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Edris A, Aswad H. A case report: New technique of proximal lengthening for treatment of injection induced rectus femoris muscle contracture. Int J Surg Case Rep 2024; 118:109691. [PMID: 38663290 PMCID: PMC11064627 DOI: 10.1016/j.ijscr.2024.109691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024] Open
Abstract
Contracture of quadriceps femoris muscle is an uncommon condition in clinical practice. It was suggested that intramuscular injections into the thigh for children are sometimes the cause of this condition. CASE REPORT The case presents a new surgical technique for the treatment of isolated rectus femoris muscle contracture. The patient is a 6- year-old boy complaining of external rotation of the left leg when he walks and inability to squat. Clinical examination showed positive Ely's test which indicated isolated rectus femoris muscle contracture. The patient underwent proximal lengthening of rectus femoris muscle. DISCUSSION Quadriceps femoris muscle contracture in children can be congenital or acquired. The identified causes of this case are multiple intramuscular injections, trauma or ischemia. The recommended treatment is proximal release in the early stage if contracture is diagnosed and distal lengthening of quadriceps tendon in the late stage. Surgical techniques that preserve continuity of the rectus femoris muscle have better outcomes, and give opportunity for second lengthening surgery if needed. This article presents a surgical technique of proximal rectus femoris muscle release that depends on using the length of the indirect head by transferring its attachment to the distal end of the direct head. CONCLUSION Quadriceps femoris contracture in children leads to limited knee flexion. Proximal release in the early stage gives excellent result. The technique used in this research gives an opportunity to restore knee flexion and a chance for second release if needed.
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Affiliation(s)
- Ahmad Edris
- University of Aleppo, Faculty of Medicine, Aleppo, Syrian Arab Republic
| | - Hadeel Aswad
- University of Aleppo, Faculty of Medicine, Aleppo, Syrian Arab Republic.
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Marinelli A, Guerra E, Bain G. Classification of elbow stiffness. J ISAKOS 2024; 9:234-239. [PMID: 37923144 DOI: 10.1016/j.jisako.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Stiffness is a clinical disorder that affects the patient's function of the entire upper limb. Many classifications systems have been developed for elbow stiffness based on the plane of motion, severity, aetiology, prognosis or anatomical location. A new classification, the Stiffness types and Influencing Factors Classification System, is proposed as a treatment algorithm to guide the surgical treatment and the preferred operative approach (open or arthroscopic).
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Affiliation(s)
- Alessandro Marinelli
- Shoulder and Elbow Unit - IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy..
| | - Enrico Guerra
- Shoulder and Elbow Unit - IRCCS Istituto Ortopedico Rizzoli, Bologna, 40100, Italy
| | - Gregory Bain
- Flinders University and Finders Medical Center, Adelaide, South Australia, 5042, Australia.
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3
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Depetris N, Lavrentieva A, Dash S, Rogers AD, Pompermaier L. Response to Letter to Editor regarding the manuscript "Quality indicators in burn care: An international burn care professionals survey to define them". Burns 2024; 50:530-531. [PMID: 38114376 DOI: 10.1016/j.burns.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Nadia Depetris
- Anaesthesiologist-Intensivist, Department of Anaesthesia and Intensive Care, City of Health and Science, CTO Hospital, Turin, Italy.
| | - Athina Lavrentieva
- Anaesthesiologist-Intensivist, ICU Director, Papanikolaou Hospital, Thessaloniki, Greece
| | - Suvashis Dash
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alan David Rogers
- Plastic Surgeon, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Laura Pompermaier
- Consultant Plastic Surgeon, Department of Plastic Surgery, Linköping University Hospital, Sweden
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Kuska EC, Steele KM. Does crouch alter the effects of neuromuscular impairments on gait? A simulation study. J Biomech 2024; 165:112015. [PMID: 38394953 PMCID: PMC10939721 DOI: 10.1016/j.jbiomech.2024.112015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 12/18/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Cerebral palsy (CP) is a neurologic injury that impacts control of movement. Individuals with CP also often develop secondary impairments like weakness and contracture. Both altered motor control and secondary impairments influence how an individual walks after neurologic injury. However, understanding the complex interactions between and relative effects of these impairments makes analyzing and improving walking capacity in CP challenging. We used a sagittal-plane musculoskeletal model and neuromuscular control framework to simulate crouch and nondisabled gait. We perturbed each simulation by varying the number of synergies controlling each leg (altered control), and imposed weakness and contracture. A Bayesian Additive Regression Trees (BART) model was also used to parse the relative effects of each impairment on the muscle activations required for each gait pattern. By using these simulations to evaluate gait-pattern specific effects of neuromuscular impairments, we identified some advantages of crouch gait. For example, crouch tolerated 13 % and 22 % more plantarflexor weakness than nondisabled gait without and with altered control, respectively. Furthermore, BART demonstrated that plantarflexor weakness had twice the effect on total muscle activity required during nondisabled gait than crouch gait. However, crouch gait was also disadvantageous in the presence of vasti weakness: crouch gait increased the effects of vasti weakness on gait without and with altered control. These simulations highlight gait-pattern specific effects and interactions between neuromuscular impairments. Utilizing computational techniques to understand these effects can elicit advantages of gait deviations, providing insight into why individuals may select their gait pattern and possible interventions to improve energetics.
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Affiliation(s)
- Elijah C Kuska
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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Yokochi M, Nakamura M, Iwata A, Kaneko R, Morishita S, Oi N. The effect of massage on the plantar flexor muscles during the fixation period in postoperative patients with an ankle fracture. J Bodyw Mov Ther 2024; 37:183-187. [PMID: 38432804 DOI: 10.1016/j.jbmt.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/15/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Ankle fractures are one of the most common lower extremity fractures. After surgery, the ankle joint is often immobilized in a plantar flexion position, and there have been many reported cases of limited ankle joint range of motion. Therefore, the purpose of the present study was to investigate the effect of regular massage interventions on ankle joint range of motion after removal of fixation. METHODS The massage group comprised 30 patients who had sustained an ankle fracture and had undergone surgical fixation, physical therapy, and massage between November 2020 and March 2022. These subjects received a 3-min massage twice daily, five times a week. The control group consisted of 38 patients who had sustained an ankle fracture between January 2015 and September 2020 and had undergone surgical fixation as well as regular physical therapy. RESULTS The respective ankle dorsiflexion and plantarflexion ranges of motion after cast removal were 2.50 ± 7.2° and 42.3 ± 7.2° in the massage group and -8.62 ± 2.9° and 34.8 ± 8.3° in the control group. An unpaired t-test showed that the ankle dorsiflexion and plantarflexion ranges of motion in the massage group were significantly greater than those in the control group (p = 0.036 and p < 0.01). CONCLUSIONS Our results indicate that regular 3-min massage interventions of the plantar flexors could prevent the progression of a range of motion limitations in postoperative patients with an ankle fracture more effectively than regular physical therapy alone.
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Affiliation(s)
- Masanobu Yokochi
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu, Fukushima, 965-8585, Japan; Department of Rehabilitation, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki, Kanzaki, Saga, 842-8585, Japan
| | - Ayaka Iwata
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu, Fukushima, 965-8585, Japan
| | - Ryota Kaneko
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu, Fukushima, 965-8585, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima City, Fukushima, 960-1295, Japan
| | - Naoyuki Oi
- Community Health Care Research Center, Nagano University of Health and Medicine, 11-1 Imaihara, Kawanakajima-machi, Nagano-city, Nagano, 381-2227, Japan
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Cho YS, Pickford M. 'Distal-to-proximal' surgical release of the proximal interphalangeal joint in Dupuytren's disease. J Plast Reconstr Aesthet Surg 2024; 88:283-284. [PMID: 38029473 DOI: 10.1016/j.bjps.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Young Seok Cho
- Dartford and Gravesham NHS Trust, Darent Valley Hospital, Darenth Wood Road, Dartford DA2 8DA, UK.
| | - Mark Pickford
- Queen Victoria Hospital NHS Foundation Trust, Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, UK.
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Yan R, Zhang Z, Wu L, Wu ZP, Yan HD. Iatrogenic flexor tendon rupture caused by misdiagnosing sarcoidosis-related flexor tendon contracture as tenosynovitis: A case report. World J Clin Cases 2023; 11:8512-8518. [PMID: 38188214 PMCID: PMC10768516 DOI: 10.12998/wjcc.v11.i36.8512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Sarcoidosis is a multisystem disease characterized by granuloma formation in various organs. Sarcoidosis-related flexor tendon contractures are uncommon in clinical settings. This contracture is similar to stenosing tenosynovitis and potentially leads to misdiagnosis and mistreatment. Herein, we report a rare case of sarcoidosis-related finger flexor tendon contracture that was misdiagnosed as tenosynovitis. CASE SUMMARY A 44-year-old woman presented to our department with flexion contracture of the right ring and middle fingers. The patient was misdiagnosed with tenosynovitis and underwent acupotomy release of the A1 pulley of the middle finger in another hospital that resulted in iatrogenic rupture of both the superficial and profundus flexors. Radiological presentation showed multiple sarcoid involvements in the pulmonary locations and ipsilateral forearm. A diagnosis of sarcoidosis was made based on the presence of non-caseating granulomas with tubercles consisting of Langhans giant cells with lymphocyte infiltration on biopsy, and the patient underwent surgical repair for the contracture. After 2 mo, the patient experienced another spontaneous rupture of the repaired middle finger tendon and underwent surgical re-repair. Satisfactory results were achieved at the 10 mo follow-up after reoperation. CONCLUSION Sarcoidosis-related finger contractures are rare; thus, caution should be exercised when dealing with such patients to avoid incorrect treatment.
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Affiliation(s)
- Rui Yan
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhe Zhang
- Department of Orthopedics (Division of Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325026, Zhejiang Province, China
| | - Long Wu
- Department of Orthopedics (Division of Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325026, Zhejiang Province, China
| | - Zhi-Peng Wu
- Department of Orthopedics (Division of Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325026, Zhejiang Province, China
| | - He-De Yan
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325026, Zhejiang Province, China
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Fournier J, Trudel G, Feibel RJ, Uhthoff H, McGonagle D, Campbell TM. Asymmetric Flexion Contracture is Associated With Leg Length Inequality in Patients With Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil 2023; 104:2067-2074. [PMID: 37209935 DOI: 10.1016/j.apmr.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To evaluate whether knee flexion contracture (FC) was associated with leg length inequality (LLI) and/or morbidity in knee osteoarthritis (OA). DESIGN We accessed 2 databases: (1) the Osteoarthritis Initiative (OAI) cohort, including participants with, or at-risk of OA, and (2) the Ottawa Knee Osteoarthritis cross-sectional database (OKOA), including participants with primary advanced knee OA. Both included demographics, radiographic data, knee range of motion, leg length, pain, and function scales. SETTING Tertiary care academic rheumatology and orthopedic clinics. PARTICIPANTS Patients with or at-risk of primary OA. We included 881 OAI and 72 OKOA participants (N=953). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The primary outcome tested the association between the difference in knee extensions of the OA and contralateral knees (the knee extension difference, or KExD) and LLI. This was evaluated using bivariate regression, followed by a multivariable linear regression model. RESULTS OAI participants had less severe knee OA [Kellgren and Lawrence (KL) score 1.9±1.3] vs OKOA (KL score 3.4±0.6). The KExD correlated with LLI for both databases (OAI: R=0.167; P≤.001; OKOA: R=0.339; P=.004). Multivariable regression showed an effect of KExD on LLI in both databases (OAI: β=0.37[0.18,0.57]; P<.001, OKOA: β=0.73[0.20,1.26]; P=.007). When broken down by subgroup, the OAI moderate-severe OA group showed a significant effect of KExD on LLI (β=0.60 [0.34,0.85]; P<.001). CONCLUSIONS OA-related loss of knee extension was associated with LLI for those with moderate-severe OA. Because LLI correlates with worse knee OA symptoms, discovering an FC should cue clinicians to evaluate for LLI, an easily-treatable finding that may help reduce OA-associated morbidity for those approaching the need for arthroplasty.
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Affiliation(s)
- John Fournier
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Guy Trudel
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, Division of Physical and Rehabilitation Medicine, Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | - Robert J Feibel
- The Ottawa Hospital, Division of Orthopedic Surgery, Ottawa, Canada
| | - Hans Uhthoff
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dennis McGonagle
- University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - T Mark Campbell
- Bone and Joint Lab, Ottawa Hospital Research Institute, Ottawa, Canada; Elisabeth Bruyère Hospital, Ottawa, Canada.
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Godleski M, Yelvington M, Jean S. Burn Injury Complications Impacting Rehabilitation. Phys Med Rehabil Clin N Am 2023; 34:799-809. [PMID: 37806698 DOI: 10.1016/j.pmr.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Successful post-burn rehabilitation requires an understanding of a wide range of complications to maximize functional recovery. This article reviews a range of potential challenges including burn scar contracture, amputation, peripheral nerve injury, heterotopic ossification, dysphagia, altered skin physiology, pain, and pruritis. The overall focus is to serve as a guide for post-injury therapy and rehabilitation spanning the phases of care and considering evidence-based approaches, prevention, and treatment with an ultimate goal of aiding in the functional recovery and long-term quality of life for burn survivors.
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Affiliation(s)
- Matthew Godleski
- Department of Physical Medicine and Rehabilitation, Sunnybrook Health Sciences Centre, University of Toronto, St. John's Rehab, 285 Cummer Avenue, Toronto, Ontario M2M 2G1, Canada.
| | - Miranda Yelvington
- Department of Rehabilitation, Arkansas Children's Hospital, 1 Children's Way, Slot 104, Little Rock, AR 72202, USA
| | - Stephanie Jean
- Department of Physical Medicine and Rehabilitation, Institut de Réadaptation Gingras-Lindsay de Montréal (Darlington), Université de Montréal, 6300 Avenue Darlington, Montréal, Québec H3S 2J4, Canada
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Rivas E, Foster J, Crandall CG, Finnerty CC, Suman-Vejas OE. Key Exercise Concepts in the Rehabilitation from Severe Burns. Phys Med Rehabil Clin N Am 2023; 34:811-824. [PMID: 37806699 PMCID: PMC10731385 DOI: 10.1016/j.pmr.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.
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Affiliation(s)
- Eric Rivas
- Microgravity Research, In-Space Solutions, Axiom Space Headquarters, 1290 Hercules Avenue, Houston, TX 77058, USA
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Craig G Crandall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231, USA
| | - Celeste C Finnerty
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA
| | - Oscar E Suman-Vejas
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA.
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Zhou CX, Wang F, Zhou Y, Fang QZ, Zhang QB. Formation process of extension knee joint contracture following external immobilization in rats. World J Orthop 2023; 14:669-681. [PMID: 37744718 PMCID: PMC10514713 DOI: 10.5312/wjo.v14.i9.669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Current research lacks a model of knee extension contracture in rats.
AIM To elucidate the formation process of knee extension contracture.
METHODS We developed a rat model using an aluminum external fixator. Sixty male Sprague-Dawley rats with mature bones were divided into the control group (n = 6) and groups that had the left knee immobilized with an aluminum external fixator for 1, 2, and 3 d, and 1, 2, 3, 4, 6, and 8 wk (n = 6 in each group). The passive extension range of motion, histology, and expression of fibrosis-related proteins were compared between the control group and the immobilization groups.
RESULTS Myogenic contracture progressed very quickly during the initial 2 wk of immobilization. After 2 wk, the contracture gradually changed from myogenic to arthrogenic. The arthrogenic contracture progressed slowly during the 1st week, rapidly progressed until the 3rd week, and then showed a steady progression until the 4rd week. Histological analyses confirmed that the anterior joint capsule of the extended fixed knee became increasingly thicker over time. Correspondingly, the level of transforming growth factor beta 1 (TGF-β1) and phosphorylated mothers against decapentaplegic homolog 2 (p-Smad2) in the anterior joint capsule also increased with the immobilization time. Over time, the cross-sectional area of muscle fibers gradually decreased, while the amount of intermuscular collagen and TGF-β1, p-Smad2, and p-Smad3 was increased. Unexpectedly, the amount of intermuscular collagen and TGF-β1, p-Smad2, and p-Smad3 was decreased during the late stage of immobilization (6-8 wk). The myogenic contracture was stabilized after 2 wk of immobilization, whereas the arthrogenic contracture was stabilized after 3 wk of immobilization and completely stable in 4 wk.
CONCLUSION This rat model may be a useful tool to study the etiology of joint contracture and establish therapeutic approaches.
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Affiliation(s)
- Chen-Xu Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Feng Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yun Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Qiao-Zhou Fang
- The Second Clinical Medicine College, Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Quan-Bing Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Attias M, Bonnefoy-Mazure A, De Coulon G, Cheze L, Armand S. Toe-walking and its impact on first and second rocker in gait patterns with different degrees of artificially emulated soleus and gastrocnemius contracture. Gait Posture 2023; 105:104-109. [PMID: 37523808 DOI: 10.1016/j.gaitpost.2023.07.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/06/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle rocker) of the foot during walking. The aim of this study is to evaluate the effect of emulated artificially gastrocnemius and soleus contractures on the first and second rocker during walking. METHOD An exoskeleton was built to emulate contractures of the bilateral gastrocnemius and soleus muscles. Ten healthy participants were recruited to walk under the following conditions: without emulated contractures or with bilateral emulated contractures at 0°,10°, 20° and 30° of plantarflexion of the soleus or gastrocnemius in order to create an artificial restriction of dorsiflexion ankle movement. A linear regression from the ankle plantar-dorsiflexion angle pattern was performed on 0-5 % of the gait cycle (first rocker) and on 12-31 % of the gait cycle (second rocker) to compute the slope of the curve. The proportion of participants with the presence of the first and second rocker was then computed. A Statistical Parametric Mapping (SPM) analysis assessed the kinematic variations among different degrees of emulated contractures. FINDINGS The first and second rockers are completely absent from 10° of plantarflexion emulated contracture. The data indicate there was a non-linear shift of the gait pattern of the ankle kinematics and an important shift toward plantarflexion values with the loss of the rockers. INTERPRETATION This study suggests that toe-walking in the experimental simulation situation is not necessarily due to a high emulated contracture level and can occur with a small emulated contracture by an adaptation choice. This study may improve interpretation of clinical gait analysis and shows that the link between the level of gastrocnemius/soleus emulated contracture and progression of toe-walking (increased plantarflexion during gait) is not linear.
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Affiliation(s)
- M Attias
- Kinesiology Laboratory, Geneva University Hospitals and Geneva University, Switzerland; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland.
| | - A Bonnefoy-Mazure
- Kinesiology Laboratory, Geneva University Hospitals and Geneva University, Switzerland
| | - G De Coulon
- Pediatric Orthopaedic Service, Department of Child and Adolescent, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - L Cheze
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T 9406, F 69622 Lyon, France
| | - S Armand
- Kinesiology Laboratory, Geneva University Hospitals and Geneva University, Switzerland
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Matozinho CV, Avelino PR, Faria CDCDM, Teixeira-Salmela LF, de Menezes KK, Sant'Anna R, Scianni AA. Relative contributions of positive, negative, and adaptive features to limitations in upper-limb function three months after stroke. J Stroke Cerebrovasc Dis 2023; 32:107226. [PMID: 37473531 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/14/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To investigate the contributions of motor impairments to limitations in upper-limb function three months after stroke. DESIGN Cross-sectional, exploratory study. METHODS Dependent variable was upper-limb function, measured by the Motor Assessment Scale (MAS), which scores range from 0 to 18. Independent variables included measures of strength, dexterity, spasticity, and contracture of the paretic upper limb. Multiple linear regression analysis was employed to identify which of the independent variables could explain the MAS scores (p<0.05). Analysis was performed with the whole sample and with a sub-group of participants, who had high function (MAS≥12). RESULTS Sixty-nine individuals participated. Out of them, 63 had high upper-limb function. Regression analysis with the whole sample revealed that strength and dexterity were retained in the models. Together they explained 64% of the variance of the MAS scores (p<0.001), being strength the greater relative contributor. When the regression analysis included only participants with high upper-limb function, dexterity had a greater relative contribution, than strength. Together they explained 52 % of the variance (p< 0.001). CONCLUSIONS Strength was the main contributor to upper-limb function in individuals three months after stroke. However, in individuals, who already had higher upper-limb function, dexterity showed to be the major contributor.
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Affiliation(s)
- Christine Vo Matozinho
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Patrick R Avelino
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Luci F Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Kênia Kp de Menezes
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Romeu Sant'Anna
- Hospital Risoleta Tolentino Neves, Belo Horizonte, MG, Brasil.
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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14
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Herzog S, David R, Speirs A, Hashemi M, Winston P. A Case Report Illustrating the Combined Use of Cryoneurolysis and Percutaneous Needle Tenotomy in the Treatment of Longstanding Spastic Shoulder Contractures After Stroke. Arch Rehabil Res Clin Transl 2023; 5:100285. [PMID: 37744199 PMCID: PMC10517357 DOI: 10.1016/j.arrct.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Adduction and internal rotation of the shoulder is a common presentation in post-stroke patients, and can often be caused by spasticity and musculotendinous retraction causing a contracture of the pectoralis major and minor muscles. A post cerebral arteriovenous malfunction rupture patient with severe refractory left shoulder spasticity with contracture was treated with cryoneurolysis to the medial and lateral pectoral nerves, combined with a percutaneous needle tenotomy to the pectoralis major tendon. There was an improvement in shoulder forward flexion, abduction and external rotation immediately and found sustained at 8 weeks by 50°, 45°, and 15°. The patient noted an immediate cessation of limitation of shoulder abduction, a liberation of range of motion of the shoulder, and looseness in their arm and shoulder. They reported a dramatic improvement in their gait, increased independence, and an improvement in overall quality of life in a structured interview 8 weeks after the procedure. The patient relayed a positive experience with the combined neuro-orthopedic procedure of cryoneurolysis and tenotomy for the treatment of their spastic shoulder. This combined treatment could be considered as a management strategy for patients experiencing shoulder spasticity with contracture.
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Affiliation(s)
- Samuel Herzog
- Faculty of Science University of British Columbia, Vancouver BC, Canada
| | - Romain David
- Vancouver Island Health Authority, Victoria, BC, Canada
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Abby Speirs
- Vancouver Island Health Authority, Victoria, BC, Canada
| | | | - Paul Winston
- Vancouver Island Health Authority, Victoria, BC, Canada
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Faculty of Medicine, Victoria, BC, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, ON, Canada
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15
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Abstract
Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be reduced with a variety of techniques, including skin grafting, external fixator application, radiation, and many others described in this article. Management of recurrence requires special attention to anatomy at risk. Adjuvant therapy may help to prevent the progression or recurrence of severe disease.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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16
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Liew SK, Park JK, Gong HS. Intrinsic contracture of the hands in sarcoid myopathy. J Rheum Dis 2023; 30:204-207. [PMID: 37476673 PMCID: PMC10351373 DOI: 10.4078/jrd.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 07/22/2023]
Abstract
Hand involvement in sarcoidosis is rare and it presents as tenosynovitis, dactylitis, nodules and osteoarticular bony destruction. We describe an unusual presentation of progressive intrinsic muscle contracture of both hands in a 42-year-old woman with sarcoid myopathy who presented with painful swelling and weakness of all four extremities. Her systemic symptoms improved with oral corticosteroids, but the hand muscle contracture remained after resolution of myositis. Serial soft tissue releases of intrinsic muscle contracture improved hand function markedly. This case highlights that surgery is a viable option to treat intrinsic muscle contracture in patients with chronic sarcoid myopathy complicated with severe muscle contracture.
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Affiliation(s)
- Siew Khei Liew
- Department of Orthopedic Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Jin Kyun Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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17
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Jeffs AD, Boyd M, Larabee L, Shelton M, Bassil A, Taylor R, Berkoff D. The role of leukotriene inhibition using a 5-lipoxygenase (5-LO) inhibitor in a joint contracture model. J Exp Orthop 2023; 10:64. [PMID: 37341811 DOI: 10.1186/s40634-023-00616-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Arthrofibrosis is a common inflammatory complication of joint trauma and surgery. 5lipoxygenase (5-LO) is a key enzyme involved in inflammation. Inhibition of 5-LO has been shown to reduce inflammation in heart and lung models but has not been examined in a joint contracture model. METHODS Twenty-six rats underwent joint contracture. Six rats served as non-surgical controls. A 5-LO inhibitor, caffeic acid (CA), suspended in 10% ethanol was orally administered to 14 rats and ethanol without CA to the remaining 12 rats daily for 21 days. Leukotriene B4 (LTB4) levels were measured, both systemically and locally. 5-LO levels in the posterior capsule were quantified by measuring the ratio of the length of the posterior capsule demonstrating 5-LO immunostaining to the total length of the capsule. RESULTS Joint contracture was successfully achieved in all rats who underwent manipulation. Levels of 5- LO measured in the posterior capsule were significantly increased in the animals who underwent surgery (56%/44-64) compared to the non-surgical control animals (7%/4-9). LTB4 levels were found to be significantly lower in the non-surgical control animals (107.79 ± 34.08 pg/ml) compared to all surgical animals (157.6 ± 55.3 pg/ml). CONCLUSION Surgical intervention resulted in increased 5-LO activity of the synovial surface of the posterior capsule and increased LTB4 levels in the patellar tendon-fat pad. Oral administration of the 5LO inhibitor, CA, was ineffective at reducing systemic and local LTB4 levels and preventing knee joint contracture. Inhibiting 5-LO activity may still be effective in preventing arthrofibrosis and warrants further investigation.
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Affiliation(s)
- Alexander D Jeffs
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA.
| | - Michael Boyd
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA
- Department of Family Medicine, The University of North Carolina, Chapel Hill, NC, USA
| | - Landon Larabee
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew Shelton
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Ross Taylor
- Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - David Berkoff
- Department of Orthopaedics, The University of North Carolina, Chapel Hill, NC, USA
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18
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Geusebroek G, van Dieën JH, Hoozemans MJM, Noort W, Houdijk H, Maas H. Constant force muscle stretching induces greater acute deformations and changes in passive mechanical properties compared to constant length stretching. J Biomech 2023; 154:111594. [PMID: 37182406 DOI: 10.1016/j.jbiomech.2023.111594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
Stretching is applied to lengthen shortened muscles in pathological conditions such as joint contractures. We investigated (i) the acute effects of different types of stretching, i.e. constant length (CL) and constant force (CF) stretching, on acute deformations and changes in passive mechanical properties of medial gastrocnemius muscle (MG) and (ii) the association of acute muscle-tendon deformations or changes in mechanical properties with the impulse or maximal strain of stretching. Forty-eight hindlimbs from 13 male and 12 female Wistar rats (13 weeks old, respectively 424.6 ± 35.5 and 261.8 ± 15.6 g) were divided into six groups (n = 8 each). The MG was initially stretched to a length at which the force was 75%, 95%, or 115% of the force corresponding to estimated maximal dorsiflexion and held at either CF or CL for 30 min. Before and after the stretching protocol, the MG peak force and peak stiffness were assessed by lengthening the passive muscle to the length corresponding to maximal ankle dorsiflexion. Also, the muscle belly length and tendon length were measured. CF stretching affected peak force, peak stiffness, muscle belly length, and tendon length more than CL stretching (p < 0.01). Impulse was associated only with the decrease in peak force, while maximal strain was associated with the decrease in peak force, peak stiffness, and the increase in muscle belly length. We conclude that CF stretching results in greater acute deformations and changes in mechanical properties than CL stretching, which appears to be dependent predominantly on the differences in imposed maximal strain.
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Affiliation(s)
- G Geusebroek
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - J H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - M J M Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - W Noort
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - H Houdijk
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - H Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
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19
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Shekar PA, Patel H, Reddy D, Dumra A. Long-term renal function in patients undergoing surgical reconstruction for tubercular cicatrized bladder. World J Urol 2023:10.1007/s00345-023-04384-1. [PMID: 37016056 DOI: 10.1007/s00345-023-04384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
PURPOSE We evaluated the long-term renal function in patients after surgical reconstruction for tuberculous contracted bladder (TBC) and determined factors associated with decreased renal function (RF) during follow up. MATERIALS AND METHODS We reviewed the records of 61 patients who underwent augmentation cystoplasty (AC) or orthotopic neobladder (ONB) for TBC between June 1994 and August 2019 in our institute. The estimated glomerular filtration rate (eGFR) was calculated preoperatively at initial presentation, before augmentation and at various intervals during follow up. Renal function decrease was defined as a defined as new-onset stage-3A Chronic kidney disease(CKD) or upstaging of pre-operative CKD stage 3A in follow-up. Multivariable analysis was done to evaluate the association of clinicopathological features and postoperative complications with decreased renal function. RESULTS We analyzed 39 patients who had a minimum follow-up of 1-year post reconstruction. At a median follow-up of 52 months (IQR 31-103 months), 16/39 patients developed RF decrease. In univariate analyses, initial eGFR, and associated ureteric stricture in contralateral renal unit were significantly associated with new-onset renal insufficiency (p < 0.001 each). On multivariable analysis, only initial presenting eGFR (p < 0.001) was an independent predictor of new-onset renal insufficiency. ROC cut-off levels for eGFR at presentation predicting the primary end point of RF decrease was 45 ml/min. CONCLUSIONS Decreased renal function is noted in most patients during long term follow-up after surgical reconstruction for TBC. After controlling for preoperative and postoperative risk factors, patients with initial presenting GFR < 45 ml/min are at greater risk of a decline in renal function following reconstruction.
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Affiliation(s)
- P Ashwin Shekar
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Hardik Patel
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India
| | - Dinesh Reddy
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India
| | - Anuj Dumra
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India
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20
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Stellar D, Lyons SR, Ramdass R, Meyr AJ. The Role of Equinus in Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:247-260. [PMID: 36841577 DOI: 10.1016/j.cpm.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Equinus plays an important role in flatfoot deformity. Proper evaluation and surgical management are critical to comprehensively treat and successfully resolved patients' symptoms. We have discussed the cause, evaluation, and some of the common surgical options. Each procedure has its inherent benefits and risks. It is imperative that the foot and ankle surgeon identify and include these procedures as part of the complete reconstructive surgery.
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Affiliation(s)
- Devrie Stellar
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA.
| | - Sean R Lyons
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA
| | - Roland Ramdass
- Foot & Ankle Center, P.C., 912 South Pleasant Valley Road, Winchester, VA 22601, USA; Residency Training Committee Inova Fairfax Medical Campus
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 2nd Floor, 148 North 8th Street, Philadelphia, PA 19107, USA
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21
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Johnson C, Manolopoulos K. Use of a relative motion flexion orthosis with dorsal hood to protect a middle phalanx finger fracture and zone III extensor tendon repair, while correcting a secondary fixed flexion proximal interphalangeal joint flexion contracture: A case report. J Hand Ther 2023; 36:448-455. [PMID: 37117068 DOI: 10.1016/j.jht.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 04/30/2023]
Abstract
BACKGROUND Proximal interphalangeal joint (PIPJ) contractures, zone III extensor tendon injuries and phalanx fractures are challenging to treat in isolation. In this case the patient presented with all 3 of these issues in a single digit, presenting a unique problem for the hand therapist. PURPOSE A case report to examine the effectiveness of using single orthosis to treat an index finger following a combined zone III extension tendon repair, surgically stabilized second phalanx fracture and PIPJ flexion contracture. METHODS A patient presented to therapy with a 40° PIPJ flexion contracture and minus 70° of active PIPJ extension (ICD10 M25.64) after left index surgical fixation of a middle phalanx fracture (ICD10 S62.621B) and zone III extensor tendon repair (ICD10 S66.321A). To correct the contracture, a distal elastic strap was added to a relative motion flexion orthosis with dorsal hood. This applied a gentle extension force to the PIPJ. Once the contracture resolved a short arc motion program (SAM) was initiated using the same orthosis. RESULTS At 20 weeks post initial therapy evaluation, active range of motion (extension/flexion) of the PIPJ was 5°/100° and distal interphalangeal joint (DIPJ) 0°/60°. The Quick DASH score improved 50 points from an initial 59 points to 9 points. The patient reported good satisfaction and full function of the hand. CONCLUSION Our case report demonstrated the effective use of a single relative motion flexion orthosis with a dorsal hood when treating a complex hand injury involving an open zone III injury, second phalanx fracture and 40-degree PIPJ contracture.
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Affiliation(s)
- Clyde Johnson
- Proliance Sports Therapy and Rehabilitation Bellevue, WA, USA.
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22
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Emamhadi M, Alijani B, Haghani Dogahe M, Emamhadi A. Hyper-selective neurectomy for knee flexion spasticity: anatomic bases and surgical technique. Surg Radiol Anat 2023; 45:201-205. [PMID: 36633655 DOI: 10.1007/s00276-022-03074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Spasticity may result from damage to neurons of the corticospinal tracts and loss of inhibitory supraspinal influences following head trauma. Traditionally, peripheral nerve surgeries for spasticity in lower limbs were limited to selective neurectomies. Here we used hyper-selective neurectomy (HSN) to release hamstring spasticity at the muscle spindle level. METHODS This study describes anatomic bases and surgical technique of HSN and its results in treating spastic knee flexion in a 23-year-old male who developed severe spasticity following severe brain injury. The spasticity was prominent in the left knee. The surgical technique including resection of over one centimeter of three-quarters of the overstimulated nerve rami at the entry point of the nerve into the muscle is shown in the video 1. RESULTS After the surgery Visual Analog Scale and Modified Ashworth Score reduced from 7 to 3 and 4 to 1, respectively. Popliteal angle improved from 118° to 73° at the second months after the surgery. CONCLUSION Hyper-selective neurectomy is a safe and reliable therapeutic option for the treatment of permanent trauma induced spasticity in the lower limb.
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Affiliation(s)
- Mohammadreza Emamhadi
- Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran. .,Brachial Plexus and Peripheral Nerve Injury Center, Rasht, Iran.
| | - Babak Alijani
- Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran
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23
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Deveci M, Arik HO. Treatment of camptodactyly with a new progressive correction device. Hand Surg Rehabil 2023; 42:75-79. [PMID: 36336265 DOI: 10.1016/j.hansur.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
The aim of this study was to introduce a new progressive correction device and present treatment results in camptodactyly patients. Eight patients (11 fingers) were treated for camptodactyly by an external fixator between February 2019 and April 2020. Mean follow-up was 28.7 ± 3.3 months (range, 24-35 months). Operative times and treatment complications were recorded. Pre- and post-operative flexion contracture, total active range of motion (TAM) and esthetic satisfaction were evaluated at final follow-up. Esthetic satisfaction was rated by the patient on a 1-5 point scale. Seven patients were male, and 1 female. Mean age was 21.6 ± 8.5 years (range, 15-42 years). Mean surgery time was 14.9 ± 2.4 min (range, 10-18 min). Mean preoperative flexion contracture was 85.9 ± 7° (range, 75-95°), and mean postoperative flexion contracture was 4 ± 3° (range, 0-10°). Transient proximal interphalangeal joint swelling was seen in 1 case and pin tract infection in 1. TAM was perfect in 5 fingers and good in 6. Patients were either very satisfied (n = 5) or satisfied (n = 3) with the esthetic appearance of each operated finger. Camptodactyly could be managed with a hinged external fixator simply and effectively with gratifying results in selected patients. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- M Deveci
- Kayseri State Hospital, Department of Orthopedics and Traumatology, Sanayi Mah. Atatürk Bulvarı Hastane Cad. No: 78, 38010, Kocasinan, Kayseri, Turkey
| | - H O Arik
- Antalya Training and Research Hospital, Department of Hand Surgery, Soğuksu mah. Kazımkarabekir Cad. Muratpaşa, 07100, Antalya, Turkey.
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24
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Ling SA, Mao BP, Lu JQ, Li SH, Liao X, Liu HW. The activation of FPR3/PKA/Rap1/ERK1/2 and FPR3/p-IκB/NF-κB axis in fibroblasts promote capsular contracture after rhinoplasty. Tissue Cell 2023; 80:101999. [PMID: 36527787 DOI: 10.1016/j.tice.2022.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Capsular contracture may occur after rhinoplasty due to rejection of silicone implants by the immune system. Our previous high-throughput sequencing of RNA in nasal capsular contracture tissue revealed that FPR3 was significantly increased in grade IV capsular contracture tissue, compared with grade II. OBJECTIVE This study aimed to elucidate the effect and specific mechanism of FPR3 on capsular formation and contracture following rhinoplasty. METHODS Using the GeneMANIA Database, the genes involved with FPR3 expression were searched, and the Gene Ontology analysis was performed to annotate the biological functions of the aforementioned genes. The mRNA and protein expressions of related genes in fibroblasts and capsular contracture tissues were analyzed using quantitative real-time PCR, western blot, and immunohistochemical staining. CCK-8 was used to determine the viability of cells. The migration capacity of fibroblasts was assessed using a wound healing assay. ELISA was used to detect levels of IL-1β, TNF-α, and IL-6. RESULTS After rhinoplasty, the expression of FPR3 in the capsular tissue increased in proportion to the degree of contracture. By activating the PKA/Rap1/ERK1/2 axis, overexpression of FPR3 can significantly increase the cell viability of fibroblasts and promote their transformation into myofibroblasts. Moreover, FPR3 phosphorylates IκB to decrease NF-κB inhibition, thereby promoting the synthesis and release of the inflammatory cytokines IL-1β, TNF-α, and IL-6. CONCLUSION FPR3 is a crucial molecule that causes capsular development and contracture following rhinoplasty. In the future, local suppression of FPR3 may be an effective treatment for relieving capsular contracture.
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Affiliation(s)
- Si-An Ling
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou 510630, PR China
| | - Bei-Ping Mao
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou 510630, PR China
| | - Jin-Qiang Lu
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou 510630, PR China
| | - Sheng-Hong Li
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou 510630, PR China
| | - Xuan Liao
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou 510630, PR China.
| | - Hong-Wei Liu
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou 510630, PR China.
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Dagneaux L, Limberg AK, Owen AR, Bettencourt JW, Dudakovic A, Bayram B, Gades NM, Sanchez-Sotelo J, Berry DJ, van Wijnen A, Morrey ME, Abdel MP. Knee immobilization reproduces key arthrofibrotic phenotypes in mice. Bone Joint Res 2023; 12:58-71. [PMID: 36647696 PMCID: PMC9872038 DOI: 10.1302/2046-3758.121.bjr-2022-0250.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS As has been shown in larger animal models, knee immobilization can lead to arthrofibrotic phenotypes. Our study included 168 C57BL/6J female mice, with 24 serving as controls, and 144 undergoing a knee procedure to induce a contracture without osteoarthritis (OA). METHODS Experimental knees were immobilized for either four weeks (72 mice) or eight weeks (72 mice), followed by a remobilization period of zero weeks (24 mice), two weeks (24 mice), or four weeks (24 mice) after suture removal. Half of the experimental knees also received an intra-articular injury. Biomechanical data were collected to measure passive extension angle (PEA). Histological data measuring area and thickness of posterior and anterior knee capsules were collected from knee sections. RESULTS Experimental knees immobilized for four weeks demonstrated mean PEAs of 141°, 72°, and 79° after zero, two, and four weeks of remobilization (n = 6 per group), respectively. Experimental knees demonstrated reduced PEAs after two weeks (p < 0.001) and four weeks (p < 0.0001) of remobilization compared to controls. Following eight weeks of immobilization, experimental knees exhibited mean PEAs of 82°, 73°, and 72° after zero, two, and four weeks of remobilization, respectively. Histological analysis demonstrated no cartilage degeneration. Similar trends in biomechanical and histological properties were observed when intra-articular violation was introduced. CONCLUSION This study established a novel mouse model of robust knee contracture without evidence of OA. This was appreciated consistently after eight weeks of immobilization and was irrespective of length of remobilization. As such, this arthrofibrotic model provides opportunities to investigate molecular pathways and therapeutic strategies.Cite this article: Bone Joint Res 2023;12(1):58-71.
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Affiliation(s)
- Louis Dagneaux
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Afton K. Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron R. Owen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Banu Bayram
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naomi M. Gades
- Department of Comparative Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andre van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA,Department of Biochemistry, University of Vermont, Burlington, Vermont, USA
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA, Matthew P. Abdel. E-mail:
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Jahanabadi S, Bakhshaeekia A, Rahbar R, Sheikhi A, Farhadi M, Hashemi SS. Local Flap Reconstruction of Burn Contractures in Extremities and Neck: A Nine-Year Experience with Long-Term Outcome Evaluation in Southwestern Iran. World J Plast Surg 2023; 12:47-56. [PMID: 38130383 PMCID: PMC10732291 DOI: 10.52547/wjps.12.2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/06/2023] [Indexed: 12/23/2023] Open
Abstract
Background Treating burn scar contractures remains challenging for reconstructive surgeons; no clear guidelines declare the optimal and most effective technique. We evaluated the efficacy of local flaps in treating patients with post-burn contractures. Methods This retrospective study included 243 patients with post-burn contractures referred to Taleghani Hospital (Khuzestan, southwest Iran) for local flap reconstruction from 2011 to 2020. Patients' demographic data, detailed descriptions of scars, surgical procedures, and flap outcomes were assessed. A plastic surgeon conducted all surgical procedures, the goals of which were to release the scar and cover the defect. Joint range of motion (ROM) (according to goniometric measurements), complications, need for second-stage surgery, and patient satisfaction were assessed. Results After scar release, 70.4% of joints were covered with a Z-plasty and similar local flaps, 26.1% with a Z-plasty plus skin grafts, and 3.5% with only skin grafts. The outcome after one year revealed a significant improvement in mean ROM (by 45.80% of the normal ROM; P< 0.001). The mean functional and aesthetic satisfaction scores were 9.45 and 7.61 out of 10, respectively. The complication rate was 10.82%: re-contracture occurred in 3.82%, flap tip necrosis in 1.27%, and partial flap necrosis in 0.31%. Conclusion Simple local flaps such as the Z-plasty are safe and effective in covering the joint following post-burn contracture release. Due to the feasibility, minimal need for facilities, steep learning curve, acceptable functional and aesthetic outcomes, and low complication rate, we strongly recommend the Z-plasty for reconstructing burn contractures, particularly in LMICs.
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Affiliation(s)
- Shahram Jahanabadi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Bakhshaeekia
- Department of Plastic and Reconstructive Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roozbeh Rahbar
- Department of Plastic and Reconstructive Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdoreza Sheikhi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahtab Farhadi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh-Sara Hashemi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, 71978-54361, Iran
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Minamimoto K, Ozawa J, Kaneguchi A, Yamaoka K. Mechanical properties within and beyond the physiological length of the semitendinosus muscle of knee-immobilized rats. Clin Biomech (Bristol, Avon) 2022; 100:105814. [PMID: 36442348 DOI: 10.1016/j.clinbiomech.2022.105814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effects of immobilization on passive muscle mechanical properties are inconsistent between studies. Here, we investigated the mechanical properties of immobilized muscle by obtaining length-force curves within and beyond the physiological muscle-tendon length in a knee-contractured rat model. METHODS Unilateral rat knee joints were immobilized using an external fixator for up to 21 days. Length-passive force relationships in the immobilized and contralateral semitendinosus muscles were determined by tensile testing. FINDINGS The semitendinosus muscle-tendon length at end physiologic length in vivo was approximately at 5% strain of the slack length. Dynamic, elastic, and viscous force (three aspects of muscle mechanical properties) evoked by instantaneous constant stretch were higher than contralateral side within the physiological muscle-tendon length limit (strains of 5% or 5%-7.5% slack length). When beyond muscle-tendon length corresponding to the maximum knee extension (strains of 7.5% or 10%-20% slack length), there was no difference between the two sides. Dynamic and elastic stiffness were also larger, as estimated by tangent angles of length-force curves, at strains of 5% slack length, and matched contralateral levels at strains of 7.5% slack length on day 21. There were no differences in semitendinosus muscle-tendon lengths overtime. Despite significantly reductions in knee extension range of motion, collagen content only showed slight changes and correlation was hardly detected between collagen and mechanical properties on day 21. INTERPRETATION Viscoelasticity in immobilized semitendinosus muscle increased within the physiological muscle-tendon length. Collagen content may have little effect on passive force and stiffness.
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Affiliation(s)
- Kengo Minamimoto
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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Fahrenkopf MP, Rhee PC. Surgical Management of Spastic Shoulder Deformities in Adult Patients. J Hand Surg Am 2022; 47:906.e1-906.e9. [PMID: 35660337 DOI: 10.1016/j.jhsa.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023]
Abstract
Spastic shoulder deformity in patients with upper motor neuron syndrome results from an imbalance of muscle forces about the shoulder girdle. In typical spastic deformities, the shoulder assumes an adducted and internally rotated posture. The severity of the deformity can range over a spectrum depending on the involved muscle groups, degree of spasticity, and presence of myostatic and/or joint contractures. Surgical options to correct the spastic shoulder deformity can be broadly classified as procedures for the functional versus nonfunctional shoulder or, in other words, preserved versus absent volitional motor control, respectively. Techniques include tenotomy, fractional lengthening, tenodesis, and periarticular soft tissue release. A focused physical examination is imperative in developing a patient-specific treatment algorithm.
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Affiliation(s)
| | - Peter C Rhee
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN.
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Ariyawatkul T, Halilamien P, Tangwiwat S, Sirivanasandha B, Pangthipampai P, Chotigavanichaya C, Wongcharoenwatana J, Eamsobhana P. Percutaneous hamstring lengthening in cerebral palsy and the risk of neurovascular transection. J Ultrasound 2022; 25:529-533. [PMID: 34993922 PMCID: PMC9402852 DOI: 10.1007/s40477-021-00620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Percutaneous hamstring lengthening is increasingly popular due to its simplicity, fast recovery rate, and low morbidity. Neurovascular anatomy changes due to knee flexion contracture and the precise proximity of peroneal nerve and Biceps femoris tendon are not well established. This study examined (1) the coronal distance between the peroneal nerve and lateral hamstring tendon ("PLD"), and (2) the distance between the popliteal vessels and medial hamstring tendons ("VMD") to determine the safe distance for percutaneous hamstring lengthening. METHODS This prospective study recruited cerebral palsy patients aged under 15 who needed hamstring lengthening. Ultrasonography was performed after the patients were anesthetized. PLDs and VMDs at popliteal angles (PAs) of 40°, 60°, and 80° knee flexions were collected. RESULTS Sixteen patients (32 knees) were enrolled. The mean minimum PLDs at PAs of 40°, 60°, and 80° were 3.5, 4.1, and 3.1 mm, respectively. The peroneal nerve physically touched the lateral hamstring tendon in 5/32 knees (15.6%). The mean minimum VMDs at PAs of 40°, 60°, and 80° were 19, 18.3, and 16.4 mm, respectively. One spastic diplegic patient had a minimum VMD < 3 mm on both sides. Changing the PAs demonstrated no statistical significance for both PLD and VMD (P value = 0.105 and 0.779, respectively). CONCLUSIONS Percutaneous medial hamstring lengthening should be done with caution. We recommend open biceps femoris surgery, with preoperative ultrasonography (to check the PLD) or peroneal nerve palpation to reduce the risk of peroneal nerve transection.
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Affiliation(s)
- Thanase Ariyawatkul
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pathom Halilamien
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Busara Sirivanasandha
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatupon Chotigavanichaya
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jidapa Wongcharoenwatana
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Perajit Eamsobhana
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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Nakagawa K, Kataoka H, Murata C, Goto K, Yamashita J, Honda Y, Sakamoto J, Origuchi T, Okita M. Relationship Between Muscle Quality or Stiffness Measured by Ultrasonography and Range of Motion in Hospitalized Older Adults. Ultrasound Med Biol 2022; 48:1858-1866. [PMID: 35717351 DOI: 10.1016/j.ultrasmedbio.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
Older adults who require nursing care have joint contractures characterized by limited range of motion (ROM). The present study investigated age-related muscle changes using ultrasonography and the relationship between ROM and muscle changes in older adults. Twenty-two healthy young adults (mean age: 23.3 y) and 60 hospitalized older adults (mean age: 86.1 y) participated. ROM of hip abduction was measured using a goniometer. Echo intensity (EI), reflecting interstitial fibrous tissue or fat within adductor longus (ADDl) was measured using B-mode ultrasonography, and strain ratio (SR), reflecting ADDl stiffness, was measured by strain elastography. The Mann-Whitney U-test and Spearman's correlation test were used for analysis. The ROM and SR of older adults were significantly lower than those of young adults (both p values <0.001). The EI was significantly higher in older adults than in young adults (p < 0.001). In older adults, the SR was moderately correlated with ROM (ρ = 0.49, p < 0.001). In conclusion, limited ROM and increase in interstitial fibrous tissue or fat and stiffness occur with aging, and the SR measured by strain elastography is useful for investigating the effect of muscle stiffness on the ROM of hospitalized older adults.
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Affiliation(s)
- Koichi Nakagawa
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Hideki Kataoka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Chiaki Murata
- Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Kyo Goto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | | | - Yuichiro Honda
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomoki Origuchi
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Okita
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Cloodt E, Lindgren A, Lauge-Pedersen H, Rodby-Bousquet E. Sequence of flexion contracture development in the lower limb: a longitudinal analysis of 1,071 children with cerebral palsy. BMC Musculoskelet Disord 2022; 23:629. [PMID: 35780097 PMCID: PMC9250270 DOI: 10.1186/s12891-022-05548-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background To prevent severe contractures and their impact on adjacent joints in children with cerebral palsy (CP), it is crucial to treat the reduced range of motion early and to understand the order by which contractures appear. The aim of this study was to determine how a hip–knee or ankle contracture are associated with the time to and sequence of contracture development in adjacent joints. Methods This was a longitudinal cohort study of 1,071 children (636 boys, 435 girls) with CP born 1990 to 2018 who were registered before 5 years of age in the Swedish surveillance program for CP and had a hip, knee or ankle flexion contracture of ≥ 10°. The results were based on 1,636 legs followed for an average of 4.6 years (range 0–17 years). The Cox proportional-hazards model adjusted for Gross Motor Function Classification System (GMFCS) levels I–V was used to compare the percentage of legs with and without more than one contracture. Results A second contracture developed in 44% of the legs. The frequency of multiple contractures increased with higher GMFCS level. Children with a primary hip or foot contracture were more likely to develop a second knee contracture. Children with a primary knee contracture developed either a hip or ankle contracture as a second contracture. Conclusions Multiple contractures were associated with higher GMFCS level. Lower limb contractures appeared in specific patterns where the location of the primary contracture and GMFCS level were associated with contracture development in adjacent joints.
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Affiliation(s)
- Erika Cloodt
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Växjö, Sweden.
| | - Anna Lindgren
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | | | - Elisabet Rodby-Bousquet
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden.,Centre for Clinical Research Västerås, Uppsala University-Region Västmanland, Västerås, Sweden
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Thomas R, Dale M, Wicks S, Toose C, Pacey V. Reliability of a novel technique to assess palmar contracture in young children with unilateral hand injuries. J Hand Ther 2022; 35:254-260. [PMID: 35491302 DOI: 10.1016/j.jht.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/20/2021] [Accepted: 03/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Palmar contracture in young children can have significant developmental consequences. Despite this, objective techniques to measure palmar range of movement and quantify contracture in young children are limited. PURPOSE The purpose of this study was to determine the reliability of hand span and hand length measures in young children and to establish whether there is any association with age, sex and presence of a palmar burn injury in the reliability of these measures. The study also sought to determine the normative difference and establish a cut off value for the between-hand difference to identify loss of movement in 1 hand. STUDY DESIGN Cross sectional METHODS: Forty-four children aged 0 to <5 years were recruited. Twenty-two children had a unilateral palmar burn injury and 22 did not have a palmar burn injury. Each child's hand span and hand length were measured 3 times. This was performed twice by the first assessor and once by the second assessor. Intraclass correlation coefficients were calculated to determine the intra-rater and inter-rater reliability. The largest of the 3 values for both hand span and hand length from the first assessor's first assessment were used to determine the normative between-hand difference. Outliers were removed prior to determining the normative difference. Children were considered outliers if their between-hand difference in hand span and/or hand length was in the top 5% of values. RESULTS Excellent reliability was established for hand span and hand length measures for the whole group (intra-rater ICC2,1 ≥0.95, inter-rater ICC2,1 ≥0.94). The mean normative between-hand difference for both measures was 2 mm. The cut-off for the normative difference in hand span was <9 mm and hand length was <6 mm. CONCLUSION This measurement technique has excellent reliability and could be a useful method to quantify palmar range of movement and identify contracture in young children with unilateral hand injuries.
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Affiliation(s)
- Rhianydd Thomas
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, New South Wales, Australia; Burns Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
| | - Marita Dale
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Stephanie Wicks
- Burns Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Claire Toose
- Burns Unit, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie University, New South Wales, Australia
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Tariq H, Collins K, Tait D, Dunn J, Altaf S, Porter S. Factors associated with joint contractures in adults: a systematic review with narrative synthesis. Disabil Rehabil 2022; 45:1755-1772. [PMID: 35544581 DOI: 10.1080/09638288.2022.2071480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults. METHODS A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079. RESULTS Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences. CONCLUSIONS The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies. Implications for rehabilitationClinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression.Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review.As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care.Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management.
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Affiliation(s)
- Hina Tariq
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Kathryn Collins
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Desiree Tait
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Joel Dunn
- Dorset Healthcare University Foundation Trust, Poole, UK
| | - Shafaq Altaf
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Sam Porter
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Svane C, Forman CR, Rasul A, Nielsen JB, Lorentzen J. Muscle Contractures in Adults With Cerebral Palsy Characterized by Combined Ultrasound-Derived Echo Intensity and Handheld Dynamometry Measures. Ultrasound Med Biol 2022; 48:694-701. [PMID: 35065812 DOI: 10.1016/j.ultrasmedbio.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
We used ultrasound-derived echo intensity and hand-held dynamometry to characterize plantar flexor muscle contractures in adults with cerebral palsy (CP). Eleven adults with CP (aged 41 ± 12 y, Gross Motor Function Classification System I-II) and 11 neurologically intact adults (aged 35 ± 10 y) participated in the study. Echo intensity was measured from the medial gastrocnemius muscle using brightness mode ultrasound. Hand-held dynamometry was used to quantify plantar flexor passive muscle stiffness and ankle joint passive range of motion (pROM). Echo intensity correlated with both passive muscle stiffness (r = 0.57, p = 0.006) and pROM (r = -0.56, p = 0.006). Ultrasound echo intensity (p = 0.02, standardized mean difference [SMD] = 1.13) and passive muscle stiffness (p < 0.001, SMD = 1.99) were higher and ankle joint pROM (p < 0.001, SMD = 2.69) was lower in adults with CP than in neurologically intact adults. We conclude that combined ultrasound-derived echo intensity and hand-held dynamometry may be used to provide an objective characterization of muscle contractures.
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Affiliation(s)
- Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark.
| | - Christian Riis Forman
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
| | - Aqella Rasul
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark; Elsass Foundation, Charlottenlund, Denmark
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AboShaban MS, Abdelaty MA. The Inferior-Based Dermoglandular Flap with Partial Subpectoral Implant Transposition and Revision Mastopexy for Subglandular Breast Augmentation Complications. Aesthetic Plast Surg 2022; 46:686-693. [PMID: 34677641 DOI: 10.1007/s00266-021-02576-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Revision augmentation-mastopexy is a complex procedure that aims to correct the complications of a previous surgery. The purpose of this study was to evaluate the reliability of the inferior-based dermoglandular flap with partial subpectoral implant coverage to correct implant- and tissue-related complications associated with primary subglandular breast augmentation and its influence on improving outcomes. METHODS This was a retrospective study in which a total of 53 patients (106 breasts) underwent revision augmentation-mastopexy using the double coverage technique for an implant with an inferior-based dermoglandular flap and superior-based pectoralis major muscle (biplane) as the first layer and a nipple-areolar flap with breast pillars as the second layer. This technique provides a suspensory reconstruction that acts as hammock to minimize the pressure on the inframammary fold and maintain position integrity. RESULTS The follow-up period ranged from 2.3 to 4 years (mean 3.6 years), and the recorded complications were minor wound dehiscence less than 1 cm2 at the "T" junction in three breasts (2.83 %) and mild hypertrophic scarring in five breasts (4.72%). CONCLUSION The use of an inferior-based dermoglandular flap with partial subpectoral biplane implant reinforcement allows autologous support and double coverage to decrease the incidence of implant- and tissue-related complications, especially pseudoptosis, lower pole widening, capsular contracture, rippling, and implant visibility. It achieves enhanced upper pole fullness, medial cleavage, projection, and breast volume. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mohammed Saad AboShaban
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Menoufia University, Yassein Abdelafar Street, Shebin Elkom, Egypt.
| | - Mahmoud Ahmed Abdelaty
- Plastic and Reconstructive Surgery Department, Ahmed Maher Teaching Hospitals, Cairo, Egypt
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Kalra GS, Gupta S, Kalra S. Long Arm Double Asymmetrical Sliding Flaps: A Technique to Treat Flexion Contractures of Digits. J Hand Surg Am 2022; 47:294.e1-4. [PMID: 34602336 DOI: 10.1016/j.jhsa.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/07/2021] [Accepted: 08/12/2021] [Indexed: 02/02/2023]
Abstract
Contracture involving flexor aspect of the fingers is one of the common sequelae encountered after burns, infection, and trauma. In the treatment of contractures, the surgeon is often challenged by the paucity of skin flaps to cover the joint area. It is then covered with skin grafts, leading to recurrence. When there is a large discrepancy between the required and the available length of skin, traditional Z-plasty techniques fail to overcome this deficiency of the skin. We employ 2 long skin flaps to cover the joint, using all the available skin around the contracture and leaving areas on the sides of the digit that are covered by full-thickness skin grafts.
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Taheri P, Salek N, Mousavi M, Maghroori R. The Effect of Shock Wave Therapy on Improving the Symptoms and Function of Patients with Dupuytren's Contracture. Adv Biomed Res 2022; 11:3. [PMID: 35284349 PMCID: PMC8906085 DOI: 10.4103/abr.abr_155_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/28/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION We aimed to evaluate the effect of shock wave therapy on the improvement of symptoms and function of patients with Dupuytren's contracture. MATERIALS AND METHODS This research is a pre-post intervention study, conducted among patients referred to the physical medicine clinics of Isfahan during 2019-2020. In this study, subjects experienced shock wave therapy for 6 sessions, each in a week, and improvement of symptoms and function were assessed and compared after the period of study and follow-up (before treatment, 6 weeks after treatment, and 14 weeks after treatment). The pain visual analog scale and disabilities of the arm shoulder and hand questionnaire were completed for all patients at the mentioned time, and the finger contraction angle was also measured by a goniometer over these intervals. RESULTS Twenty patients, 11 (55%) men and 9 (45%) women participated in the study. The mean and standard deviation of their age was 66.6 ± 7.11 years. The trend of pain severity of patients was continuously and significantly decreasing up to 14 weeks, which implies the effectiveness of the intervention (P < 0.05). Moreover, the patients' functional status improved due to the continuation of the intervention, and its trend was decreasing up to 14 weeks (P < 0.05). As for the contraction angle, there was a continuous and significant decreasing trend until week 14, and the intervention was also effective on the contraction angle (P < 0.05). CONCLUSION It can be concluded that shock wave therapy can be effective in improving the symptoms and function of patients with Dupuytren's Contracture.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Najmeh Salek
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Mousavi
- Rheumatology Division, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Razieh Maghroori
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Razieh Maghroori, Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Prasetyono TOH, Sadikin PM. A randomized controlled trial: Comparison of one-per-mil tumescent technique and tourniquet in surgery for burn hand contracture in creating clear operative field and assessment of functional outcome. Burns 2022; 48:1909-1916. [PMID: 35016790 DOI: 10.1016/j.burns.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/20/2021] [Accepted: 01/03/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND This study aims to compare the use of one-per-mil tumescent solution (a mixture of epinephrine and 0.2% lidocaine in a ratio of 1:1,000,000 in normal saline solution) and tourniquet to create clear operative fields and to evaluate the functional outcomes after post burn hand contracture surgery. METHODS The subjects of this randomized controlled trial were divided into one-permil tumescent technique and tourniquet group for a similar surgical procedure. Three independent assessors evaluated the clarity of the operative fields through recorded videos for the first 15 min and the first 10-minute of each hour of the surgery. Functional outcome was evaluated at least three months postoperatively using total active and passive motion (TAM and TPM) of each digit. Malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) were tested during baseline (5 min before the procedures), ischemia phase, and reperfusion phase (a phase when the blood flow returned to the tissue). RESULTS 35 subjects were included in this study: 17 in the tumescent group and 18 in the tourniquet group. We found a significant difference in the clarity of operative field between tumescent and tourniquet groups, 5 vs 35 bloodless operative fields, respectively (p < 0.05). TAM and TPM of each digit before surgery and 3 months postoperatively showed no significant difference between both groups (p > 0.05). Furthermore, we found no difference in MDA and TNF-α levels between both groups at their respective phases. CONCLUSIONS The use of one-per-mil tumescent technique does not replace tourniquet use to create bloodless operative fields in burned hand contracture surgery. However, the postoperative functional results were similar in both groups showing that tumescent technique can be used as an alternative to tourniquet without compromising outcomes. The MDA and TNF-α examinations do not provide conclusive outcomes regarding ischemia and reperfusion injury.
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Affiliation(s)
- Theddeus Octavianus Hari Prasetyono
- Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia; ICTEC (Indonesian Clinical Training and Education Center), Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia; Medical Technology Cluster, IMERI (Indonesian Medical Education and Research Institute), Faculty of Medicine Universitas Indonesia, Education Tower, 2nd Floor, Jl. Salemba Raya No. 6, Jakarta, Indonesia.
| | - Patricia Marcellina Sadikin
- Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia
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Chaves C, Ciais G, Sánchez-Migallón CM, Roulot E, Le Viet D, Dumontier C. Distal interphalangeal contracture in Dupuytren's disease. J Plast Reconstr Aesthet Surg 2021; 74:3443-3476. [PMID: 34593338 DOI: 10.1016/j.bjps.2021.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Camilo Chaves
- Institut de la Main Nantes Atlantique, Boulevard Charles-Gautier, Saint-Herblain 44800, France.
| | - Grégoire Ciais
- Institut de la main Jouvenet, 6 Square Jouvenet, Paris, France
| | - Carlos Morales Sánchez-Migallón
- Unidad de Cirugía de la Mano, Traumatología y Cirugía Ortopédica, Hospital General Universitario de Ciudad Real Avda Tomelloso s/n, Ciudad Real 13005 Spain
| | - Eric Roulot
- Institut de la main Jouvenet, 6 Square Jouvenet, Paris, France
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Bourne DA, James I, Wang S, Bliley J, Grahovac T, Mitchell RT, Brown SA, Ambrosio F, Ho J, Lannau B, Kemp PD, Gusenoff J, Rubin JP, Gusenoff J. Treatment of burn contractures with allogeneic human dermal fibroblasts improves Vancouver scar scale: A phase I/II trial. J Plast Reconstr Aesthet Surg 2021:S1748-6815(21)00405-8. [PMID: 34593339 DOI: 10.1016/j.bjps.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/22/2020] [Accepted: 08/26/2021] [Indexed: 11/21/2022]
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Gatin L, Hollier Larousse B, Mailhan L, Calé F, Geffrier A, Denormandie P. Functional and/or hygienic surgery of the hypertonic upper limb. Hand Surg Rehabil 2021:S2468-1229(21)00175-4. [PMID: 34216811 DOI: 10.1016/j.hansur.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 11/07/2018] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
Neuro-orthopedic complications of the upper limb affect all of its joints and lead to a multitude of clinical pictures. The clinical assessment, which should be multidisciplinary, will have to answer basic questions to define the goal(s) and the appropriate surgical strategy. What is the patient's and family's complaint? What is the possible utility of the deformities? What is the type of deformity? Is it reducible or not? What is the contribution of the upper limb deformities versus that of any associated injuries to the discomfort? Several difficulties exist in the clinical assessment: evaluation of the antagonists especially the wrist extensor muscles; the intrinsic deformity component, which can be masked by the extrinsic component when retracted, the muscles responsible for a wrist flexion contracture and the complex shoulder deformities. Many patients have multiple deformities, which creates a problem for the hierarchy of corrections depending on the objectives. The answer to these questions helps to define a clear objective that will be formalized in a contract with the patient and subsequently to define the surgical strategy. Surgery is based on a simple principle: relax the muscles on the side of the deformity, either by selective neurotomy if there is a simple hypertonia, or by a tendon procedure if the muscle is retracted; compensate for the antagonists if they are deficient, and potentially stabilize the joint. Conservative procedures are preferred to preserve the possibility of functional recovery in the future. The wide range of medical and surgical solutions allows the patient's care to be personalized. In the upper limb, the results are better for hygienic, positioning, and analgesic objectives. They remain more difficult to obtain for functional objectives, due to the biomechanical complexity of gripping.
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Yoshikawa K, Shima H, Yasuda T, Tsujinaka S, Neo M. Extensor hallucis longus muscle contracture after distal tibial physeal injury: A report of two cases. Foot (Edinb) 2021; 47:101802. [PMID: 33946006 DOI: 10.1016/j.foot.2021.101802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/05/2021] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
Few studies have reported about isolated contracture in the extensor hallucis longus (EHL) muscle, but none of the EHL muscle contracture after distal tibial physeal injury. Two such cases in 16- and 14-year-old boys who underwent surgeries for distal physeal injury of the tibia at a previous hospital are presented. Extension contracture of the hallux appeared 1-2 months post-surgery. Physical examinations revealed that the extension contracture of the first metatarsophalangeal joint was aggravated in plantar flexion of the ankle due to a tenodesis effect, and magnetic resonance imaging showed atrophy and signal changes in the anterior compartment muscles. This was diagnosed as EHL muscle contracture due to anterior compartment syndrome (ACS) after distal tibial physeal injury. The EHL tendon transfers were performed in both cases, with favorable short-term results. Therefore, the EHL tendon transfer might be preferable in case of the EHL muscle contracture due to partial ACS.
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Affiliation(s)
- Kei Yoshikawa
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Toshito Yasuda
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Seiya Tsujinaka
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Phamaceutical University, 2-7, Daigaku-machi, Takatsuki 569-8686, Japan.
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Abstract
Upper extremity function is highly dependent on elbow motion in order to adequately position the hand in space. Loss of this motion due to stiffness following trauma can cause patients substantial disability, leading to difficulties with performing activities of daily living. Post-traumatic elbow stiffness is challenging to treat, and therefore prevention is of paramount importance. Key measures that can be used to prevent elbow stiffness are early surgical intervention for fracture or joint instability, as well as active mobilisation, which helps to prevent oedema and an increase in viscosity of inflammatory exudates. Other options include splinting and continuous passive mobilisation. Once non-operative methods of addressing post-traumatic stiffness have been exhausted, arthrolysis of the stiff elbow can be performed via open or arthroscopic means depending on the type of pathology involved (intrinsic or extrinsic contracture) and experience of the surgeon with elbow arthroscopy. The particular open approach used depends on several factors, which include the formation and location of any heterotopic ossification present. Improvements in range of motion can be expected with both open and arthroscopic techniques, which can be effective and rewarding for patients. Post-operative rehabilitation, particularly early active mobilisation, should be considered essential in order to optimise patient outcomes following surgery. This review aims to explore elbow stiffness following traumatic aetiology, assessing its pathogenesis and prevention, as well as reviewing surgical treatment options and post-operative rehabilitation.
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Tanaka S, Uehara K, Sugimura R, Miura T, Ohe T, Tanaka S, Morizaki Y. Evaluation of the first annular pulley stretch effect under isometric contraction of the flexor tendon in healthy volunteers and trigger finger patients using ultrasonography. BMC Musculoskelet Disord 2021; 22:421. [PMID: 33957913 PMCID: PMC8101114 DOI: 10.1186/s12891-021-04299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Isometric exercises for a flexed finger have been reported to be effective for treating trigger finger as the flexor tendon widens the space under the first annular (A1) pulley towards the palmar destination during the exercise. This study aimed to evaluate the structural changes during the A1 pulley stretch in healthy volunteers and patients with trigger finger using ultrasonography. Methods We enrolled 25 male and 14 female patients (39 middle fingers). The thickness of the subcutaneous tissue (parameter a), A1 pulley (parameter b), and the flexor tendon (parameter c) and the distance between the dorsal surface of the flexor tendon and the palmar surface of the metacarpal head (parameter d) were measured using ultrasonography of the metacarpophalangeal joint of the middle finger flexed at 45° at rest (pattern A) and under isometric contraction of the flexor tendon against an extension force of the proximal interphalangeal joint (pattern B). Results The average differences between patterns A and B in the healthy volunteers were 0.29 mm (parameter a; P = 0.02), 0.017 mm (parameter b; P = 0.63), 0.16 (parameter c; P = 0.26), and 0.41 (parameter d; P = 0.004), and those in patients with trigger finger were 0.22 mm (parameter a; P = 0.23), 0.019 mm (parameter b; P = 0.85), 0.03 mm (parameter c; P = 0.82), and 0.78 mm (parameter d; P < 0.001). The distance between the dorsal side of the A1 pulley and the palmar surface of the metacarpal head was also significantly increased by 0.57 mm (8.2%) in healthy volunteers (P < 0.001) and 0.81 mm (11%) in patients with trigger finger (P < 0.001). Conclusions In this study, the space under the A1 pulley was expanded under isometric contraction of the flexor tendon. These findings support the effectiveness of pulley stretch exercises for the trigger finger condition.
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Affiliation(s)
- Shinya Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kosuke Uehara
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Ryota Sugimura
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiki Miura
- Department of Orthopaedic Surgery, JR General Hospital, Tokyo, Japan
| | - Takashi Ohe
- Department of Orthopaedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Morizaki
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Lao N, Brackstone M, Formenti SC, Doherty C, Perera F, Chow R, DeLyzer T, Grant A, Boldt G, Lock M. Redefining postmastectomy radiation contouring in the era of immediate breast reconstruction: An accurate assessment of local recurrence risk. Clin Transl Radiat Oncol 2021; 29:33-39. [PMID: 34113723 PMCID: PMC8170417 DOI: 10.1016/j.ctro.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/12/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022] Open
Abstract
Breast cancer recurrences deep to pectoralis are very rare after mastectomy. Post-mastectomy chest wall radiation should exclude deep chest wall structures. Radiation after immediate implant reconstruction increases complications. Post-mastectomy radiation should target subcutaneous tissues and pectoralis major.
Introduction Most studies report post-mastectomy local recurrences as chest wall recurrences without clarifying whether the recurrence is in the subcutaneous tissue, muscle or underlying rib. Post-mastectomy chest wall radiation is recommended in patients at increased risk of locoregional recurrence. Chest wall radiation-related fibrosis has become an important clinical consideration in the era of immediate implant-based breast reconstruction. In patients with commonly performed subpectoral implant-based reconstruction, the pectoralis major becomes relocated anterior to the implant and just deep to skin, therefore raising the question of value in radiating deep chest wall structures. This study assessed the rate of recurrence in each anatomical region of chest wall in post-mastectomy patients. Methods A comprehensive breast cancer database of 4287 patients at a single regional cancer center from 2006 to 2018 was retrospectively analyzed to identify 1571 mastectomy patients. Recurrences were classified as local skin/subcutaneous, pectoralis muscle (pectoralis major), deep chest wall (pectoralis minor, intercostal muscle or rib) or regional axillary recurrence. Results A total of 26 patients with locoregional recurrence were identified. Most recurrences were in the skin/subcutaneous level. Of 1571 mastectomy patients, only one patient developed a local recurrence posterior to pectoralis major. Our literature search and meta-analysis revealed that local recurrences post-mastectomy are much more likely to be in subcutaneous tissues/pectoralis major versus deeper chest wall. Conclusion A reduced clinical target volume which encompasses skin/subcutaneous and pectoralis muscle layers without treating deep chest wall may be more appropriate to reduce radiation-associated toxicity since avoiding circumferential radiation of an implant may prevent capsular contracture without compromising treatment benefit.
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Affiliation(s)
- Nicholas Lao
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| | - Muriel Brackstone
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada.,Div General Surgery, London Health Sciences Centre, London, ON, Canada
| | | | - Christopher Doherty
- Div Plastic & Reconstructive Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Francisco Perera
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| | - Ronald Chow
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Tanya DeLyzer
- Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - Aaron Grant
- Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - Gabriel Boldt
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
| | - Michael Lock
- Dept. Oncology, London Regional Cancer Program, London, ON, Canada
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Cheewasukanon S, Osateerakun P, Limpaphayom N. Recurrence of knee flexion contracture after surgical correction in children with cerebral palsy. Int Orthop 2021; 45:1523-30. [PMID: 33822275 DOI: 10.1007/s00264-021-05035-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Knee flexion contracture (FC) and crouch gait are challenging to treat in children with cerebral palsy (CCP), and recurrent knee FC after surgery is a severe complication. The aim was to identify factors associated with recurrent knee FC after surgery. METHODS The records of 62 CCP (age 10.6±2.6 years) who underwent surgery and were followed for > six months were reviewed. Knee FC was treated by hamstring lengthening, posterior knee capsulotomy, and femoral shortening/extension osteotomy until full extension was obtained. Kaplan-Meier analysis was used to estimate the probability of the correction being maintained. Cox proportional hazard modeling was used to compare parameters between patients with and without recurrent knee FC, with the time to recurrence as the endpoint. Potential confounding factors were included in the multivariate analysis. RESULTS In total, the procedure was performed on 122 knees. The average weight-for-age z score was -1.3±1.2. The average follow-up period was 5.4±4.2 years. Knee FC recurrence was observed in 37 knees (30%). The average recurrence-free time was 4.9 years, with most cases of recurrence (33 knees) occurring within six years after surgery. The factors associated with recurrence were age (HR, 1.19) and a required posterior knee capsulotomy procedure (HR, 4.53). CONCLUSION Recurrent knee FC after correction is associated with CCP who are older at the time of operation and when posterior knee capsulotomy is performed. The age at operation should be optimized. The sequence of procedures should be performed only as necessary to minimize the chance of post-operative muscle weakness and recurrence.
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Hoang PD, Psarakis M, Kwah LK, Clarke JL, Gandevia SC, Diong J. Brief report: Passive mechanical properties of gastrocnemius in multiple sclerosis and ankle contracture. Clin Biomech (Bristol, Avon) 2021; 84:105338. [PMID: 33812198 DOI: 10.1016/j.clinbiomech.2021.105338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/21/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle contracture is common in people with multiple sclerosis (MS) but the mechanisms of contracture are not clear. This study aimed to identify the mechanisms of contracture in MS by comparing passive muscle length and stiffness at known tension, separated into contributions by muscle fascicles and tendons, between people with MS who had contracture and healthy people. METHODS Passive length-tension curves of the gastrocnemius muscle-tendon unit were derived from passive ankle torque and angle using a published biomechanical method. Ultrasound images of medial gastrocnemius muscle fascicles were used to partition length-tension curves into fascicle and tendon components. Lengths and stiffness of the muscle-tendon unit, muscle fascicles and tendons were compared between groups with linear regression. FINDINGS Data were obtained from 15 participants with MS who had contracture [age 53 (12) years, mean (SD)] and 25 healthy participants [48 (20) years]. Participants with MS had clinically significant ankle contracture, and had shorter fascicles at slack length (between-groups mean difference -0.8 cm, 95% CI -1.2 to -0.4 cm, p < 0.001) and at 100 N (-0.7 cm, 95% CI -1.3 to -0.1 cm, p = 0.02) compared to healthy participants. There were no differences between groups in all other outcomes. INTERPRETATION Tension-referenced comparisons of passive muscle length and stiffness show that people with MS who had contracture had shorter fascicles at low and high tension compared to healthy people, but there were no changes to the muscle-tendon unit or tendon. Further studies are needed to identify the causes and mechanisms of contracture in neurological conditions.
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Affiliation(s)
- Phu D Hoang
- Neuroscience Research Australia (NeuRA) and University of New South Wales, NSW, Australia.
| | - Michael Psarakis
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, NSW, Australia
| | - Li Khim Kwah
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Jillian L Clarke
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia (NeuRA) and University of New South Wales, NSW, Australia
| | - Joanna Diong
- Neuroscience Research Australia (NeuRA) and University of New South Wales, NSW, Australia; School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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Patel AH, Kreuzer SW, Sherman WF. Bilateral Total Hip Arthroplasty in the Setting of Developmental Dysplasia of the Hip and Extreme Hip Flexion Requirements due to Phocomelia. Arthroplast Today 2021; 8:262-267.e1. [PMID: 34095402 PMCID: PMC8167324 DOI: 10.1016/j.artd.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
Phocomelia is a rare congenital birth defect marked by hypoplastic or markedly absent limbs. Developmental dysplasia of the hip (DDH) is a congenital disorder with a failure of the native acetabulum to provide complete coverage over the femoral head. The secondary osteoarthritis that develops from DDH is technically challenging for orthopedic surgeons because of distorted anatomy. The present case describes the diagnosis of Crowe 3 DDH in a phocomelia patient with hyperflexion requirements who successfully underwent staged bilateral total hip arthroplasty via a direct anterior approach. It highlights the utility of preoperative computerized tomography and intraoperative computer navigation to assist in implant placement. Recognizing difficult arthroplasty cases in advance is imperative as these cases may require great expertise and more extensive surgical planning.
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Affiliation(s)
- Akshar H. Patel
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Goyal N, Luchetti TJ, Blank AT, Cohen MS. Atraumatic, Progressive, and Painful Elbow Contracture From a Ganglion Cyst. J Hand Surg Am 2021; 46:345.e1-345.e3. [PMID: 32690340 DOI: 10.1016/j.jhsa.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/20/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
Ganglion cysts are benign soft tissue tumors that often occur adjacent to joints or tendons. We report a case of an elbow joint ganglion cyst in a patient who presented with a painful, progressive elbow contracture. The patient was successfully treated with resection of the subbrachialis ganglion cyst combined with an anterior capsular release and an ulnar nerve decompression to recover elbow motion. This case highlights the value of advanced imaging in patients presenting with an atraumatic, painful, and progressive elbow contracture.
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Affiliation(s)
- Nitin Goyal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
| | - Timothy J Luchetti
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Alan T Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Leung AKC, Leong KF, Lam JM. An ulcerated giant segmental hemangioma resulting in contracture of the left elbow. Paediatr Child Health 2021; 26:e70-e72. [PMID: 33747313 DOI: 10.1093/pch/pxaa050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
The majority of infantile hemangiomas are benign and will resolve on their own. We report a 4-month-old infant with an ulcerated giant segmental infantile hemangioma involving the left upper limb who developed a contracture of the left elbow despite treatment with oral propranolol, proper wound care, and regular intense physiotherapy. To our knowledge, contracture resulting from an infantile hemangioma has not been reported previously.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and the Alberta Children's Hospital, Calgary, Alberta
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia
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