIONS: These changes were noted without any cases of tendon re-rupture in either type of cast. Thus, functional casting following surgery of Achilles tendons appears to improve healing without significant risks of re-rupture.

Achilles Tendon↗
PubMed1998

Biochemistry and biomechanics of healing tendon: Part II. Effects of combined laser therapy and electrical stimulation.

PURPOSE: In previous studies we demonstrated that early mechanical loading and laser photo-stimulation independently promoted tendon healing. Thus, we tested the hypothesis that a combination of laser phototherapy and mechanical load would further accelerate healing of experimentally tenotomized and repaired rabbit Achilles tendons. METHODS: Following surgical tenotomy and repair, the tendons of experimental and control rabbits were immobilized in polyurethane casts for 5 d. The repaired tendons of experimental rabbits received mechanical load via electrical stimulation-induced contraction of the triceps surae for 5 d. In addition, experimental tendons were treated with daily doses of 1 J.cm-2 low intensity helium-neon laser throughout the 14-d experimental period. RESULTS: The combination of laser photostimulation and mechanical load increased the maximal stress, maximal strain, and Young's modulus of elasticity of the tendons 30, 13, and 33%, respectively. However, MANOVA revealed no statistically significant differences in these biomechanical indices of repair of control and experimental tendons. Biochemical assays showed a 32% increase in collagen levels (P < 0.05) and an 11% decrease in mature cross-links in experimental tendons compared with that in controls (P > 0.05). Electron microscopy and computer morphometry revealed no significant differences in the morphometry of the collagen fibers and no visible differences in the ultrastructure of cellular and matrical components of control and experimental tendons. CONCLUSIONS: These findings indicate that the combination of laser photostimulation and early mechanical loading of tendons increased collagen production, with marginal biomechanical effects on repaired tendons.

Achilles Tendon↗
PubMed1990

The management of paralytic spasticity.

The treatment of spasticity in severely paralyzed patients undergoing rehabilitation constitutes a significant neurosurgical challenge that requires comprehensive management. In this study, 118 patients were treated with invasive modalities when medical therapy failed. The results of percutaneous radiofrequency foraminal rhizotomy were initially successful in 95% of the 77 patients who underwent this procedure; the rate of minor complications was 5%. This procedure was satisfactorily supplemented with percutaneous radiofrequency sciatic neurectomy in 32 of these 77 patients. Four myelotomies were performed with complete success and no major complications in patients in whom percutaneous techniques had proven inadequate. In 35 instances of focal spasticity and incomplete paralysis, intramuscular neurolysis by phenol injection was used. The success rate was 89%. In 9 patients with persistent recurrent spasticity of the lower limb, open tenotomies and peripheral neurectomies were done. Success was complete and without complications. Multiple modalities must be available for the comprehensive management of patients with paralytic spasticity.

Humans↗
PubMed1983

The importance of the correct resting tension in muscle transplantation: experimental and clinical aspects.

The influence of a reduction of resting tension by elongation of the tendon on muscle function and morphology is investigated in the rectus femoris muscle of the rabbit. An elongation of the patellar tendon of 5 mm causes a reduction of the twitch tension to 73.5 percent of the contralateral control side and a reduction of the tetanic tension to 78.3 percent 6 months after surgery. The histologic, histochemical, and planimetric changes are similar to those reported by other authors for tenotomy, but they are less marked. The clinical relevance of these experimental results for free muscle transplantation with microneurovascular anastomoses and some technical details are discussed.

Animals↗
PubMed2001

Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.

Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.

Adolescent↗
PubMed2002

Lip augmentation with superficial musculoaponeurotic system grafts: report of 103 cases.

Many patients suitable for a lip augmentation are of face lift age, and could benefit from a simultaneous lip enhancement during the rhytidectomy procedure. The healthy, live superficial musculoaponeurotic system (SMAS) tissue obtained from the face lift can be recycled and grafted with minimal additional operating time. From April of 1995 to January of 2000, 103 patients (99 women and four men) underwent a lip augmentation procedure by the senior author (N.L.) using SMAS grafts harvested from a simultaneous rhytidectomy. Indications for surgery were purely aesthetic in all 103 cases. The surgical technique used for the SMAS graft lip augmentation is as follows: Using a narrow tenotomy scissors, an intramuscular tunnel was created with blunt and sharp dissection across the lip. The graft, obtained from the posterior edge of the SMAS dissection, is left as long as possible, and is pulled through the tunnel with a tendon forceps. The lips are then stretched manually from the central point upward and downward, respectively. It is important to avoid suturing the ends of the graft into the closure; the grafts should be allowed to move freely, to avoid postoperative tethering on smiling or mouth opening. Most patients expressed some initial concern with their early appearances caused mainly by the swelling. By 2 weeks, most patients were extremely pleased with the size and shape, and their main concern was that the lip fullness would shrink even more. By 3 to 4 weeks, shrinkage largely ceased and the correction remained for varying periods, some as long as 5 years. A sampling of the results was obtained by means of a questionnaire mailed to all patients having undergone the SMAS graft lip augmentation. Fifty-four patients (52 percent) returned the questionnaire with their responses. Of those who responded to the survey, 42 patients (78 percent) reported fuller lips than before their operation. Significantly, 11 of 14 patients (79 percent) followed up after 24 months postoperatively reported fuller lips and excellent or good results. Complications and unsatisfactory results were very rare, occurring generally at the beginning of the learning curve of the series.SMAS grafts are useful for long-lasting lip augmentation, producing a youthful appearance by adding natural, soft roundness and fullness to lips without the artificial look and feel of synthetic material.

Cosmetic Techniques↗
PubMed1977

Osteotomy of the metatarsals for pes cavus.

Described is a surgical procedure for pes cavus which includes multiple osteotomies of the metatarsals, usually combined with Steindler fasciotomy and extensor tenotomy. This method permits the correction of the cavus deformity and preserves the length of the foot without disturbing any joint. A total of 11 patients with 14 procedures have been followed up for an average of more than three years. Results of 12 of the 14 operations were favorable according the the criteria used.

Adolescent↗