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PubMedDate not supplied

Electromyographic activity of selected trunk muscles during stabilization exercises using a gym ball.

Trunk stabilization is very important for the injured lower back. The use of a gym ball, the surface of which is labile, is becoming more popular for strengthening the trunk muscles and challenging the motor control system in trunk stabilization exercises. However, little is known about the activity of the trunk muscles during such exercises. The purpose of this study was to compare the electromyographic (EMG) activity of the trunk muscles during seven stabilization exercises using a gym ball. Eleven healthy men (19.9 +/- 1.8 years old) without low back pain volunteered to participate in the study. Bipolar surface electrodes were attached to the right side of the upper and lower rectus abdominis, the obliquus externus abdominis and the upper and lower back extensor muscles. EMG signals were recorded during seven types of stabilization exercises using a gym ball and normalized to maximal voluntary contraction (% MVC). A two-way analysis of variance (ANOVA) was performed on % MVC from each task for each of the five trunk muscle sites (p < 0.05). Push-up exercise, supporting with both hands on the gym ball and toes on the floor in prone position, resulted in the highest activity of all abdominal muscles, and an exercise of the lifting the gym ball up, holding it actively between both legs with both knees flexed in supine position resulted in the lowest. Lifting up of the pelvis in a bridged position exercise, supporting the head with the gym ball and with the feet on the floor in supine position, resulted in higher muscle activity of the back extensor muscles than another exercise. It is very important for physical therapists to make clear the purpose of the trunk stabilization exercises, because different kinds of exercises with the gym ball demand various levels of muscular activity and use of various parts of the trunk muscles.

Adolescent↗
PubMed2000

Osteomalacia that became symptomatic 13 years after a total gastrectomy.

A 66-year-old man who underwent a total gastrectomy 13 years ago was admitted to our hospital complaining of severe low back pain and muscle weakness. Biochemical examinations revealed hypocalcemia, hypophosphathemia, low serum 25 (OH) vitamin D and hyperparathyroidism. A chest CT scan revealed pseudofractured ribs, whereas plain X-photography did not show any significant findings. We diagnosed the illness as osteomalacia due to malabsorption. The patient has been receiving oral active vitamin D and calcium, and the pain and serum calcium and phosphate values have improved to the point that he can receive out-patient treatment.

Aged↗
PubMed2005

Influence of zinc on the status of hepatic trace elements and biokinetics of 65Zn in ethanol treated rats.

Whole body counting studies of 65Zn indicated that the Tb1 (the faster component) was significantly decreased while the slower component (Tb2) was increased significantly following ethanol treatment. Interestingly, following zinc treatment to ethanol treated rats, slower component (Tb2) of 65Zn came back to within normal limits while the faster component (Tb1) got significantly elevated in comparison to ethanol treatment. Percent uptake values of 65Zn were found to be increased in liver, intestine, muscle, brain and kidney, and decreased in bone under alcoholic conditions. Interestingly, the uptake values of 65Zn in all the organs except muscle were reverted back to within normal limits upon zinc supplementation to these ethanol intoxicated animals. A significant decrease in zinc contents was noticed in ethanol treated rats, which, however, were raised to normal levels upon zinc supplementation: Copper levels, on the other hand, were significantly enhanced in both ethanol fed and combined ethanol + zinc treated rats. Calcium levels were significantly decreased in both ethanol and zinc treated rats, which however were further reduced upon zinc supplementation to ethanol fed rats. However, no significant change was observed in the concentrations of sodium and potassium in any of the treatment groups. In conclusion, zinc appears to play a protective role by normalizing the turnover of 65Zn in whole body as well as in its uptake in different organs under alcoholic conditions.

Animals↗
PubMed1996

Isokinetic performance capacity of trunk muscles. Part I: The effect of repetition on measurement of isokinetic performance capacity of trunk muscles among healthy controls and two different groups of low-back pain patients.

The aim of this investigation was to assess the reproducibility of the isokinetic trunk muscle performance measurement among patients with different degrees of low-back pain. Twenty-two healthy volunteers, 20 patients with mild and 18 patients with severe low-back pain participated in isokinetic measurements. Lidoback isokinetic dynamometer was used. The measurements were performed with the subjects standing, using velocities of 60, 90 and 120 degrees/second. Five repetitions were performed at each velocity. All subjects were tested three times with a 1-week interval between the tests. Peak torque, average peak torque, coefficient of variation, total work done and peak torque to body weight ratio were calculated for each velocity for both flexion and extension. The results showed that in every measurement peak torque, average peak torque, peak torque to body weight ratio and total work done correlated with each other very strongly both in flexion and extension (r > or = 0.9). The average peak torques increased in further measurements. The change had a strong correlation with the severity of the back problem, which was evaluated by means of the Oswestry disability index. The critical value was found to be 20% in the Oswestry index: values above this meant big changes between measurements and values below this meant small changes between measurements.

Adult↗
PubMedDate not supplied

[Human tolerance to Coriolis acceleration during exertion of different muscle groups].

The effect of an arbitrary loading of different muscle groups (shoulder, back, legs) and motor acts on the tolerance to Coriolis accelerations was investigated in 140 experiments in which 40 test subjects participated. The accelerations were cumulated and simulated by the Bryanov scheme. Muscle tension was accompanied by a less expressed vestibulo-vegetative reaction and shortening of the recovery period after the development of motion sickness symptoms. The greatest changes were observed during the performance of complex motor acts and tension of shoulder muscles. Possible mechanisms of these effects are discussed.

Adult↗
PubMed2000

Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial.

BACKGROUND: Knee-joint pathologies, such as anterior knee pain (AKP), are associated with strength deficits and reduced activation of the knee extensors, which is referred to as muscle inhibition (MI). MI is thought to prevent full functional recovery, and treatment modalities that help to reduce or eliminate MI appear necessary for successful rehabilitation. Clinical observations suggest that AKP is typically associated with sacroiliac (SI) joint dysfunction. It is unknown whether SI-joint dysfunction contributes to knee-extensor deficits and whether correction of SI-joint dysfunction alleviates MI. OBJECTIVE: The objective of this study was to assess whether conservative low back treatment reduces lower limb MI. STUDY DESIGN: In a randomized, controlled, double-blind study the effects of conservative lower back treatment on knee-extensor strength and MI were evaluated in patients with AKP. METHODS: Twenty-eight patients with AKP were randomly assigned to either a treatment or a control group. After a lower back functional assessment, the treatment group received a conservative treatment in the form of a chiropractic spinal manipulation aimed at correcting SI-joint dysfunction. The control group underwent a lower back functional assessment but received no joint manipulation. Before and after the manipulation or the lower back functional assessment, knee-extensor moments, MI, and muscle activation during full effort, isometric knee extensions were measured. RESULTS: Patients showed substantial MI in both legs. Functional assessment revealed SI-joint dysfunction in all subjects (23 symptomatic and 5 asymptomatic). After the SI-joint manipulation, a significant decrease in MI of 7.5% was observed in the involved legs of the treatment group. MI did not change in the contralateral legs of the treatment group or the involved and contralateral legs of the control group. There were no statistically significant changes in knee-extensor moments and muscle activation in either group. CONCLUSIONS: The results of this study suggest that SI-joint manipulation reduces knee-extensor MI. Spinal manipulation may possibly be an effective treatment of MI in the lower limb musculature.

Adult↗
PubMed2002

Clonal separation and regionalisation during formation of the medial and lateral myotomes in the mouse embryo.

In vertebrates, muscles of the back (epaxial) and of the body wall and limbs (hypaxial) derive from precursor cells located in the dermomyotome of the somites. In this paper, we investigate the mediolateral regionalisation of epaxial and hypaxial muscle precursor cells during segmentation of the paraxial mesoderm and myotome formation, using mouse LaacZ/LacZ chimeras. We demonstrate that precursors of medial and lateral myotomes are clonally separated in the mouse somite, consistent with earlier studies in birds. This clonal separation occurs after segmentation of the paraxial mesoderm. We then show that myotome precursors are mediolaterally regionalised and that this regionalisation precedes clonal separation between medial and lateral precursors. Strikingly, the properties of myotome precursors are remarkably similar in the medial and lateral domains. Finally, detailed analysis of our clones demonstrates a direct spatial relationship between the myocytes in the myotome and their precursors in the dermomyotome, and earlier in the somite and presomitic mesoderm, refuting several models of myotome formation, based on permanent stem cell systems or extensive cell mingling. This progressive mediolateral regionalisation of the myotome at the cellular level correlates with progressive changes in gene expression in the dermomyotome and myotome.

Animals↗
PubMed2002

Muscle activation during exercises to improve trunk stability in men with low back pain.

OBJECTIVES: To evaluate the relative activation amplitudes from 3 abdominal and 2 trunk extensor muscle sites of persons with low back pain (LBP) performing the pelvic-tilt, the abdominal-hollowing, and level 1 of the trunk stability test (TST) exercises and to compare the activation amplitudes among muscle sites and exercises. DESIGN: A prospective, comparative, repeated-measures design. SETTING: Motion analysis research laboratory. PARTICIPANTS: Fourteen men with LBP (mean duration, 8y; mean age +/- standard deviation, 39+/-5y). INTERVENTIONS: Subjects performed 3 exercises in random order while surface electromyograms were recorded from 5 muscle sites: lower and upper rectus abdominus, external oblique, erector spinae, and multifidus. The exercises were divided into 2 phases: a movement phase and a stabilization phase. The root-mean-square (RMS) electromyographic amplitude for each phase was calculated and normalized to the highest RMS amplitude from a series of 4 exercises, which attempted to elicit maximal voluntary isometric contractions (MVICs) for each muscle. A 2-factor, repeated-measures analysis of variance (ANOVA) tested the muscle by exercise interaction and the 2 main effects for each phase separately. MAIN OUTCOME MEASURES: Normalized RMS amplitude was the main dependent variable. The ensemble-average profiles for each muscle were calculated to examine the phasing of activation throughout the exercises. RESULTS: The ANOVA revealed a statistically significant muscle-by-exercise interaction (P<.05) for both phases, which showed that the 3 exercises; recruited the 5 muscle sites using different patterns of relative amplitudes. The external oblique muscle site was activated to higher amplitudes than the other 4 muscle sites for all 3 exercises; the highest normalized RMS activity occurred at the external oblique during the pelvic tilt (32% MVIC). The phasic patterns among the 5 muscle sites were not consistent for the TST but were consistent among the 5 sites for the other 2 exercises. CONCLUSIONS: None of the exercises recruited the abdominal muscles to intensities deemed adequate for strengthening. The TST challenges the coordination of muscle activity during the leg-loading task (stabilization phase) as evidenced by changes in amplitudes over the total exercise time for the external oblique site, but not the other 4 sites. All 3 exercises could be used as initial exercises in a dynamic stability progression when low-recruitment amplitudes of specific muscles were the objective but not for strengthening.

Abdominal Muscles↗
PubMed1998

Back and hip extensor fatigability in chronic low back pain patients and controls.

OBJECTIVE: To compare the lumbar paraspinal and gluteus maximus muscle fatigability between chronic low back pain patients and healthy controls by using electromyographic (EMG) spectral analysis during a maximal isometric endurance task. DESIGN: A cross-sectional comparative study between chronic low back pain patients and healthy control subjects. SETTING: Physical medicine and rehabilitation clinic in Finland. SUBJECTS: Twenty women with nonspecific chronic low back pain (longer than 3 months) and 15 healthy controls. INTERVENTION: Subjects performed maximal voluntary isometric back extensions (MVC) at 30 degrees forward flexion in a specially designed measurement unit. A 50% MVC load was used in isometric endurance test. OUTCOME MEASURES: Low back pain intensity was assessed by using the visual analogue scale and functional disability by the Oswestry disability index. Time to endurance was measured. Bipolar surface EMG recordings were made over the lumbar paraspinal muscles (L3-L4, L5-S1) and over the gluteus maximus muscles. Average EMG (aEMG%), and initial spectral median frequency (MFinit) and change over time (MFslope) were computed. RESULTS: Pain intensity and functional disability were higher and MVC and time to endurance were lower in the chronic low back pain group (p < .05). Similar muscle activity levels (aEMG%) and MFinit indicated similar muscle loading in both groups at the beginning of the endurance test. EMG spectral decreases (MFslope) indicated that lumbar paraspinal muscle fatigability was similar in both groups. In the chronic low back pain group, the gluteus maximus fatigued faster than in the control group (greater MFslope, p < .05). However, the shorter endurance time indicated greater fatigability in the chronic low back pain group in general (p < .05). CONCLUSIONS: The chronic low back pain patients were weaker and fatigued faster than the healthy controls. The EMG fatigue analysis results suggest that the gluteus maximus muscles are more fatigable in chronic low back pain patients than in healthy control subjects during a sustained back extension endurance test.

Adult↗
PubMed1984

Heterogeneity of contractile proteins. Purification and characterization of two species of troponin T from rabbit fast skeletal muscle.

Two species of troponin T have been purified by ion-exchange chromatography from erector spinae, the major fast white muscle of the rabbit back, and from a pool of the fast hindlimb muscles gastrocnemius and plantaris. Designated Tn-T1f and Tn-T2f, they can be resolved by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis, with apparent molecular weights of 37,500 and 37,000 respectively. Their amino acid compositions are similar and correlate well with that reported for troponin T from fast muscle (Pearlstone, J. R., Carpenter, M. R., and Smillie, L. B. (1977) J. Biol. Chem. 252, 971-977). Tn-T2f most likely corresponds to the previously studied troponin T; further characterization was undertaken to determine how the newly identified Tn-T1f differs from Tn-T2f. Phosphorylation of alkaline phosphatase-treated troponin demonstrated that Tn-T1f and Tn-T2f are not interconverted by a change in phosphorylation state. Comparison of the CNBr fragments of Tn-T1f and Tn-T2f by SDS-gel electrophoresis and reverse phase high-performance liquid chromatography revealed similar but not identical peptide patterns. The major difference occurs in the amino-terminal CNBr peptides corresponding to CB3. Since both Tn-T1f and Tn-T2f have blocked amino termini, the difference does not result from proteolysis at the amino terminus of one of the proteins. These observations indicate that the two species of troponin T do not result from a known post-translational modification, but rather from differences in the amino acid sequence, suggesting that they arise either from the expression of different genes or a single gene from which different mRNAs are transcribed.

Amino Acids↗
PubMed2000

The comparison of trunk muscles EMG activation between subjects with and without chronic low back pain during flexion-extension and lateral bending tasks.

The purpose of the study was to compare the electromyographic (EMG) activity of the trunk muscles between normal subjects and chronic low back pain (CLBP) patients during standardized trunk movements. Thirty-three male subjects (18 normals, 15 suffering from non specific CLBP) aged between 35 and 45 yr participated. A biomechanical analysis involving the recording of EMG signals from 12 trunk muscles, the kinematics of trunk segments and the computation of L5/S1 moments was performed. The subjects performed flexion-extension and lateral bending (left and right) tasks (three complete cycles) with and without a 12 kg load. Between group comparisons were performed on the full cycle average pattern of all biomechanical variables for each task. The reliability of EMG variables was evaluated for 10 subjects (5 normals and 5 CLBP) who performed the tasks on three different days. The reliability of EMG amplitude values was generally excellent for agonist muscles but poor to moderate for antagonists. The EMG amplitude analysis revealed significant differences between groups for some muscles (left lumbar and thoracic erector spinae). The abnormal (asymmetric) EMG patterns detected among CLBP patients were not explained by postural asymmetries.

Adult↗
PubMed1994

A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain.

STUDY DESIGN: A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain. OBJECTIVES: The authors determined the relative efficacy of chiropractic treatment to massage, corset, and TMS. SUMMARY OF BACKGROUND DATA: Although all of these treatments are used for subacute low back pain treatment, there have been few comparative trials using objective outcome criteria. Patients were enrolled for a period of 3 weeks. They were evaluated once a week by questionnaires, visual analog scale, range of motion, maximum voluntary extension effort, straight leg raising and Biering-Sorensen fatigue test. The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group. Rates of full compliance did not differ significantly across treatments. A measure of patient confidence was greatest in the manipulation group. RESULTS: After 3 weeks, the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time, and the muscle stimulation group the best extension. CONCLUSION: None of the changes in physical outcome measures (range of motion, fatigue, strength or pain) were significantly different between any of the groups.

Adult↗
PubMed1973

Input from muscle and cutaneous nerves of the hand and forearm to neurones of the precentral gyrus of baboons and monkeys.

1. The precentral bank of the Rolandic fissure of the cortical arm area has been explored with extracellular micro-electrodes in primates (baboons and monkeys) under nitrous oxide and oxygen anaesthesia, supplemented by small doses of Parkesernyl(R) and chloralose. The results in baboons and monkeys were the same.2. Single units were classified as pyramidal tract neurones or non-pyramidal tract neurones according to their antidromic responsiveness to stimuli applied in the dorsolateral funiculus at C1-2.3. Responses to electrical stimulation of the deep (motor) radial nerve, the deep palmar (motor) branch of the ulnar nerve, and the superficial (cutaneous) radial nerve could be recorded in the majority of neurones of the motor cortex provided that short trains of strong stimuli were used. Minimal responses to muscle nerve stimulation were observed in a few neurones at 1.4 x group I threshold, but most units reacted only with higher stimulus intensities (2-3 x group I threshold).4. The latencies to peripheral nerve stimulation were measured from the first peak of the incoming volley recorded at the root entry zone. The mean response latencies of pyramidal tract cells were between 20 and 25 msec; non-pyramidal tract cells were activated at slightly shorter mean latencies, the difference being significant for superficial radial nerve stimulation only (4 msec). These latencies are more than twice as long as those recorded in the postcentral gyrus, and the probability of discharge is lower than for postcentral neurones.5. A further difference between neurones of the postcentral and precentral gyrus is the pronounced convergence from different nerves and also from different modalities (cutaneous and muscle afferents) in units of the precentral cortex in contrast to units of the postcentral cortex.6. The high thresholds, necessary to activate precentral neurones by muscle nerve stimulation, make it unlikely that group I muscle afferents are involved. This is, furthermore, indicated by the lack of responsiveness to intravenous injection of succinylcholine which was, however, effective for driving neurones of the specific projection area for group I afferents, area 3a. The present experiments are consistent with the view that sensitivity of precentral neurones to muscle stretch (described in previous studies) is due to activation of secondary muscle spindle endings and their ascending pathways.7. The original hypothesis of a load compensating ;pyramidal reflex' with an oligosynaptic afferent contribution from the spindle primaries can be discarded. The present findings indicate that there is a feed-back from secondary muscle spindle afferents which, by way of a more complex pathway, can modulate the firing frequency of neurones in the motor cortex.

Animals↗
PubMed1983

H-protein and X-protein. Two new components of the thick filaments of vertebrate skeletal muscle.

With a view to obtaining a more complete view of the composition and structure of the thick filaments of vertebrate skeletal muscle, we have isolated and characterized two new myofibrillar components, H-protein and X-protein. These were purified by hydroxyapatite column chromatography of an impure C-protein preparation itself made from impure myosin extracted from rabbit back and leg muscles. H-protein is the protein responsible for band H on sodium dodecyl sulphate/polyacrylamide gel electrophoresis of crude myosin. X-protein, although present in such preparations in significant quantities, was not detected previously since it is difficult to resolve from C-protein by sodium dodecyl sulphate/polyacrylamide gel electrophoresis. Physical-chemical parameters have been determined for the new proteins and compared with those of C-protein. The apparent chain weight of H-protein estimated by sodium dodecyl sulphate/polyacrylamide gel electrophoresis is 69,000, whereas that of X-protein (152,000) is only slightly greater than that of C-protein (140,000). The molecular weights of H- and X-proteins determined by sedimentation equilibrium centrifugation show that the molecules contain only a single polypeptide chain. The circular dichroism spectra indicate that the proteins have low alpha-helical contents. Both proteins, particularly H-protein, have a high proline content. Although X-protein is of similar chain weight to C-protein, the two show distinct differences in other properties. The sedimentation coefficient of X-protein is markedly lower than that of C-protein, suggesting X-protein is a more asymmetrical molecule. The amino acid compositions, although broadly similar, also show clear differences. Antibodies to H-protein, X-protein and C-protein have been raised in goats and shown not to cross-react.

Amino Acids↗
PubMed2003

Caveolae, caveolin and cav-p60 in smooth muscle and renin-producing cells in the rat kidney.

AIMS: In vascular smooth muscle cells caveolae are important for signalling mechanisms regulating vascular contraction. In smooth muscle layer of the renal afferent arteriole juxtaglomerular cells (JG cells) are non-contractile renin producing cells that have the capacity to change their phenotype into smooth muscle cells and back again by metaplastic transformation. Signalling mechanisms in JG cells are not fully understood and we therefore investigated if caveolae were present, and thereby could be involved as integrators of cellular signalling in both of these phenotypes of smooth muscle cells. METHODS: Using electron microscopy we compared the number of caveolae in JG cells and smooth muscle cells in the afferent arteriole of the rat kidney. The expression of caveolin and cav-p60 was examined using a combination of immunogold electron microscopy and immunofluorescence microscopy. RESULTS: We found that JG cells have sixfold less caveolae per cell surface sectional length than smooth muscle cells. The expression of cavolin-1 and cav-p60 correlated with the number of caveolae. An examination of the general distribution of caveolae, cav-p60 and caveolins in the rat kidney showed that cav-p60, like caveolin-1, is a specific maker of caveolae. CONCLUSION: The number of caveolae in JG cells is very low, and this makes it unlikely that caveolae are of major importance for the renin secretion specific for JG cells.

Animals↗
PubMed1990

Transitions from fetal to fast troponin T isoforms are coordinated with changes in tropomyosin and alpha-actinin isoforms in developing rabbit skeletal muscle.

In adult fast skeletal muscle, specific combinations of thin filament and Z-line protein isoforms are coexpressed. To determine whether the expression of these sets of proteins, designated the TnT1f, TnT2f, and TnT3f programs, is coordinated during development, we characterized the transitions in troponin T (TnT), tropomyosin (Tm), and alpha-actinin isoforms that occur in developing fetal and neonatal rabbit skeletal muscle. Two coordinated developmental transitions were identified, and a novel pattern of thin filament expression was found in fetal muscle. In fetal muscle, new TnT species--whose protein and immunochemical properties suggest that they are the products of a new TnT gene--are expressed in combination with beta 2 Tm and alpha-actinin1f/s. This pattern, which is found in both back and hindlimb muscles, is specific to fetal and early neonatal muscle. Just prior to birth, there is a transition from the fetal program to the isoforms that define the TnT3f program, TnT3f, and alpha beta Tm. Like the fetal program, expression of the TnT3f program appears to be a general feature of muscle development, because it occurs in a variety of fast muscles as well as in the slow muscle soleus. The transition to adult patterns of thin filament expression begins at the end of the first postnatal week. Based on studies of erector spinae, the isoforms comprising the TnT2f program, TnT2f, alpha 2 Tm, and alpha-actinin2f, appear and increase coordinately at this time. The transitions, first to the TnT3f program, and then to adult patterns of expression indicate that synthesis of the isoforms comprising each program is coordinated during muscle specialization and throughout muscle development. In addition, these observations point to a dual role for the TnT3f program, which is the major thin filament program in some adult muscles, but appears to bridge the transition from developmentally to physiologically regulated patterns of thin filament expression during the late fetal and early neonatal development.

Actinin↗
PubMed1997

[Orthopedic hippotherapy--new methods in treatment of segmental instabilities of the lumbar spine].

The orthopedic hippotherapy represents a new form of therapeutic exercise in the conservative treatment of segmental instabilities in the lumbar spine region. This kind of therapy works on the principle of conveying to the patient the three-dimensional swinging motion of the horse's back. The patient reacts to these movement impulses by moving up and down (vertical movement of the spine), back and forth (sagittal movement) and to the right and the left (horizontal movement). The small movements of the spine thus produced bring about a mobilization of the segments involved in movement and therefore eliminate articular hypomobilities. Moreover, the short monosegmental muscles of the back are subjected to an excentric training which leads to a muscular stabilization of segmental hypermobilities. Due to the varying pressure load during the riding exercise the trophic conditions of the active and passive structures of the spine are improved.

Adult↗
PubMed1991

The muscle-sparing thoracotomy in infants and children.

Deformities of the chest wall, breast, shoulder girdle, and spine are well-documented sequelae of major thoracotomies that transect muscles, divide major motor nerves, resect ribs, or cause them to fuse. These deformities are probably aggravated by the growth process. This is why we make a plea for the routine use, in infants and children, of a muscle-sparing thoracotomy that will minimize these sequelae without sacrificing exposure. Major (lateral) thoracotomy by this technique involves these steps: (1) creating a transverse incision below the tip of the scapula, or a vertical axillary incision; (2) elevating the skin flaps to expose the muscles; (3) retracting the latissimus dorsi posteriorly; (4) retracting the serratus anterior and scapula superiorly; (5) disinserting the lower origins of the serratus if required only; (6) opening the desired intercostal space; (7) reapproximating the ribs without crowding, using a pericostal suture that is passed along the inferior rib subperiosteally, to avoid any compression on the neurovascular bundle; and (8) allowing the muscles to fall back into place, reattaching the serratus insertions as indicated. Lessened postoperative pain and improved respiratory function are additional benefits.

Child↗