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Sample records for osteofibroso flexor das

  1. Hip flexor strain - aftercare

    MedlinePlus

    Pulled hip flexor - aftercare; Hip flexor injury - aftercare; Hip flexor tear - aftercare; Iliopsoas strain - aftercare; Strained iliopsoas muscle - aftercare; Torn iliopsoas muscle - aftercare; Psoas strain - aftercare

  2. Traumatic flexor tendon injuries.

    PubMed

    Lapegue, F; Andre, A; Brun, C; Bakouche, S; Chiavassa, H; Sans, N; Faruch, M

    2015-12-01

    The flexor system of the fingers consisting of flexor tendons and finger pulleys is a key anatomic structure for the grasping function. Athletes and manual workers are particularly at risk for closed injuries of the flexor system: ruptured pulleys, ruptures of the flexor digitorum profundus from its distal attachment ("jersey finger"), and less frequently, ruptures of the flexor digitorum superficialis and of the lumbrical muscles. Open injuries vary more and their imaging features are more complex since tendons may be torn in several locations, the locations may be unusual, the injuries may be associated with nerve and vascular injuries, fibrosis… Sonography is the best imaging modality to associate with the clinical exam for it allows an experienced physician to make an accurate and early diagnosis, crucial to appropriate early treatment planning. PMID:26564614

  3. Hip flexor strain - aftercare

    MedlinePlus

    ... such as sprinting, kicking, and changing direction while running or moving, can stretch and tear the hip flexors. Runners, people who do martial arts, and football, soccer, and hockey players are more likely to have ...

  4. Flexor pulley reconstruction.

    PubMed

    Dy, Christopher J; Daluiski, Aaron

    2013-05-01

    Flexor pulley reconstruction is a challenging surgery. Injuries often occur after traumatic lacerations or forceful extension applied to an acutely flexed finger. Surgical treatment is reserved for patients with multiple closed pulley ruptures, persistent pain, or dysfunction after attempted nonoperative management of a single pulley rupture, or during concurrent or staged flexor tendon repair or reconstruction. If the pulley cannot be repaired primarily, pulley reconstruction can be performed using graft woven into remnant pulley rim or looping graft around the phalanx. Regardless of the reconstructive technique, the surgeon should emulate the length, tension, and glide of the native pulley. PMID:23660059

  5. Human flexor reflexes

    PubMed Central

    Shahani, Bhagwan T.; Young, Robert R.

    1971-01-01

    One type of flexor reflex, that recorded from the tibialis anterior muscle in response to electrical stimulation of the sole of the foot, was studied in normal subjects and patients with several neurological disorders. Normally this reflex consists of two components, the second of which is related to the actual withdrawal. The first component, normally of lower threshold, is difficult to evoke in patients with chronic spinal cord or discrete cerebral lesions, whereas it has an unusually low threshold and is very clearly seen in those with Parkinson's disease. In patients with spinal cord disease, the exaggerated flexor reflexes are seen at long latencies after relatively small stimuli. During the early phase of recovery from spinal transection, both components may be seen and are, therefore, spinal in origin. Studies of patients with the sensory neuropathy of Friedreich's ataxia suggest that the afferent fibres responsible for these flexor reflexes are the small myelinated fibres. Recovery curves demonstrate very long-lasting changes in flexor reflex excitability in normal subjects and patients with `spasticity' from spinal lesions. This differs in patients with `spasticity' from lesions rostral to the brain-stem. Examples in man of such physiological phenomena as reciprocal inhibition, local sign, habituation, temporal and spatial summation are discussed. Images PMID:5122389

  6. Flexor tendon repair in zone III.

    PubMed

    Al-Qattan, Mohammad M

    2011-01-01

    There is a paucity of the literature on the outcome of zone III flexor tendon injuries. In this paper, we report on the results of zone III flexor tendon repair in 35 consecutive adult patients with clean cut lacerations of both flexor tendons in 42 fingers. There were 25 men and 10 women with an average age of 32 years. Repair of both flexor tendons was performed using 'figure of eight' core sutures and a continuous epitendinous suture. Postoperatively, an immediate active range of motion protocol was applied to ensure full active extension of the interphalangeal joints. The results were assessed using the Strickland-Glogovac grading system. There were no ruptures. One patient with two injured fingers developed complex regional pain syndrome and the final outcome was fair in both fingers. In the remaining 34 patients (40 fingers), 33 patients (38 fingers) had an excellent outcome and the remaining patient (two fingers) had a good outcome. PMID:20807720

  7. Pyogenic Flexor Tenosynovitis Caused by Shewanella algae.

    PubMed

    Fluke, Erin C; Carayannopoulos, Nikoletta L; Lindsey, Ronald W

    2016-07-01

    Pyogenic flexor tenosynovitis is an orthopedic emergency most commonly caused by Staphylococcus aureus and streptococci and occasionally, when associated with water exposure, Mycobacterium marinum. Shewanella algae, a gram-negative bacillus found in warm saltwater environments, has infrequently been reported to cause serious soft tissue infections and necrosis. In this case, S. algae caused complicated flexor tenosynovitis requiring open surgical irrigation and debridement. Flexor tenosynovitis caused by S. algae rapidly presented with all 4 Kanavel cardinal signs as well as subcutaneous purulence, ischemia, and necrosis, thus meeting the requirements for Pang et al group III classification of worst prognosis. Because of its rarity and virulence, S. algae should always be considered in cases of flexor tenosynovitis associated with traumatic water exposure to treat and minimize morbidity appropriately. PMID:27206398

  8. Flexor pulley system: anatomy, injury, and management.

    PubMed

    Zafonte, Brian; Rendulic, Dora; Szabo, Robert M

    2014-12-01

    Flexor pulley injuries are most commonly seen in avid rock climbers; however, reports of pulley ruptures in nonclimbers are increasing. In addition to traumatic disruption, corticosteroid-induced pulley rupture has been reported as a complication of treating stenosing tenosynovitis. Over the last decade, there have been 2 new developments in the way hand surgeons think about the flexor pulley system. First, the thumb pulley system has been shown to have 4 component constituents, in contrast to the classic teaching of 3 pulleys. Second, in cases of zone II flexor tendon injury, the intentional partial A2 and/or A4 pulley excision or venting is emerging as a component for successful treatment. This is challenging the once-held dogma that preserving the integrity of the entire A2 and A4 pulleys is indispensable for normal digit function. PMID:25459958

  9. Biomechanical effects of dissecting flexor carpi ulnaris.

    PubMed

    Kreulen, M; Smeulders, M J C; Hage, J J; Huijing, P A

    2003-08-01

    Our aim was to determine whether the length and function of the flexor carpi ulnaris muscle were affected by separating it from its soft tissue connections. We measured the length of flexor carpi ulnaris before and after its dissection in ten patients with cerebral palsy. After tenotomy, tetanic contraction shortened the muscle by a mean of 8 mm. Subsequent dissection to separate it from all soft tissue connections, resulted in a further mean shortening of 17 mm (p < 0.001). This indicated that the dissected connective tissue had been strong enough to maintain the length of the contracting muscle. Passive extension of the wrist still lengthened the muscle after tenotomy, whereas this excursion significantly decreased after subsequent dissection. We conclude that the connective tissue envelope, which may be dissected during tendon transfer of flexor carpi ulnaris may act as a myofascial pathway for the transmission of force. This may have clinical implications for the outcome after tendon transfer. PMID:12931805

  10. Coexistent digital gouty and infective flexor tenosynovitis.

    PubMed

    Akram, Qasim; Hughes, Michael; Muir, Lindsay

    2016-01-01

    Flexor tenosynovitis of the hand is often caused by trauma or infection. Gouty tenosynovitis is an uncommon presentation of the condition and is usually misdiagnosed as infection with the patient undergoing surgery. The coexistence of infection and gout causing flexor tenosynovitis has never been described before in the literature; we report the first ever case and emphasise the importance of its awareness for optimal treatment. A 54-year-old man was initially diagnosed and treated as having infective flexor tenosynovitis and, later, due to a lack of improvement in his symptoms, was discovered to also have gout. We review the literature and suggest management strategy for use in daily clinical practice, including an algorithm, for this presentation. PMID:27358092

  11. Simultaneous closed rupture of flexor digitorum superficialis and flexor digitorum profundus tendons in the middle finger: a case report

    PubMed Central

    Jordan, Robert W.; Lotfi, Naeil; Shyamalan, Gunaratnam

    2015-01-01

    Abstract A 20-year-old man suffered a closed rupture of both flexor tendons in the middle finger while playing rugby. Primary repair of the flexor digitorum profundus and excision of the flexor digitorum superficialis was performed. At follow up he reported a Disabilities of the Arm, Shoulder and Hand score of 0 and unrestricted return to activities.

  12. Secondary repair of flexor tendon injuries.

    PubMed

    Battiston, B; Triolo, P F; Bernardi, A; Artiaco, S; Tos, P

    2013-03-01

    Tendon adhesions or even secondary ruptures causing severe hand functional impairment still represent a frequent complication after repair of flexor tendon injuries. Secondary treatment of these problems includes tenolysis, one or two stages flexor tendons reconstruction by grafts or even the use of tendon prosthesis. The mechanism and severity of injury, the status of the surrounding tissues and injured finger, the presence of associated lesions, the age of the patient, post-operative management, patient motivation and the surgeon's skill, may all have implications in the final outcome of the tendon reconstruction. A correct evaluation of the problem by means of classifications such as the one described by Boyes, may help the surgeon in choosing the appropriate technique. PMID:23347767

  13. [Flexor tendon repair: a short story].

    PubMed

    Moutet, F; Corcella, D; Forli, A; Mesquida, V

    2014-12-01

    This short story of flexor tendon repair aims to illustrate hesitations and wanderings of this surgery. Obviously tendon repair was very early considered, but it developed and diffused rather lately. It became a routine practice only in 20th century. This was due on the one hand, in Occident, to the Galen's dogmatic interdiction, on the other hand, to the repair difficulties of this paradoxical structure. Actually tendon is made of fibroblasts and collagen (sticky substances), and then its only goal is to move. According to this necessity, whatever the used techniques are, gliding is the final purpose. Technical evolutions are illustrated by historical contributions to flexor tendon surgery of several "giants" of hand surgery. PMID:24837978

  14. Nutrient pathways of flexor tendons in primates

    SciTech Connect

    Manske, P.R.; Lesker, P.A.

    1982-09-01

    The perfusion and diffusion pathways to the flexor profundus tendons of 40 monkeys were investigated by measuring the uptake of tritiated proline by various tendon segments. In the absence of all vascular connections, the process of diffusion provides nutrients to all areas of flexor tendon and in this study the process of diffusion was greater. The distal segment of tendon was observed to be profused most rapidly. The proximal tendon segment is perfused from both the muscular-tendinous junction and the vinculum longus; vincular segment perfusion is via the vinculum longus vessels alone; central segment perfusion is shared by the vinculum longus and vinculum brevis vasculature. The distal segment uptake is by both the process of diffusion or vinculum brevis perfusion. The osseous attachment at the distal phalanx contributes little to tendon nutrition.

  15. Effect of flexor sheath integrity on nutrient uptake by chicken flexor tendons

    SciTech Connect

    Peterson, W.W.; Manske, P.R.; Lesker, P.A.

    1985-12-01

    The effect of varying degrees of flexor sheath integrity (sheath excised, incised, or incised and repaired) on the uptake of /sub 2/H-proline by chicken flexor tendons in Zone II was studied. The tendons were either: normal and uninjured, lacerated and repaired, or uninjured except for vinculum longum ligation. Different degrees of sheath integrity did not influence the uptake of /sub 2/H-proline by the tendons. The tendon does not appear to be dependent on a synovial environment for nutrients and is capable of obtaining these nutrients by diffusion from the surrounding extracellular tissue fluid. Diffusion is the primary nutrient pathway to the flexor tendon in this area, because removing its major vascular attachment (i.e., the vinculum longum) did not effect proline uptake. Careful closure of the sheath with restoration of a synovial environment does not appear to be necessary for tendon nutrition.

  16. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).

    PubMed

    Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther

    2014-01-01

    Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries. PMID:23962872

  17. A new device for flexor tendon injuries.

    PubMed

    Dymarczyk, M

    2001-01-01

    Managing the treatment of patients with zone II flexor tendon injuries for successful outcomes has always been a challenge for the hand therapist. Working closely with the patient to help ensure follow-through with the protocol is frequently necessary. If a patient is compliant, the therapist's concern then becomes one of "scar wars" (to use a phrase coined by Ken Flowers). Early active range of motion and tendon gliding are critical parts of most programs. This author has developed a new idea in conjunction with the Indiana Hand Center protocol. PMID:11511017

  18. Bilateral flexor tendon contracture following onychectomy in 2 cats.

    PubMed

    Cooper, Maureen A; Laverty, Peter H; Soiderer, Emily E

    2005-03-01

    Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646

  19. Bilateral flexor tendon contracture following onychectomy in 2 cats

    PubMed Central

    2005-01-01

    Abstract Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646

  20. Should we think about wrist extensor after flexor tendon repair?

    PubMed Central

    Ferreira, Aline M; Tanaka, Denise M; Barbosa, Rafael I; Marcolino, Alexandre M; Elui, Valeria MC; Mazzer, Nilton

    2013-01-01

    Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair. Design: Cross-sectional clinical measurement study. Setting: Laboratory for biomechanics and rehabilitation. Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age. Intervention: Volunteers performed an isometric standardized gripping task. Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis. Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated. Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary. PMID:26770674

  1. The effects of eye coordination during deep cervical flexor training on the thickness of the cervical flexors

    PubMed Central

    Moon, Hyun-Ju; Goo, Bong-Oh; Kwon, Hae-Yeon; Jang, Jun-Hyeok

    2015-01-01

    [Purpose] The purpose of this study was to identify changes in the thicknesses of the cervical flexors according to eye coordination during deep cervical flexor training. [Subjects and Methods] Twenty normal adults were randomly selected, and during their deep cervical flexor training and eye tracking, the thicknesses of the longus colli and the sternocleidomastoid were measured using ultrasonic waves. [Results] The thickness of the longus colli statistically significantly increased when deep cervical flexor training and eye coordination were performed simultaneously. However, the thickness of the sternocleidomastoid did not show statistically significant differences according to eye coordination. [Conclusion] Eye coordination during deep cervical flexor training is likely to increase the thickness of the longus colli selectively. PMID:26834355

  2. Biological Augmentation of Flexor Tendon Repair: A Challenging Cellular Landscape.

    PubMed

    Loiselle, Alayna E; Kelly, Meghan; Hammert, Warren C

    2016-01-01

    Advances in surgical technique and rehabilitation have transformed zone II flexor tendon injuries from an inoperable no-man's land to a standard surgical procedure. Despite these advances, many patients develop substantial range of motion-limiting adhesions after primary flexor tendon repair. These suboptimal outcomes may benefit from biologic augmentation or intervention during the flexor tendon healing process. However, there is no consensus biological approach to promote satisfactory flexor tendon healing; we propose that insufficient understanding of the complex cellular milieu in the healing tendon has hindered the development of successful therapies. This article reviews recent advances in our understanding of the cellular components of flexor tendon healing and adhesion formation, including resident tendon cells, synovial sheath, macrophages, and bone marrow-derived cells. In addition, it examines molecular approaches that have been used in translational animal models to improve flexor tendon healing and gliding function, with a specific focus on progress made using murine models of healing. This information highlights the importance of understanding and potentially exploiting the heterogeneity of the cellular environment during flexor tendon healing, to define rational therapeutic approaches to improve healing outcomes. PMID:26652792

  3. Zone III flexor tendon injuries - A proposed modification to rehabilitation.

    PubMed

    Chinchalkar, Shrikant J; Pipicelli, Joey G; Agur, Anne; Athwal, George S

    2015-01-01

    In this manuscript, these authors have utilized years of clinical experience to suggest rehabilitation modifications for Zone III flexor tendon injuries. - VictoriaPriganc, PhD, OTR, CHT, CLT, Practice Forum Editor. PMID:26089286

  4. The flexor tendon pulley system and rock climbing.

    PubMed

    Crowley, Timothy P

    2012-06-01

    Rock climbing has increased in popularity over the past two decades. Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. This article reviews the anatomy and biomechanics of the finger flexor tendon pulleys, how they may be injured in rock climbing and how these injuries are best diagnosed and managed. PMID:23730085

  5. Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis.

    PubMed

    Lui, Tun Hing

    2015-10-01

    Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus. PMID:26697294

  6. Arthroscopic Synovectomy for Zone 2 Flexor Hallucis Longus Tenosynovitis

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    Tenosynovitis of the flexor hallucis longus tendon is a condition typically found in ballet dancers and sometimes in soccer players and is related to chronic overuse. It mostly involves the portion of the tendon behind the ankle joint. However, the portion of the tendon under the sustentaculum tali can also be involved. Open synovectomy requires extensive dissection. We report the technique of arthroscopic synovectomy of the deep portion of the flexor hallucis longus. PMID:26697294

  7. Human flexor reflex modulation during cycling.

    PubMed

    Brown, D A; Kukulka, C G

    1993-04-01

    1. Human flexor reflex (HFR) responses were elicited during ergometer cycling in neurologically intact humans with the objective of understanding the influence of lower limb muscle activity on phase-dependent reflex modulation during movement. The experimental setup permitted control over background muscle activity and stimulus intensity without significantly interfering with the cycling motion. 2. All experiments involved cycling on an ergometer at a set rate and workload. A 333-Hz, 15-ms pulse train of electrical stimulation was randomly delivered to the skin over the tibial nerve at the ankle at selected lower limb positions. In the first group of experiments, subjects were stimulated at six cycling phases while pedaling with normal, phasic ankle activity (free-form cycling). The second and third group of experiments involved stimulation under static limb positioning conditions and during active pedaling while subjects were asked to maintain a consistent background level of isolated tibialis anterior (TA) or soleus (SOL) electromyographic (EMG) activity. 3. Control criteria were established to assure similar isolated muscle EMG levels and sensory stimulation intensities throughout the experiments. With the aid of the application of a lower extremity brace and visual EMG feedback, SOL and TA activity were confined by the subject to a narrow range during the task of cycling. Stimulus consistency was achieved through maintenance of flexor hallucis brevis M-waves to within an envelope encompassing the mean value +/- 5% of the maximum M-wave amplitude in all experimental conditions. 4. When the subject's limb was statically positioned, the HFR responses in the SOL muscle showed no significant changes in pattern when compared at various limb positions. During cycling with consistent SOL activity, a response waveform pattern of early-latency-long-duration depression was followed by a later-latency facilitation response in all positions except the initial power phase

  8. Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction.

    PubMed

    Wei, David H; Terrono, Andrew L

    2015-10-01

    Swan neck deformity, or hyperextension of the proximal interphalangeal joint, may occur secondary to trauma, rheumatoid arthritis, cerebral palsy, or Ehlers-Danlos syndrome, and can be treated with tenodesis of one slip of the flexor digitorum sublimis tendon. This technique has several variations, differing primarily in the specific location and method that a single slip of the flexor digitorum sublimis tendon is secured, but they all serve to create a static volar restraint against hyperextension. Options include tunneling the tendon through the bone of the proximal phalanx, attaching the tendon to the A1 or A2 pulley, or securing the tendon with bone anchors in the proximal phalanx. PMID:26328902

  9. Flexor digitorum brevis tendon transfer to the flexor digitorum longus tendon according to Valtin in posttraumatic flexible claw toe deformity due to extrinsic toe flexor shortening.

    PubMed

    Gonçalves, H; Kajetanek, C; Graff, W; Thiongo, M; Laporte, C

    2015-04-01

    Claw toe deformity after posterior leg compartment syndrome is rare but incapacitating. When the mechanism is flexor digitorum longus (FDL) shortening due to ischemic contracture of the muscle after posterior leg syndrome, a good treatment option is the Valtin procedure in which the flexor digitorum brevis (FDB) is transferred to the FDL after FDL tenotomy. The Valtin procedure reduces the deformity by lengthening and reactivating the FDL. Here, we report the outcomes of FDB to FDL transfer according to Valtin in 10 patients with posttraumatic claw toe deformity treated a mean of 34 months after the injury. Toe flexion was restored in all 10 patients, with no claw toe deformity even during dorsiflexion of the ankle. PMID:25703152

  10. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    PubMed Central

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion. PMID:26060592

  11. Single-Stage Flexor Tendon Grafting: Refining the Steps.

    PubMed

    Fletcher, Derek R; McClinton, Michael A

    2015-07-01

    Single-stage tendon grafting for reconstruction of zone I and II flexor tendon injuries is a challenging procedure in hand surgery. Careful patient selection, strict indications, and adherence to sound surgical principles are mandatory for return of digital motion. PMID:26026357

  12. Comparison of modified Kessler tendon suture at different levels in the human flexor digitorum profundus tendon and porcine flexors and porcine extensors: an experimental biomechanical study.

    PubMed

    Havulinna, J; Leppänen, O V; Järvinen, T L N; Göransson, H

    2011-10-01

    This study compared the biomechanical behaviour of repairs in the human flexor digitorum profundus tendon in zones I, II and III with repairs of different segments of the porcine flexor tendon of the second digit and the extensor digiti quarti proprius tendon, in order to assess the validity of porcine tendons as models for human flexor tendon repairs. These porcine tendons were selected after comparing their size with the human flexor digitorum profundus tendon. The tendon repairs were done in three segments of each porcine tendon and repairs in the human tendons were done in zones I,II and III. Ten tendons in each group yielded a total of 90 specimens. A modified Kessler repair was done with 3-0 coated braided polyester suture and subjected to uniaxial tensile testing. In human flexor tendons, the ultimate force was higher in zones I and II than in zone III. The porcine flexor digitorum profundus tendon from the second digit and the proximal segment of the extensor digiti quarti proprius tendon behaved similarly to the human flexor tendon in zone III and can be considered as surrogates for the human flexor tendon. PMID:21816887

  13. Amplitude transitions of swimmers and flexors in viscoelastic fluids

    NASA Astrophysics Data System (ADS)

    Guy, Robert; Thomases, Becca

    2015-11-01

    In both theoretical and experimental studies of the effect of fluid elasticity on micro-organism swimming, very different behavior has been observed for small and large amplitude strokes. We present simulations of an undulatory swimmer in an Oldroyd-B fluid and show that the resulting viscoelastic stresses are a nonlinear function of the amplitude. Specifically, there appears to be an amplitude dependent transition that is key to obtaining a speed-up over the Newtonian swimming speed. To understand the physical mechanism of the transition, we examine the stresses in a time-symmetric oscillatory bending beam, or flexor. We compare the flow in a neighborhood of the flexor tips with a large-amplitude oscillatory extensional flow, and we see similar amplitude dependent transitions. We relate these transitions to observed speed-ups in viscoelastic swimmers.

  14. Surgery for ganglia of the flexor tendon sheath

    PubMed Central

    Finsen, Vilhjalmur; Håberg, Øyvind; Borchgrevink, Grethe Elisabeth

    2013-01-01

    There are very few reports in the literature on the results of surgery for ganglia of the flexor tendon sheaths of the digits. We reviewed 24 patients operated for flexor tendon sheath ganglia 8 (3–11) years previously. Two operations were for recurrences and one of these recurred again. There was one permanent digital nerve injury and one patient complained of cold sensibility. VAS (0=best; 100=worst) for mean general complaints from the hand was remembered as 51 before surgery and was 5 at review. Mean pain at review was reported as VAS 4 and general satisfaction with the operation as VAS 3. All stated that they would have consented to surgery if they had known the outcome in advance. We conclude that the results of surgery are good, although complications do occur. PMID:23705064

  15. Ultrasound of the digital flexor system: Normal and pathological findings☆

    PubMed Central

    Bianchi, S.; Martinoli, C.; de Gautard, R.; Gaignot, C.

    2007-01-01

    Recent improvements in ultrasound (US) software and hardware have markedly increased the role of this imaging modality in the evaluation of the musculoskeletal system. US is currently one of the main imaging tools used to diagnose and assess most tendon, muscle, and ligament disorders. Compared with magnetic resonance imaging, US is much less expensive; it has no contraindications and is also widely available. Diseases affecting the digital flexor system (DFS) require early diagnosis if treatment is expected to limit functional impairment of the hand. US scans performed with high-resolution, broad-band transducers allows superb visualization of the flexor tendons of the hand and the annular digital pulleys. In addition, dynamic US can be used to assess movement of the tendon within the pulleys during passive or active joint movements. This article examines the anatomy and US appearance of the normal DFS and reviews the US findings associated with the most common disorders affecting it. PMID:23396583

  16. Spring ligament reconstruction using the autogenous flexor hallucis longus tendon.

    PubMed

    Lee, Woo-Chun; Yi, Young

    2014-07-01

    The calcaneonavicular (spring) ligament complex is the soft tissue most often seen to fail in flatfoot pathology and is associated with deformity of the talonavicular joint. The spring ligament complex supports the talar head, preventing it from displacing into excessive plantar flexion/adduction. An anatomical reconstruction of the spring ligament should replicate this function. A new method of spring ligament reconstruction using autogenous flexor hallucis longus tendon transfer is reported. PMID:24992052

  17. Volar wrist ganglion excision through the flexor carpi radialis sheath.

    PubMed

    Sawyer, Gregory A; DaSilva, Manuel F; Akelman, Edward

    2012-09-01

    Volar wrist ganglions are much less frequent than their dorsal counterparts but provide much more surgical trepidation due to their proximity to the radial artery. With the majority arising from the radiocarpal joint, we have found that entering the flexor carpi radialis sheath and accessing the ganglion through the floor of the sheath allows for a relatively safe excision of these benign hand tumors. PMID:22913995

  18. Effect of pulley excision on flexor tendon biomechanics.

    PubMed

    Peterson, W W; Manske, P R; Bollinger, B A; Lesker, P A; McCarthy, J A

    1986-01-01

    Flexor tendon function following excision of various portions of the fibro-osseous pulley system was measured biomechanically using a tensile testing machine. The biomechanical parameters measured were tendon excursion (the excursion of the tendon required to fully flex the digit) and work of flexion (the area under the force-excursion curve, representing all the forces that resist tendon flexion). In this experiment, work of flexion included the forces necessary to accomplish full digital flexion against a 15-g counter-weight, as well as the frictional forces that resist tendon gliding. The results indicate that the work of flexion was affected to a greater degree by pulley loss than was tendon excursion, suggesting that it is a more sensitive measurement of tendon function. A2 was found to be the single most important pulley for flexor tendon function, followed by A4. However, both A2 and A4 had to be present if near-normal hand function was to be achieved; sacrificing the A1 pulley was not associated with a significant loss of flexion. The "pulley effect" of the skin and soft tissue as a supplement to the fibro-osseous pulleys in reducing tendon bow-stringing was also noted. Although the parameters of tendon excursion and work of flexion were used in this study to determine the effect of pulley loss on tendon function, they can also be used to evaluate other flexor tendon studies, such as pulley reconstruction. PMID:3950813

  19. Partial Flexor Tendon Laceration Assessment: Interobserver and Intraobserver Reliability.

    PubMed

    Barker, B Justin; Kolovich, Gregory P; Klinefelter, Ryan D

    2016-01-01

    Accurate assessment of partial-thickness flexor tendon lacerations in the hand is difficult owing to the subjectivity of evaluation. In this study, we created 12 partial-thickness flexor tendon lacerations in a cadaveric hand, evaluated the accuracy of 6 orthopedic residents and 4 fellowship-trained hand surgeons in estimating the percentage thickness of each laceration, and assessed the groups' interobserver and intraobserver agreement. The 10 participants estimated each laceration independently and on 2 separate occasions and indicated whether they would repair it. The actual thickness of each laceration was calculated from measurements made with a pair of digital microcalipers. Overall estimates differed significantly from calibrated measurements. Estimates grouped by residents and fellowship-trained hand surgeons also differed significantly. Third-year residents were the most accurate residents, and fellowship-trained hand surgeons were more accurate than residents. Overall interobserver agreement was poor for both readings. There was moderate overall intraobserver agreement. Fellowship-trained hand surgeons and first-year residents had the highest intraobserver agreement. These results highlight the difficulty in accurately assessing flexor tendon lacerations. Accuracy appears not to improve with surgeon experience. PMID:26991579

  20. Toe Flexor Strength, Flexibility and Function and Flexor Hallucis Longus Tendon Morphology in Dancers and Non-Dancers.

    PubMed

    Rowley, K Michael; Jarvis, Danielle N; Kurihara, Toshiyuki; Chang, Yu-Jen; Fietzer, Abbigail L; Kulig, Kornelia

    2015-09-01

    Tendinopathy of the flexor hallucis longus (FHL), colloquially referred to as "dancer's tendinitis," is a common condition in dancers and attributed to high demand on this muscle in positions of extreme ankle plantarflexion and metatarsophalangeal (MTP)) flexion and extension. Despite such a high prevalence, there has been little research into preventative or nonsurgical interventions. As a means to identify potential targets for prevention and intervention, this study aimed to characterize toe flexors in dancers by measuring strength, flexibility, function, and FHL tendon morphology. Dancers (n=25) were compared to non-dancers (n=25) in toe flexor isometric strength, first MTP joint range of motion, foot longitudinal arch flexibility, balance ability, endurance during modified heel raises without use of the toes, and FHL tendon thickness, cross-sectional area, and peak spatial frequency. Significant differences were found in functional first MTP joint extension (dancers 101.95°, non-dancers 91.15°, p<0.001), balance ability during single-leg stance on the toes (dancers 11.43 s, non-dancers 5.90 s, p=0.013), and during modified heel raises (dancers 22.20 reps, non-dancers 28.80 reps, p=0.001). Findings indicate that dancers rely on toe flexors more than non-dancers to complete balance and heel raise tasks. Efficacy of using this modified heel raise task with the toes off the edge of a block as a means to train larger plantarflexors and as a nonsurgical intervention should be studied in the future. Improving interventions for FHL tendinopathy will be impactful for dancers, in whom this condition is highly prevalent. PMID:26395616

  1. Early reduction in toe flexor strength is associated with physical activity in elderly men

    PubMed Central

    Suwa, Masataka; Imoto, Takayuki; Kida, Akira; Yokochi, Takashi

    2016-01-01

    [Purpose] To compare the toe flexor, hand grip and knee extensor strengths of young and elderly men, and to examine the association between toe flexor strength and physical activity or inactivity levels. [Subjects and Methods] Young (n=155, 18–23 years) and elderly (n=60, 65–88 years) men participated in this study. Toe flexor, hand grip, and knee extensor strength were measured. Physical activity (time spent standing/walking per day) and inactivity (time spent sitting per day) were assessed using a self-administered questionnaire. [Results] Toe flexor, hand grip, and knee extensor strength of the elderly men were significantly lower than those of the young men. Standing/walking and sitting times of the elderly men were lower than those of the young men. Toe flexor strength correlated with hand grip and knee extensor strength in both groups. In elderly men, toe flexor strength correlated with standing/walking time. In comparison to the young men’s mean values, toe flexor strength was significantly lower than knee extensor and hand grip strength in the elderly group. [Conclusion] The results suggest that age-related reduction in toe flexor strength is greater than those of hand grip and knee extensor strengths. An early loss of toe flexor strength is likely associated with reduced physical activity in elderly men. PMID:27313353

  2. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.

    PubMed

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M

    2015-12-28

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  3. Flexor Tendon Sheath Ganglions: Results of Surgical Excision

    PubMed Central

    Spencer, Edwin E.

    2007-01-01

    The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient’s medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21–68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5–38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath. PMID:18780066

  4. Viscosity of the flexor muscles of the elbow joint under maximum contraction condition.

    PubMed

    Niku, S; Henderson, J M

    1989-01-01

    The maximum contractile moments developed by the elbow flexors of eleven normal subjects at different elbow angles were measured, both isometrically and at various shortening velocities. The results were used to predict the damping coefficient of the viscous element of the elbow flexor muscles and soft tissue under maximum contraction condition for various angles and shortening velocities. PMID:2808437

  5. An atypical presentation of a flexor intratendinous ganglion of the hand.

    PubMed

    Chia, Dawn Sinn Yii; Kong, Jun Cheong; Teoh, Lam Chuan

    2015-03-01

    Intratendinous ganglions of the hand are rare. We report an unusual case of a ganglion arising within the flexor tendon in the hand. The intratendinous ganglion arose from the flexor digitorium profundus tendon of the little finger, causing flexion deformity of the finger. PMID:24051457

  6. Rhythmic Isometric Fatigue Patterns of the Elbow Flexors and Knee Extensors

    ERIC Educational Resources Information Center

    Ordway, George A.; And Others

    1977-01-01

    During a rhythmic, all-out task, the rates of fatigue experienced by elbow flexor and knee extendor muscle groups tend to differ, with the elbow flexors fatiguing more rapidly initially, but reaching a plateau at a relatively higher level than the knee extensors. (Author)

  7. Point-of-Care Ultrasound in the Evaluation of Pyogenic Flexor Tenosynovitis.

    PubMed

    Cohen, Stephanie G; Beck, Sierra C

    2015-11-01

    A 4-year-old girl presented to the emergency department for evaluation of finger swelling after a dog bite. Point-of-care ultrasound was used to diagnose pyogenic flexor tenosynovitis of the digit after visualizing a fluid collection within the flexor tendon sheath. The patient underwent emergent incision and drainage of the digit with good outcome. PMID:26535504

  8. Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

    PubMed Central

    Yun, Sung Joon; Kim, Moon-Hwan; Weon, Jong-Hyuck; Kim, Young; Jung, Sung-Hoon; Kwon, Oh-Yun

    2016-01-01

    [Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball.

  9. Differences in Plantar Flexor Fascicle Length and Pennation Angle between Healthy and Poststroke Individuals and Implications for Poststroke Plantar Flexor Force Contributions

    PubMed Central

    Ramsay, John W.; Buchanan, Thomas S.; Higginson, Jill S.

    2014-01-01

    Poststroke plantar flexor muscle weakness has been attributed to muscle atrophy and impaired activation, which cannot collectively explain the limitations in force-generating capability of the entire muscle group. It is of interest whether changes in poststroke plantar flexor muscle fascicle length and pennation angle influence the individual force-generating capability and whether plantar flexor weakness is due to uniform changes in individual muscle force contributions. Fascicle lengths and pennation angles for the soleus, medial, and lateral gastrocnemius were measured using ultrasound and compared between ten hemiparetic poststroke subjects and ten healthy controls. Physiological cross-sectional areas and force contributions to poststroke plantar flexor torque were estimated for each muscle. No statistical differences were observed for any muscle fascicle lengths or for the lateral gastrocnemius and soleus pennation angles between paretic, nonparetic, and healthy limbs. There was a significant decrease (P < 0.05) in the paretic medial gastrocnemius pennation angle compared to both nonparetic and healthy limbs. Physiological cross-sectional areas and force contributions were smaller on the paretic side. Additionally, bilateral muscle contributions to plantar flexor torque remained the same. While the architecture of each individual plantar flexor muscle is affected differently after stroke, the relative contribution of each muscle remains the same. PMID:25147753

  10. Resistance exercise prevents plantar flexor deconditioning during bed rest

    NASA Technical Reports Server (NTRS)

    Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.

    1997-01-01

    Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional

  11. Operative technique for human composite flexor tendon allograft procurement and engraftment.

    PubMed

    DeGeorge, Brent R; Rodeheaver, George T; Drake, David B

    2014-01-01

    Devastating volar hand injuries with significant damage to the pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. Postoperative adhesion formation and lack of suitable donor material for tendon autograft are 2 fundamental problems that continue to challenge the hand surgeon. In 1967, Erle E. Peacock, Jr, described a technique of flexor tendon reconstruction using cadaveric composite flexor tendon allograft, which consisted of both the flexor digitorum profundus and superficialis tendons in their respective fibro-osseous sheaths consisting of the digital pulley structures and the underlying periosteum and volar plates. This technique never gained widespread acceptance due to concerns regarding tissue antigenicity, infectious disease transmission, and the rising popularity of the method of Hunter for silastic rod-based flexor tendon reconstruction initially described during the same period. With modern-day advances in tissue processing with acellularization and extensive donor screening for transmissible diseases, this technique should be revisited to address the reconstructive needs of patients with extensive volar soft tissue and tendon injury. Herein, we describe the operative technique of composite flexor tendon procurement and reconstruction with key modifications from the initial technique described by Peacock for improved composite construct elevation, soft tissue inset, and bony attachment. PMID:24691346

  12. Avoidance of unfavourable results following primary flexor tendon surgery

    PubMed Central

    Elliot, D.; Giesen, T.

    2013-01-01

    This review describes the biological problems faced by those managing primary flexor tendon injuries and explains why these problems still thwart attempts to achieve normal, or near normal, function after this injury, despite a century of surgical effort. It considers the historical background of the early 20th century attempts to improve the results and analyses the clinical usefulness of more recent research into tendon core and circumferential suture modification, including the authors’ work in this field, and changes in post-operative mobilisation over the last 50 years. More recent manipulation of the sheath to improve results and the future possibility of manipulation of adhesions are discussed. It also discusses other factors, e.g., the patient, the experience of the surgeon, the use of therapists, the timing of repair, complex injuries, injuries in zones other than zone 2, which can have a bearing on the results and considers how these can be modified to avoid an unfavourable outcome. PMID:24501468

  13. An Unusual Cause of Flexor Tenosynovitis: Streptococcus mitis

    PubMed Central

    Ulucay, Cağatay; Ozler, Turhan

    2014-01-01

    Summary: Streptococcus mitis is a commensal organism of the human oropharynx that rarely causes infection in healthy individuals. Herein, we describe a previously healthy 35-year-old woman who presented with acute pyogenic flexor tenosynovitis of the left index finger due to S. mitis infection. The patient’s infection was treated successfully via surgical and medical interventions, and during follow-up, it was determined that she was complement component C3 deficient. Tenosynovitis is an emergent clinical syndrome that can result in permanent disability or amputation. To the best of our knowledge, this case report is the first to describe tenosynovitis due to S. mitis; in addition, it highlights the importance of initiating therapy with antibiotics that are effective against this rare pathogen. PMID:25587497

  14. Determining flexor-tendon repair techniques via soft computing

    NASA Technical Reports Server (NTRS)

    Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.

    2001-01-01

    An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

  15. Haemodynamic kinetics and intermittent finger flexor performance in rock climbers.

    PubMed

    Fryer, S; Stoner, L; Lucero, A; Witter, T; Scarrott, C; Dickson, T; Cole, M; Draper, N

    2015-02-01

    Currently it is unclear whether blood flow (BF) or muscle oxidative capacity best governs performance during intermittent contractions to failure. The aim of this study was to determine oxygenation kinetics and BF responses during intermittent (10 s contraction: 3 s release) contractions at 40% of MVC in rock climbers of different ability (N=38). Total forearm BF, as well as de-oxygenation and re-oxygenation of the flexor digitorum profundus (FDP) and the flexor carpi radialis (FCR) were assessed. Compared to the control, intermediate and advanced groups, the elite climbers had a significantly (p<0.05) greater force time integral (FTI), MVC and MVC/kg. Furthermore, the elite climbers de-oxygenated the FDP significantly more during the first (7.8, 11.9, 12.4 vs. 15.7 O2%) and middle (7.3, 8.8, 10.4 vs.15.3 O2%) phases of contractions as well as for the FCR during the first phase only (8.3, 7, 11.7 vs. 13.3 O2%). They also had a significantly higher BF upon release of the contractions (656, 701, 764 vs. 971 mL ∙ min(-1)). The higher FTI seen in elite climbers may be attributable to a greater blood delivery, and an enhanced O2 recovery during the 3 s release periods, as well as a superior muscle oxidative capacity associated with the greater de-oxygenation during the 10 s contractions. PMID:25251449

  16. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation

    PubMed Central

    Rymer, Ben; Theobald, Peter; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  17. Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus Tendon Treated by Tendoscopy.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Tendosynovial chondromatosis of the foot and ankle is a rare disease entity. We reported 3 patients with tenosynovial osteochondromatosis of flexor hallucis longus. They were successfully treated by arthroscopic synovectomy and removal of the loose bodies. PMID:25979294

  18. Computed Tomographic Tenography of Normal Equine Digital Flexor Tendon Sheath: An Ex Vivo Study

    PubMed Central

    Lacitignola, Luca; De Luca, Pasquale; Guarracino, Alessandro; Crovace, Antonio

    2015-01-01

    Aim of this study was to document the normal computed tomographic tenography findings of digital flexor tendon sheath. Six ex vivo normal equine forelimbs were used. An axial approach was used to inject 185 mg/mL of iopamidol in a total volume of 60 mL into the digital flexor tendon sheaths. Single-slice helical scans, with 5 mm thickness, spaced every 3 mm, for a pitch of 0.6, and with bone algorithm reconstruction, were performed before and after injections of contrast medium. To obtain better image quality for multiplanar reconstruction and 3D reformatting, postprocessing retroreconstruction was performed to reduce the images to submillimetre thickness. Computed tomographic tenography of digital flexor tendon sheaths could visualize the following main tendon structures for every forelimb in contrast-enhanced images as low densities surrounded by high densities: superficial digital flexor tendon, deep digital flexor tendon, manica flexoria, mesotendons, and synovial recess. Results of this study suggest that computed tomographic tenography can be used with accuracy and sensitivity to evaluate the common disorders of the equine digital flexor tendon sheath and the intrathecal structures. PMID:26185709

  19. Assessment of Effective Ankle Joint Positioning in Strength Training for Intrinsic Foot Flexor Muscles: A Comparison of Intrinsic Foot Flexor Muscle Activity in a Position Intermediate to Plantar and Dorsiflexion with that in Maximum Plantar Flexion Using Needle Electromyography

    PubMed Central

    Hashimoto, Takayuki; Sakuraba, Keishoku

    2014-01-01

    [Purpose] The effectiveness of intrinsic foot flexor strength training performed in the plantar flexion position was examined using needle electromyography. [Subjects] The subjects of this study were 18 healthy men. [Methods] We used needle electromyography to measure the muscle activities of the flexor hallucis brevis (FHB), and the flexor digitorum brevis (FDB) in maximum plantar and an intermediate position. [Results] Significant increases in muscle activities were observed for both FHB and FDB, and the rates of increase from the intermediate position to the plantar flexion position were 43% for FHB and 46% for FDB. [Conclusion] This study demonstrated that it is possible to evaluate intrinsic foot flexors, in addition to the numerous reports on treatment methods focusing on extrinsic foot flexors. Furthermore, the results suggest that toe flexion exercises performed during plantar flexion of the ankle joint are an effective method for intrinsic foot flexor strength training. PMID:24707106

  20. Plantar flexor moment arm and muscle volume predict torque-generating capacity in young men

    PubMed Central

    Baxter, Josh R.

    2013-01-01

    Muscle volume is known to correlate with maximal joint torque in humans, but the role of muscle moment arm in determining maximal torque is less clear. Moderate correlations have been reported between maximal isometric knee extensor torque and knee extensor moment arm, but no such observations have been made for the ankle joint. It has been suggested that smaller muscle moment arms may enhance force generation at high rates of joint rotation, but this has not yet been observed for ankle muscles in vivo. The purpose of the present study was to correlate plantar flexor moment arm and plantar flexor muscle volume with maximal plantar flexor torque measured at different rates of plantar flexion. Magnetic resonance imaging was used to quantify the plantar flexor moment arm and muscle volume of the posterior compartment in 20 healthy young men. Maximal plantar flexor torque was measured isometrically and at three plantar flexion speeds using an isokinetic dynamometer. Plantar flexor torque was significantly correlated with muscle volume (0.222 < R2 < 0.322) and with muscle moment arm at each speed (0.323 < R2 < 0.494). While muscle volume was strongly correlated with body mass and stature, moment arm was not. The slope of the torque-moment arm regression line decreased as the rate of joint rotation increased, indicating that subjects with small moment arms experienced smaller reductions in torque at high speeds. The findings of this study suggest that plantar flexor moment arm is a determinant of joint strength that is at least as important as muscle size. PMID:24371016

  1. Flexor bias of joint position in humans during spaceflight

    NASA Technical Reports Server (NTRS)

    McCall, G. E.; Goulet, C.; Boorman, G. I.; Roy, R. R.; Edgerton, V. R.

    2003-01-01

    The ability to estimate ankle and elbow joint position was tested before, during, and after a 17-day spaceflight. Subjects estimated targeted joint angles during isovelocity (IsoV) joint movements with agonist muscle groups either active or relaxed. These movements included elbow extension (EE) and elbow flexion (EF), and plantarflexion (PF) and dorsiflexion (DF) of the ankle. Subjects also estimated these joint positions while moving the dynamometer at their chosen (variable) velocity (VarV) during EE and PF. For IsoV tests, no differences were observed between active and passive movements for either the ankle or elbow. Compared with those of pre-flight test days, estimates of targeted elbow joint angles were approximately 5 degrees to 15 degrees more flexed in-flight, and returned toward the pre-flight values during recovery. The spaceflight effects for the ankle were inconsistent and less prevalent than those for the elbow. The VarV PF test condition for the 120 degrees target angle at the ankle exhibited approximately 5 degrees to 7 degrees more DF target angle estimates in-flight compared with those pre- or post-flight. In contrast, during IsoV PF there was a tendency for ankle estimates to be approximately 2 degrees to 3 degrees more PF after 2-3 days exposure to spaceflight. These data indicate that during spaceflight the perception of elbow extension is greater than actuality, and are consistent with the interpretation that microgravity induced a flexor bias in the estimation of the actual elbow joint position. Moreover, these effects in joint proprioception during spaceflight were observed in individual isolated single-joint movements during tasks in which vestibular function in maintaining posture were minimal.

  2. Finite element modelling of plantar pressure beneath the second ray with flexor muscle loading.

    PubMed

    Lemmon, DR; Cavanagh, PR

    1997-04-01

    INTRODUCTION:: Little is understood about the effects of flexor loading on plantar pressure distribution. The goal of the current work is to model flexor muscle loading applied to the distal phalanges in order to study the effect of these loads on plantar normal stress (pressure) beneath the metatarsal head. METHODS:: The finite element model is a two-dimensional, plane strain sagittal section incorporating the second metatarsal, proximal phalanx, and plantar and dorsal soft tissue (Figure 1). The metatarsophalangeal joint is simulated by a nodal hinge that transfers loads and produces reasonable kinematic motion between the articular surfaces of the proximal[Figure: see text] phalanx and metatarsal head. Soft tissues are simulated by a uniform continuum. A single flexor tendon passes over the condyle of the metatarsal heads with sliding contact against intervening soft tissue, and is attached to the distal end of the proximal phalanx. A rigid element at the proximal end is fixed by boundary conditions to simulate reactions at the distal cuneiform joint. Material properties of bone are from published values, one tenth the stiffness of bone is used for the flexor tendon, and the soft tissue continuum is hyperelastic using coefficients obtained from compression of the heel plantar fat pad. A 188 N vertical ground reaction force and a flexor tendon load at a 10 degree angle from the X (horizontal) axis are applied to the model. RESULTS:: Figure 2 shows Y direction normal stress distribution along the plantar surface for two load cases: no load and a 250 N load to the flexor tendon. DISCUSSION:: Bending moments at the proximal metatarsal correspond to values obtained by Sharkey et al. Tension in the flexor tendon served to counter the moment in the metatarsal created by the vertical load, and at the same time, to apply an additional axial load. Under flexor loading, focal plantar pressure shifts toward the proximal phalanx and yields a 60% reduction in peak pressure

  3. Isokinetic dynamometry of the knee extensors and flexors in Iranian healthy males and females

    PubMed Central

    Rezaei, Mandana; Ebrahimi, Ismael; Vassaghi- Gharamaleki, Behnoush; Pirali, Milad; Mortaza, Niyousha; Malmir, Kazem; Ghasemi, Kobra; A. Jamshidi, Ali

    2014-01-01

    Background: This paper explores the gender-related bilateral differences of extensor and flexor torques of the knee joint at low and high angular velocities in Iranian healthy males and females. Methods: 70 healthy subjects (29 males (26.61±4.34 yrs and 41 females with average age of 23.07±3.70 yrs)) were participated in this study. Isokinetic peak torque values for knee extensors and flexors in concentric and eccentric contraction modes were measured and flexors and extensors strength ratios (HQR) computed among both dominant and non-dominant legs in lying position at 60 and 180°.s-1angular velocities. Results: There was significant gender-velocity interactions detected for knee flexor to extensor strength ratios presenting that increasing velocity escaled this, ratios in females more than males (p<0.05). There was no gender- velocity-leg side interaction (p>0.05). Bilateral differences were found for eccentric flexor peak torques (p<0.05). By increasing velocity, peak torque values decreased and HQR was increased (p<0.05). Conclusion: Measurement procedures including test position is an important factor when interpreting genderrelated and bilateral differences of isokinetic knee strength ratios in healthy individuals. PMID:25664309

  4. Modified flexor digitorum superficialis slip technique for A4 pulley reconstruction.

    PubMed

    Odobescu, A; Radu, A; Brutus, J-P; Gilardino, M S

    2010-07-01

    We describe a variation in the A4 pulley reconstruction technique using one slip of the flexor digitorum superficialis insertion and report the results of a biomechanical analysis of this reconstruction in cadavers. While conserving the distal bony insertion, one slip of flexor digitorum superficialis is transferred over the flexor digitorum profundus tendon and sutured to the contralateral superficialis slip insertion. This creates a new pulley at the base of the original A4 pulley that can be adjusted to accommodate an FDP repair of increased bulk. We found a 57% reduction in excess excursion due to bowstringing when compared with no repair. Furthermore the repairs were sturdy, 94% of specimens maintaining their integrity when a proximally directed force of 50 N was applied. PMID:20427405

  5. Knee extension fatigue attenuates repeated force production of the elbow flexors.

    PubMed

    Halperin, Israel; Aboodarda, Saied J; Behm, David G

    2014-01-01

    Non-local muscle fatigue has been demonstrated with unilateral activities, where fatiguing one limb alters opposite limb forces. Fewer studies have examined if non-local fatigue occurs with unrelated muscles. The purpose of this study was to investigate if knee extensors fatigue alters elbow flexors force and electromyography (EMG) activity. Eighteen males completed a control and fatiguing session (randomised). Blood lactate was initially sampled followed by three maximal voluntary contractions (MVC) with the elbow flexors and two with the knee extensors. Thereafter, subjects either sat (control) or performed five sets of bilateral dynamic knee extensions to exhaustion using a load equal to the dominant limb MVC (1-min rest between sets). Immediately afterwards, subjects were assessed for blood lactate and unilateral knee extensors MVC, and after 1 min performed a single unilateral elbow flexor MVC. Two minutes later, subjects performed 12 unilateral elbow flexor MVCs (5 s contraction/10 s rest) followed by a third blood lactate test. Compared to control, knee extensor force dropped by 35% (p < 0.001; ES = 1.6) and blood lactate increased by 18% (p < 0.001; ES = 2.8). Elbow flexor forces were lower after the fatiguing protocol only during the last five MVCs (p < 0.05; ES = ∼ 0.58; ∼ 5%). No changes occurred between conditions in EMG. Elbow flexor forces significantly decreased after knee extensors fatigue. The effect was revealed during the later stages of the repeated MVCs protocol, demonstrating that non-local fatigue may have a stronger effect on repeated rather than on single attempts of maximal force production. PMID:24766625

  6. DAS performance analysis

    SciTech Connect

    Bates, G.; Bodine, S.; Carroll, T.; Keller, M.

    1984-02-01

    This report begins with an overview of the Data Acquisition System (DAS), which supports several of PPPL's experimental devices. Performance measurements which were taken on DAS and the tools used to make them are then described.

  7. Flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

    PubMed

    Okamoto, Syunro; Tada, Kaoru; Ai, Hachinota; Tsuchiya, Hiroyuki

    2014-01-01

    The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty. PMID:25400974

  8. Flexor Carpi Ulnaris Muscle Flap for Soft Tissue Reconstruction after Total Elbow Arthroplasty

    PubMed Central

    Okamoto, Syunro; Ai, Hachinota; Tsuchiya, Hiroyuki

    2014-01-01

    The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty. PMID:25400974

  9. Hallux checkrein deformity resulting from the scarring of long flexor muscle belly - case report.

    PubMed

    Boszczyk, Andrzej; Zakrzewski, Piotr; Pomianowski, Stanisław

    2015-01-01

    A case of posttraumatic checkrein deformity of the hallux is presented. This deformity is most often caused by scarring of the muscle belly or tethering of the tendon. A 22-year old woman developed a hallux checkrein deformity after a bimaleolar fracture. Intraoperatively, a linear scar tethering the muscle belly to the posterior tibia was observed. Resection of the scar allowed for full flexor hallucis longus mobility. Full hallux range of motion as well as foot function was restored. The cause of the checkrein deformity in our patient was a scar tethering the flexor hallucis belly to the posterior tibia. PMID:25759157

  10. Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome.

    PubMed

    Winkes, Michiel B; Teijink, Joep A; Scheltinga, Marc R

    2016-01-01

    We discuss a case of a 26-year-old man, a motorcycle racer, who presented with progressive pain, weakness and swelling of his right forearm and loss of power in his index finger, experienced during motor racing. Chronic exertional compartment syndrome (CECS) of both flexor and extensor compartments of his forearm was diagnosed by dynamic intracompartmental muscle pressure measurements. After fasciotomies, all symptoms were resolved and the patient was able to improve on his preinjury racing skills, without any limitations. A literature review and a surgical 'how-to' for correct release of the extensor and deep flexor compartments of the forearm are provided. PMID:27080851

  11. Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors

    PubMed Central

    2013-01-01

    Background A common goal of persons post-stroke is to regain community ambulation. The plantar flexor muscles play an important role in propulsion generation and swing initiation as previous musculoskeletal simulations have shown. The purpose of this study was to demonstrate that simulation results quantifying changes in plantar flexor activation and function in individuals post-stroke were consistent with (1) the purpose of an intervention designed to enhance plantar flexor function and (2) expected muscle function during gait based on previous literature. Methods Three-dimensional, forward dynamic simulations were created to determine the changes in model activation and function of the paretic ankle plantar flexor muscles for eight patients post-stroke after a 12-weeks FastFES gait retraining program. Results An median increase of 0.07 (Range [−0.01,0.22]) was seen in simulated activation averaged across all plantar flexors during the double support phase of gait from pre- to post-intervention. A concurrent increase in walking speed and plantar flexor induced forward center of mass acceleration by the plantar flexors was seen post-intervention for seven of the eight subject simulations. Additionally, post-training, the plantar flexors had an simulated increase in contribution to knee flexion acceleration during double support. Conclusions For the first time, muscle-actuated musculoskeletal models were used to simulate the effect of a gait retraining intervention on post-stroke muscle model predicted activation and function. The simulations showed a new pattern of simulated activation for the plantar flexor muscles after training, suggesting that the subjects activated these muscles with more appropriate timing following the intervention. Functionally, simulations calculated that the plantar flexors provided greater contribution to knee flexion acceleration after training, which is important for increasing swing phase knee flexion and foot clearance. PMID

  12. Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting

    PubMed Central

    Mon, Daniel; Zakynthinaki, María S.; Cordente, Carlos A.; Antón, Antonio J. Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López

    2015-01-01

    The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting. PMID:26121145

  13. Flexor carpi ulnaris transfer for radial nerve palsy: functional testing of long-term results.

    PubMed

    Raskin, K B; Wilgis, E F

    1995-09-01

    Controversy persists over the use of the flexor carpi ulnaris for transfer to the extensor digitorum communis in the treatment of radial nerve palsy. Six patients with complete, irreparable radial nerve palsies were treated in part with the flexor carpi ulnaris to extensor digitorum communis tendon transfer (standard transfers: pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to the rerouted extensor pollicis longus) and were functionally tested for long-term results. The average follow-up time was 8 years (range, 3-15). A control group was comprised of 10 volunteers of similar demographics. This study evaluates the long-term functional recovery in three categories: range of motion, dynamic power of wrist motion, and functional ability as determined by work simulation techniques. The activities simulated were swinging a hammer, sawing wood, tightening screws, and using pliers. A functional range of motion was maintained in all patients, and the power of wrist motion was sufficient to perform all activities of daily living. The work simulation testing revealed no significant difference between the tendon transfer patients and control group with respect to hand dominance and normal variance. All patients were able to perform the simulated work with the same variance in power as the control group. Despite the obvious anatomic loss, wrist function is not significantly impaired after flexor carpi ulnaris tendon transfer for radial nerve palsy. PMID:8522738

  14. The use of magnetic resonance imaging in diagnosing equine deep digital flexor tendinopathies--own experience.

    PubMed

    Jaskólska, M; Adamiak, Z; Zhalniarovich, Y; Przyborowska, P; Peczyński, Z

    2014-01-01

    Deep digital flexor tendinopathy is a common problem in horses of different athletic disciplines. Nowadays, the use of magnetic resonance imaging is considered to be a noninvasive and superior choice for recognizing bone and soft tissue pathologies especially related to difficult to access structures within the hoof capsule. PMID:25286667

  15. EFFECT OF USING WRIST ORTHOSES ON FOREARM FLEXOR AND EXTENSOR MUSCLE ACTIVATION

    PubMed Central

    Novais Van Petten, Adriana Maria Valladão; Ávila, Antônio Ferreira

    2015-01-01

    Objective: To investigate the effect of using wrist immobilization orthoses made from different materials, on activation of the flexor and extensor musculature of the forearm while performing specific tasks. Methods: Twenty-six adults, with an average age of 26.2 years, underwent the Jebsen-Taylor functional hand test and the grip strength test (Jamar® dynamometer) under three conditions: free hand, wearing a composite orthosis and wearing a thermoplastic orthosis. The tests were carried out using the dominant hand only. During the tests, surface electrodes were attached to the flexor and extensor muscles of the forearm to record the muscle electrical activity. The results obtained under the three conditions were compared and analyzed using the Wilcoxon statistical test. Results: Significant differences in muscle activation were found between using the free hand and using any of the orthoses. There was no significant difference in muscle activation between the two types of orthosis. A decrease in activity of the extensor muscles of the forearm was observed during all the tasks, as well as an increase in activation of the flexor muscles with the use of the orthoses. Conclusion: These results are important for defining whether an orthosis should be prescribed during the rehabilitation process for a wide range of disorders, such as tendinitis of the flexors and extensors of the wrist and fingers, as well as for predicting the length of time for which these devices should be used. PMID:27022523

  16. Tendoscopic Excision of an Intratendinous Ganglion in the Flexor Hallucis Longus Tendon: A Case Report.

    PubMed

    Endo, Jun; Yamaguchi, Satoshi; Sasho, Takahisa

    2016-01-01

    Intratendinous ganglion cysts are rare lesions of unknown etiology that originate within a tendon. We report the case of a 34-year-old female with an intratendinous ganglion in the plantar portion of the flexor hallucis longus tendon. The intratendinous ganglion recurred after ultrasound-guided needle aspiration. Tendoscopic excision of the intratendinous ganglion cyst achieved a satisfactorily result without recurrence. PMID:25456345

  17. Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture

    PubMed Central

    Cavadas, Pedro C.; Rubi, Carlo G.

    2016-01-01

    Summary: A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion. PMID:27200249

  18. Finger Flexor Force Influences Performance in Senior Male Air Pistol Olympic Shooting.

    PubMed

    Mon, Daniel; Zakynthinaki, María S; Cordente, Carlos A; Antón, Antonio J Monroy; Rodríguez, Bárbara Rodríguez; Jiménez, David López

    2015-01-01

    The ability to stabilize the gun is crucial for performance in Olympic pistol shooting and is thought to be related to the shooters muscular strength. The present study examines the relation between performance and finger flexor force as well as shoulder abduction isometric force in senior male air pistol shooting. 46 Spanish national level shooters served as test subjects of the study. Two maximal force tests were carried out recording handgrip and deltoid force data under competition conditions, during the official training time at national Spanish championships. Performance was measured as the total score of 60 shots at competition. Linear regressions were calculated to examine the relations between performance and peak and average finger flexor forces, peak and average finger flexor forces relative to the BMI, peak and average shoulder abduction isometric forces, peak shoulder abduction isometric force relative to the BMI. The connection between performance and other variables such as age, weight, height, BMI, experience in years and training hours per week was also analyzed. Significant correlations were found between performance at competition and average and peak finger flexor forces. For the rest of the force variables no significant correlations were found. Significant correlations were also found between performance at competition and experience as well as training hours. No significant correlations were found between performance and age, weight, height or BMI. The study concludes that hand grip strength training programs are necessary for performance in air pistol shooting. PMID:26121145

  19. Recovery Kinetics of Knee Flexor and Extensor Strength after a Football Match

    PubMed Central

    Draganidis, Dimitrios; Chatzinikolaou, Athanasios; Avloniti, Alexandra; Barbero-Álvarez, José C.; Mohr, Magni; Malliou, Paraskevi; Gourgoulis, Vassilios; Deli, Chariklia K.; Douroudos, Ioannis I.; Margonis, Konstantinos; Gioftsidou, Asimenia; Fouris, Andreas D.; Jamurtas, Athanasios Z.; Koutedakis, Yiannis; Fatouros, Ioannis G.

    2015-01-01

    We examined the temporal changes of isokinetic strength performance of knee flexor (KF) and extensor (KE) strength after a football match. Players were randomly assigned to a control (N = 14, participated only in measurements and practices) or an experimental group (N = 20, participated also in a football match). Participants trained daily during the two days after the match. Match and training overload was monitored with GPS devices. Venous blood was sampled and muscle damage was assessed pre-match, post-match and at 12h, 36h and 60h post-match. Isometric strength as well as eccentric and concentric peak torque of knee flexors and extensors in both limbs (dominant and non-dominant) were measured on an isokinetic dynamometer at baseline and at 12h, 36h and 60h after the match. Functional (KFecc/KEcon) and conventional (KFcon/KEcon) ratios were then calculated. Only eccentric peak torque of knee flexors declined at 60h after the match in the control group. In the experimental group: a) isometric strength of knee extensors and knee flexors declined (P<0.05) at 12h (both limbs) and 36h (dominant limb only), b) eccentric and concentric peak torque of knee extensors and flexors declined (P<0.05) in both limbs for 36h at 60°/s and for 60h at 180°/s with eccentric peak torque of knee flexors demonstrating a greater (P<0.05) reduction than concentric peak torque, c) strength deterioration was greater (P<0.05) at 180°/s and in dominant limb, d) the functional ratio was more sensitive to match-induced fatigue demonstrating a more prolonged decline. Discriminant and regression analysis revealed that strength deterioration and recovery may be related to the amount of eccentric actions performed during the match and athletes' football-specific conditioning. Our data suggest that recovery kinetics of knee flexor and extensor strength after a football match demonstrate strength, limb and velocity specificity and may depend on match physical overload and players' physical

  20. Intracellular autogenetic and synergistic effects of muscular contraction on flexor motoneurones

    PubMed Central

    Green, D. G.; Kellerth, J.-O.

    1967-01-01

    1. Intracellular records have been taken from cat motoneurones innervating flexor muscles of the hind limb. Contractions of the ankle flexors tibialis anterior and extensor digitorum longus were elicited by stimulation of the peripheral end of the cut L 7 ventral root and the reflex effects of these contractions were recorded in silent and repetitively firing motoneurones. 2. Contraction usually produces a hyperpolarizing response inside flexor motoneurones. This hyperpolarization is tension-sensitive in the sense that when, at constant muscle extension, the strength of the contraction is increased, the magnitude of the inhibitory response is augmented. 3. Increasing the resting length of the muscles, while using a stimulus of constant strength to the ventral root, causes this inhibitory response to increase in some cells. More often, however, the hyperpolarization caused by contraction is gradually reduced in duration and/or amplitude as the muscles are extended. 4. Even with the muscles slackened, so that they develop no tension at their ends, contraction usually produces prominent hyperpolarization of the motoneurones. 5. By passing polarizing currents or injecting chloride ions through the intracellular micro-electrode, the hyperpolarizing potentials produced by contraction of the slack and extended muscles are shown to be, at least in part, genuinely post-synaptic inhibitory events. 6. When the neurone is fired repetitively by injected current, the `silent period' in contraction corresponds to the hyperpolarization of the post-synaptic membrane. 7. Monosynaptic testing of the flexor motoneurone pool has been used to confirm the essential features of the intracellularly recorded activity. 8. Acutely spinalizing the animal increases the magnitude of the inhibitory responses caused by contraction. 9. Recordings from dorsal root fibres show that Golgi tendon organs of the ankle flexors are very sensitive to contraction and are indeed often activated by the

  1. Comparison of the Thickness of Pulley and Flexor Tendon Between in Neutral and in Flexed Positions of Trigger Finger

    PubMed Central

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo

    2016-01-01

    Objective: This study aims to compare the morphology of the A1 pulley and flexor tendons in idiopathic trigger finger of digits other than the thumb between in neutral position and in the position with the interphalangeal joints full flexed and with the metacarpophalangeal (MP) joint 0° extended (hook grip position). Method: A total of 48 affected digits and 48 contralateral normal digits from 48 patients who initially diagnosed with idiopathic trigger finger were studied sonographically. Sonographic analysis was focused on the A1 pulley and flexor tendons at the level of the MP joint in the transverse plane. We measured the anterior-posterior thickness of A1 pulley and the sum of the flexor digitorum superficialis and profundus tendons, and also measured the maximum radialulnar width of the flexor tendon in neutral and hook grip positions, respectively. Each measurement was compared between in neutral and in hook grip positions, and also between the affected and contralateral normal digits in each position. Results: In all the digits, the anterior-posterior thickness of flexor tendons significantly increased in hook grip position as compared with in neutral position, whereas radial-ulnar width significantly decreased. Both the A1 pulley and flexor tendons were thicker in the affected digits as compared with contralateral normal digits. Conclusion: The thickness of flexor tendons was significantly increased anteroposteriorly in hook grip position as compared with in neutral position. In trigger finger, A1 pulley and flexor tendon were thickened, and mismatch between the volume of the flexor tendon sheath and the tendons, especially in anterior-posterior direction, might be a cause of repetitive triggering. PMID:27099639

  2. Persistent spontaneous synovial drainage from digital flexor sheath in proliferative tenosynovitis: Two case reports and a review of the literature.

    PubMed

    Chin, Brian; Cheung, Kevin; Farhangkhoee, Hana; Thoma, Achilleas

    2015-01-01

    Proliferative flexor tenosynovitis of the hand is an inflammatory process involving the synovial sheaths surrounding the tendons. It is most commonly caused by infection, but may also be caused by overuse, diabetes and rheumatic conditions such as rheumatoid arthritis and crystal arthropathies. The present report describes two patients with severe proliferative tenosynovitis, who developed a fistula between the tendon sheath and skin after instrumentation, resulting in persistent synovial drainage. After failing conservative management, both patients were managed with extensive flexor tenosynovectomy to prevent inoculation of bacteria into the flexor sheath. The presentation, management and outcome of each case is described in addition to a discussion of the literature on tenosynovial fistulas. PMID:26090353

  3. Flexor tendon excursion and load during passive and active simulated motion: a cadaver study.

    PubMed

    Sapienza, A; Yoon, H K; Karia, R; Lee, S K

    2013-11-01

    The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen. PMID:23221181

  4. A Conservatively Managed Anatomical Variant of the Flexor Digitorum Superficialis Muscle in the Hand.

    PubMed

    Chatterton, Benjamin D; Moores, Thomas S; Heinz, Nicholas; Datta, Praveen; Smith, Kevin D; Thomas, Peter B M

    2016-04-01

    Anomalous flexor digitorum superficialis muscles in the hand are an uncommon phenomenon, and therefore present challenges in diagnosis and management. We report a case of a 16-year-old girl presenting with a painful, slowly enlarging palmar swelling. The swelling was investigated with ultrasound and magnetic resonance imaging, and was found to be an anomalous muscle belly of the flexor digitorum superficialis muscle. After careful consideration, multidisciplinary discussion, and thorough imaging, the patient was treated successfully without surgical exploration or excision, in comparison to previously reported cases. The patient was pain free and had no concerns at 8-month follow-up, demonstrating the value of conservative management in these cases. PMID:27616828

  5. The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath.

    PubMed

    Havulinna, J; Leppänen, O V; Göransson, H

    2013-09-01

    In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component. PMID:23315625

  6. Rupture of a flexor pollicis longus tendon in Scheie's syndrome. Case report.

    PubMed

    Weiss, G G; Ritt, M J; Bos, K E

    1997-09-01

    We describe a case of Scheie's syndrome with a closed rupture of the flexor pollicis longus tendon, probably caused by a combination of extrinsic and intrinsic tendon changes. Early detection of carpal tunnel syndrome in all patients who have some form of mucopolysaccharidosis in which this is a universal occurrence (such as Scheie's syndrome), is recommended. Release of the carpal tunnel prevents long term complications, as described in this case report. PMID:9299691

  7. Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair

    PubMed Central

    Geary, Michael B.; Orner, Caitlin A.; Bawany, Fatima; Awad, Hani A.; Hammert, Warren C.; O’Keefe, Regis J.; Loiselle, Alayna E.

    2015-01-01

    Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the

  8. Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair.

    PubMed

    Geary, Michael B; Orner, Caitlin A; Bawany, Fatima; Awad, Hani A; Hammert, Warren C; O'Keefe, Regis J; Loiselle, Alayna E

    2015-01-01

    Flexor tendon injuries are a common clinical problem, and repairs are frequently complicated by post-operative adhesions forming between the tendon and surrounding soft tissue. Prostaglandin E2 and the EP4 receptor have been implicated in this process following tendon injury; thus, we hypothesized that inhibiting EP4 after tendon injury would attenuate adhesion formation. A model of flexor tendon laceration and repair was utilized in C57BL/6J female mice to evaluate the effects of EP4 inhibition on adhesion formation and matrix deposition during flexor tendon repair. Systemic EP4 antagonist or vehicle control was given by intraperitoneal injection during the late proliferative phase of healing, and outcomes were analyzed for range of motion, biomechanics, histology, and genetic changes. Repairs treated with an EP4 antagonist demonstrated significant decreases in range of motion with increased resistance to gliding within the first three weeks after injury, suggesting greater adhesion formation. Histologic analysis of the repair site revealed a more robust granulation zone in the EP4 antagonist treated repairs, with early polarization for type III collagen by picrosirius red staining, findings consistent with functional outcomes. RT-PCR analysis demonstrated accelerated peaks in F4/80 and type III collagen (Col3a1) expression in the antagonist group, along with decreases in type I collagen (Col1a1). Mmp9 expression was significantly increased after discontinuing the antagonist, consistent with its role in mediating adhesion formation. Mmp2, which contributes to repair site remodeling, increases steadily between 10 and 28 days post-repair in the EP4 antagonist group, consistent with the increased matrix and granulation zones requiring remodeling in these repairs. These findings suggest that systemic EP4 antagonism leads to increased adhesion formation and matrix deposition during flexor tendon healing. Counter to our hypothesis that EP4 antagonism would improve the

  9. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    SciTech Connect

    Ayad, K. E.; Abd El Mejeed, S. F.; El Gohary, H. M.; Abd Elrahman, M.; Bekheet, A. B.

    2009-09-27

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  10. Clinical Results of Flexor Tendon Repair in Zone II Using a six Strand Double Loop Technique.

    PubMed

    Savvidou, Christiana; Tsai, Tsu-Min

    2015-06-01

    The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation. PMID:26078499

  11. The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.

    PubMed

    Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki

    2011-12-01

    Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues. PMID:21813313

  12. Enhanced Zone II Flexor Tendon Repair through a New Half Hitch Loop Suture Configuration

    PubMed Central

    Thomopoulos, Stavros; Gelberman, Richard H.

    2016-01-01

    This study evaluated the impact of a new half hitch loop suture configuration on flexor tendon repair mechanics. Cadaver canine flexor digitorum profundus tendons were repaired with 4- or 8-strands, 4–0 or 3–0 suture, with and without half hitch loops. An additional group underwent repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand repairs by 21% when 4–0, and 33% when 3–0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor tendon repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period. PMID:27101409

  13. Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative?

    PubMed

    Kabakaş, Fatih; Uğurlar, Meriç; Turan, Derya Bayirli; Yeşiloğlu, Nebil; Mersa, Berkan; Özçelik, İsmail Bülent

    2016-08-01

    The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery. PMID:26418769

  14. Effects of lubricant and autologous bone marrow stromal cell augmentation on immobilized flexor tendon repairs.

    PubMed

    Zhao, Chunfeng; Ozasa, Yasuhiro; Shimura, Haruhiko; Reisdorf, Ramona L; Thoreson, Andrew R; Jay, Gregory; Moran, Steven L; An, Kai-Nan; Amadio, Peter C

    2016-01-01

    The purpose of the study was to test a novel treatment that carbodiimide-derivatized-hyaluronic acid-lubricin (cd-HA-lubricin) combined cell-based therapy in an immobilized flexor tendon repair in a canine model. Seventy-eight flexor tendons from 39 dogs were transected. One tendon was treated with cd-HA-lubricin plus an interpositional graft of 8 × 10(5) BMSCs and GDF-5. The other tendon was repaired without treatment. After 21 day of immobilization, 19 dogs were sacrificed; the remaining 20 dogs underwent a 21-day rehabilitation protocol before euthanasia. The work of flexion, tendon gliding resistance, and adhesion score in treated tendons were significantly less than the untreated tendons (p < 0.05). The failure strength of the untreated tendons was higher than the treated tendons at 21 and 42 days (p < 0.05). However, there is no significant difference in stiffness between two groups at day 42. Histologic analysis of treated tendons showed a smooth surface and viable transplanted cells 42 days after the repair, whereas untreated tendons showed severe adhesion formation around the repair site. The combination of lubricant and cell treatment resulted in significantly improved digit function, reduced adhesion formation. This novel treatment can address the unmet needs of patients who are unable to commence an early mobilization protocol after flexor tendon repair. PMID:26177854

  15. Efficacy of Low Level Laser Therapy After Hand Flexor Tendon Repair

    NASA Astrophysics Data System (ADS)

    Ayad, K. E.; El Gohary, H. M.; Abd Elrahman, M.; Abd El Mejeed, S. F.; Bekheet, A. B.

    2009-09-01

    Flexor tendon injury is a common problem requiring suturing repair followed by early postoperative mobilization. Muscle atrophy, joint stiffness, osteoarthritis, infection, skin necrosis, ulceration of joint cartilage and tendocutaneous adhesion are familiar complications produced by prolonged immobilization of surgically repaired tendon ruptures. The purpose of this study was to clarify the importance of low level laser therapy after hand flexor tendon repair in zone II. Thirty patients aging between 20 and 40 years were divided into two groups. Patients in group A (n = 15) received a conventional therapeutic exercise program while patients in group B (n = 15) received low level laser therapy combined with the same therapeutic exercise program. The results showed a statistically significant increase in total active motion of the proximal and distal interphalangeal joints as well as maximum hand grip strength at three weeks and three months postoperative, but improvement was more significant in group B. It was concluded that the combination of low level laser therapy and early therapeutic exercises was more effective than therapeutic exercises alone in improving total active motion of proximal and distal interphalangeal joints and hand grip strength after hand flexor tendon repair.

  16. Ganglion Cyst Contiguity of the Flexor Hallusis Longus Tendon in a National Swimmer

    PubMed Central

    Çirci, Esra; Özyalvaç, Osman Nuri; Tüzüner, Tolga; Ermutlu, Cenk

    2014-01-01

    Objectives: Tendinopathy of the flexor hallusis longus tendon is common in the athletes. This case is intended to be reported diagnose and treatment ganglion cyst contiguity of the flexor hallucis longus tendon that located atypical region and adversely affect the athlete's training program. Methods: 25-year-old male national swimmer was assessed with a left ankle pain. He had an intensive training program in the pool using pallets at the everyday. Pain in the left ankle was localized posterior and distal of the medial malleolus . Ankle range of motion and muscle strength was full. Neurovascular examination was normal. Radiography with anterior posterior, lateral and oblique analysis was not any unusual finding. In the evaluation with magnetic resonance imaging, thickening of the tendon sheath and effusion around the flexor hallucis longus was revealed and tendon integrity was exact. Results: Conservative treatment was planned. It was applied non-steroidal anti-inflammatory medicine, modification of the training (without or low weight pallet), platelet rich plasma (two weeks, two times peer weeks). During the six-month follow-up the patient's symptoms improved, but with the increased intensity of training at follow-up complaints started again. Professional athletes who did not respond adequately to conservative treatment surgical exposure were planned. Patient is approached the flexor hallucis longus musculotendinous junction from the posteromedial ankle at the level of the posterior talar tubercles. During the tendon exposure cyst was found at the level of talocalcaneal joint. Excision of the cyst was achieved; its size was 5x5 mm, looking transparent, well defined and soft consistency. Tenolysis is accomplished from superior to inferior to the level of the superior calcaneus. A histopathologic examination result of the cyst consistent with ganglion cyst was detected. Sport-specific training program started at the 6 weeks. There was no recurrence during the 6

  17. Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel.

    PubMed

    Main, Erin K; Goetz, Jessica E; Rudert, M James; Goreham-Voss, Curtis M; Brown, Thomas D

    2011-03-15

    Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome. PMID:21194695

  18. Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players

    PubMed Central

    Chalker, Wade J.; Shield, Anthony J.; Opar, David A.

    2016-01-01

    Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler’s and batter’s mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries. PMID:26925310

  19. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation

    PubMed Central

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-01-01

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved. PMID:24739650

  20. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis

    PubMed Central

    Tan, Ai Lyn; Fukuba, Eiji; Halliday, Nicola Ann; Tanner, Steven F; Emery, Paul; McGonagle, Dennis

    2015-01-01

    Objective Dactylitis is a hallmark of psoriatic arthritis (PsA) where flexor tenosynovitis is common. This study explored the microanatomical basis of dactylitis using high-resolution MRI (hrMRI) to visualise the small entheses around the digits. Methods Twelve patients with psoriatic dactylitis (4 fingers, 8 toes), and 10 healthy volunteers (6 fingers, 4 toes) had hrMRI of the digits using a ‘microscopy’ coil and contrast enhancement. All structures were evaluated including the tendons and ligaments, related enthesis organs, pulleys, volar/plantar plates and tendon sheaths. Results In dactylitis, collateral ligament enthesitis was seen in nine digits (75%), extensor tendon enthesitis in six digits (50%), functional enthesitis (5 digits, 42%), abnormal enhancement at the volar plates (2/5 joints, 40%) and the plantar plate (1/5 joints, 20%). Nine cases (75%) demonstrated flexor tenosynovitis, with flexor tendon pulley/flexor sheath microenthesopathy observed in 50% of all cases. Less abnormalities which were milder was observed in the normal controls, none of whom had any signal changes in the tendon pulleys or fibrous sheaths. Conclusions This study provides proof of concept for a link between dactylitis and ‘digital polyenthesitis’ including disease of the miniature enthesis pulleys of the flexor tendons, further affirming the concept of enthesitis in PsA. PMID:25261575

  1. Musculoskeletal modelling deconstructs the paradoxical effects of elastic ankle exoskeletons on plantar-flexor mechanics and energetics during hopping

    PubMed Central

    Farris, Dominic James; Hicks, Jennifer L.; Delp, Scott L.; Sawicki, Gregory S.

    2014-01-01

    Experiments have shown that elastic ankle exoskeletons can be used to reduce ankle joint and plantar-flexor muscle loading when hopping in place and, in turn, reduce metabolic energy consumption. However, recent experimental work has shown that such exoskeletons cause less favourable soleus (SO) muscle–tendon mechanics than is observed during normal hopping, which might limit the capacity of the exoskeleton to reduce energy consumption. To directly link plantar-flexor mechanics and energy consumption when hopping in exoskeletons, we used a musculoskeletal model of the human leg and a model of muscle energetics in simulations of muscle–tendon dynamics during hopping with and without elastic ankle exoskeletons. Simulations were driven by experimental electromyograms, joint kinematics and exoskeleton torque taken from previously published data. The data were from seven males who hopped at 2.5 Hz with and without elastic ankle exoskeletons. The energetics model showed that the total rate of metabolic energy consumption by ankle muscles was not significantly reduced by an ankle exoskeleton. This was despite large reductions in plantar-flexor force production (40–50%). The lack of larger metabolic reductions with exoskeletons was attributed to increases in plantar-flexor muscle fibre velocities and a shift to less favourable muscle fibre lengths during active force production. This limited the capacity for plantar-flexors to reduce activation and energy consumption when hopping with exoskeleton assistance. PMID:25278469

  2. Ipsilateral motor cortical responses to TMS during lengthening and shortening of the contralateral wrist flexors

    PubMed Central

    Howatson, Glyn; Taylor, Mathew B.; Rider, Patrick; Motawar, Binal R.; McNally, Michael P.; Solnik, Stanislaw; DeVita, Paul; Hortobágyi, Tibor

    2010-01-01

    Unilateral lengthening contractions provide a greater stimulus for neuromuscular adaptation than shortening contractions in the active and non-active contralateral homologous muscle, although little is known of the potential mechanism. Here we examined the possibility that corticospinal and spinal excitability vary in a contraction-specific manner in the relaxed right flexor carpi radialis (FCR) when humans perform unilateral lengthening and shortening contractions of the left wrist flexors at the same absolute force. Corticospinal excitability in the relaxed right FCR increased more during lengthening than shortening at 80 and 100% of maximum voluntary contraction (MVC). Short-interval intracortical inhibition (SICI) diminished during shortening contractions and it became nearly abolished during lengthening. Intracortical facilitation (ICF) lessened during shortening but increased during lengthening. Interhemispheric inhibition (IHI) to the “non-active” motor cortex diminished during shortening and became nearly abolished during lengthening at 90% MVC. The amplitude of the H-reflex in the relaxed right FCR decreased during and remained depressed for 20 s after lengthening and shortening of the left wrist flexors. We discuss the possibility that instead of the increased afferent input, differences in the descending motor command and activation of brain areas that link function of the motor cortices during muscle lengthening vs. shortening may cause the contraction-specific modulation of ipsilateral motor cortical output. In conclusion, ipsilateral M1 responses to TMS are contraction-specific; unilateral lengthening and shortening contractions reduced contralateral spinal excitability but uniquely modulated ipsilateral corticospinal excitability and the networks involved in intracortical and interhemispheric connections, which may have clinical implications. PMID:21219480

  3. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study.

    PubMed

    Ettema, Anke M; Zhao, Chunfeng; Amadio, Peter C; O'Byrne, Megan M; An, Kai-Nan

    2007-04-01

    The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the ulnar tenosynovial bursa. Fibrosis of the SSCT may well affect its gliding characteristics. To investigate this possibility, the relative motion of the flexor tendon and VS was observed during finger flexion in patients undergoing carpal tunnel surgery, and for comparison in hands without CTS, in an in vitro cadaver model. We used a camera to document the gliding motion of the middle finger flexor digitorum superficialis (FDS III) tendon and SSCT in three patients with CTS during carpal tunnel release and compared this with simulated active flexion in three cadavers with no antemortem history of CTS. The data were digitized with the use of Analyze Software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN). In the CTS patients, the SSCT moved en bloc with the tendon, whereas, in the controls the SSCT moved smoothly and separately from the tendon. The ratio of VS to tendon motion was higher for the patients than in the cadaver controls. These findings suggest that in patients with CTS the synovial fibrosis has altered the gliding characteristics of the SSCT. The alterations in the gliding characteristics of the SSCT may affect the ability of the tendons in the carpal tunnel to glide independently from each other, or from the nearby median nerve. These abnormal tendon mechanics may play a role in the etiology of CTS. PMID:16944527

  4. A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis

    PubMed Central

    2011-01-01

    Background Tenosynovitis is widely accepted to be common in rheumatoid arthritis (RA) and postulated to be the first manifestation of RA, but its true prevalence in early disease and in particular the hand has not been firmly established. The aims of this study were first to investigate the frequency and distribution of finger flexor tenosynovitis using ultrasound in early arthritis, second to compare clinical examination with ultrasound (US) using the latter as the gold standard. Methods 33 consecutive patients who had who were initially diagnosed with polyarthritis and suspected of polyarthritis and clinical suspicion of inflammatory arthritis of the hands and wrists were assessed during consecutive, routine presentations to the rheumatology outpatient clinic. We scanned a total of 165 finger tendons and subsequent comparisons were made using clinical examination. Results Flexor tenosynovitis was found in 17 patients (51.5%) on ultrasound compared with 16 (48.4%) of all patients on clinical examination. Most commonly damaged joint involved on US was the second finger followed by the third, fifth, and fourth. Both modalities demonstrated more pathology on the second and third metacarpophalangeal (MCP) compared with the fourth and fifth MCP. A joint-by-joint comparison of US and clinical examination demonstrated that although the sensitivity, specificities and positive predictive values of clinical examination were relatively high, negative predictive value of clinical examination was low (0.23). Conclusions Our study suggest that clinical examination can be a valuable tool for detecting flexor disease in view of its high specificity and positive predictive values, but a negative clinical examination does not exclude inflammation and an US should be considered. Further work is recommended to standardize definitions and image acquisition for peritendinous inflammation for ultrasound. PMID:21549008

  5. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training

    PubMed Central

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0–100, 100–200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114

  6. Looped Versus Single-Stranded Flexor Tendon Repairs: A Cadaveric Mechanical Study

    PubMed Central

    Calfee, Ryan P.; Boone, Sean; Stepan, Jeffrey G.; Osei, Daniel A.; Thomopoulos, Stavros; Boyer, Martin I.

    2015-01-01

    Purpose To compare the tensile properties of 4-strand modified Kessler flexor tendon repairs using a looped or single-stranded suture. Methods We evaluated the mechanical properties of 4-strand Kessler zone II core suture repairs using either looped or single-stranded suture in human flexor digitorum profundus and flexor pollicis longus tendons. Forty repairs were performed on tendons from bilateral cadaveric hands: 20 matched tendons were divided into equal groups of 3-0 looped and 3-0 single-strand repairs and 20 additional matched tendons were divided into equal groups of 4-0 looped and 4-0 single-strand repairs. Repaired tendons were tested in uniaxial tension to failure to determine mechanical properties and failure modes. Data were analyzed to determine the effect of repair type (ie, looped vs single-stranded) for each suture caliber (ie, 3-0 and 4-0). Results Single-strand repairs with 3-0 suture demonstrated a significantly greater maximum load to failure and a significantly higher force at 2-mm gap compared with repairs with looped 3-0 suture. All 8 looped repairs with 3-0 suture failed by suture pullout whereas 7 of 8 repairs with 3-0 single-stranded suture failed by suture breakage. The mechanical properties of looped versus single-stranded repairs with 4-0 caliber suture were not statistically different. Repairs with 4-0 caliber suture failed by suture breakage in 8 of 10 single-strand repairs and failed by suture pullout in 6 of 10 repairs with looped suture. Conclusions In a time-0 ex vivo human cadaveric core suture model, the mechanical properties of a 4-strand repair using 3-0 single-stranded suture were significantly better than the same 4-strand repair performed with looped suture. Clinical relevance Four-strand flexor tendon repairs with 3-0 suture are mechanically superior when performed with single-strand suture versus looped suture. PMID:25801581

  7. Acute calcific tendinitis of the flexor pollicis longus in an 8-year-old boy.

    PubMed

    Kheterpal, Arvin; Zoga, Adam; McClure, Kristen

    2014-10-01

    Calcific tendinitis is a common source of musculoskeletal pain in adults; however, it is rarely encountered in children. Calcific tendinitis is the most commonly encountered manifestation of hydroxyapatite deposition disease, in which calcium hydroxyapatite crystal deposition occurs in tendons. It may cause acute or chronic pain, or may be entirely asymptomatic. We describe a case of acute calcific tendinitis of the flexor pollicis longus tendon in an 8-year-old boy, who initially presented to our department for workup of a mass felt along the volar aspect of the right wrist. PMID:24867130

  8. A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment

    PubMed Central

    Aliu, Oluseyi; Samra, Saleh; Lewis, Eric

    2007-01-01

    A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient’s treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma. PMID:18780113

  9. A splint for controlled active motion after flexor tendon repair. Design, mechanical testing, and preliminary clinical results.

    PubMed

    Chow, S P; Stephens, M M; Ngai, W K; So, Y C; Pun, W K; Chu, M; Crosby, C

    1990-07-01

    A splint for controlled active motion after flexor tendon repair is described. It incorporates a single core-coated elastic band passing around a palmar pulley and attached proximally to a spring wire. Its mechanical properties were tested against six other systems. The tension in various systems all rose near full extension. However, the palmar pulley, the spring wire, and the elastic band each could lower the tension significantly. When the bending moments at the interphalangeal joints were measured, all systems produced a peak during the latter part of extension. With the palmar pulley, spring wire, and elastic band, the rise was minimal and in fact, the bending moments diminished near full extension. Initial results in 28 flexor tendon repairs using this splint showed less flexion contracture when compared with 78 flexor tendon repairs using a standard rubber band anchored at the wrist. PMID:2380531

  10. Impaired Foot Plantar Flexor Muscle Performance in Individuals With Plantar Heel Pain and Association With Foot Orthosis Use.

    PubMed

    McClinton, Shane; Collazo, Christopher; Vincent, Ebonie; Vardaxis, Vassilios

    2016-08-01

    Study Design Controlled laboratory study. Background Plantar heel pain is one of the most common foot and ankle conditions seen in clinical practice, and many individuals continue to have persisting or recurrent pain after treatment. Impaired foot plantar flexor muscle performance is a factor that may contribute to limited treatment success, but reliable methods to identify impairments in individuals with plantar heel pain are needed. In addition, foot orthoses are commonly used to treat this condition, but the implications of orthosis use on muscle performance have not been assessed. Objectives To assess ankle plantar flexor and toe flexor muscle performance in individuals with plantar heel pain using clinically feasible measures and to examine the relationship between muscle performance and duration of foot orthosis use. Methods The rocker-board plantar flexion test (RBPFT) and modified paper grip test for the great toe (mPGTGT) and lesser toes (mPGTLT) were used to assess foot plantar flexor muscle performance in 27 individuals with plantar heel pain and compared to 27 individuals without foot pain who were matched according to age, sex, and body mass. Pain ratings were obtained before and during testing, and self-reported duration of foot orthosis use was recorded. Results Compared to the control group, individuals with plantar heel pain demonstrated lower performance on the RBPFT (P = .001), the mPGTGT (P = .022), and the mPGTLT (P = .037). Longer duration of foot orthosis use was moderately correlated to lower performance on the RBPFT (r = -0.52, P = .02), the mPGTGT (r = -0.54, P = .01), and the mPGTLT (r = -0.43, P = .03). Conclusion Ankle plantar flexor and toe flexor muscle performance was impaired in individuals with plantar heel pain and associated with longer duration of self-reported foot orthosis use. J Orthop Sports Phys Ther 2016;46(8):681-688. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6482. PMID:27374013

  11. Healthy Older Adults Have Insufficient Hip Range of Motion and Plantar Flexor Strength to Walk Like Healthy Young Adults

    PubMed Central

    Anderson, Dennis E.; Madigan, Michael L.

    2014-01-01

    Limited plantar flexor strength and hip extension range of motion (ROM) in older adults are believed to underlie common age-related differences in gait. However, no studies of age-related differences in gait have quantified the percentage of strength and ROM used during gait. We examined peak hip angles, hip torques and plantar flexor torques, and corresponding estimates of functional capacity utilized (FCU), which we define as the percentage of available strength or joint ROM used, in ten young and ten older healthy adults walking under self-selected and controlled (slow and fast) conditions. Older adults walked with about 30% smaller hip extension angle, 28% larger hip flexion angle, 34% more hip extensor torque in the slow condition, and 12% less plantar flexor torque in the fast condition than young adults. Older adults had higher FCU than young adults for hip flexion angle (47% vs. 34%) and hip extensor torque (48% vs. 27%). FCUs for plantar flexor torque (both age groups) and hip extension angle (older adults in all conditions; young adults in self-selected gait) were not significantly <100%, and were higher than for other measures examined. Older adults lacked sufficient hip extension ROM to walk with a hip extension angle as large as that of young adults. Similarly, in the fast gait condition older adults lacked the strength to match the plantar flexor torque produced by young adults. This supports the hypothesis that hip extension ROM and plantar flexor strength are limiting factors in gait and contribute to age-related differences in gait. PMID:24461576

  12. Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence

    PubMed Central

    Elliot, David; Giesen, Thomas

    2013-01-01

    As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence. PMID:24459333

  13. Restricted differentiation potential of progenitor cell populations obtained from the equine superficial digital flexor tendon (SDFT)

    PubMed Central

    Humphreys, William James Edward; Comerford, Eithne Josephine Veronica; Clegg, Peter David; Canty‐Laird, Elizabeth Gail

    2015-01-01

    ABSTRACT The aim of this study was to characterize stem and progenitor cell populations from the equine superficial digital flexor tendon, an energy‐storing tendon with similarities to the human Achilles tendon, which is frequently injured. Using published methods for the isolation of tendon‐derived stem/progenitor cells by low‐density plating we found that isolated cells possessed clonogenicity but were unable to fully differentiate towards mesenchymal lineages using trilineage differentiation assays. In particular, adipogenic differentiation appeared to be restricted, as assessed by Oil Red O staining of stem/progenitor cells cultured in adipogenic medium. We then assessed whether differential adhesion to fibronectin substrates could be used to isolate a population of cells with broader differentiation potential. However we found little difference in the stem and tenogenic gene expression profile of these cells as compared to tenocytes, although the expression of thrombospondin‐4 was significantly reduced in hypoxic conditions. Tendon‐derived stem/progenitor cells isolated by differential adhesion to fibronectin had a similar differentiation potential to cells isolated by low density plating, and when grown in either normoxic or hypoxic conditions. In summary, we have found a restricted differentiation potential of cells isolated from the equine superficial digital flexor tendon despite evidence for stem/progenitor‐like characteristics. © 2015 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 33:849–858, 2015. PMID:25877997

  14. Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries

    PubMed Central

    Sade, Ilgin; İnanir, Murat; Şen, Suzan; Çakmak, Esra; Kablanoğlu, Serkan; Selçuk, Barin; Dursun, Nigar

    2016-01-01

    [Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs.

  15. Elbow torques and EMG patterns of flexor muscles during different isometric tasks.

    PubMed

    Caldwell, G E; Van Leemputte, M

    1991-01-01

    This paper examines the torque responses and EMG activity levels in four muscles acting at the elbow joint during different combinations of one- and two- degree of freedom isometric torque production (single and dual tasks, respectively). Flexor and supinator/pronator torques and surface EMG signals from m. biceps brachii, m. brachialis, m. brachioradialis and m. triceps brachii were measured in 16 male subjects while they performed maximal effort isometric contractions of pure flexion, pure supination, pure pronation, combined flexion and supination and combined flexion and pronation. In the single tasks, the torque responses were consistent with task requirements, but the dual task results were surprising in that flexor torque levels were reduced as compared to pure flexion, while supinator/pronator torque levels were as high or higher than in pure supination or pronation. Muscle activity levels varied with task, and could not always explain the differences observed in torque responses. These data are discussed within the framework of subpopulations of task-specific motor units within each muscle. The implications of such task-specific muscle units are related to musculoskeletal modelling and previous EMG - torque relationships found at the elbow. PMID:1748080

  16. Human ankle plantar flexor muscle-tendon mechanics and energetics during maximum acceleration sprinting.

    PubMed

    Lai, Adrian; Schache, Anthony G; Brown, Nicholas A T; Pandy, Marcus G

    2016-08-01

    Tendon elastic strain energy is the dominant contributor to muscle-tendon work during steady-state running. Does this behaviour also occur for sprint accelerations? We used experimental data and computational modelling to quantify muscle fascicle work and tendon elastic strain energy for the human ankle plantar flexors (specifically soleus and medial gastrocnemius) for multiple foot contacts of a maximal sprint as well as for running at a steady-state speed. Positive work done by the soleus and medial gastrocnemius muscle fascicles decreased incrementally throughout the maximal sprint and both muscles performed more work for the first foot contact of the maximal sprint (FC1) compared with steady-state running at 5 m s(-1) (SS5). However, the differences in tendon strain energy for both muscles were negligible throughout the maximal sprint and when comparing FC1 to SS5. Consequently, the contribution of muscle fascicle work to stored tendon elastic strain energy was greater for FC1 compared with subsequent foot contacts of the maximal sprint and compared with SS5. We conclude that tendon elastic strain energy in the ankle plantar flexors is just as vital at the start of a maximal sprint as it is at the end, and as it is for running at a constant speed. PMID:27581481

  17. Musical beat influences corticospinal drive to ankle flexor and extensor muscles in man.

    PubMed

    Wilson, Emily M F; Davey, Nick J

    2002-05-01

    Body movements in man are frequently observed in relation to musical rhythms. In this study we have investigated the effect of strongly rhythmic music on corticospinal drive to the ankle extensor and flexor muscles involved in foot tapping. Surface electromyographic (EMG) recordings were made from tibialis anterior (TA) and lateral gastrocnemius (LGN) muscles in 12 normal subjects. Rock music with a strong rhythmic beat or white noise was played. Transcranial magnetic stimulation (TMS) was delivered to the motor cortex in time with the music to produce motor evoked potentials (MEPs) in both muscles while relaxed. During white noise trials nine subjects showed a significant correlation of MEP areas in TA with LGN, compared with only three subjects during music. Overall, there was a significant decrease in the correlation coefficient during music. We conclude that correlated variations in MEP areas between the muscles seen during white noise can be destroyed in the presence of music. This may be due to sub-threshold variations in corticospinal excitability to ankle extensors and flexors, which are time-locked to the musical beat but out of phase with one another. PMID:11909649

  18. Development of a synthetic replacement for the flexor tendon pulleys--an experimental study.

    PubMed

    Peterson, W W; Manske, P R; Lesker, P A; Kain, C C; Schaefer, R K

    1986-05-01

    A method was developed to reconstruct the fibro-osseous pulleys with Nitex, a synthetic material. Nitex is a closely woven fabric constructed from monofilament nylon fibers. Six adult monkeys (24 digits) had excision of the A1 and A2 pulleys; this was followed by reconstruction of the A2 pulley with the Nitex synthetic material. The animals were killed, two at a time, at 4, 8, and 12 weeks to evaluate the effectiveness of the Nitex pulleys. Flexor tendon function was assessed by biomechanical methods with a tensile testing machine to measure the tendon excursion and the work of flexion (the area under the force-excursion curve) necessary to fully flex each digit; these parameters revealed that the Nitex pulleys were capable of preventing tendon bow-stringing and did not significantly impair tendon gliding. The breaking strength of the Nitex pulleys was comparable to that of normal A2 pulleys (for monkeys weighing less than 10 kg) and it was sufficient to allow immediate mobilization of the digits postoperatively without fear of pulley rupture. Histologic examination showed minimal foreign body reaction around the Nitex, and the gliding surface of a Nitex pulley was found to be covered with a smooth layer of fibrous tissue with minimal adhesions to the underlying flexor tendon. The synthetic Nitex pulley appears to have the potential to function as an effective fibro-osseous pulley replacement. PMID:3086425

  19. A classic improved: minor tweaks yield major benefits in crayfish slow-flexor preparations.

    PubMed

    Weller, Cynthia; Hochhaus, A Maren; Wright, T Michael; Mulloney, Brian

    2015-01-01

    Action potentials and the postsynaptic potentials they evoke fill the pages of neuroscience textbooks, but students have relatively few opportunities to record these phenomena on their own. However, the act of making such recordings can be key events in a student's scientific education. The crayfish abdominal slow flexor muscle system is a well-established platform for recording spikes and PSPs. It enables students to see nerves and the muscles they innervate, record spontaneous spikes from several motor axons in these nerves as well as PSPs in their postsynaptic muscle fibers, and interpret these recordings quantitatively. Here we describe an improved method for preparing the slow-flexor system for recording that employs transmitted illumination through the stereo microscope's conventional substage lighting. Oblique transmitted lighting allows students to see the nerve and muscles fibers in each segment clearly and position recording electrodes accurately under visual control. Because students can see the nerves, muscles, and recording electrodes, broken electrode tips are relatively uncommon and the first successful recordings come more quickly. Many kinds of neurons in the CNS have the same pattern of multineuronal, multiterminal innervation that occurs on these muscle fibers. To visualize these innervation patterns on these fibers, we describe an immunohistochemical protocol that labels the GABAergic inhibitory motor axon and all the synaptic vesicles in the synaptic terminals on these muscle fibers. Dual-color images reveal extensive branching of the axons and fields of presynaptic terminals, only some of which are double-labeled for GABA. PMID:25838805

  20. Das DNA-Puzzle

    NASA Astrophysics Data System (ADS)

    Kirchner, Stefan

    Im Jahre 1953 wurde von James Watson und Francis Crick erstmalig der strukturelle Aufbau der sogenannten DNA (Desoxyribonukleinsäure) beschrieben, welche das Erbgut jedes Lebewesens enthält. Der wesentliche Teil des Erbguts wird dabei durch eine sehr lange Folge der vier Basen Adenin (A), Cytosin (C), Guanin (G) und Thymin (T) codiert. Seit einigen Jahren ist es möglich, die Folge der vier Basen zu einer gegebenen DNA zu bestimmen. Biologen bezeichnen diesen Vorgang als Sequenzierung.

  1. V1 and v2b interneurons secure the alternating flexor-extensor motor activity mice require for limbed locomotion.

    PubMed

    Zhang, Jingming; Lanuza, Guillermo M; Britz, Olivier; Wang, Zhi; Siembab, Valerie C; Zhang, Ying; Velasquez, Tomoko; Alvarez, Francisco J; Frank, Eric; Goulding, Martyn

    2014-04-01

    Reciprocal activation of flexor and extensor muscles constitutes the fundamental mechanism that tetrapod vertebrates use for locomotion and limb-driven reflex behaviors. This aspect of motor coordination is controlled by inhibitory neurons in the spinal cord; however, the identity of the spinal interneurons that serve this function is not known. Here, we show that the production of an alternating flexor-extensor motor rhythm depends on the composite activities of two classes of ventrally located inhibitory neurons, V1 and V2b interneurons (INs). Abrogating V1 and V2b IN-derived neurotransmission in the isolated spinal cord results in a synchronous pattern of L2 flexor-related and L5 extensor-related locomotor activity. Mice lacking V1 and V2b inhibition are unable to articulate their limb joints and display marked deficits in limb-driven reflex movements. Taken together, these findings identify V1- and V2b-derived neurons as the core interneuronal components of the limb central pattern generator (CPG) that coordinate flexor-extensor motor activity. PMID:24698273

  2. V1 and V2b interneurons secure the alternating flexor-extensor motor activity mice require for limbed locomotion

    PubMed Central

    Zhang, Jingming; Lanuza, Guillermo M.; Britz, Olivier; Wang, Zhi; Siembab, Valerie C.; Zhang, Ying; Velasquez, Tomoko; Alvarez, Francisco J.; Frank, Eric; Goulding, Martyn

    2014-01-01

    SUMMARY The reciprocal activation of flexor and extensor muscles constitutes the fundamental mechanism that tetrapod vertebrates use for locomotion and limb-driven reflex behaviors. This aspect of motor coordination is controlled by inhibitory neurons in the spinal cord; however, the identity of the spinal interneurons that serve this function is not known. Here we show that the production of an alternating flexor-extensor motor rhythm depends on the composite activities of two classes of ventrally-located inhibitory neurons, V1 and V2b interneurons (INs). Abrogating V1 and V2b IN-derived neurotransmission in the isolated spinal cord results in a synchronous pattern of L2 flexor-related and L5 extensor-related locomotor activity. Mice lacking V1 and V2b inhibition are unable to articulate their limb joints and display marked deficits in limb-driven reflex movements. Taken together, these findings identify V1- and V2b-derived neurons as the core interneuronal components of the limb central pattern generator (CPG) that coordinate flexor-extensor motor activity. PMID:24698273

  3. Ultrasonographic diagnosis of porcupine quill foreign bodies in the plantar flexor tendon sheath region in a heifer.

    PubMed

    Mulon, Pierre-Yves; Achard, Damien; Babkine, Marie

    2010-08-01

    A 17-month-old Holstein heifer was presented for persistent enlargement above the right hind fetlock of 1-month's duration. Diffuse plantar soft tissue swelling was present on the radiographs and ultrasonography revealed the presence of multiple porcupine quill extremities embedded in the subcutaneous tissue within the flexor tendon sheath wall. Surgical removal was performed. PMID:21037892

  4. Inter-Rater Reliability of the Modified Ashworth Scale and Modified Modified Ashworth Scale in Assessing Poststroke Elbow Flexor Spasticity

    ERIC Educational Resources Information Center

    Kaya, Taciser; Goksel Karatepe, Altinay; Gunaydin, Rezzan; Koc, Aysegul; Altundal Ercan, Ulku

    2011-01-01

    The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade "1+" of the MAS and redefining grade "2". The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity.…

  5. Neural and Nonneural Contributions to Wrist Rigidity in Parkinson's Disease: An Explorative Study Using the NeuroFlexor

    PubMed Central

    Zetterberg, H.; Frykberg, G. E.; Gäverth, J.; Lindberg, P. G.

    2015-01-01

    Objective. The NeuroFlexor is a novel method incorporating a biomechanical model for the measurement of neural and nonneural contributions to resistance induced by passive stretch. In this study, we used the NeuroFlexor method to explore components of passive movement resistance in the wrist and finger muscles in subjects with Parkinson's disease (PD). Methods. A cross-sectional comparison was performed in twenty-five subjects with PD with clinically identified rigidity and 14 controls. Neural (NC), elastic (EC), and viscous (VC) components of the resistance to passive extension of the wrist were calculated using the NeuroFlexor. Measurements were repeated during a contralateral activation maneuver. Results. PD subjects showed greater total resistance (P < 0.001) and NC (P = 0.002) compared to controls. EC and VC did not differ significantly between groups. Contralateral activation maneuver resulted in increased NC in the PD group but this increase was due to increased resting tension. Total resistance and NC correlated with clinical ratings of rigidity and with bradykinesia. Conclusions. The findings suggest that stretch induced reflex activity, but not nonneural resistance, is the major contributor to rigidity in wrist muscles in PD. The NeuroFlexor is a potentially valuable clinical and research tool for quantification of rigidity. PMID:25685778

  6. Tendon elastic strain energy in the human ankle plantar-flexors and its role with increased running speed.

    PubMed

    Lai, Adrian; Schache, Anthony G; Lin, Yi-Chung; Pandy, Marcus G

    2014-09-01

    The human ankle plantar-flexors, the soleus and gastrocnemius, utilize tendon elastic strain energy to reduce muscle fiber work and optimize contractile conditions during running. However, studies to date have considered only slow to moderate running speeds up to 5 m s(-1). Little is known about how the human ankle plantar-flexors utilize tendon elastic strain energy as running speed is advanced towards maximum sprinting. We used data obtained from gait experiments in conjunction with musculoskeletal modeling and optimization techniques to calculate muscle-tendon unit (MTU) work, tendon elastic strain energy and muscle fiber work for the ankle plantar-flexors as participants ran at five discrete steady-state speeds ranging from jogging (~2 m s(-1)) to sprinting (≥8 m s(-1)). As running speed progressed from jogging to sprinting, the contribution of tendon elastic strain energy to the positive work generated by the MTU increased from 53% to 74% for the soleus and from 62% to 75% for the gastrocnemius. This increase was facilitated by greater muscle activation and the relatively isometric behavior of the soleus and gastrocnemius muscle fibers. Both of these characteristics enhanced tendon stretch and recoil, which contributed to the bulk of the change in MTU length. Our results suggest that as steady-state running speed is advanced towards maximum sprinting, the human ankle plantar-flexors continue to prioritize the storage and recovery of tendon elastic strain energy over muscle fiber work. PMID:24948642

  7. Ultrasonic properties of tendon: velocity, attenuation, and backscattering in equine digital flexor tendons.

    PubMed

    Miles, C A

    1996-05-01

    Ultrasound velocity, attenuation, and backscattering were measured in vitro in samples of equine digital flexor tendon sandwiched between plane, parallel rexolite buffer rods. The buffer rods were coupled to transmitting and receiving transducers (nominally 10 MHz) mounted in-line and facing one another on the jaws of a digital caliper. Six superficial digital flexor (SDF) tendons and six deep digital flexor (DDF) tendons were measured in three orthogonal directions: along the long axis of the tendon (D), and across the tendon in the dorsal-volar (C), and lateral (L) directions. Substantial anisotropy was apparent in all the measured properties. The velocity data, which in both tendons showed a higher velocity along the fibers than across (e.g., in the DDF tendon at 0 degrees C: 1713 +/- 9 m/s in the D direction compared with 1650 +/- 5 m/s in the C direction), were consistent with a composite comprising stiff fibers embedded in a less stiff medium of lower speed. The apparent backscattering coefficient adjusted for the tissue's frequency-dependent attenuation (e.g., in the C direction of the DDF tendon at 0 degrees C: 7.4 x 10(-3) cm-1 sr-1), was independent of frequency in both transverse directions and larger than that measured along the long axis of the tendon (e.g., in DDF tendon at 0 degrees C: 1.2 x 10(-3) cm-1 sr-1 at 7 MHz) in which direction the apparent backscattering coefficient increased with frequency as f4.0 +/- 1.2. The frequency-independent backscattering was thought to be due to specular reflection from the boundaries between the fascicles, i.e., the bundles of fibers making up the tendon, while backscattering along the axis was due to structures of unknown origin, but of a size much smaller than 45 microns. Attenuation of ultrasound directed along the fibers was higher than that across (at 7 MHz in DDF tendon at 0 degrees C: 58 dB/cm in the D direction compared with 11.3 dB/cm in the C direction). Calculations indicated that the attenuation was

  8. Firing of antagonist small-diameter muscle afferents reduces voluntary activation and torque of elbow flexors.

    PubMed

    Kennedy, David S; McNeil, Chris J; Gandevia, Simon C; Taylor, Janet L

    2013-07-15

    During muscle fatigue, firing of small-diameter muscle afferents can decrease voluntary activation of the fatigued muscle. However, these afferents may have a more widespread effect on other muscles in the exercising limb. We examined if the firing of fatigue-sensitive afferents from elbow extensor muscles in the same arm reduces torque production and voluntary activation of elbow flexors. In nine subjects we examined voluntary activation of elbow flexors by measuring changes in superimposed twitches evoked by transcranial magnetic stimulation of the motor cortex during brief (2-3 s) maximal voluntary contractions (MVC). Inflation of a blood pressure cuff following a 2-min sustained MVC blocked blood flow to the fatigued muscle and maintained firing of small-diameter afferents. After a fatiguing elbow flexion contraction, maximal flexion torque was lower (26.0 ± 4.4% versus 67.9 ± 5.2% of initial maximal torque; means ± s.d.; P < 0.001) and superimposed twitches were larger (4.1 ± 1.1% versus 1.8 ± 0.2% ongoing MVC, P = 0.01) with than without ischaemia. After a fatiguing elbow extensor contraction, maximal flexion torque was also reduced (82.2 ± 4.9% versus 91.4 ± 2.3% of initial maximal torque; P = 0.007), superimposed twitches were larger (2.7 ± 0.7% versus 1.3 ± 0.2% ongoing MVC; P = 0.02) and voluntary activation lower (81.6 ± 8.2% versus 95.5 ± 6.9%; P = 0.04) with than without ischaemia. After a fatiguing contraction, voluntary drive to the fatigued muscles is reduced with continued input from small-diameter muscle afferents. Furthermore, fatigue of the elbow extensor muscles decreases voluntary drive to unfatigued elbow flexors of the same arm. Therefore, firing of small-diameter muscle afferents from one muscle can affect voluntary activation and hence torque generation of another muscle in the same limb. PMID:23652589

  9. Flexor Tendon Entrapment at the Malunited Base Fracture of the Proximal Phalanx of the Finger in Child: A Case Report.

    PubMed

    Lee, Young-Keun; Park, Soojin; Lee, Malrey

    2015-09-01

    The proximal phalangeal base is the most commonly fractured hand bone in children. Such fractures are rarely reported as irreducible due to flexor tendon entrapment. Here, we describe a patient who sustained a malunited fracture on the right fifth finger proximal phalanx with flexor tendon entrapment after treatment with closed reduction with K-wires fixation.A 13-year-old patient came to the clinic following a bicycle accident 6 weeks ago. He presented with flexion limitation in his small finger on the right hand. During physical examination, the patient felt no pain, and the neurovascular structures were intact. However range of motion (ROM) in his small finger was not normal. Plain radiographs displayed a Salter-Harris type II fracture of the small finger proximal phalanx base and volar angulation with callus formation. During the operation, it was established that the flexor digitorum superficialis (FDS) around the fracture had a severe adhesion, whereas the flexor digitorum profundus (FDP) was entrapped between the volarly displaced metaphyses and the epiphyses and united with the bone. We removed the volarly displaced metaphyses and freed FDP and repaired the A2 pulley. The bone was anatomically fixed with K-wires. In the treatment after the operation, on the 2nd day, the patient was permitted the DIP joint motion by wearing a dynamic splint.At the 12-months follow-up, the patient had regained full ROM with no discomfort and the proximal phalanx growth plate of the small finger closed naturally with normal alignment.When treating a proximal phalangeal base fracture in children, the possibility of flexor tendon entrapment should be considered and should be carefully dealt with in its treatment. PMID:26334897

  10. The clinical and biomechanical effects of fascial-muscular lengthening therapy on tight hip flexor patients with and without low back pain

    PubMed Central

    Avrahami, Daniel; Potvin, Jim R.

    2014-01-01

    Background: Many patients have tight hip flexors with or without low back pain. Manual fascial-muscular lengthening therapy (FMLT) is one commonly used treatment for this population. Objective: Investigate the clinical and biomechanical effects of manual FMLT on tight hip flexor patients with and without low back pain. Methods: A nonrandomized trial, before-and-after experiment with multiple baselines conducted on two different patient populations: 1) Mechanical low back pain patients with tight hip flexors (n = 10) and 2) Asymptomatic group with tight hip flexors (n = 8). Four treatments of manual FMLT were performed on the hip flexor of the two groups of patients over a two-week period. Primary outcome measures over the two-week period were 1) Maximum voluntary trunk flexor and extensor moments, 2) Disability (Roland Morris Disability Questionnaire) and pain (10-cm Visual Analogue Scale), 3) Passive hip extension mobility. Results: Primary outcome analysis involved within-groups comparisons. Maximum voluntary trunk extension demonstrated increases for the low back pain patients. The low back pain patients demonstrated a small, but significant, reduction in disability and pain. Both groups demonstrated an increase in passive hip extension measurements. Conclusion: This preliminary study demonstrated interesting results from manual FMLT on two tight hip flexor patient populations with and without low back pain. However, there were several significant limitations from this study, which restrict the ability to generalize the results. PMID:25550670

  11. Surgical treatment of simple syndactylism with secondary deep digital flexor tendon contracture in a Basset Hound.

    PubMed

    Towle, H; Friedlander, K; Ko, R; Aper, R; Breur, G

    2007-01-01

    A five-month-old, female Basset Hound was presented for lameness associated with a fused 3rd and 4th digital pad on the left hind limb (simple incomplete syndactyly), and secondary contracture of the deep digital flexure tendon of the 3rd and 4th digit. An onychectomy of the third phalanx of the third and fourth digits was performed. Following the operation, the dog gained good use of the affected limb for one month until intermittent non-weight bearing lameness developed. A second surgery was performed six months later, partially removing the second phalanx of digits three and four. Follow-up reports indicate that the dog is doing well and is without lameness. This is the first report of deep digital flexor tendon contracture and surgical treatment of this complication in canine simple syndactylism. PMID:17846689

  12. Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm - A Case Report.

    PubMed

    Nayak, Satheesha B; Swamy, Ravindra S; Shetty, Prakashchandra; Maloor, Prasad A; Dsouza, Melanie R

    2016-02-01

    Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis. PMID:27042440

  13. Myofascial force transmission between transferred rat flexor carpi ulnaris muscle and former synergistic palmaris longus muscle

    PubMed Central

    Maas, Huub; Huijing, Peter A.

    2011-01-01

    Summary We investigated the extent of mechanical interaction between rat flexor carpi ulnaris (FCU) and palmaris longus (PL) muscles following transfer of FCU to the distal tendons of extensor carpi radialis brevis and longus (ECRB/L) muscles. Five weeks after recovery from surgery, isometric forces exerted at the distal tendons of FCU and PL were quantified at various FCU lengths. PL was kept at a constant length. Changing the muscle-tendon complex length of transferred FCU (by maximally 3.5 mm) decreased PL force significantly (by 7%). A linear relationship was found between changes in FCU muscle belly length, being a measure of muscle relative positions, and PL force. These results indicate that despite transfer of FCU muscle to the extensor side of the forearm, changing FCU length still affects force transmission of its, now, antagonistic PL muscle. We conclude that a transferred muscle may still be mechanically linked to its former synergistic muscles. PMID:23738260

  14. Effects of plantar flexor muscle fatigue induced by electromyostimulation on postural coordination.

    PubMed

    Ponce, Antoine; Fouque, Florent; Cahouët, Violaine; Martin, Alain

    2007-02-27

    The aim of the present study was to investigate the influence of a modification of an intrinsic capacity (plantar flexor strength) on the implementation of in-phase and anti-phase mode of coordination. Analysis of hip and ankle relative phases during fore-aft tracking task was done before and after an electromyostimulation fatigue protocol on the soleus muscles. Results showed participants used exclusively in-phase and anti-phase modes of coordination, with a sudden switch from one to the other with target frequency increase. Regarding tracking tasks, fatigue induces a decrease of performance for lower frequencies, and a significant decrease of switch frequency (-0.08 Hz) for each subject. In conclusion, changes in mode of coordination implementation suggest that the in-phase mode implementation is highly linked to the strength production capacity at the ankle joint. PMID:17280784

  15. Tenosynovial chondromatosis of the flexor hallucis longus in a 17-year-old girl.

    PubMed

    Winters, Nichelle I; Thomson, A Brian; Flores, Raina R; Jordanov, Martin I

    2015-11-01

    Tenosynovial chondromatosis is a benign chondrogenic metaplasia of extra-articular synovial tissue. The most common locations for tenosynovial chondromatosis to develop are the hands and feet. The condition has rarely been reported in children. We present a case of tenosynovial chondromatosis of the flexor hallucis longus in a 17-year-old girl. The presentation was unusual not only due to the location and young age of the patient but also the absence of any palpable mass on physical exam and complete lack of calcification of the cartilage bodies. Initial diagnosis was made by MRI. The patient underwent tenosynovectomy with an excellent postoperative recovery at 6-month follow-up. Histopathology confirmed the diagnosis of tenosynovial chondromatosis. PMID:26008872

  16. Irreducible tongue-type calcaneal fracture due to interposition of flexor hallucis longus.

    PubMed

    Wong-Chung, John; O'Longain, Diarmaid; Lynch-Wong, Matthew; Julian, Harriet

    2016-06-01

    We present a rare case of interposition of the flexor hallucis longus (FHL) tendon blocking percutaneous closed reduction of a displaced tongue-type calcaneal fracture, and necessitating open repositioning of the tendon and internal fixation through a single extensile lateral approach. Although not recognized until during surgery, with a high index of suspicion, preoperative diagnosis of this injury combination should be possible on high resolution CT, thus enabling better planning of the procedure. The presence of a small sustentacular fragment, especially if markedly displaced or rotated, should further alert the physician as to increased likelihood of such tendon entrapment within the fracture. In the literature, fracture fixation and extrication of the FHL tendon have been performed via either or both lateral and medial approaches. A medial approach may prove necessary when there is severe displacement or rotation of the sustentacular fragment. Arthroscopically assisted surgery may aid in disengaging the tendon from within the fracture site. PMID:26802813

  17. [Use of tissue engineering in the reconstruction of flexor tendon injuries of the hand].

    PubMed

    Bíró, Vilmos

    2015-02-01

    In his literary analysis, the author describes a novel method applied in the reconstruction of flexor tendon injuries of the hand. This procedure is named tissue engineering, and it is examined mainly under experimental circumstances. After definition of the method and descriptions of literary preliminaries the author discusses the healing process of the normal tendon tissue, then development of the scaffold, an important step of tissue engineering is described. After these topics the introduction of the pluripotent mesenchymal stem cells into the scaffold, and proliferation of these cells and development of the sliding systems are presented. The mechanical resisting ability of the formed tendon tissue is also discussed. Finally, the author concludes that as long as results of experimental research cannot be successfully applied into clinical practice, well-tried tendon reconstruction operations and high quality postoperative rehabilitation are needed. PMID:25639635

  18. Layered chitosan-collagen hydrogel/aligned PLLA nanofiber construct for flexor tendon regeneration.

    PubMed

    Deepthi, S; Nivedhitha Sundaram, M; Deepti Kadavan, J; Jayakumar, R

    2016-11-20

    The aim of our study was to develop a tendon construct of electrospun aligned poly (l-lactic acid) (PLLA) nanofibers, to mimic the aligned collagen fiber bundles and layering PLLA fibers with chitosan-collagen hydrogel, to mimic the glycosaminoglycans of sheath ECM for tendon regeneration. The hydrogel coated electrospun membrane was rolled and an outer coating of alginate gel was given to prevent peritendinous adhesion. The developed constructs were characterized by SEM, FT-IR and tensile testing. Protein adsorption studies showed lower protein adsorption on coated scaffolds compared to uncoated scaffolds. The samples were proven to be non-toxic to tenocytes. The chitosan-collagen/PLLA uncoated scaffolds and alginate gel coated chitosan-collagen/PLLA scaffolds showed good cell proliferation. The tenocytes showed good attachment and spreading on the scaffolds. This study indicated that the developed chitosan-collagen/PLLA/alginate scaffold would be suitable for flexor tendon regeneration. PMID:27561521

  19. Management of acute pyogenic flexor tenosynovitis: Literature review and current trends

    PubMed Central

    Giladi, Aviram M.; Malay, Sunitha; Chung, Kevin C.

    2016-01-01

    Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of PFT has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute PFT management. Twenty-eight case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies amongst the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of PFT and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in PFT management. PMID:25670687

  20. Closed traumatic rupture of the flexor pollicis longus tendon in zone T I: a case report.

    PubMed

    Uekubo, Kazuaki; Itoh, Soichiro; Yoshioka, Taro

    2015-01-01

    A healthy 41-year-old male suffered a direct blow on the palmar side of his right thumb when folding a table, which slipped along his thumb until it was stopped at the inter-phalangeal (IP) joint, resulting in a complete rupture of the flexor pollicis longus (FPL) tendon in zone T I. The proximal tendon stump was passed through the oblique pulley, fixed to the base of the distal phalanx with a pull-out wire technique and augmented on it using a part of the distal tendon remnant. After removal of the cast and the pull-out wire three weeks postoperatively, range of motion exercise was initiated and good functional recovery was obtained. PMID:25609290

  1. Contractile properties of muscle fibers from the deep and superficial digital flexors of horses

    PubMed Central

    Chase, P. B.; Hermanson, J. W.; Clark, A. N.; Brunet, N. M.; Bertram, J. E. A.

    2010-01-01

    Equine digital flexor muscles have independent tendons but a nearly identical mechanical relationship to the main joint they act upon. Yet these muscles have remarkable diversity in architecture, ranging from long, unipennate fibers (“short” compartment of DDF) to very short, multipennate fibers (SDF). To investigate the functional relevance of the form of the digital flexor muscles, fiber contractile properties were analyzed in the context of architecture differences and in vivo function during locomotion. Myosin heavy chain (MHC) isoform fiber type was studied, and in vitro motility assays were used to measure actin filament sliding velocity (Vf). Skinned fiber contractile properties [isometric tension (P0/CSA), velocity of unloaded shortening (VUS), and force-Ca2+ relationships] at both 10 and 30°C were characterized. Contractile properties were correlated with MHC isoform and their respective Vf. The DDF contained a higher percentage of MHC-2A fibers with myosin (heavy meromyosin) and Vf that was twofold faster than SDF. At 30°C, P0/CSA was higher for DDF (103.5 ± 8.75 mN/mm2) than SDF fibers (81.8 ± 7.71 mN/mm2). Similarly, VUS (pCa 5, 30°C) was faster for DDF (2.43 ± 0.53 FL/s) than SDF fibers (1.20 ± 0.22 FL/s). Active isometric tension increased with increasing Ca2+ concentration, with maximal Ca2+ activation at pCa 5 at each temperature in fibers from each muscle. In general, the collective properties of DDF and SDF were consistent with fiber MHC isoform composition, muscle architecture, and the respective functional roles of the two muscles in locomotion. PMID:20702801

  2. Muscle fibre types of the lumbrical, interossei, flexor, and extensor muscles moving the index finger.

    PubMed

    Hwang, Kun; Huan, Fan; Kim, Dae Joong

    2013-09-01

    The aim of this study was to determine the fibre types of the muscles moving the index fingers in humans. Fifteen forearms of eight adult cadavers were used. The sampled muscles were the first lumbrical (LM), first volar interosseous (VI), first dorsal interosseus (DI), second flexor digitorum profundus (FDP), second flexor digitorum superficialis (FDS), and extensor digitorum (ED). Six micrometer thick sections were stained for fast muscle fibres. The procedure was performed by applying mouse monoclonal anti-skeletal myosin antibody (fast) and avidin-biotin peroxidase complex staining. Rectangular areas (0.38 mm × 0.38 mm) were photographed and the boundaries of the muscle areas were marked on the translucent film. The numbers and sizes of the muscle fibres in each part were evaluated by the image analyser program and calculated per unit area (1 mm(2)). The proportion of the fast fibres was significantly (p = 0.012) greater in the intrinsic muscles (55.7 ± 17.1%) than in the extrinsic muscles (45.9 ± 17.1%). Among the six muscles, the VI had a significantly higher portion (59.3%) of fast fibres than the FDS (40.6%) (p = 0.005) or the FDP (45.1%) (p = 0.023). The density of the non-fast fibres was significantly (p = 0.015) greater in the extrinsic muscles (539.2 ± 336.8/mm(2)) than in the intrinsic muscles (383.4 ± 230.4/mm2). Since the non-fast fibres represent less fatigable fibres, it is thought that the extrinsic muscles have higher durability against fatigue, and the intrinsic muscles, including the LM, should move faster than the FDS or FDP because the MP joint should be flexed before the IP joint to grip an object. PMID:23692210

  3. Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel.

    PubMed

    Kociolek, Aaron M; Tat, Jimmy; Keir, Peter J

    2015-02-01

    Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0° and 30° flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures. PMID:25553671

  4. Oxygen recovery kinetics in the forearm flexors of multiple ability groups of rock climbers.

    PubMed

    Fryer, Simon M; Stoner, Lee; Dickson, Tabitha G; Draper, Steve B; McCluskey, Michael J; Hughes, Johnathan D; How, Stephen C; Draper, Nick

    2015-06-01

    The purpose of this study was to determine muscle tissue oxidative capacity and recovery in intermediate, advanced, and elite rock climbers. Forty-four male participants performed (a) sustained and (b) intermittent contractions at 40% of maximal volitional contraction (MVC) on a sport-specific fingerboard until volitional fatigue. Near-infrared spectroscopy was used to assess muscle tissue oxygenation during both the exercise and the 5-minutes passive recovery period, in the flexor digitorum profundus (FDP) and flexor carpi radialis (FCR). During the sustained contraction only, muscle tissue deoxygenation (O2 debt) in the FDP and FCR was significantly greater in elite climbers compared with the control, intermediate, and advanced groups (FDP: 32 vs. 15, 19, 22%; FCR: 19 vs. 11, 8, 15%, respectively). However, elite climbers had a significantly quicker time to half recovery (T1/2) than the control and intermediate groups in the FDP (8 vs. 95 and 47 seconds, respectively) and the FCR (7 vs. 30 and 97 seconds, respectively) because the O2% recovered per second being significantly greater (FDP: 4.2 vs. 0.7 and 0.3; FCR: 4.8 vs. 0.1 and 0.2, respectively). Furthermore, during the intermittent contraction, T1/2 in elite climbers was significantly quicker compared with the control and intermediate groups in the FDP (8 vs. 93 and 83 seconds, respectively) and FCR (16 vs. 76 and 50 seconds, respectively). Consequently, lower-level climbers should focus training on specific intermittent fatigue protocols. Competition or elite climbers should make use of appropriate rests on route to aid recovery and increase the chances of reaching the next hold. PMID:25536538

  5. Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans.

    PubMed

    Blazevich, A J; Cannavan, D; Waugh, C M; Miller, S C; Thorlund, J B; Aagaard, P; Kay, A D

    2014-09-01

    The neuromuscular adaptations in response to muscle stretch training have not been clearly described. In the present study, changes in muscle (at fascicular and whole muscle levels) and tendon mechanics, muscle activity, and spinal motoneuron excitability were examined during standardized plantar flexor stretches after 3 wk of twice daily stretch training (4 × 30 s). No changes were observed in a nonexercising control group (n = 9), however stretch training elicited a 19.9% increase in dorsiflexion range of motion (ROM) and a 28% increase in passive joint moment at end ROM (n = 12). Only a trend toward a decrease in passive plantar flexor moment during stretch (-9.9%; P = 0.15) was observed, and no changes in electromyographic amplitudes during ROM or at end ROM were detected. Decreases in H(max):M(max) (tibial nerve stimulation) were observed at plantar flexed (gastrocnemius medialis and soleus) and neutral (soleus only) joint angles, but not with the ankle dorsiflexed. Muscle and fascicle strain increased (12 vs. 23%) along with a decrease in muscle stiffness (-18%) during stretch to a constant target joint angle. Muscle length at end ROM increased (13%) without a change in fascicle length, fascicle rotation, tendon elongation, or tendon stiffness following training. A lack of change in maximum voluntary contraction moment and rate of force development at any joint angle was taken to indicate a lack of change in series compliance of the muscle-tendon unit. Thus, increases in end ROM were underpinned by increases in maximum tolerable passive joint moment (stretch tolerance) and both muscle and fascicle elongation rather than changes in volitional muscle activation or motoneuron pool excitability. PMID:24947023

  6. The effect of muscle loading on flexor tendon-to-bone healing in a canine model

    PubMed Central

    Thomopoulos, Stavros; Zampiakis, Emmanouil; Das, Rosalina; Silva, Matthew J.; Gelberman, Richard H.

    2008-01-01

    SUMMARY Previous tendon and ligament studies demonstrated a role for mechanical loading in tissue homeostasis and healing. In uninjured musculoskeletal tissues, increased loading leads to an increase in mechanical properties, while decreased loading leads to a decrease in properties. The role of loading on healing tissues is less clear. We studied tendon-to-bone healing in a canine flexor tendon-to-bone injury and repair model. To examine the effect of muscle loading on healing, repaired tendons were either cut proximally to remove all load from the distal phalanx repair site (unloaded group) or left intact proximally (loaded group). All paws were cast post-operatively and subjected to daily passive motion rehabilitation. Specimens were tested to determine functional properties, biomechanical properties, repair-site gapping, and bone mineral density. Loading across the repair site led to improved functional and biomechanical properties (e.g., stiffness for the loaded group was 8.2 ± 3.9 vs. 5.1 ± 2.5 N/mm for the unloaded group). Loading did not affect bone mineral density or gapping. The formation of a gap between the healing tendon and bone correlated with failure properties. Using a clinically relevant model of flexor tendon injury and repair, we found that muscle loading was beneficial to healing. Complete removal of load by proximal transection resulted in tendon-to-bone repairs with less range of motion and lower biomechanical properties compared to repairs in which the muscle-tendon-bone unit was left intact. PMID:18524009

  7. Flexor tendon repairs in children: Outcomes from a specialist tertiary centre.

    PubMed

    Cooper, L; Khor, W; Burr, N; Sivakumar, B

    2015-05-01

    We evaluate the functional outcomes of early active mobilization (EAM) after paediatric flexor tendon repair at one centre from 2006 to 2013. A generic rehabilitation protocol was used for the first four to six weeks: boxing glove immobilization (<5 years), dorsal blocking splint and cage (5-10 years) or dorsal blocking splint ± cage (10-16 years). Outcomes were assessed using the Total Active Mobilization (TAM) method of the American Society for Surgery of the Hand and original Strickland criteria (OSC). Sixty-three fingers and 99 tendons were identified, in 57 children. Thirty-five per cent (n = 20) were in zone 2, 23% in zone 1, 18% in zone 5, 14% in zone 3 and 2% in zone 4. Good/excellent results were obtained in 82% by the TAM method and 79% by the OSC of those suitable for analysis (56 tendons in 44 children). The surgical approaches used varied in technique and material; a modified Kessler stitch (n = 42) using prolene (n = 60) represented the majority of core sutures. Epitendinous repair was employed in 76% of repairs (n = 75). The median length of hand therapy follow-up was 83.5 days (IQR 43.5-143.75 days). Complications included: one rupture, one post-operative infection requiring washout and three contractures, two requiring re-operation. EAM is a practical and safe way to rehabilitate children after flexor tendon repair, without increasing ruptures or adhesions. Most children under five are managed effectively in a bulky bandage. PMID:25613292

  8. EVALUATION OF THE RESULTS OF ARTHROSCOPIC ACL RECONSTRUCTION WITH AUTOGENOUS FLEXOR TENDONS

    PubMed Central

    Almeida, Alexandre; Valin, Múrcio Rangel; Ferreira, Ramon; Roveda, Gilberto; de Almeida, Nayvaldo Couto; Agostini, Ana Paula

    2015-01-01

    Objective: To evaluate the results from reconstruction of the anterior cruciate ligament (ACL) using with flexor tendon autografts from the thigh, with analysis on data relating to sex, body mass index (BMI) and associations with lower limb fracture. Methods: A group of 265 patients who underwent knee arthroscopy for the purposes of ACL reconstruction using an ipsilateral graft from the flexor tendon of the thigh between July 6, 2000, and November 19, 2007, were evaluated. Results: One hundred and seventy-six patients were evaluated over a mean period of 34.95 ± 18.8 months (median: 31 months) (IQR: 20-48 months). The minimum evaluation period was 12 months and the maximum was 87 months. One hundred and thirty-eight patients (78.4%) had excellent results, 22 (12.5%) had good results, eight (4.5%) had fair results and eight (4.5%) had poor results. Higher incidence of good and excellent results for the following categories was not considered to be significant: males (p = 0.128), patients with BMI < 25 (p = 0.848), or patients with ACL injuries unrelated to an initial traumatic episode of lower-limb fracture (p = 0.656). Conclusion: The ACL reconstruction technique using tendon autografts from the thigh showed good and excellent results for 91.4% of the sample. Male patients seemed to present a greater tendency towards good and excellent results. No statistically significant difference was found when the results were analyzed in relation to BMI or associations with initial traumatic fracture episodes in the lower limbs. PMID:27022571

  9. Effect of the vibration board on the strength of ankle dorsal and plantar flexor muscles: a preliminary randomized controlled study.

    PubMed

    Costantino, Cosimo; Pogliacomi, Francesco; Soncini, Giovanni

    2006-04-01

    Aim of this preliminary work is to study the effects of the vibration board on the strength of dorsal and plantar flexor muscles of the ankle through a randomized and controlled observation. Sixteen sedentary right-handed females, ranged from 20 to 30 years of age, were selected; they were not affected by previous ankle sprains and were divided into two randomized groups. The study group followed a vibration board training in the orthostatic position with a 60 degrees flexion of the knee in order to direct its mechanical impulses to the inferior limbs. Each patient of the study group performed daily, for 2 weeks, 10 repetitions that lasted 1 minute each (25 hertz of frequency). The control group followed a training protocol including 10 daily sessions for 2 weeks. Each session included 3 series of 10 repetitions of flexi-extension of the foot versus an opposite resistance of an elastic band, 60 centimetres long, that was stretched till 100 cm. Both groups were tested before and after these training programmes by Biodex isokinetic dynamometer in order to quantify the strength of the plantar and dorsal flexor muscles of the dominant ankle. Peak torque, power and total work of the dorsal and plantar flexor muscles were assessed. A power test at an angular velocity of 60 degrees/sec for five repetitions and a resistance test at an angular velocity of 180 degrees/sec. for 20 repetitions were performed. After the final isokinetic test, the results were submitted to a statistic evaluation (T test of Student) in order to analyze any possible significant differences (p < 0.05) among the initial and final values before and after the treatment. The results of the study group compared to the control group showed a significant increase in the power of the dorsal flexor muscles at an angular velocity of 60 degrees/sec and in the peak torque, power and total work of the plantar flexor muscles at an angular velocity of 60 degrees/sec and 180 degrees/sec. We conclude that the use

  10. Focal experimental injury leads to widespread gene expression and histologic changes in equine flexor tendons.

    PubMed

    Jacobson, Else; Jacobsen, Else; Dart, Andrew J; Mondori, Takamitsu; Horadogoda, Neil; Jeffcott, Leo B; Little, Christopher B; Smith, Margaret M

    2015-01-01

    It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3 cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re

  11. The Artificial Gravity Bed Rest Pilot Project: Effects on Knee Extensor and Plantar Flexor Muscle Groups

    NASA Technical Reports Server (NTRS)

    Caiozzo, V. J.; Haddad, F.; Lee, S.; Baker, M.; Baldwin, K. M.

    2007-01-01

    The goal of this project was to examine the effects of artificial gravity (2.5 g) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) control (C) group (N=7); and 2) an AG group (N=8), which was exposed to 21 days of bed-rest plus daily 1 hr exposures to AG (2.5 g). This particular experiment was part of an integrated AG Pilot Project sponsored by NASA/Johnson Space Center. The in vivo torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre and post treatment. Also, pre- and post treatment biopsy samples were obtained from both the vastus lateralis and soleus muscles and were used, in part, for a series of analyses on gene expression (mRNA abundance) of key factors implicated in the anabolic versus catabolic state of the muscle. Post/Pre toque-velocity determinations revealed greater decrements in knee extensor performance in the C versus AG group (P less than 0.04). The plantar flexor muscle group of the AG subjects actually demonstrated a net gain in torque-velocity relationship; whereas, in the C group the overall post/pre responses declined (AG vs C; P less than 0.001). Measurements of muscle fiber cross-sectional area (for both muscles) demonstrated a loss of approx. 20% in the C group while no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity (IGF-1, IGF-1 BP4, mechano growth factor, total RNA, and pro-collagen 3a) were higher in the AG group, whereas catabolic markers (myostatin and atrogen) were elevated in the C group. Importantly, these patterns were seen in both muscles. Based on these observations we conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading states. These findings also

  12. Unilateral Plantar Flexors Static-Stretching Effects on Ipsilateral and Contralateral Jump Measures

    PubMed Central

    da Silva, Josinaldo Jarbas; Behm, David George; Gomes, Willy Andrade; Silva, Fernando Henrique Domingues de Oliveira; Soares, Enrico Gori; Serpa, Érica Paes; Vilela Junior, Guanis de Barros; Lopes, Charles Ricardo; Marchetti, Paulo Henrique

    2015-01-01

    The aim of this study was to evaluate the acute effects of unilateral ankle plantar flexors static-stretching (SS) on the passive range of movement (ROM) of the stretched limb, surface electromyography (sEMG) and single-leg bounce drop jump (SBDJ) performance measures of the ipsilateral stretched and contralateral non-stretched lower limbs. Seventeen young men (24 ± 5 years) performed SBDJ before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) unilateral ankle plantar flexor SS (6 sets of 45s/15s, 70-90% point of discomfort). SBDJ performance measures included jump height, impulse, time to reach peak force, contact time as well as the sEMG integral (IEMG) and pre-activation (IEMGpre-activation) of the gastrocnemius lateralis. Ankle dorsiflexion passive ROM increased in the stretched limb after the SS (pre-test: 21 ± 4° and post-test: 26.5 ± 5°, p < 0.001). Post-stretching decreases were observed with peak force (p = 0.029), IEMG (P<0.001), and IEMGpre-activation (p = 0.015) in the stretched limb; as well as impulse (p = 0.03), and jump height (p = 0.032) in the non-stretched limb. In conclusion, SS effectively increased passive ankle ROM of the stretched limb, and transiently (less than 10 minutes) decreased muscle peak force and pre-activation. The decrease of jump height and impulse for the non-stretched limb suggests a SS-induced central nervous system inhibitory effect. Key points When considering whether or not to SS prior to athletic activities, one must consider the potential positive effects of increased ankle dorsiflexion motion with the potential deleterious effects of power and muscle activity during a simple jumping task or as part of the rehabilitation process. Since decreased jump performance measures can persist for 10 minutes in the stretched leg, the timing of SS prior to performance must be taken into consideration. Athletes, fitness enthusiasts and therapists should

  13. Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons

    PubMed Central

    Jacobsen, Else; Dart, Andrew J.; Mondori, Takamitsu; Horadogoda, Neil; Jeffcott, Leo B.; Little, Christopher B.; Smith, Margaret M.

    2015-01-01

    It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re

  14. Deep cervical flexor training with a pressure biofeedback unit is an effective method for maintaining neck mobility and muscular endurance in college students with forward head posture.

    PubMed

    Kang, Dong Yeon

    2015-10-01

    [Purpose] This study investigated the effects of deep cervical flexor training on maintaining forward head posture, muscular endurance, and cervical mobility. It also examined the effectiveness of deep cervical flexor training with a pressure biofeedback unit. [Subjects and Methods] Twenty college students were recruited and randomly assigned to groups that underwent either deep cervical flexor training with a pressure biofeedback unit (experimental group, n=10) or conventional deep cervical flexor training (control group, n=10). The craniovertebral angle of each subject was measured with a lateral-view picture. Neck mobility was assessed using a cervical range of motion device and muscular endurance was measured using a pressure biofeedback unit. Both groups performed conventional deep cervical flexor exercises three times a week for six weeks. The experimental group underwent a pressure biofeedback unit training was 5 to10 minutes/day, thrice a week. [Results] Cervical range of motion in the experimental group increased significantly between the end of training and the end of the four week detraining period, compared to that in control group. [Conclusion] Deep cervical flexor training with a pressure biofeedback unit is a useful method for maintaining neck mobility and muscular endurance in people with forward head posture. PMID:26644676

  15. High-Intensity Running and Plantar-Flexor Fatigability and Plantar-Pressure Distribution in Adolescent Runners

    PubMed Central

    Fourchet, François; Kelly, Luke; Horobeanu, Cosmin; Loepelt, Heiko; Taiar, Redha; Millet, Grégoire

    2015-01-01

    Context: Fatigue-induced alterations in foot mechanics may lead to structural overload and injury. Objectives: To investigate how a high-intensity running exercise to exhaustion modifies ankle plantar-flexor and dorsiflexor strength and fatigability, as well as plantar-pressure distribution in adolescent runners. Design: Controlled laboratory study. Setting: Academy research laboratory. Patients or Other Participants: Eleven male adolescent distance runners (age = 16.9 ± 2.0 years, height = 170.6 ± 10.9 cm, mass = 54.6 ± 8.6 kg) were tested. Intervention(s): All participants performed an exhausting run on a treadmill. An isokinetic plantar-flexor and dorsiflexor maximal-strength test and a fatigue test were performed before and after the exhausting run. Plantar-pressure distribution was assessed at the beginning and end of the exhausting run. Main Outcome Measure(s): We recorded plantar-flexor and dorsiflexor peak torques and calculated the fatigue index. Plantar-pressure measurements were recorded 1 minute after the start of the run and before exhaustion. Plantar variables (ie, mean area, contact time, mean pressure, relative load) were determined for 9 selected regions. Results: Isokinetic peak torques were similar before and after the run in both muscle groups, whereas the fatigue index increased in plantar flexion (28.1%; P = .01) but not in dorsiflexion. For the whole foot, mean pressure decreased from 1 minute to the end (−3.4%; P = .003); however, mean area (9.5%; P = .005) and relative load (7.2%; P = .009) increased under the medial midfoot, and contact time increased under the central forefoot (8.3%; P = .01) and the lesser toes (8.9%; P = .008). Conclusions: Fatigue resistance in the plantar flexors declined after a high-intensity running bout performed by adolescent male distance runners. This phenomenon was associated with increased loading under the medial arch in the fatigued state but without any excessive pronation. PMID:25531143

  16. Closed Rupture of the Flexor Tendon Secondary to Sclerosis of the Hook of the Hamate: A Report of Two Cases.

    PubMed

    Yamazaki, Hiroshi; Uchiyama, Shigeharu; Hosaka, Masato; Kato, Hiroyuki

    2016-10-01

    Closed flexor tendon ruptures in the little finger can be caused by fracture or nonunion of the hook of the hamate, but no case of the disorder secondary to the sclerosis and thinning of the hamate hook has been reported. We report two rare cases with this complication due to rough surface of the hamate hook. Carpal tunnel view radiographs and computed tomography showed the sclerosis and thinning of the hook. PMID:27595962

  17. Attritional Rupture of the Little Finger Flexor Digitorum Profundus Tendon in the Carpal Tunnel in a Patient with Acromegaly.

    PubMed

    Lee, Munn Yi Tina; Jin, Yeo Chong

    2016-02-01

    Spontaneous rupture of flexor tendons within the carpal tunnel is rare in the absence of rheumatoid arthritis. Other predisposing conditions such as gout, infection, pisotriquetrial osteoarthritis, as well as hook of hamate fracture non-union, have previously been reported. However, tendon ruptures of the hand in the presence of acromegaly, as well as spontaneous ruptures within the carpal tunnel, have not been described in the literature. PMID:27454510

  18. Connecting the Dots in DAS

    ERIC Educational Resources Information Center

    Ford, Tracy

    2012-01-01

    Many institutions implement a distributed antenna system (DAS) as part of a holistic approach to providing better wireless coverage and capacity on campus. A DAS provides wireless service within a particular area or structure via a network of separate antenna nodes that are connected to a common source through fiber or coaxial cable. Because DAS…

  19. Clinical use of a combined grasping and locking core suture technique for flexor tendon repair in zone II.

    PubMed

    Al-Qattan, Mohammad M

    2013-12-01

    Previous authors have used either a grasping or a locking technique for flexor tendon repair in zone II. A combined (grasping and locking) 10-strand repair was used by the author in 22 adults (n = 28 fingers) with lacerations of both flexor tendons in zone II. The combined repair is known to be strong (mean tensile strength of 164 N), and the technique was used in selected cases who were thought to be at higher risk of rupture either because of excessive digital oedema (in early tendon repairs) or because of tendon retraction (in late primary tendon repairs). The 10-strand repair was bulky and, hence, only the profundus tendon was repaired; and "venting" of the pulley system was done proximal to the repair site as recommended by other authors. Supervised early active mobilisation was done immediately after the operation. At final follow-up, the outcome was calculated using the original Strickland-Glogovac grading system. There were no ruptures and the final outcome was considered excellent in 19 patients (n = 25 fingers), good in two patients (n = 2 fingers), and fair in the remaining patient (n = 1 finger). It was concluded that the bulky 10-strand repair may be used for zone II finger flexor tendon lacerations as long as a profundus-(?) only repair and "venting" of the pulley system are performed. PMID:23829500

  20. Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

    PubMed Central

    Beyersdoerfer, Sascha Tobias; Vollmar, Brigitte; Mittlmeier, Thomas; Gierer, Philip

    2016-01-01

    Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs. Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining. Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly. Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response. PMID:27446949

  1. The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain

    PubMed Central

    2014-01-01

    Background Several tests have been suggested to assess the isometric endurance of the cervical flexor (NFME) and extensors (NEE) muscles. This study proposes to determine whether neck flexors endurance is related to extensor endurance, and whether cervical muscle endurance is related to disability, pain amount and pain stage in subjects with neck pain. Methods Thirty subjects (18 women, 12 men, mean ± SD age: 43 ± 12 years) complaining of neck pain filled out the Visual Analogue Scale (VAS) and the Neck Pain and Disability Scale-Italian version (NPDS-I). They also completed the timed endurance tests for the cervical muscles. Results The mean endurance was 246.7 ± 150 seconds for the NEE test, and 44.9 ± 25.3 seconds for the NMFE test. A significant correlation was found between the results of these two tests (r = 0.52, p = 0.003). A positive relationship was also found between VAS and NPDS-I (r = 0.549, p = 0.002). The endurance rates were similar for acute/subacute and chronic subjects, whereas males demonstrated significantly higher values compared to females in NFME test. Conclusions These findings suggest that neck flexors and extensors endurance are correlated and that the cervical endurance is not significantly altered by the duration of symptoms in subjects with neck pain. PMID:24581272

  2. Computer Vision Based Automatic Extraction and Thickness Measurement of Deep Cervical Flexor from Ultrasonic Images.

    PubMed

    Kim, Kwang Baek; Song, Doo Heon; Park, Hyun Jun

    2016-01-01

    Deep Cervical Flexor (DCF) muscles are important in monitoring and controlling neck pain. While ultrasonographic analysis is useful in this area, it has intrinsic subjectivity problem. In this paper, we propose automatic DCF extractor/analyzer software based on computer vision. One of the major difficulties in developing such an automatic analyzer is to detect important organs and their boundaries under very low brightness contrast environment. Our fuzzy sigma binarization process is one of the answers for that problem. Another difficulty is to compensate information loss that happened during such image processing procedures. Many morphologically motivated image processing algorithms are applied for that purpose. The proposed method is verified as successful in extracting DCFs and measuring thicknesses in experiment using two hundred 800 × 600 DICOM ultrasonography images with 98.5% extraction rate. Also, the thickness of DCFs automatically measured by this software has small difference (less than 0.3 cm) for 89.8% of extracted DCFs. PMID:26949411

  3. Autologous bone marrow aspirate for treatment of superficial digital flexor tendonitis in 105 racehorses.

    PubMed

    Russell, J W; Russell, T M; Vasey, J R; Hall, M S

    2016-07-16

    To evaluate a treatment protocol whereby superficial digital flexor (SDF) tendonitis in Thoroughbred and Standardbred racehorses was treated with autologous bone marrow aspirate (ABMA) obtained from the sternebrae. This treatment was combined with desmotomy of the accessory ligament of the SDF tendon (DAL-SDFT) in selected cases. Medical records of 105 horses treated using the reported protocol were reviewed. Signalment, history and details of treatment were recorded. Racing records were reviewed and performance recorded. Of Thoroughbreds, 82 per cent had one or more starts within the follow-up period and 59 per cent had five or more starts. Of Standardbreds, 76 per cent had one or more starts and 62 per cent had five or more starts. A statistically significant difference was found when comparing race starts between sexes, with females having less starts than males (≥1start P=0.017 and ≥5 starts P=0.008, respectively). The proportions of horses having one or more starts and five or more starts did not differ significantly if a DAL-SDFT was performed or not (P=0.31 and 0.63, respectively). Horses with a core lesion in the body of the SDFT have a good prognosis for return to racing following intralesional ABMA injection. Addition of DAL-SDFT to the treatment regimen did not significantly influence outcome. PMID:27206445

  4. Computer Vision Based Automatic Extraction and Thickness Measurement of Deep Cervical Flexor from Ultrasonic Images

    PubMed Central

    Kim, Kwang Baek; Song, Doo Heon; Park, Hyun Jun

    2016-01-01

    Deep Cervical Flexor (DCF) muscles are important in monitoring and controlling neck pain. While ultrasonographic analysis is useful in this area, it has intrinsic subjectivity problem. In this paper, we propose automatic DCF extractor/analyzer software based on computer vision. One of the major difficulties in developing such an automatic analyzer is to detect important organs and their boundaries under very low brightness contrast environment. Our fuzzy sigma binarization process is one of the answers for that problem. Another difficulty is to compensate information loss that happened during such image processing procedures. Many morphologically motivated image processing algorithms are applied for that purpose. The proposed method is verified as successful in extracting DCFs and measuring thicknesses in experiment using two hundred 800 × 600 DICOM ultrasonography images with 98.5% extraction rate. Also, the thickness of DCFs automatically measured by this software has small difference (less than 0.3 cm) for 89.8% of extracted DCFs. PMID:26949411

  5. The effect of distraction strategies on pain perception and the nociceptive flexor reflex (RIII reflex).

    PubMed

    Ruscheweyh, Ruth; Kreusch, Annette; Albers, Christoph; Sommer, Jens; Marziniak, Martin

    2011-11-01

    Distraction from pain reduces pain perception, and imaging studies have suggested that this may at least partially be mediated by activation of descending pain inhibitory systems. Here, we used the nociceptive flexor reflex (RIII reflex) to directly quantify the effects of different distraction strategies on basal spinal nociception and its temporal summation. Twenty-seven healthy subjects participated in 3 distraction tasks (mental imagery, listening to preferred music, spatial discrimination of brush stimuli) and, in a fourth task, concentrated on the painful stimulus. Results show that all 3 distraction tasks reduced pain perception, but only the brush task also reduced the RIII reflex. The concentration-on-pain task increased both pain perception and the RIII reflex. The extent of temporal summation of pain perception and the extent of temporal summation of the RIII reflex were not affected by any of the tasks. These results suggest that some, but not all, forms of pain reduction by distraction rely on descending pain inhibition. In addition, pain reduction by distraction seems to preferentially affect mechanisms of basal nociceptive transmission, not of temporal summation. PMID:21925793

  6. Active recovery of the finger flexors enhances intermittent handgrip performance in rock climbers.

    PubMed

    Baláš, Jiří; Michailov, Michail; Giles, David; Kodejška, Jan; Panáčková, Michaela; Fryer, Simon

    2016-10-01

    This study aimed to (1) evaluate the effect of hand shaking during recovery phases of intermittent testing on the time-force characteristics of performance and muscle oxygenation, and (2) assess inter-individual variability in the time to achieve the target force during intermittent testing in rock climbers. Twenty-two participants undertook three finger flexor endurance tests at 60% of their maximal voluntary contraction until failure. Performances of a sustained contraction and two intermittent contractions, each with different recovery strategies, were analysed by time-force parameters and near-infrared spectroscopy. Recovery with shaking of the forearm beside the body led to a significantly greater intermittent test time (↑ 22%, P < .05), force-time integral (↑ 28%, P < .05) and faster muscle re-oxygenation (↑ 32%, P < .05), when compared to the hand over hold condition. Further, the ratio of intermittent to continuous test time distinguished specific aerobic muscular adaptations among sport climbers (2.02), boulderers (1.74) and lower grade climbers (1.25). Lower grade climbers and boulderers produced shorter duration contractions due to the slower development of target force during the intermittent test, indicating worse kinaesthetic differentiation. Both the type of recovery and climbing discipline determined muscle re-oxygenation and intermittent performance in rock climbers. PMID:27491378

  7. Comparison of ankle plantar flexor activity between double-leg heel raise and walking.

    PubMed

    Fujisawa, Hiroyuki; Suzuki, Hiroto; Nishiyama, Toru; Suzuki, Makoto

    2015-05-01

    [Purpose] We aimed to evaluate the difference in the muscle activity between the double-leg heel raise (DHR) and treadmill walking. [Subjects] Thirty healthy males aged 21.5 ± 1.6 years (body mass 63.6 ± 9.3 kg, height 171.0 ± 4.5 cm) participated in the study. [Methods] Electromyograms were simultaneously recorded from both heads of the gastrocnemius and the soleus of the right side during the DHR and treadmill walking. The DHR conditions were maximum plantar flexion (MPF), 3/4 MPF, 2/4 MPF, and 1/4 MPF, and the walking speeds were 20, 40, 60, 80, and 100 m/min. [Results] The muscle activity during the DHR and walking significantly increased with increments in the height of the heel raise and walking speed, respectively. Comparison of the muscle activity at MPF with that at each walking speed revealed that the muscle activity in the soleus and gastrocnemius medial head during walking exceeded that during the DHR in less than 3.3% of cases. [Conclusion] The DHR test is useful for evaluating the ankle plantar flexor activity necessary for walking. PMID:26157255

  8. Influence of vibration on mechanical power and electromyogram activity in human arm flexor muscles.

    PubMed

    Bosco, C; Cardinale, M; Tsarpela, O

    1999-03-01

    The aim of this study was to evaluate the influence of vibration on the mechanical properties of arm flexors. A group of 12 international level boxers, all members of the Italian national team, voluntarily participated in the experiment: all were engaged in regular boxing training. At the beginning of the study they were tested whilst performing forearm flexion with an extra load equal to 5% of the subjects' body mass. Following this. one arm was given the experimental treatment (E; mechanical vibration) and the other was the control (no treatment). The E treatment consisted of five repetitions lasting 1-min each of mechanical vibration applied during arm flexion in isometric conditions with 1 min rest between them. Further tests were performed 5 min immediately after the treatment on both limbs. The results showed statistically significant enhancement of the average power in the arm treated with vibrations. The root mean square electromyogram (EMGrms) had not changed following the treatment but, when divided by mechanical power, (P) as an index of neural efficiency, it showed statistically significant increases. It was concluded that mechanical vibrations enhanced muscle P and decreased the related EMG/P relationship in elite athletes. Moreover, the analysis of EMGrms recorded before the treatment and during the treatment itself showed an enormous increase in neural activity during vibration up to more than twice the baseline values. This would indicate that this type of treatment is able to stimulate the neuromuscular system more than other treatments used to improve neuromuscular properties. PMID:10090628

  9. Facilitation from flexor digitorum superficialis to extensor carpi radialis in humans.

    PubMed

    Nito, Mitsuhiro; Hashizume, Wataru; Miyasaka, Takuji; Suzuki, Katsuhiko; Sato, Toshiaki; Fujii, Hiromi; Shindo, Masaomi; Naito, Akira

    2016-08-01

    Effects of low-threshold afferents from the flexor digitorum superficialis (FDS) to the extensor carpi radialis (ECR) motoneurons were examined using a post-stimulus time-histogram (PSTH) and electromyogram-averaging (EMG-A) methods in eight healthy human subjects. In the PSTH study in five of the eight subjects, electrical conditioning stimuli (ES) to the median nerve branch innervating FDS with the intensity below the motor threshold induced excitatory effects (facilitation) in 39 out of 92 ECR motor units. In 11 ECR motor units, the central synaptic delay of the facilitation was -0.1 ± 0.3 ms longer than that of the homonymous facilitation of ECR. Mechanical conditioning stimuli (MS) to FDS with the intensity below the threshold of the tendon(T)-wave-induced facilitation in 51 out of 51 ECR motor units. With the EMG-A method, early and significant peaks were produced by ES and MS in all the eight subjects. The difference between latencies of the peaks by ES and MS was almost equivalent to that of the Hoffmann- and T-waves of FDS by ES and MS. The peak was diminished by tonic vibration stimuli to FDS. These findings suggest that a facilitation from FDS to ECR exists in humans and group Ia afferents mediate the facilitation through a monosynaptic path. PMID:27010723

  10. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain

    PubMed Central

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain. PMID:26957772

  11. Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients.

    PubMed

    Huang, Han-Wei; Ju, Ming-Shaung; Lin, Chou-Ching K

    2016-05-01

    The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent. PMID:26765753

  12. Quantitative application of transverse friction massage and its neurological effects on flexor carpi radialis.

    PubMed

    Lee, Hsin-Min; Wu, Shyi-Kuen; You, Jia-Yuan

    2009-10-01

    The purpose of the study was to determine the effects of transverse friction massage (TFM) on flexor carpi radialis (FCR) motoneuron (MN) pool excitability. Twenty-eight healthy subjects were randomly assigned into massage and control groups. Pre- vs post-TFM H-reflex data were collected. Controls received a rest period instead of massage. Massage dose was standardized by a novel electronic method which recorded the massage rate, momentary pressure and total cumulative pressure (energy). Two-way ANOVA of H/M ratios derived from maximal amplitudes of Hoffman reflexes (Hmax) and motor responses (Mmax) was used to analyze neurological effects and group differences. Analysis of pressure/time curve data showed: mean massage rate was 0.501+/-0.005 Hz; mean duration of massage sessions was 184.6+/-26.4s; mean peak pressure was 4.990+/-1.006 psi. Hmax/Mmax ratios declined from 14.3% to 10.3% for massage (P<0.01) but showed no change for controls (P>0.05). In conclusion a novel quantitative approach to the study of massage has been demonstrated while testing the effects of TFM on FCR MN pool excitability. TFM appears to reduce MN pool excitability. The novel method of quantifying massage permits more rigorous testing of client-centered massage in future research. PMID:19027340

  13. Digital oedema, adhesion formation and resistance to digital motion after primary flexor tendon repair.

    PubMed

    Cao, Y; Chen, C H; Wu, Y F; Xu, X F; Xie, R G; Tang, J B

    2008-12-01

    The development of digital oedema, adhesion formation, and resistance to digital motion at days 0, 3, 5, 7, 9 and 14 after primary flexor tendon repairs using 102 long toes of 51 Leghorn chickens was studied. Oedema presented as tissue swelling from days 3 to 7, which peaked at day 3. After day 7, oedema was manifest as hardening of subcutaneous tissue. The degree of digital swelling correlated with the resistance to tendon motion between days 3 and 7. At day 9, granulation tissues were observed around the tendon and loose adhesions were observed at day 14. Resistance to digital motion increased significantly from day 0 to day 3, but did not increase between days 3 and 9. The early postoperative changes appear to have three stages: initial (days 0-3, increasing resistance with development of oedema), delayed (days 4-7, higher resistance with continuing oedema) and late (after day 7-9, hardening of subcutaneous tissue with development of adhesions). PMID:18936126

  14. A cross-sectional study of the plantar flexor muscle and tendon during growth.

    PubMed

    Kubo, K; Teshima, T; Hirose, N; Tsunoda, N

    2014-09-01

    The purpose of this study was to investigate growth changes in human plantar flexor muscle and tendons. In addition, we ascertained whether growth changes in muscle and tendon were more closely related to skeletal age than chronological age. 22 elementary school children (ESC), 19 junior high school students (JHS), and 23 young adults (ADT) men participated in this study. Maximal strain and hysteresis of tendon structures and cross-sectional area of Achilles tendon were measured using ultrasonography. In addition, skeletal age was assessed using Tanner-Whitehouse III method. Maximal strain of ESC was significantly greater than that of other groups, while no significant difference was observed between JHS and ADT. There was no difference in hysteresis among 3 groups. Relative cross-sectional area (to body mass(2/3)) of ADT was significantly smaller than that of other groups. For ESC and JHS, measured variables of muscle and tendon were significantly correlated to both chronological and skeletal ages. These results suggested that immature musculoskeletal system was protected by more extensible and larger tendon structures in ESC and only by larger tendon structures in JHS, respectively. Furthermore, there were no differences in correlation coefficient values between measured variables of muscle and tendon and chronological or skeletal ages. PMID:24577863

  15. Pre-contraction dynamic electrical impedance myography of the forearm finger flexors.

    PubMed

    Shiffman, C A

    2016-02-01

    Electrical activity in the sensory-motor and supplementary motor areas of the cerebral cortex is known to occur during a 'readiness interval', extending up to 2 s before the relevant muscle actually contracts. This paper presents evidence that there are also changes in the properties of the muscle itself during a similar preparatory period, as revealed by dynamic electrical impedance myography. 11 healthy subjects aged 23.5 ± 2.5 years were asked to perform a series of isometric gripping exercises during which the force, resistance and reactance of the forearm finger flexor muscles were monitored. A change in reactance, ΔX, or resistance, ΔR, which occurred before the generation of force, ΔF, was dubbed a 'PIC', shorthand for precontraction impedance change (subject to criteria to rule out the possibility of simple 'noise'), of which 1206 qualified in the entire subject cohort. Such PIC's are statistically well correlated when expressed in terms of differences between PIC and force onset times (r ≈ 0.9, p ≈ 0). This is demonstrated using a variation on the 'computer of average transients' method. Precontraction impedance changes (PICs) occurring as much as 2 s before the onset of force generation were found, in qualitative agreement with precontraction EEG activity reported in the literature. Also, a subset of PIC's was found in which the scaled and time-shifted ΔX(t) was virtually identical to ΔF(t). Since the occurrence and timing of all the PICs depend on oral commands, it is clear that the auditory cortex is likely involved, but the detailed mechanism coupling brain activity with PICs is not known. PMID:26814557

  16. Ex vivo penetration of low-level laser light through equine skin and flexor tendons.

    PubMed

    Duesterdieck-Zellmer, Katja F; Larson, Maureen K; Plant, Thomas K; Sundholm-Tepper, Andrea; Payton, Mark E

    2016-09-01

    OBJECTIVE To measure penetration efficiencies of low-level laser light energy through equine skin and to determine the fraction of laser energy absorbed by equine digital flexor tendons (superficial [SDFT] and deep [DDFT]). SAMPLE Samples of skin, SDFTs, and DDFTs from 1 metacarpal area of each of 19 equine cadavers. PROCEDURES A therapeutic laser with wavelength capabilities of 800 and 970 nm was used. The percentage of energy penetration for each wavelength was determined through skin before and after clipping and then shaving of hair, through shaved skin over SDFTs, and through shaved skin, SDFTs, and DDFTs (positioned in anatomically correct orientation). Influence of hair color; skin preparation, color, and thickness; and wavelength on energy penetration were assessed. RESULTS For haired skin, energy penetration was greatest for light-colored hair and least for dark-colored hair. Clipping or shaving of skin improved energy penetration. Light-colored skin allowed greatest energy penetration, followed by medium-colored skin and dark-colored skin. Greatest penetration of light-colored skin occurred with the 800-nm wavelength, whereas greatest penetration of medium- and dark-colored skin occurred with the 970-nm wavelength. As skin thickness increased, energy penetration of samples decreased. Only 1% to 20% and 0.1% to 4% of energy were absorbed by SDFTs and DDFTs, respectively, depending on skin color, skin thickness, and applied wavelength. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that most laser energy directed through equine skin was absorbed or scattered by the skin. To achieve delivery of energy doses known to positively affect cells in vitro to equine SDFTs and DDFTs, skin preparation, color, and thickness and applied wavelength must be considered. PMID:27580111

  17. Low-intensity resistance training attenuates dexamethasone-induced atrophy in the flexor hallucis longus muscle.

    PubMed

    Macedo, Anderson G; Krug, André L O; Herrera, Naiara A; Zago, Anderson S; Rush, James W E; Amaral, Sandra L

    2014-09-01

    This study investigated the potential protective effect of low-intensity resistance training (RT) against dexamethasone (DEX) treatment induced muscle atrophy. Rats underwent either an 8 week period of ladder climbing RT or remained sedentary. During the last 10 days of the exercise protocol, animals were submitted to a DEX treatment or a control saline injection. Muscle weights were assessed and levels of AKT, mTOR, FOXO3a, Atrogin-1 and MuRF-1 proteins were analyzed in flexor hallucis longus (FHL), tibialis anterior (TA), and soleus muscles. DEX induced blood glucose increase (+46%), body weight reduction (-19%) and atrophy in FHL (-28%) and TA (-21%) muscles, which was associated with a decrease in AKT and an increase in MuRF-1 proteins levels. Low-intensity RT prevented the blood glucose increase, attenuated the FHL atrophy effects of DEX, and was associated with increased mTOR and reductions in Atrogin-1 and MuRF-1 in FHL. In contrast, TA muscle atrophy and signaling proteins were not affected by RT. These are the first data to demonstrate that low-intensity ladder-climbing RT specifically mitigates the FHL atrophy, which is the main muscle recruited during the training activity, while not preventing atrophy in other limb muscle not as heavily recruited. The recruitment-dependent prevention of atrophy by low intensity RT likely occurs by a combination of attenuated muscle protein degradation signals and enhanced muscle protein synthesis signals including mTOR, Atrogin-1 and MuRF-1. PMID:24861267

  18. Biomechanical trial of modified flexor tendon sutures: an in vitro study.

    PubMed

    Vlajcic, Zlatko; Zic, Rado; Skenderi, Zenun; Bilic-Zulle, Lidija; Martic, Kresimir; Stanec, Zdenko

    2012-09-01

    Proven benefits of early active mobilisation for intra-synovial flexor tendon repairs have inducted new criteria for a 'perfect suture'. This study has examined different variations of modified Kessler's suture, which could fulfil the new criteria. A total of 93 swine extensor tendons were transected, repaired and tested using a dynamometer with constant rate of extension. The first part of study tested clinically the most used modified Kessler suture, a variation of double modified Kessler suture and intact tendons as a control group. Further variations in the second part of study were due to type of suture, location and number of the knots and type of peripheral suture. According to the results, the tested version of double modified Kessler suture with crossed peripheral suture was the strongest one among all tested variations. The ultimate force for the authors preferred modification of the double modified Kessler (DMK) is significantly higher than modified Kessler suture. The version of DMK with crossed peripheral suture is the strongest one among all tested variations. The lowest strength manifests variation with two knots between tendon ends. The variations with interlocked and outsided knot or monofilament tread are not statistically significant regarding ultimate force. The frequency of suture failure events (suture pull out or tendon and/or suture rupture) is equal respecting braided or monofilament suture. The preferred modification of the double modified Kessler (DMK) suture with crossed peripheral suture is the strongest one among all tested variations and could achieve, concerning range of force, early active mobilisation. Further variations due to the type of thread and location, type and number of the knots did not show statistical significance. PMID:22784225

  19. The effects of passive stretching plus vibration on strength and activation of the plantar flexors.

    PubMed

    Miller, Jonathan D; Herda, Trent J; Trevino, Michael A; Mosier, Eric M

    2016-09-01

    This study examined the effects of passive stretching only (PS+CON) and passive stretching with the addition of continuous vibration (VIB) during post-passive stretching tests (PS+VIB) on peak torque (PT), percent voluntary inactivation (%VI), single stimulus twitch torque (TTSINGLE), and doublet stimuli twitch torque (TTDOUBLET) of the plantar flexors at a short (20° plantar flexion (PF)) and long muscle length (15° dorsiflexion (DF)). Fourteen healthy men (age = 22 ± 3 years) performed isometric maximal voluntary contractions at PF and DF, and passive range of motion (PROM) assessments before and after 8 × 30-s passive stretches without (PS+CON) or with VIB (PS+VIB) administered continuously throughout post-passive stretching tests. The passive properties of the muscle tendon unit were assessed pre- and post-passive stretching via PROM, passive torque (PASSTQ), and musculotendinous stiffness (MTS) measurements. PT, TTSINGLE, and TTDOUBLET decreased, whereas, %VI increased following passive stretching at PF and DF (P < 0.05) with no significant differences between PS+CON and PS+VIB. PASSTQ and MTS decreased while PROM increased post-passive stretching during both trials (P < 0.05). The stretching-induced force/torque deficit and increases in %VI were evident following passive stretching at short and long muscle lengths. Although not statistically significant, effect size calculations suggested large and moderate differences in the absolute changes in PT (Cohen's d = 1.14) and %VI (Cohen's d = 0.54) from pre- to post-passive stretching between treatments, with PS+VIB having greater decreases of PT and higher %VI than PS+CON. The decrement in PT following passive stretching may be primarily neural in origin. PMID:27512816

  20. The influence of ageing on the force-velocity-power characteristics of human elbow flexor muscles.

    PubMed

    Valour, D; Ochala, J; Ballay, Y; Pousson, M

    2003-04-01

    The purpose of this study was to quantify the effects of ageing on the maximal power (P(max)) of the elbow flexor muscles and to determine the impact of velocity on the loss of power in older people. Sixteen elderly subjects (7 men and 9 women, age range 61-78 years) and 17 young subjects (11 men and 6 women, age range 18-27 years) participated in this study. Maximal elbow flexions were performed against increasing inertia. The maximal force (F(max)), maximal shortening velocity (V(max)), P(max), dynamic constants (a, b and a/F(max)), optimal force (F(opt)), optimal velocity (V(opt)) and V(opt)/V(max) were determined from Hill's equation. Myoelectrical activity (EMG) of the biceps and triceps muscles was quantified as an root mean square (RMS) value. F(max), V(max), P(max), F(opt), and V(opt) were significantly lower in elderly than in young subjects (28, 31, 45, 24 and 28% lower, respectively; p<0.05), whereas a/F(max) and V(opt)/V(max) were not different between the two age groups. In women, the greater decrease in P(max) appears to be more dependent on V(opt) than F(opt). In addition, V(max) decreased with age in women but not in men. The absence of significant differences between age groups in normalised RMS values indicates that P(max) and V(max) loss with increasing age could result more from changes in the properties of contractile element than from changes in muscular activity. PMID:12670625

  1. Effects of aging on force, velocity, and power in the elbow flexors of males.

    PubMed

    Toji, Hideki; Kaneko, Masahiro

    2007-11-01

    The effect of aging on muscular power development was investigated by determining the force-velocity relationship. The muscle cross-sectional area (CSA) was estimated by the thickness of the elbow flexors. The subjects were 19 elderly males aged 69.1+/-3.7 years old (G-70 group), 15 middle-aged males aged 50.9+/-3.5 years old (G-50), and 19 young males aged 21.2+/-1.3 years old (G-20). The G-70 group had the slowest shortening velocities under various load conditions, resulting in the lowest force-velocity relationship. The maximum values for force (Fmax), velocity (Vmax), power (Pmax), dynamic constants (a, b), and the a/Fmax ratio were determined using Hill's equation. The a/Fmax ratio determines the degree of concavity in the force-velocity curve. The a/Fmax ratio was greatest in G-70, followed by those in G-50 and G-20, while the maximum values for force (Fmax), velocity (Vmax), and power (Pmax) were significantly lower in G-70 than in the other groups. Fmax and Pmax per CSA were lowest in G-70, and Vmax per unit muscle length was also lowest in G-70 as compared to the other age groups. The ratio of G-70/G-20 was greatest in Pmax (69.6%), followed by Fmax (75.3%) and Vmax (83.4%). However, there were no significant differences in CSA among the 3 age groups. Our findings suggest that muscle force and shortening velocity may decline gradually in the process of aging attributed to declining muscle function rather than CSA. PMID:18174666

  2. Evidence of Preserved Oxidative Capacity and Oxygen Delivery in the Plantar Flexor Muscles With Age.

    PubMed

    Hart, Corey R; Layec, Gwenael; Trinity, Joel D; Liu, Xin; Kim, Seong-Eun; Groot, H Jonathan; Le Fur, Yann; Sorensen, Jacob R; Jeong, Eun-Kee; Richardson, Russell S

    2015-09-01

    Studies examining the effect of aging on skeletal muscle oxidative capacity have yielded equivocal results; however, these investigations may have been confounded by differences in oxygen (O(2)) delivery, physical activity, and small numbers of participants. Therefore, we evaluated skeletal muscle oxidative capacity and O(2) delivery in a relatively large group (N = 40) of young (22 ± 2 years) and old (73 ± 7 years) participants matched for physical activity. After submaximal dynamic plantar flexion exercise, phosphocreatine (PCr) resynthesis ((31)P magnetic resonance spectroscopy), muscle reoxygenation (near-infrared spectroscopy), and popliteal artery blood flow (Doppler ultrasound) were measured. The phosphocreatine recovery time constant (Tau) (young: 33 ± 16; old: 30 ± 11 seconds), maximal rate of adenosine triphosphate (ATP) synthesis (young: 25 ± 9; old: 27 ± 8 mM/min), and muscle reoxygenation rates determined by the deoxyhemoglobin/myoglobin recovery Tau (young: 48 ± 5; old: 47 ± 9 seconds) were similar between groups. Similarly, although tending to be higher in the old, there were no significant age-related differences in postexercise popliteal blood flow (area under the curve: young: 1,665 ± 227 vs old: 2,404 ± 357 mL, p = .06) and convective O(2) delivery (young: 293 ± 146 vs old: 404 ± 191 mL, p = .07). In conclusion, when physical activity and O(2) delivery are similar, oxidative capacity in the plantar flexors is not affected by aging. These findings reveal that diminished skeletal muscle oxidative capacity is not an obligatory accompaniment to the aging process. PMID:25165028

  3. Relationships of ultrasound measures of intrinsic foot muscle cross-sectional area and muscle volume with maximum toe flexor muscle strength and physical performance in young adults

    PubMed Central

    Abe, Takashi; Tayashiki, Kota; Nakatani, Miyuki; Watanabe, Hironori

    2016-01-01

    [Purpose] To investigate the relationships between toe flexor muscle strength with (TFS-5-toes) and without (TFS-4-toes) the contribution of the great toe, anatomical and physiological muscle cross-sectional areas (CSA) of intrinsic toe flexor muscle and physical performance were measured. [Subjects] Seventeen men (82% sports-active) and 17 women (47% sports-active), aged 20 to 35 years, volunteered. [Methods] Anatomical CSA was measured in two intrinsic toe flexor muscles (flexor digitorum brevis [FDB] and abductor hallucis) by ultrasound. Muscle volume and muscle length of the FDB were also estimated, and physiological CSA was calculated. [Results] Both TFS-5-toes and TFS-4-toes correlated positively with walking speed in men (r=0.584 and r=0.553, respectively) and women (r=0.748 and r=0.533, respectively). Physiological CSA of the FDB was significantly correlated with TFS-5-toes (r=0.748) and TFS-4-toes (r=0.573) in women. In men, physiological CSA of the FDB correlated positively with TFS-4-toes (r=0.536), but not with TFS-5-toes (r=0.333). [Conclusion] Our results indicate that physiological CSA of the FDB is moderately associated with TFS-4-toes while toe flexor strength correlates with walking performance. PMID:26957721

  4. Arm-cycling sprints induce neuromuscular fatigue of the elbow flexors and alter corticospinal excitability of the biceps brachii.

    PubMed

    Pearcey, Gregory E P; Bradbury-Squires, David J; Monks, Michael; Philpott, Devin; Power, Kevin E; Button, Duane C

    2016-02-01

    We examined the effects of arm-cycling sprints on maximal voluntary elbow flexion and corticospinal excitability of the biceps brachii. Recreationally trained athletes performed ten 10-s arm-cycling sprints interspersed with 150 s of rest in 2 separate experiments. In experiment A (n = 12), maximal voluntary contraction (MVC) force of the elbow flexors was measured at pre-sprint 1, post-sprint 5, and post-sprint 10. Participants received electrical motor point stimulation during and following the elbow flexor MVCs to estimate voluntary activation (VA). In experiment B (n = 7 participants from experiment A), supraspinal and spinal excitability of the biceps brachii were measured via transcranial magnetic and transmastoid electrical stimulation that produced motor evoked potentials (MEPs) and cervicomedullary motor evoked potentials (CMEPs), respectively, during a 5% isometric MVC at pre-sprint 1, post-sprint 1, post-sprint 5, and post-sprint 10. In experiment A, mean power output, MVC force, potentiated twitch force, and VA decreased 13.1% (p < 0.001), 8.7% (p = 0.036), 27.6% (p = 0.003), and 5.6% (p = 0.037), respectively, from pre-sprint 1 to post-sprint 10. In experiment B, (i) MEPs decreased 42.1% (p = 0.002) from pre-sprint 1 to post-sprint 5 and increased 40.1% (p = 0.038) from post-sprint 5 to post-sprint 10 and (ii) CMEPs increased 28.5% (p = 0.045) from post-sprint 1 to post-sprint 10. Overall, arm-cycling sprints caused neuromuscular fatigue of the elbow flexors, which corresponded with decreased supraspinal and increased spinal excitability of the biceps brachii. The different post-sprint effects on supraspinal and spinal excitability may illustrate an inhibitory effect on supraspinal drive that reduces motor output and, therefore, decreases arm-cycling sprint performance. PMID:26799694

  5. Innervation pattern of a pool of nine excitatory motor neurons in the flexor tibiae muscle of a locust hind leg

    PubMed

    Sasaki; Burrows

    1998-05-21

    The flexor tibiae muscle of a locust hind leg consists of 10-11 pairs of fibre bundles in the main body of the muscle and a distal pair of bundles that form the accessory flexor muscle, all of which insert onto a common tendon. It is much smaller than the antagonistic extensor tibiae muscle and yet it is innervated by nine excitatory motor neurons, compared with only two for the extensor. To determine the pattern of innervation within the muscle by individual motor neurons, branches of the nerve (N5B2) that supplies the different muscle bundles were backfilled to reveal somata in the metathoracic ganglion. This showed that different muscle bundles are innervated by different numbers of excitatory motor neurons. Physiological mapping of the innervation was then carried out by intracellular recordings from the somata of flexor motor neurons in the metathoracic ganglion using microelectrodes. Spikes were evoked in these neurons by the injection of current, and matching junctional potentials were sought in fibres throughout the muscle using a second intracellular electrode. Each motor neuron innervates only a restricted array of muscle fibres and, although some innervate a larger array than others, none innervates fibres throughout the muscle. Some motor neurons innervate only proximal fibres and others only more distal fibres, so that the most proximal and most distal bundles of muscle fibres are innervated by non-overlapping sets of motor neurons. More motor neurons innervate proximal bundles than distal ones, and there are some asymmetries in the number of motor neurons innervating corresponding bundles on either side of the tendon. Individual motor neurons cause slow, fast or intermediate movements of the tibia, but their patterns of innervation overlap in the different muscle bundles. Furthermore, individual muscle fibres may also be innervated by motor neurons with different properties. PMID:9600870

  6. Subtalar arthrodesis with flexor digitorum longus transfer and spring ligament repair for treatment of posterior tibial tendon insufficiency.

    PubMed

    Johnson, J E; Cohen, B E; DiGiovanni, B F; Lamdan, R

    2000-09-01

    The surgical treatment of flexible pes planovalgus deformities resulting from Stage 2 posterior tibial tendon insufficiency is controversial and many techniques have been proposed. We retrospectively reviewed the results of subtalar arthrodesis combined with spring ligament repair/reefing and flexor digitorum longus (FDL) transfer to the navicular. There were sixteen patients (seventeen feet) with an average follow-up of 27 months (9-52). All deformities were passively correctable. The average age was 56 yrs (39-78). All patients had failed conservative management, 88% had previously been treated with orthotics, and 53% had lateral pain from subfibular impingement. Two patients were noted to have degenerative changes of the subtalar joint. Successful subtalar joint fusion occurred in all patients with an average time to radiographic union of 10.1 weeks (5-24). The average AOFAS hindfoot score and Maryland foot score postoperatively was 82 and 86 respectively. Standing radiographic analysis demonstrated an average improvement in the AP talo-1st metatarsal angle of 6 degrees (24 degrees preoperative, 18 degrees postoperative). The talonavicular coverage angle improved an average of 17 degrees (34 degrees preoperative, 17 degrees postoperative). The lateral talo-1st metatarsal angle improved an average of 10 degrees (18 degrees preoperative, 8 degrees postoperative). The lateral talocalcaneal angle decreased an average of 21o (55 degrees preoperative, 34 degrees postoperative). The distance of the medial cuneiform to the floor on the lateral radiograph averaged 12mm preoperatively and 18mm postoperatively (avg. improvement 6mm). The combination of the flexor digitorum longus tendon transfer and spring ligament repair with subtalar arthrodesis is an effective and reliable procedure which provides excellent correction of hindfoot valgus as well as forefoot abduction and restoration of the height of the longitudinal arch. These results compare favorably with flexor

  7. Assessing Finger Joint Biomechanics by Applying Equal Force to Flexor Tendons In Vitro Using a Novel Simultaneous Approach

    PubMed Central

    Yang, Tai-Hua; Lu, Szu-Ching; Lin, Wei-Jr; Zhao, Kristin; Zhao, Chunfeng; An, Kai-Nan; Jou, I-Ming; Lee, Pei-Yuan

    2016-01-01

    Background The flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) are critical for finger flexion. Although research has recently focused on these tendons’ coactivity, their contributions in different tasks remain unclear. This study created a novel simultaneous approach to investigate the coactivity between the tendons and to clarify their contributions in different tasks. Methods Ten human cadaveric hands were mounted on our custom frame with the FDS and FDP of the third finger looped through a mechanical pulley connected to a force transducer. Joint range of motion, tendon excursion and loading force were recorded during individual joint motion and free joint movement from rest to maximal flexion. Each flexor tendon’s moment arm was then calculated. Results In individual motions, we found that the FDP contributed more than the FDS in proximal interphalangeal (PIP) joint motion, with an overall slope of 1.34 and all FDP-to-FDS excursion (P/S) ratios greater than 1.0 with force increase. However, the FDP contributed less than the FDS in metacarpophalangeal (MCP) joint motion, with an overall slope of 0.95 and P/S ratios smaller than 1.0 throughout the whole motion except between 1.9% and 13.1% force. In free joint movement, the FDP played a greater role than the FDS, with an overall ratio of 1.37 and all P/S ratios greater than 1.0. Conclusions The new findings include differences in finger performance and excursion amounts between the FDS and FDP throughout flexion. Such findings may provide the basis for new hand models and treatments. PMID:27513744

  8. Cerebral Palsy Tendon Transfers: Flexor Carpi Ulnaris to Extensor Carpi Radialis Brevis and Extensor Pollicis Longus Reroutement.

    PubMed

    Bansal, Anchal; Wall, Lindley B; Goldfarb, Charles A

    2016-08-01

    The flexor carpi ulnaris to extensor carpi radialis brevis transfer and extensor pollicis longus rerouting combined with thenar release are 2 successful surgical interventions for children with spastic cerebral palsy. The goal of both procedures is to improve quality of life for patients who have previously failed conservative management, and the degree of expected improvement is predicated on several patient variables, making careful patient selection crucial for ensuring successful outcomes. Here, surgical technique is described; risk factors are discussed, and outcomes related to both procedures are presented. PMID:27387086

  9. Functional linkages between motor cortical cells and elbow flexor muscles. Evidence for and characteristics of postspike facilitation.

    PubMed

    Fourment, A; Belhaj-Saïf, A; Maton, B

    1995-07-01

    1. Two monkeys (Macaca fascicularis) making high-level but submaximal isometric flexions of the elbow were investigated for the output effect of motor cortical cells on the electromyogram (EMG) activity of two main elbow flexors using the method of spike-triggered averaging of rectified EMGs (STAs). 2. Monkeys were trained to perform individual isometric contractions for > 2 s, and two series of > or = 20 contractions, the second series being at a greater force. EMG electrodes pairs were implanted in the biceps brachii and brachioradialis. A total of 257 cortical cells were found that discharged with the active and passive movements of the elbow. We examined the EMG postspike facilitations (PSFs) produced in either one or the two flexors for only those cells that discharged during the isometric contraction, and provoked PSFs in the two series of contractions. 3. The main characteristics of the EMG isometric contractions in the agonists were analyzed. Spectral analysis showed that the increases in the EMG median frequency with force stabilized at the force levels performed by monkeys. Cross correlation methods showed no cross talk between agonists. 4. The 26 selected cortical cells had a regular discharge frequency. Ten cells did not change frequency with a 22-30% force increase, 14 cells discharged at a higher frequency, and 2 cells discharged at a lower frequency. For single-cell frequencies of 5-65 Hz, interspike intervals < 10 ms were rare: the median and modal intervals were 20-30 ms. 5. The significance of PSFs with respect to the EMG background noise was estimated statistically. STAs from successive epochs under identical load conditions, and STAs performed at a distance from the trigger, showed that PSFs were authentic postspike effects and not sudden EMG changes synchronized by chance with the triggering cell. The features distinguishing PSF from secondary postspike EMG changes or coactivation and task-related effects were studied in simultaneous STAs of

  10. Efficiency of Hyaloglide in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: a randomized, controlled, multicentre clinical trial.

    PubMed

    Riccio, M; Battiston, B; Pajardi, G; Corradi, M; Passaretti, U; Atzei, A; Altissimi, M; Vaienti, L; Catalano, F; Del Bene, M; Fasolo, P; Ceruso, M; Luchetti, R; Landi, A

    2010-02-01

    Hyaloglide is a hyaluronan-based gel based on a novel auto-crosslinked technology designed to reduce postsurgical adhesions. Its efficacy was assessed in a multicentred randomized controlled trial comparing the results of flexor tenolysis in zone 2 following failed flexor tendon repairs. In the control group a standard release was performed. In the treated group, Hyaloglide was applied into the flexor sheath and around the site of tenolysis. Forty-five patients, 19 controls and 26 treated with Hyaloglide, were enrolled in 13 centres. All the patients were evaluated at 30, 60, 90 and 180 days after surgery by testing Total Active Motion, Quick-DASH questionnaire and number of working days lost after surgery. Patients in the Hyaloglide group had a statistically better recovery of finger motion at all time intervals and returned earlier to work and daily activities. The use of Hyaloglide did not appear to increase the complication rate. PMID:19710086

  11. Do rhythms exist in elbow flexor torque, oral temperature and muscle thickness during normal waking hours?

    PubMed

    Buckner, Samuel L; Dankel, Scott J; Counts, Brittany R; Barnett, Brian E; Jessee, Matthew B; Mouser, J Grant; Halliday, Tanya M; Loenneke, Jeremy P

    2016-06-01

    The purpose of the current study was to examine the influence of "time" on isometric elbow flexion torque, body temperature and muscle size without interrupting the sleep wake cycle in college aged males. Two hours following the participants normal wake time, oral temperature was measured, followed by muscle thickness of the upper and lower body using ultrasound, as well as elbow flexor torque via a maximal voluntary contraction (MVC). Measurements were repeated every 2h for 12h (Time points 1-7). To examine the repeatability of the rhythm, participants returned and completed the same procedures as before within 14days of their first circadian visit (Circadian visit 2). There was no time×day interaction for body temperature (p=0.29), nor were there main effects for time (p=0.15) or day (p=0.74). For MVC, there was no time×day interaction (p=0.93) or main effect for day (p=0.50), however, there was a main effect for time (p=0.01). MVC at time points 1 (86.4±6.4Nm) and 2 (87.1±6.2Nm) was greater than time points 4 (84.2±6.6Nm) and 6 (83.4±6.8Nm, p<0.05). Additionally, time point 5 MVC was greater than time point 4. For upper body muscle thickness, there was no time×day interaction (p=0.34), nor was there a main effect for day (p=0.38), or time (p=0.06). For lower body muscle thickness, there was no time×day interaction (p=0.57), nor was there a main effect for day (p=0.75), or time (p=0.13). Cosinor analyses revealed no group level rhythms for oral temperature, muscle thickness or strength (p>0.05), however, there were some individual rhythms noted for muscle thickness and strength. Results suggest that, when accounting for an individuals normal wake time, circadian rhythms of strength, temperature and muscle thickness are not apparent in most individuals. PMID:27020314

  12. Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report☆

    PubMed Central

    Gomes Júnior, Nelson Pelozo; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Raduan, Fernando Cipolini; Ejnisman, Benno; Cohen, Moisés

    2015-01-01

    The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome. PMID:26962495

  13. Strength Training for the Intrinsic Flexor Muscles of the Foot: Effects on Muscle Strength, the Foot Arch, and Dynamic Parameters Before and After the Training

    PubMed Central

    Hashimoto, Takayuki; Sakuraba, Keishoku

    2014-01-01

    [Purpose] The purpose of the present study was to verify the effects of intrinsic foot flexor strength training. [Subjects] The subjects were 12 healthy males without motor system disease. [Methods] A training method that involved flexion of all toe interphalangeal and metatarsophalangeal joints against a 3-kg load was implemented and was performed for 200 repetitions once per day, three times per week, for a period of eight weeks. [Results] Significant changes were observed for intrinsic foot flexor strength scores, foot arches, vertical jumping, 1-legged long jumping, and 50-m dash time. [Conclusion] This muscle strength training method significantly improved muscle strength scores, foot arch shape, and movement performance. PMID:24707086

  14. Distinct and developmentally regulated activity-dependent plasticity at descending glutamatergic synapses on flexor and extensor motoneurons

    PubMed Central

    Lenschow, Constanze; Cazalets, Jean-René; Bertrand, Sandrine S.

    2016-01-01

    Activity-dependent synaptic plasticity (ADSP) is paramount to synaptic processing and maturation. However, identifying the ADSP capabilities of the numerous synapses converging onto spinal motoneurons (MNs) remain elusive. Using spinal cord slices from mice at two developmental stages, 1–4 and 8–12 postnatal days (P1–P4; P8–P12), we found that high-frequency stimulation of presumed reticulospinal neuron axons in the ventrolateral funiculus (VLF) induced either an NMDA receptor-dependent-long-term depression (LTD), a short-term depression (STD) or no synaptic modulation in limb MNs. Our study shows that P1–P4 cervical MNs expressed the same plasticity profiles as P8–P12 lumbar MNs rather than P1–P4 lumbar MNs indicating that ADSP expression at VLF-MN synapses is linked to the rostrocaudal development of spinal motor circuitry. Interestingly, we observed that the ADSP expressed at VLF-MN was related to the functional flexor or extensor MN subtype. Moreover, heterosynaptic plasticity was triggered in MNs by VLF axon tetanisation at neighbouring synapses not directly involved in the plasticity induction. ADSP at VLF-MN synapses specify differential integrative synaptic processing by flexor and extensor MNs and could contribute to the maturation of spinal motor circuits and developmental acquisition of weight-bearing locomotion. PMID:27329279

  15. Recovery of equine forelimb function after desmotomy of the accessory ligament of the deep digital flexor tendon.

    PubMed

    Savelberg, H H; Buchner, H H; Becker, C K

    1997-05-01

    The recovery process of the equine locomotor system after desmotomy of the accessory ligament of the deep digital flexor tendon (AL-DDFT) was investigated by studying the movement patterns and joint moments in 6 horses before and 10 days and 6 months following surgery. Using a modified CODA-3 system the joint angles and angular velocities of the lower limb were assessed in the operated forelimb as before the operation. Simultaneously ground reaction forces were measured and joint moments calculated. At 10 days and 6 months after the operation the carpal joint started to bend earlier in the stance phase. At that instant, the fetlock joint was more extended and displayed a higher angular velocity. The moment of the coffin joint was significantly decreased 10 days after desmotomy. After 6 months it had recovered considerably, but still the shape of the curve was significantly different compared to that before the operation. The fetlock joint moment was not affected, but turned out to be generated for a greater part by the suspensory ligament and the superficial digital flexor 10 days after the operation. Further analysis of these results showed that 6 months after the desmotomy the locomotor system was able to cope with almost similar external moments. To accomplish this, it had adopted a new co-ordination pattern during the recovery process. PMID:9354283

  16. Isolated flexor digitorum profundus tendon injuries in zones IIA and IIB repaired with figure of eight sutures.

    PubMed

    Al-Qattan, M M

    2011-02-01

    The 'figure of eight' suture technique for flexor tendon repair is known to be simple and strong but it has the major disadvantage of being bulky, with the knots outside the repair site. When the superficialis tendon is intact it may cause impingement and/or increase the work of flexion with postoperative mobilization and it is not known whether this bulky repair is suitable for isolated profundus injuries in zone II. A series of 36 patients (36 fingers) with clean-cut isolated flexor digitorum profundus tendon injuries in zones IIA/IIB were reviewed retrospectively. Repairs were done with three 'figure of eight' sutures and the pulleys proximal to the tendon laceration level were vented. Postoperatively, early active exercises were carried out. There were no ruptures. At a mean final follow-up of 6 months, the outcome (in range of motion) was excellent in 27 fingers and good in the remaining nine fingers by the Strickland criteria. It was concluded that the bulky 'figure of eight' technique can be used in isolated profundus tendon injuries in zones IIA/IIB. PMID:21045020

  17. Biomechanical and Electromyographic Comparisons of Isometric Trunk Flexor Endurance Test Postures: Prone Plank Versus V-Sit.

    PubMed

    Musalem, Lindsay L; Stankovic, Tatjana; Glisic, Drazen; Cook, Gillian E; Beach, Tyson A

    2015-12-01

    The objective of this study was to investigate why holding times on 2 different tests of isometric trunk flexor endurance capacity (prone plank and v-sit) are weakly correlated. Body position and ground reaction force data from 10 men and 10 women were used to conduct static biomechanical analyses of both test postures, and bilateral activations of the rectus abdominis, internal and external obliques, latissimus dorsi, and lumbar and thoracic erector spinae were measured in a second sample of 15 men and 15 women while holding the test postures. No between-posture differences in net low back flexor moments were found (P = .111), but the lumbar spine was 28° more flexed in the v-sit than in the plank (P < .001). No between-posture differences were detected in the rectus abdominis (P = .397), external obliques (P = .204), internal obliques (P = .226), or lumbar erector spinae (P = .116) activation levels, but those of the thoracic erector spinae (P = .0253) and latissimus dorsi (P < .001) were greater in the plank than in the v-sit. Altogether, the findings suggest that differences between plank and v-sit holding times are most likely related to between-test differences in lumbar spine postures and shoulder demands. PMID:26252077

  18. Bundles of Spider Silk, Braided into Sutures, Resist Basic Cyclic Tests: Potential Use for Flexor Tendon Repair

    PubMed Central

    Hennecke, Kathleen; Redeker, Joern; Kuhbier, Joern W.; Strauss, Sarah; Allmeling, Christina; Kasper, Cornelia; Reimers, Kerstin; Vogt, Peter M.

    2013-01-01

    Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials. PMID:23613793

  19. The effects of 5-HT on sensory, central and motor neurons driving the abdominal superficial flexor muscles in the crayfish.

    PubMed

    Strawn, J R; Neckameyer, W S; Cooper, R L

    2000-12-01

    Serotonin (5-HT) induces a variety of physiological and behavioral effects in crustaceans. However, the mechanisms employed by 5-HT to effect behavioral changes are not fully understood. Among the mechanisms by which these changes might occur are alterations in synaptic drive and efficacy of sensory, interneurons and motor neurons, as well as direct effects on muscles. We investigated these aspects with the use of a defined sensory-motor system, which is entirely contained within a single abdominal segment and consists of a 'cuticular sensory neurons segmental ganglia abdominal superficial flexor motor neurons-muscles' circuit. Our studies address the role of 5-HT in altering (1) the activity of motor neurons induced by sensory stimulation; (2) the inherent excitability of superficial flexor motor neurons; (3) transmitter release properties of the motor nerve terminal and (4) input resistance of the muscle. Using en passant recordings from the motor nerve, with and without sensory stimulation, and intracellular recordings from the muscle, we show that 5-HT enhances sensory drive and output from the ventral nerve cord resulting in an increase in the firing frequency of the motor neurons. Also, 5-HT increases transmitter release at the neuromuscular junction, and alters input resistance of the muscle fibers. PMID:11281271

  20. Effects of 4 Weeks of Explosive-type Strength Training for the Plantar Flexors on the Rate of Torque Development and Postural Stability in Elderly Individuals.

    PubMed

    Kobayashi, Y; Ueyasu, Y; Yamashita, Y; Akagi, R

    2016-06-01

    This study aimed to investigate the effect of a 4-week explosive-type strength training program for the plantar flexors on the rate of torque development and postural stability. The participants were 56 elderly men and women divided into training (17 men and 15 women) and control (14 men and 10 women) groups. The participants in the training group underwent explosive-type strength training of the plantar flexors 2 days per week for 4 weeks. Training consisted of 3 sets of 10 repetitions of explosive plantar flexion lasting less than 1 s. The following parameters were determined: muscle volume of the plantar flexors estimated by the muscle thickness and lower leg length, maximal voluntary contraction torque and rate of torque development of plantar flexion, and one-leg standing ability. The training increased the maximal voluntary contraction torque and rate of torque development, but corresponding increases in muscle volume and one-leg standing ability were not found. These results suggest that, for elderly individuals, the 4-week explosive-type strength training of the plantar flexors is effective for increasing the maximal voluntary contraction torque and rate of torque development of plantar flexion but is not effective for improving postural stability. PMID:26990722

  1. Flexor Carpi Radialis to Palmaris Longus Tendon Transfer for Spontaneous Rupture of the Flexor Carpi Radialis Tendon-A Review of an Uncommon Finding and Surgical Technique for Operative Correction.

    PubMed

    Shearin, Jonathan Winkworth; Walters, Brian; Yang, S Steven

    2016-10-01

    Spontaneous ruptures of the flexor carpi radialis tendon (FCR) are rare and associated with systemic inflammatory diseases, localized tendinopathy related to scaphotrapezial-trapezoidal arthritis, or chronic immunosuppression from corticosteroids. While most cases do not require operative intervention, some patients develop weakness, impaired range of motion, and persistent pain. Previously reported surgical options include synovectomy, tendon stump resection, and osteophyte removal. We describe a surgical technique for patients with persistent symptomatology following FCR rupture in which the FCR is transposed end-to-side to the palmaris longus tendon. Three cases using this technique are presented with follow-up of 4-9 months that were collected at Lenox Hill Hospital. All three patients did well regarding specific outcome measures: grip strength, range of motion, and functional activity. FCR transfer to palmaris is an alternative to other surgical options for the spontaneous rupture of the FCR tendon in patients who remain symptomatic despite a course of non-operative therapy. PMID:27595965

  2. PXL01 in Sodium Hyaluronate for Improvement of Hand Recovery after Flexor Tendon Repair Surgery: Randomized Controlled Trial

    PubMed Central

    Wiig, Monica E.; Dahlin, Lars B.; Fridén, Jan; Hagberg, Lars; Larsen, Sören E.; Wiklund, Kerstin; Mahlapuu, Margit

    2014-01-01

    Background Postoperative adhesions constitute a substantial clinical problem in hand surgery. Fexor tendon injury and repair result in adhesion formation around the tendon, which restricts the gliding function of the tendon, leading to decreased digit mobility and impaired hand recovery. This study evaluated the efficacy and safety of the peptide PXL01 in preventing adhesions, and correspondingly improving hand function, in flexor tendon repair surgery. Methods This prospective, randomised, double-blind trial included 138 patients admitted for flexor tendon repair surgery. PXL01 in carrier sodium hyaluronate or placebo was administered around the repaired tendon. Efficacy was assessed by total active motion of the injured finger, tip-to-crease distance, sensory function, tenolysis rate and grip strength, and safety parameters were followed, for 12 months post-surgery. Results The most pronounced difference between the treatment groups was observed at 6 months post-surgery. At this timepoint, the total active motion of the distal finger joint was improved in the PXL01 group (60 vs. 41 degrees for PXL01 vs. placebo group, p = 0.016 in PPAS). The proportion of patients with excellent/good digit mobility was higher in the PXL01 group (61% vs. 38%, p = 0.0499 in PPAS). Consistently, the PXL01 group presented improved tip-to-crease distance (5.0 vs. 15.5 mm for PXL01 vs. placebo group, p = 0.048 in PPAS). Sensory evaluation showed that more patients in the PXL01 group felt the thinnest monofilaments (FAS: 74% vs. 35%, p = 0.021; PPAS: 76% vs. 35%, p = 0.016). At 12 months post-surgery, more patients in the placebo group were considered to benefit from tenolysis (30% vs. 12%, p = 0.086 in PPAS). The treatment was safe, well tolerated, and did not increase the rate of tendon rupture. Conclusions Treatment with PXL01 in sodium hyaluronate improves hand recovery after flexor tendon repair surgery. Further clinical trials are warranted to determine the

  3. Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm – A Case Report

    PubMed Central

    Nayak, Satheesha B; Shetty, Prakashchandra; Maloor, Prasad A; Dsouza, Melanie R

    2016-01-01

    Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis. PMID:27042440

  4. Absence of Flexor Carpi Radialis during an Elective Carpometacarpal Arthroplasty of the Thumb: A Rare Anatomical Variation

    PubMed Central

    Riaz, Muhammad

    2016-01-01

    Purpose. We present an extremely rare anatomical variation of unilateral flexor carpi radialis (FCR) absence. This rare anatomical variation posed a clinical dilemma to us and we highlight the importance of the surgeon being aware of this anatomical variation of an important structure both as a reconstruction tool and as an anatomical landmark. Methods. This anatomical variation of the unilaterally absent FCR was found upon dissection during a carpometacarpal arthroplasty of the thumb. Results. Upon the discovery of an absent FCR tendon, we proceeded with a simple trapeziectomy. Conclusions. We present an extremely rare anatomical variation of unilateral FCR absence. This rare anatomical variation may pose clinical dilemmas to the operating surgeon who aims to utilise the FCR either for tendon transfer, for tendon graft, or, as seen in our case, in the reconstruction of a carpometacarpal excision at the thumb. We highlight this diagnosis of suspicion, which may influence the clinical procedure. PMID:27051425

  5. In vivo measurements of flexor tendon and suspensory ligament forces during trotting using the thoroughbred forelimb model.

    PubMed

    Takahashi, Toshiyuki; Mukai, Kazutaka; Ohmura, Hajime; Aida, Hiroko; Hiraga, Atsushi

    2014-01-01

    The purpose of this study was to create a lower forelimb model of the Thoroughbred horse for measuring the force in the superficial and deep digital flexor tendons (SDFT and DDFT), and the suspensory ligament (SL) during a trot. The mass, centers of gravity, and inertial moments in the metacarpus, pastern, and hoof segments were measured in 4 Thoroughbred horses. The moment arms of the SDFT, DDFT, and SL in the metacarpophalangeal (fetlock) and distal interphalangeal (coffin) joints were measured in 7 Thoroughbred horses. The relationship between the fetlock joint angle and the force in the SL was assessed in 3 limbs of 2 Thoroughbred horses. The forces in the SDFT, DDFT, and SL during a trot were also measured in 7 Thoroughbred horses. The mass of the 3 segments, and the moment arms of the SDFT and DDFT in the fetlock joint of the Thoroughbred horses were smaller than those of the Warmblood horses, whereas the other values were almost the same in the 2 types. The calculated force in the SDFT with this Thoroughbred model reached a peak (4,615 N) at 39.3% of the stance phase, whereas that in the DDFT reached a peak (5,076 N) at 51.2% of the stance phase. The force in the SL reached a peak (11,957 N) at 49.4% of the stance phase. This lower forelimb model of the Thoroughbred can be applied to studying the effects of different shoe types and change of hoof angle for the flexor tendon and SL forces. PMID:24834009

  6. Analysis of the gliding pattern of the canine flexor digitorum profundus tendon through the A2 pulley.

    PubMed

    Uchiyama, Shigeharu; Amadio, Peter C; Berglund, Lawrence J; An, Kai-Nan

    2008-01-01

    Friction between a tendon and its pulley was first quantified using the concept of the arc of contact. Studies of human tendons conformed closely to a theoretical nylon cable/nylon rod model. However, we observed differences in measured friction that depended on the direction of motion in the canine model. We hypothesized that fibrocartilaginous nodules in the tendon affected the measurements and attempted to develop a theoretical model to explain the observations we made. Two force transducers were connected to each end of the canine flexor digitorum profundus tendon and the forces were recorded when it was moved through the A2 pulley toward a direction of flexion by an actuator and then reversed a direction toward extension. The changes of a force as a function of tendon excursion were evaluated in 20 canine paws. A bead cable/rod model was developed to simulate the canine tendon-pulley complex. To interpret the results, a free-body diagram was developed. The two prominent fibrocartilaginous nodules in the tendon were found to be responsible for deviation from a theoretical nylon cable gliding around the rod model, in a fashion analogous to the effect of the patella on the quadriceps mechanism. A bead cable/rod model qualitatively reproduced the findings observed in the canine tendon-pulley complex. Frictional coefficient of the canine flexor tendon-pulley was 0.016+/-0.005. After accounting for the effect created by the geometry of two fibrocartilaginous nodules within the tendon, calculation of frictional force in the canine tendon was possible. PMID:18328488

  7. Frequency dependence of power and its implications for contractile function of muscle fibers from the digital flexors of horses

    PubMed Central

    Butcher, Michael T.; Bertram, John E.A.; Syme, Douglas A.; Hermanson, John W.; Chase, P. Bryant

    2014-01-01

    Abstract The digital flexors of horses must produce high force to support the body weight during running, and a need for these muscles to generate power is likely limited during locomotion over level ground. Measurements of power output from horse muscle fibers close to physiological temperatures, and when cyclic strain is imposed, will help to better understand the in vivo performance of the muscles as power absorbers and generators. Skinned fibers from the deep (DDF) and superficial (SDF) digital flexors, and the soleus (SOL) underwent sinusoidal oscillations in length over a range of frequencies (0.5–16 Hz) and strain amplitudes (0.01–0.06) under maximum activation (pCa 5) at 30°C. Results were analyzed using both workloop and Nyquist plot analyses to determine the ability of the fibers to absorb or generate power and the frequency dependence of those abilities. Power absorption was dominant at most cycling frequencies and strain amplitudes in fibers from all three muscles. However, small amounts of power were generated (0.002–0.05 Wkg−1) at 0.01 strain by all three muscles at relatively slow cycling frequencies: DDF (4–7 Hz), SDF (4–5 Hz) and SOL (0.5–1 Hz). Nyquist analysis, reflecting the influence of cross‐bridge kinetics on power generation, corroborated these results. The similar capacity for power generation by DDF and SDF versus lower for SOL, and the faster frequency at which this power was realized in DDF and SDF fibers, are largely explained by the fast myosin heavy chain isoform content in each muscle. Contractile function of DDF and SDF as power absorbers and generators, respectively, during locomotion may therefore be more dependent on their fiber architectural arrangement than on the physiological properties of their muscle fibers. PMID:25293602

  8. Specific modulation of spinal and cortical excitabilities during lengthening and shortening submaximal and maximal contractions in plantar flexor muscles.

    PubMed

    Duclay, Julien; Pasquet, Benjamin; Martin, Alain; Duchateau, Jacques

    2014-12-15

    This study investigated the influence of the torque produced by plantar flexor muscles on cortical and spinal excitability during lengthening and shortening voluntary contractions. To that purpose, modulations of motor-evoked potential (MEP) and Hoffmann (H) reflex were compared in the soleus (SOL) and medial gastrocnemius (MG) during anisometric submaximal and maximal voluntary contraction (MVC) of the plantar flexor muscles. For the submaximal shortening and lengthening contractions, the target torque was set at 50% of their respective MVC force. The results indicate that the amplitudes of both MEP and H-reflex responses, normalized to the maximal M wave, were significantly (P < 0.05) lower during lengthening compared with shortening submaximal contraction. For these two parameters, the reduction reached, respectively, 22.1 and 31.9% for the SOL and 34.5 and 29.3% for the MG. During MVC, normalized MEP and H reflex of the SOL were both reduced significantly by 19.9% (P < 0.05) and 29.9% (P < 0.001) during lengthening and shortening contraction, respectively, whereas no significant change (P > 0.05) was observed for MG. In addition, the silent period in the ongoing electromyogram (EMG) activity following the MEP was significantly (P < 0.01) briefer during lengthening than shortening contractions but did not differ (P > 0.05) between contraction intensities and muscles. Together, these results indicate that cortical and spinal mechanisms involved in the modulation of muscle activation during shortening and lengthening contractions differ between synergistic muscles according to the torque produced. Data further document previous studies reporting that the specific modulation of muscle activation during lengthening contraction is not torque dependent. PMID:25324516

  9. Frequency dependence of power and its implications for contractile function of muscle fibers from the digital flexors of horses.

    PubMed

    Butcher, Michael T; Bertram, John E A; Syme, Douglas A; Hermanson, John W; Chase, P Bryant

    2014-10-01

    The digital flexors of horses must produce high force to support the body weight during running, and a need for these muscles to generate power is likely limited during locomotion over level ground. Measurements of power output from horse muscle fibers close to physiological temperatures, and when cyclic strain is imposed, will help to better understand the in vivo performance of the muscles as power absorbers and generators. Skinned fibers from the deep (DDF) and superficial (SDF) digital flexors, and the soleus (SOL) underwent sinusoidal oscillations in length over a range of frequencies (0.5-16 Hz) and strain amplitudes (0.01-0.06) under maximum activation (pCa 5) at 30°C. Results were analyzed using both workloop and Nyquist plot analyses to determine the ability of the fibers to absorb or generate power and the frequency dependence of those abilities. Power absorption was dominant at most cycling frequencies and strain amplitudes in fibers from all three muscles. However, small amounts of power were generated (0.002-0.05 Wkg(-1)) at 0.01 strain by all three muscles at relatively slow cycling frequencies: DDF (4-7 Hz), SDF (4-5 Hz) and SOL (0.5-1 Hz). Nyquist analysis, reflecting the influence of cross-bridge kinetics on power generation, corroborated these results. The similar capacity for power generation by DDF and SDF versus lower for SOL, and the faster frequency at which this power was realized in DDF and SDF fibers, are largely explained by the fast myosin heavy chain isoform content in each muscle. Contractile function of DDF and SDF as power absorbers and generators, respectively, during locomotion may therefore be more dependent on their fiber architectural arrangement than on the physiological properties of their muscle fibers. PMID:25293602

  10. Isokinetic assessment of the flexor-extensor balance of the knee in athletes with total rupture of the anterior cruciate ligament.

    PubMed

    Terreri, A S; Ambrósio, M A; Pedrinelli, A; Albuquerque, R F; Andrusaitis, F; Greve, J M; Carazzato, J G; Amatuzzi, M M

    1999-01-01

    The purpose of this study was to assess the flexor-extensor group of muscles of the knee in young athletes diagnosed with a total rupture of the anterior cruciate ligament (ACL). Eighteen knees of 18 athletes (14 men and 4 women) with an average age of 21.6 years (range 16-32 years) were assessed with a Cybex 6000 model isokinetic apparatus. The average internal between occurrence of the injury and assessment was 10.2 months (range 2-48 months). There was an associated meniscal injury in eight of the knees. Athletes with any other kind of associated injury, limitation, or blockage of the movement of the joint, significant pain during the exam, or interval between injury and exam of less than two months were excluded from the study. The parameters studied were the peak torque-velocity and flexor-extensor relationships at the constant angular velocities of 60 degrees/sec and 240 degrees/sec. Previous warming-up was done by means of an ergometric bicycle and adaptation with 3 submaximal repetitions. The contra-lateral side, which presented no injury, was used as control. Peak torque (PT) at the constant velocity of 60 degrees/sec was greater than that at 240 degrees/sec for knees with and without injuries. However, there was no significant difference between the injured and uninjured sides at 60 degrees/sec or at 240 degrees/sec. The average value for the flexor-extensor relationship at 60 degrees/sec on the injured was 60% ((6), compared to 57% ((10) on the contra-lateral side. At 240 degrees/sec, the average value was 75% ((10) on the injured side, and 65% ((12) on the contra-lateral side. In conclusion, despite the complete rupture of the ACL of one knee, the average values for the flexor-extensor relationship were similar on the injured and uninjured sides at the velocity of 60 degrees/sec. As the velocity increased, an increase in the values for the flexor-extensor relationship of the knee also occurred, indicating a tendency of the performance of the flexor

  11. Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs--an in vitro biomechanical study.

    PubMed

    McDonald, E; Gordon, J A; Buckley, J M; Gordon, L

    2013-05-01

    Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength. PMID:22745156

  12. Effects of ankle plantar flexors stretching with closed kinetic chain on pelvic movements and gait speed in hemiplegia patients: a case study

    PubMed Central

    Moon, Sang-Hyun; Boo, Jung-A; Park, Si-Eun

    2016-01-01

    [Purpose] The purpose of this study was to identify the effects of ankle plantar flexors stretching with closed kinetic chain (CKC) in hemiplegia patients. [Methods] This study used a reversal design (A-B-A’) for a stroke with hemiplagia. The intervention program consisted of 30 min sessions, once a day, for 15 days. The subjects were trained for 15 sessions in total. Pelvic movements (anterior ·posterior tilting, elevation, depression, forward·backward rotation) during walking and gait speed were measured in hemiplegia patients. [Results] Overall, the angle of pelvic movements was increased in Treatment and, Baseline II compared with Baseline I. The gait speed was maximally increased in Baseline II, followed by Treatment and Baseline I. [Conclusion] These results suggest that ankle plantar flexors stretching with closed kinetic chain had a positive effect on pelvic movements and gait speed in hemiplegia patients. Also, after treatment, its effect on gait of hemiplegia patients was maintained. PMID:26957780

  13. Evaluation of the peak torque, total work, average power of flexor-estensor and prono-supinator muscles of the elbow in baseball players.

    PubMed

    Costantino, Cosimo; Vaienti, Enrico; Pogliacomi, Francesco

    2003-08-01

    The Authors, after a short analysis on biomechanics of the elbow during throwing in baseball, show the movements of the elbow during the different phases of the throw and the stabilizing action of the ulnar collateral ligament, flexor-pronator muscles of the wrist, anconeus and brachial triceps muscles. Aim of this study is the evaluation of the peak torque, total work and average power of the flexor-extensor and pronator-supinator muscles of the elbows in professional baseball players. Isokinetic test data show that a mayor peak torque in flexo-extension at power and resistance test in the pitchers compared to the strikers. Whereas the strikers show a higher peak torque in pronation at the resistance test. This may happen because during a baseball match the ball is hit many times by the bat and the pronator muscle of the wrist are notably stimulated and reinforced. PMID:14509917

  14. Effect of pre-exercise phototherapy applied with different cluster probe sizes on elbow flexor muscle fatigue.

    PubMed

    Rossato, Mateus; Dellagrana, Rodolfo A; Lanferdini, Fábio J; Sakugawa, Raphael L; Lazzari, Caetano D; Baroni, Bruno M; Diefenthaeler, Fernando

    2016-08-01

    Phototherapy has been used for reducing muscle fatigue. In view of the various types of phototherapy cluster probes available in the market, the purpose of this study was to compare the effects of a similar phototherapy dosage with two different cluster probes on elbow flexor muscle fatigue: small cluster probe (SC = 9 diodes; 7.5 cm(2)) vs. large cluster probe (LC = 33 diodes; 30.2 cm(2)). Ten physically active male aged 18-35 years participate in a randomized, crossover, double-blind, placebo-controlled trial, which each participant was submitted to the same testing protocol in four sessions (separated by at least 48 h) with different treatments: LC-phototherapy, SC-phototherapy, LC-placebo, and SC-placebo. The elbow flexion maximal isometric voluntary contraction (MIVC) was performed before and after a fatigue protocol (60 % of MIVC until exhaustion). Electromyography (EMG) of the biceps brachii muscle was collected during all testing procedure. Phototherapy with dose of 60 J per muscle [LC: 33 diodes = 5 lasers (850 nm), 12 LEDs (670 nm), 8 LEDs (880 nm), and 8 LEDs (950 nm); SC: 9 diodes = 5 lasers (850 nm) and 4 LEDs (670 nm)] or placebo applications occurred before fatigue protocol. Two-way ANOVA (treatment and time factors) and one-way ANOVA were used, followed by LSD post hoc. Time to exhaustion was significantly higher in active LC (15 %; p = 0.031) and SC (14 %; p = 0.038) in comparison with their respective placebo treatments, without differences between LC and SC (p > 0.05) or between placebo conditions (p > 0.05). This larger exercise tolerance in phototherapy conditions was not accompanied by a higher decrement in the volunteers' maximal strength capacity (11-15 %; p > 0.05 for all). EMG signals presented no difference between the four condition tested here. In both large and small cluster probes (according parameters tested in this study) led to reduced fatigue in elbow flexor muscles, without

  15. Gene expression analysis of the pleiotropic effects of TGF-β1 in an in vitro model of flexor tendon healing.

    PubMed

    Farhat, Youssef M; Al-Maliki, Alaa A; Chen, Tony; Juneja, Subhash C; Schwarz, Edward M; O'Keefe, Regis J; Awad, Hani A

    2012-01-01

    Flexor tendon injuries are among the most challenging problems for hand surgeons and tissue engineers alike. Not only do flexor tendon injuries heal with poor mechanical strength, they can also form debilitating adhesions that may permanently impair hand function. While TGF-β1 is a necessary factor for regaining tendon strength, it is associated with scar and adhesion formation in the flexor tendons and other tissues as well as fibrotic diseases. The pleiotropic effects of TGF-β1 on tendon cells and tissue have not been characterized in detail. The goal of the present study was to identify the targets through which the effects of TGF-β1 on tendon healing could be altered. To accomplish this, we treated flexor tendon tenocytes cultured in pinned collagen gels with 1, 10 or 100 ng/mL of TGF-β1 and measured gel contraction and gene expression using RT-PCR up to 48 hours after treatment. Specifically, we studied the effects of TGF-β1 on the expression of collagens, fibronectin, proteoglycans, MMPs, MMP inhibitors, and the neotendon transcription factors, Scleraxis and Mohawk. Area contraction of the gels was not dose-dependent with the TGF-β1 concentrations tested. We observed dose-dependent downregulation of MMP-16 (MT3-MMP) and decorin, and upregulation of biglycan, collagen V, collagen XII, PAI-1, Scleraxis, and Mohawk by TGF-β1. Inter-gene analyses were also performed to further characterize the expression of ECM and MMP genes in the tenocyte-seeded collagen gels. These analyses illustrate that TGF-β1 tilts the balance of gene expression in favor of ECM synthesis rather than the matrix-remodeling MMPs, a possible means by which TGF-β1 promotes adhesion formation. PMID:23251524

  16. Anatomical study of the musculus deltoideus and musculus flexor carpi ulnaris in 3 species of wild birds.

    PubMed

    Canova, Marco; Bedoni, Carla; Harper, Valeria; Rambaldi, Anna Maria; Bombardi, Cristiano; Grandis, Annamaria

    2016-01-01

    Given the limited information regarding the anatomy of the thoracic limb in European avian species, we decided to investigate the related muscles in the grey heron (Ardea cinerea), in the eurasian buzzard (Buteo buteo), and in the common kestrel (Falco tinnunculus). Therefore we performed a stratigraphic dissection of the wing in 3 subjects. The pars major and minor of the musculus deltoideus, despite being roughly in line with those reported by other authors in other species, displayed unique features. Concerning the pars propatagialis of the musculus deltoideus, from what was observed in the grey heron, we believe this structure can contribute to maintain the propatagial tension. In this way vibrations of this structure, which could cause diminished lift, are avoided. Moreover the peculiarity evidenced in the distal insertion of the common kestrel could influence the control of the pronation-supination of the wing during hovering. With respect to the musculus flexor carpi ulnaris, we believe the presence of a sesamoid-like structure at the base tendon, found in the grey heron and in the eurasian buzzard, may help complete the articular surfaces of the elbow. This study shows interesting data on species not previously examined and provides a possible functional correlation between the peculiarity observed and the kind of flight of each species. PMID:26681506

  17. In vitro mechanical properties of the accessory ligament of the deep digital flexor tendon in horses in relation to age.

    PubMed

    Becker, C K; Savelberg, H H; Barneveld, A

    1994-11-01

    The material properties of the accessory ligament of the deep digital flexor tendon (AL) of 21 forelimbs from horses between ages one day and 15 years were determined. The force (634-11416 N), failure stress (45-138 N/mm2), failure strain (7-24%) and tangent modulus (33-1639 MPa) are presented in relation to age. Tangent modulus did not indicate changes in elasticity due to age. The results demonstrate that complete ligament failures (CLF) of ALs of older horses (mean 7835 N) occur at lower forces than ALs of young adult horses (mean 8894 N). Sudden decreases, 'dips', in the force-time curves were noticed in ligaments from foals and yearlings and in ligaments from horses > 10 years. They were interpreted as the failure of a number of fibres which either fail at lower forces or are subject to higher forces than the rest. These differences in mechanical properties could be the result of age related differences in the material properties of ALs of older horses similar to alterations in collagenous tissue in other species. When analysing the data of the proximal, middle and distal regions of the ligaments separately, higher strain and elasticity were found in the distal compared to the proximal parts. It is suggested that the clinical occurrence of desmitis of the AL of older horses could be due to fibrillar failure caused by differences in the material properties of the ligaments. PMID:7889918

  18. In vivo tendon forces correlate with activity level and remain bounded: evidence in a rabbit flexor tendon model.

    PubMed

    Malaviya, P; Butler, D L; Korvick, D L; Proch, F S

    1998-11-01

    While some tendons and ligaments in the lower extremity develop peak forces proportional to the intensity of activity (Komi 1990; Komi et al., 1992; Korvick et al., 1996), others maintain a steady force regardless of activity level (Herzog et al., 1993; Prilutsky et al., 1994). Investigators (Biewener et al., 1988; Korvick et al., 1996) have also shown that peak knee and ankle tendon forces approach one-quarter to one-third of ultimate or failure force values. In the rabbit flexor digitorum profundus (FDP) tendon model we tested several hypotheses, chiefly that peak in vivo forces not only increase with increasing activity but do not exceed one-third of their ultimate or failure values. The FDP tendon was instrumented in three animals, and each rabbit subjected to an experimental design involving three activity levels. Peak tensile forces and rates of rise and fall in tendon force increased significantly with increasing activity (p < 0.01). Further, the tendon maintained a non-zero force level throughout all trials. For the most vigorous activity, inclined hopping, tensile forces and stresses were, on average, within 30% of the tendon's ultimate force and stress values, respectively. Such in vivo measurements in different tendon systems should help investigators better understand the recruitment and contribution of important muscle-tendon units to joint stability and gait. PMID:9880061

  19. A novel approach using tendon vibration of the human flexor carpi radialis muscle to study spinal reflexes.

    PubMed

    Tsang, Kenneth; de Bruin, Hubert; Archambeault, Mark

    2008-01-01

    Although most muscle spindle investigations have used the cat model and invasive measurement techniques, several investigators have used microneurography to record from the Ia and II fibres in humans during tendon vibration. In these studies the muscle spindle primary endings are stimulated using transverse vibration of the tendon at reflex sub-threshold amplitudes. Others have used low amplitude vibration and the stretch evoked M-wave response to determine reflex properties during both agonist and antagonist voluntary contractions. In the past we have developed a PC based instrument that uses Labview and a linear servomotor to study tendon reflex properties by recording stretch evoked M-wave responses from single tendon taps or electrical stimuli to the afferent nerve. In this paper we describe a further development of this system to provide precise vibrations of the tendon up to 65 Hz with amplitudes up to 4 mm. The resultant M-wave train is extracted from background noise via phase coherent subtractive filtering. Test results from vibrating the human distal flexor carpi radialis tendon at 10 and 30 Hz, for relaxed, slight flexion and slight extension, are also presented. PMID:19163861

  20. EVALUATION OF THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING FLEXOR TENDONS AND RIGID GUIDE TRANSVERSE SCREW

    PubMed Central

    de Castro, Renato Luiz Bevilacqua; Acras, Sandor Dosa

    2015-01-01

    Objective: The aim of this study was to analyze the results of ACL (anterior cruciate ligament) reconstruction using quadruple flexor tendons as grafts, with ligament fixation in the femur using a rigid guide transverse screw and in the tibia, using a cancellous screw with a fixing washer. Methods: 173 knees (166 from males and seven from females) that had undergone surgery with ACL reconstruction using this technique between December 2002 and February 2007 were evaluated. The mean age was 30 years (from 13 to 56 years), and the mean follow-up time was 30 months (6-55 months). We divided the knees into three groups, which were assessed using the Lysholm scale: Group A with six months of follow-up; Group B with 12 months of follow-up; and Group C with 24 months of follow-up. Results: We evaluated the results, and groups A, B and C received 94, 95 and 95 points respectively on the Lysholm scale. Conclusions: The surgical technique proved to be safe and easy to perform, with good results and a low complication rate. Also, its results were maintained throughout the study period of 24 months. PMID:27027002

  1. Development of antisense oligonucleotide (ASO) technology against Tgf-β signaling to prevent scarring during flexor tendon repair.

    PubMed

    Loiselle, Alayna E; Yukata, Kiminori; Geary, Michael B; Kondabolu, Sirish; Shi, Shanshan; Jonason, Jennifer H; Awad, Hani A; O'Keefe, Regis J

    2015-06-01

    Flexor tendons (FT) in the hand provide near frictionless gliding to facilitate hand function. Upon injury and surgical repair, satisfactory healing is hampered by fibrous adhesions between the tendon and synovial sheath. In the present study we used antisense oligonucleotides (ASOs), specifically targeted to components of Tgf-β signaling, including Tgf-β1, Smad3 and Ctgf, to test the hypothesis that local delivery of ASOs and suppression of Tgf-β1 signaling would enhance murine FT healing by suppressing adhesion formation while maintaining strength. ASOs were injected in to the FT repair site at 2, 6 and 12 days post-surgery. ASO treatment suppressed target gene expression through 21 days. Treatment with Tgf-β1, Smad3 or Ctgf ASOs resulted in significant improvement in tendon gliding function at 14 and 21 days, relative to control. Consistent with a decrease in adhesions, Col3a1 expression was significantly decreased in Tgf-β1, Smad3 and Ctgf ASO treated tendons relative to control. Smad3 ASO treatment enhanced the maximum load at failure of healing tendons at 14 days, relative to control. Taken together, these data support the use of ASO treatment to improve FT repair, and suggest that modulation of the Tgf-β1 signaling pathway can reduce adhesions while maintaining the strength of the repair. PMID:25761254

  2. Development of Antisense Oligonucleotide (ASO) Technology Against Tgf-β Signaling to Prevent Scarring During Flexor Tendon Repair

    PubMed Central

    Loiselle, Alayna E.; Yukata, Kiminori; Geary, Michael B.; Kondabolu, Sirish; Shi, Shanshan; Jonason, Jennifer H.; Awad, Hani A.; O’Keefe, Regis J.

    2015-01-01

    Flexor tendons (FT) in the hand provide near frictionless gliding to facilitate hand function. Upon injury and surgical repair, satisfactory healing is hampered by fibrous adhesions between the tendon and synovial sheath. In the present study we used antisense oligonucleotides (ASOs), specifically targeted to components of Tgf-β signaling, including Tgf-β1, Smad3 and Ctgf, to test the hypothesis that local delivery of ASOs and suppression of Tgf-β1 signaling would enhance murine FT healing by suppressing adhesion formation while maintaining strength. ASOs were injected in to the FT repair site at 2, 6 and 12 days post-surgery. ASO treatment suppressed target gene expression through 21 days. Treatment with Tgf-β1, Smad3 or Ctgf ASOs resulted in significant improvement in tendon gliding function at 14 and 21 days, relative to control. Consistent with a decrease in adhesions, Col3a1 expression was significantly decreased in Tgf-β1, Smad3 and Ctgf ASO treated tendons relative to control. Smad3 ASO treatment enhanced the max load at failure of healing tendons at 14 days, relative to control. Taken together, these data support the use of ASO treatment to improve FT repair, and suggest that modulation of the Tgf-β1 signaling pathway can reduce adhesions while maintaining the strength of the repair. PMID:25761254

  3. The role of human ankle plantar flexor muscle-tendon interaction and architecture in maximal vertical jumping examined in vivo.

    PubMed

    Farris, Dominic James; Lichtwark, Glen A; Brown, Nicholas A T; Cresswell, Andrew G

    2016-02-01

    Humans utilise elastic tendons of lower limb muscles to store and return energy during walking, running and jumping. Anuran and insect species use skeletal structures and/or dynamics in conjunction with similarly compliant structures to amplify muscle power output during jumping. We sought to examine whether human jumpers use similar mechanisms to aid elastic energy usage in the plantar flexor muscles during maximal vertical jumping. Ten male athletes performed maximal vertical squat jumps. Three-dimensional motion capture and a musculoskeletal model were used to determine lower limb kinematics that were combined with ground reaction force data in an inverse dynamics analysis. B-mode ultrasound imaging of the lateral gastrocnemius (GAS) and soleus (SOL) muscles was used to measure muscle fascicle lengths and pennation angles during jumping. Our results highlighted that both GAS and SOL utilised stretch and recoil of their series elastic elements (SEEs) in a catapult-like fashion, which likely serves to maximise ankle joint power. The resistance of supporting of body weight allowed initial stretch of both GAS and SOL SEEs. A proximal-to-distal sequence of joint moments and decreasing effective mechanical advantage early in the extension phase of the jumping movement were observed. This facilitated a further stretch of the SEE of the biarticular GAS and delayed recoil of the SOL SEE. However, effective mechanical advantage did not increase late in the jump to aid recoil of elastic tissues. PMID:26685172

  4. Bilateral Knee Extensor Fatigue Modulates Force and Responsiveness of the Corticospinal Pathway in the Non-fatigued, Dominant Elbow Flexors

    PubMed Central

    Šambaher, Nemanja; Aboodarda, Saied Jalal; Behm, David George

    2016-01-01

    Exercise-induced fatigue affects muscle performance and modulates corticospinal excitability in non-exercised muscles. The purpose of this study was to investigate the effect of bilateral knee extensor fatigue on dominant elbow flexor (EF) maximal voluntary force production and corticospinal excitability. Transcranial magnetic, transmastoid electrical and brachial plexus electrical stimulation (BPES) were used to investigate corticospinal, spinal, and muscle excitability of the dominant EF before and after a bilateral knee extensor fatiguing protocol or time matched rest period (control). For both sessions three stimuli were delivered every 1.5 s during the three pre-test time points and during the 1st, 3rd, 6th, 9th and 12th post-test 5 s EF isometric maximal voluntary contractions (MVC). In both conditions, overall, EF MVC force (p < 0.001) decreased progressively from repetition #1 to #12 during the post-test MVC protocol. EF MVC force (p < 0.001, ES = 0.9, Δ10.3%) decrements were more pronounced in the knee extensor fatigue intervention condition. In addition, there were no significant differences between conditions for biceps brachii electromyographic (EMG) activity (p = 0.43), motor evoked potentials (MEPs) amplitude (p = 0.908) or MEP silent period (SP; p = 0.776). However, the fatigue condition exhibited a lower MEP/cervicomedullary MEP (CMEP) ratio (p = 0.042, ES = 2.5, Δ25%) and a trend toward higher CMEP values (p = 0.08, ES = 0.5, Δ20.4%). These findings suggest that bilateral knee extensor fatigue can impair performance and modulate corticospinal excitability of the EF. PMID:26869902

  5. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons☆

    PubMed Central

    de Souza Leao, Marcos George; Pampolha, Abelardo Gautama Moreira; Orlando Junior, Nilton

    2015-01-01

    Objectives To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. Methods This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. Results From the statistical analysis, it could be seen that the patients’ functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results (p = >0.05), in all the comparisons. Conclusions The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery. PMID:27218084

  6. Gross ultrastructural changes and necrotic fiber segments in elbow flexor muscles after maximal voluntary eccentric action in humans.

    PubMed

    Lauritzen, Fredrik; Paulsen, Gøran; Raastad, Truls; Bergersen, Linda Hildegard; Owe, Simen Gylterud

    2009-12-01

    Eccentric muscle actions are associated with ultrastructural changes. The severity and types of change depend on the nature of the stimulation protocol, and on the method for assessing such changes, and can be regarded as a continuum from mild changes to pathological-like changes. Most studies describing more severe changes have been performed on animals and only a few in humans, some using electrical stimuli. Hence, a debate has emerged on whether voluntary actions are associated with the pathological-like end of the continuum. The aim of this study was to determine whether severe muscle damage, i.e., extensive ultrastructural changes, is confined to animal studies and studies on humans using electrical stimuli. Second, because there is no generally approved method to quantify the degree of muscle damage, we compared two published methods, analyzing the Z disks or sarcomeres, as well as novel analyses of pathological-like changes. A group of untrained subjects performed 70 voluntary maximal eccentric muscle actions using the elbow flexors. On the basis of large reductions in maximal force-generating capacity (on average, -62 +/- 3% immediately after exercise, and -35 +/- 6% 9 days later), five subjects were selected for further analysis. Biopsies were taken from m. biceps brachii in both the exercised and nonexercised arm. In exercised muscle, more disrupted (13 +/- 4 vs. 3 +/- 3%) and destroyed (15 +/- 6 vs. 0%) Z disks were found compared with nonexercised muscle. A significant proportion of exercised myofibers had focal (85 +/- 5 vs. 11 +/- 7%), moderate (65 +/- 7 vs. 11 +/- 6%), and extreme (38 +/- 9 vs. 0%) myofibrillar disruptions. Hypercontracted myofibrils, autophagic vacuoles, granular areas, central nuclei, and necrotic fiber segments were found to various degrees. The present study demonstrates that the more severe end of the continuum of ultrastructural changes occurs in humans after voluntary exercise when maximal eccentric muscle actions are involved

  7. Influence of length-restricted strength training on athlete's power-load curves of knee extensors and flexors.

    PubMed

    Ullrich, Boris; Kleinöder, Heinz; Brüggemann, Gert-Peter

    2010-03-01

    This study investigated whether different length-restricted strength training regimens affect voluntary explosive concentric power-load curves of the quadriceps femoris (QF) and hamstring (HAM) muscles. Thirty-two athletes were divided into 3 different training groups (G1-G3): G1 performed isometric training at knee joint angles corresponding to long muscle-tendon unit (MTU) length for QF and HAM; G2 conducted concentric-eccentric contraction cycles that were restricted to a knee joint range of motion corresponding to predominantly long MTU length for QF and HAM; and G3 combined the protocols of G1 and G2. Knee joint angle-dependent power-load curves during maximal voluntary explosive concentric knee extensions and flexions were measured for loads corresponding to 40, 60, and 80% of individual 1 repetition maximum at 5 different occasions: 2 times before, after 5 and 8 weeks of training, and 4 weeks post training. Power values of each subject were normalized to the largest value produced at any knee joint position (percent maximum). Obtained by curve fitting, the optimal knee joint angle for power production of QF and HAM remained unaltered throughout the course of the study for all testing loads and training groups. Therefore, different strength training regimens with a common restriction to long MTU lengths failed to induce length-dependent alterations in athlete's voluntary concentric power-load curves of knee extensors and flexors. The approach to develop strength training programs that induce systematic shifts in length-dependent power production of QF and HAM is of direct practical relevance for athletic activities such as cycling, ice skating, and skiing. However, restricting the muscle excursion range during loading seems to be an inappropriate trigger to cause length-dependent alterations in athlete's voluntary concentric power-load curves. PMID:20145573

  8. Relative motion between the flexor digitorum superficialis tendon and paratenon in zone V increases with wrist flexion angle.

    PubMed

    Kociolek, Aaron M; Keir, Peter J

    2016-07-01

    Carpal tunnel syndrome is characterized by non-inflammatory fibrosis of the subsynovial connective tissue (SSCT), a paratenon-like structure inside the carpal tunnel. This pathology suggests repetitive and/or excessive shear forces are involved in injury development. We assessed relative motion between the flexor digitorum superficialis (FDS) tendon and adjacent paratenon in Zone V using colour Doppler imaging as 16 healthy participants completed three long finger movements (metacarpophalangeal joint flexion, proximal and distal interphalangeal joint flexion, full finger flexion) in three wrist postures (30° extension, 0°, 30° flexion). While the type of finger movement did not affect tendon-paratenon relative motion, we found a significant main effect of wrist posture (p < 0.001). Relative displacement between the FDS tendon and paratenon (as a percentage of tendon displacement) increased from 27.2% (95%CI = 24.8-29.5%) in 30° wrist extension to 39.9% (95%CI = 37.3-42.4%) in 30° wrist flexion. Optical motion capture confirmed that wrist posture did not affect metacarpophalangeal joint range of motion (p = 0.265) or proximal interphalangeal joint range of motion (p = 0.582). These results indicate that relative motion increased due to paratenon strain when the wrist was flexed. While our findings agree with previous cadaveric research in wrist flexion, we found that relative displacement decreased in 30° wrist extension (compared to 0°). These results differ from cadaveric research, possibly due to challenges maintaining anatomic fidelity of the viscoelastic paratenon tissue in vitro. Overall, our study suggests a greater susceptibility to shear injury during repetitive finger movements, particularly when the wrist is flexed. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1248-1255, 2016. PMID:26686976

  9. Bilateral Knee Extensor Fatigue Modulates Force and Responsiveness of the Corticospinal Pathway in the Non-fatigued, Dominant Elbow Flexors.

    PubMed

    Šambaher, Nemanja; Aboodarda, Saied Jalal; Behm, David George

    2016-01-01

    Exercise-induced fatigue affects muscle performance and modulates corticospinal excitability in non-exercised muscles. The purpose of this study was to investigate the effect of bilateral knee extensor fatigue on dominant elbow flexor (EF) maximal voluntary force production and corticospinal excitability. Transcranial magnetic, transmastoid electrical and brachial plexus electrical stimulation (BPES) were used to investigate corticospinal, spinal, and muscle excitability of the dominant EF before and after a bilateral knee extensor fatiguing protocol or time matched rest period (control). For both sessions three stimuli were delivered every 1.5 s during the three pre-test time points and during the 1st, 3rd, 6th, 9th and 12th post-test 5 s EF isometric maximal voluntary contractions (MVC). In both conditions, overall, EF MVC force (p < 0.001) decreased progressively from repetition #1 to #12 during the post-test MVC protocol. EF MVC force (p < 0.001, ES = 0.9, Δ10.3%) decrements were more pronounced in the knee extensor fatigue intervention condition. In addition, there were no significant differences between conditions for biceps brachii electromyographic (EMG) activity (p = 0.43), motor evoked potentials (MEPs) amplitude (p = 0.908) or MEP silent period (SP; p = 0.776). However, the fatigue condition exhibited a lower MEP/cervicomedullary MEP (CMEP) ratio (p = 0.042, ES = 2.5, Δ25%) and a trend toward higher CMEP values (p = 0.08, ES = 0.5, Δ20.4%). These findings suggest that bilateral knee extensor fatigue can impair performance and modulate corticospinal excitability of the EF. PMID:26869902

  10. Passive and active mechanical properties of the superficial and deep digital flexor muscles in the forelimbs of anesthetized Thoroughbred horses.

    PubMed

    Swanstrom, Michael D; Zarucco, Laura; Stover, Susan M; Hubbard, Mont; Hawkins, David A; Driessen, Bernd; Steffey, Eugene P

    2005-03-01

    The superficial (SDF) and deep digital flexor (DDF) muscles are critical for equine forelimb locomotion. Knowledge of their mechanical properties will enhance our understanding of limb biomechanics. Muscle contractile properties derived from architectural-based algorithms may overestimate real forces and underestimate shortening capacity because of simplistic assumptions regarding muscle architecture. Therefore, passive and active (=total - passive) force-length properties of the SDF and DDF muscles were measured directly in vivo. Muscles from the right forelimbs of four Thoroughbred horses were evaluated during general anesthesia. Limbs were fixed to an external frame with the muscle attached to a linear actuator and load cell. Each muscle was stretched from an unloaded state to a range of prefixed lengths, then stimulated while held at that length. The total force did not exceed 4000 N, the limit for the clamping device. The SDF and DDF muscles produced 716+/-192 and 1577+/-203 N maximum active isometric force (F(max)), had ascending force-length ranges (R(asc)) of 5.1+/-0.2 and 9.1+/-0.4 cm, and had passive stiffnesses of 1186+/-104 and 1132+/-51 N/cm, respectively. The values measured for F(max) were much smaller than predicted based on conservative estimates of muscle specific tension and muscle physiological cross-sectional area. R(asc) were much larger than predicted based on muscle fiber length estimates. These data suggest that accurate prediction of the active mechanical behavior of architecturally complex muscles such as the equine DDF and SDF requires more sophisticated algorithms. PMID:15652557

  11. The Effects of Temporal and Spatial Predictions on Stretch Reflexes of Ankle Flexor and Extensor Muscles While Standing

    PubMed Central

    Kawashima, Noritaka; Nakazawa, Kimitaka

    2016-01-01

    The purpose of the present study was to investigate how stretch reflex (SR) responses in the ankle extensor (soleus: SOL) and flexor (tibialis anterior: TA) muscles would be modulated with temporal and/or spatial predictions of external perturbations and whether their effects are specific to the standing posture. SR responses in the SOL/TA were elicited by imposing quick ankle toes-up/toes-down rotations while standing upright and in the supine position. We designed four experimental conditions based on pre-information about perturbations: no information (No Cue), the timing of the perturbation onset (TIM), the direction of the perturbation (DIR), and both the timing and direction of the perturbation (TIM/DIR). Each condition was separated and its order was counterbalanced. In the SR of TA evoked by toes-down rotation, integrated electromyography activities of the late component were significantly reduced in the TIM and TIM/DIR conditions as compared with those in the No Cue and DIR conditions. The occurrence rate of late SR components that reflects how often the reflex response was observed was also lower in the TIM and TIM/DIR conditions as compared with that in the No Cue and DIR conditions. On the other hand, no significant changes were seen among the four conditions in the early SR component in the TA and both SR components in the SOL. The same results in the occurrence rate were found in the supine position. The present results suggest (1) only temporal predictions have a remarkable effect on the SR excitability of the TA, and (2) this effect is independent of posture. PMID:27385043

  12. Neuromuscular adjustments of the knee extensors and plantar flexors following match-play tennis in the heat

    PubMed Central

    Périard, Julien D; Girard, Olivier; Racinais, Sébastien

    2014-01-01

    Objectives This study tested the hypothesis that impairments in lower limb maximal strength and voluntary activation (VA) are exacerbated following match-play tennis in hot compared with cool conditions. Methods Torque and VA were evaluated during brief (5 s) and sustained (20 s) maximal voluntary isometric contractions of the knee extensors (KE) and plantar flexors (PF) in 12 male tennis players before (pre) and after (post, 24 h and 48 h) ∼115 min of play in hot (∼37°C) and cool (∼22°C) conditions. Results Rectal temperature was higher following play in hot than in cool (∼39.2 vs ∼38.5°C; p<0.05). Torque production decreased from prematch to postmatch during the brief and sustained contractions in hot (KE: ∼22%; PF: ∼13%) and cool (KE: ∼9%, PF: ∼7%) (p<0.05). KE strength losses in hot were greater than in cool (p<0.05) and persisted for 24 h (p<0.05). Postmatch brief and sustained KE VA was lower in hot than in cool (p<0.05), in which VA was maintained. PF VA was maintained throughout the protocol. Peak twitch torque and maximum rates of torque development and relaxation in the KE and PF were equally reduced postmatch relative to prematch in hot and cool conditions (p<0.05), and were restored near baseline within 24 h. Conclusions Neuromuscular system integrity of the lower limbs is compromised immediately following match-play tennis in hot and cool conditions due to the development of peripheral fatigue. The larger and persistent KE strength losses observed under heat stress are associated with greater levels of central fatigue especially during sustained contractions. PMID:24668379

  13. Age-related greater Achilles tendon compliance is not associated with larger plantar flexor muscle fascicle strains in senior women

    PubMed Central

    Csapo, R.; Malis, V.; Hodgson, J.

    2014-01-01

    The aim of the present study was to test the hypothesis that the age-associated decrease of tendon stiffness would necessitate greater muscle fascicle strains to produce similar levels of force during isometric contraction. Greater fascicle strains could force sarcomeres to operate in less advantageous regions of their force-length and force-velocity relationships, thus impairing the capacity to generate strong and explosive contractions. To test this hypothesis, sagittal-plane dynamic velocity-encoded phase-contrast magnetic resonance images of the gastrocnemius medialis (GM) muscle and Achilles tendon (AT) were acquired in six young (YW; 26.1 ± 2.3 yr) and six senior (SW; 76.7 ± 8.3 yr) women during submaximal isometric contraction (35% maximum voluntary isometric contraction) of the plantar flexor muscles. Multiple GM fascicle lengths were continuously determined by automatically tracking regions of interest coinciding with the end points of muscle fascicles evenly distributed along the muscle's proximo-distal length. AT stiffness and Young's modulus were measured as the slopes of the tendon's force-elongation and stress-strain curves, respectively. Despite significantly lower AT stiffness at older age (YW: 120.2 ± 52.3 N/mm vs. SW: 53.9 ± 44.4 N/mm, P = 0.040), contraction-induced changes in GM fascicle lengths were similar in both age groups at equal levels of absolute muscular force (4–5% fascicle shortening in both groups), and even significantly larger in YW (YW: 11–12% vs. SW: 6–8% fascicle shortening) at equal percentage of maximum voluntary contraction. These results suggest that factors other than AT stiffness, such as age-associated changes in muscle composition or fascicle slack, might serve as compensatory adaptations, limiting the degree of fascicle strains upon contraction. PMID:24505104

  14. Trapeziectomy With Ligament Reconstruction and Tendon Interposition Arthroplasty With the Entire Width of the Flexor Carpi Radialis Tendon.

    PubMed

    Marenghi, Letizia; Paterlini, Marco; Tocco, Silvio; Corradi, Maurizio

    2016-06-01

    The original Burton-Pellegrini technique used to treat trapeziometacarpal joint osteoarthritis suggests the use of half of the flexor carpi radialis (FCR) width to reconstruct the ligament and perform the tendon interposition arthroplasty. In our study, unlike the original technique, we used the full thickness of the FCR and evaluated a sample of 100 thumbs (95 patients) preoperatively and postoperatively, with a mean follow-up of 36 months. According to the Eaton classification, 1 thumb was grade II, 81 were grade III, and 18 were grade IV. The mean patient age at the time of surgery was 62.4 years. The finger-tip pinch improved by 46.3%, the key pinch improved by 34.5%, the grip strength improved by 50.8%, and the Kapandji test improved by 7.4%. Pain measured with visual analog score improved by 78.8%. The self-administrated questionnaires DASH and PRWHE were completed postoperatively from 2006 to 2012, because the Italian version of PRWHE was not yet validated: the postoperative DASH and PRWHE were, respectively, 9.9 and 10.5. No complications such as metacarpal subluxation of the thumb, impingement, fracture of the first metacarpal base, or a decrease in the wrist function were found in our population after surgical treatment. Therefore, according to our series, this variation of the original Burton-Pellegini surgical technique provides pain relief, stability, and mobility of the thumb without any morbidity caused by the full harvest of the FCR tendon. PMID:27015407

  15. Effects of eccentric training on torque-angular velocity-power characteristics of elbow flexor muscles in older women.

    PubMed

    Valour, D; Rouji, M; Pousson, M

    2004-03-01

    The purpose of this study was to investigate the potential of eccentric training to improve elbow flexor muscle power in elderly subjects. Fourteen older female volunteers (age range 60-78 years) were randomly assigned into either a training group (TG) or a control group (CG). For the TG, the 21-session 7-week eccentric training program consisted of 5x6 eccentric muscle actions at 60-100% of concentric three maximal repetitions. Before and after training, maximal elbow flexions were performed against increasing inertia. Maximal isokinetic elbow flexions at four angular velocities (eccentric actions, -60 degrees s(-1), -30 degrees rads(-1); concentric actions, 30, 60 degrees s(-1)) and maximal isometric actions were also performed. Maximal power (Pmax) and an index of maximal shortening velocity (VImax)were determined. For all action conditions, the myoelectric activities of the biceps and the triceps brachii muscles were recorded and quantified as a root mean square (RMS) value. In the TG, maximal torque developed under isometric, isokinetic and inertial conditions increased significantly after training (ranging from 11 to 19%). Pmax and VImax also increased significantly (31.3 and 25.9%, respectively). These parameters remained unchanged in the CG. The RMS activity of the biceps and triceps muscles was not affected by eccentric training for all action conditions excepting the eccentric condition at -30 degrees s(-1) where the RMS activity of the biceps increased significantly. The gains in maximal torque, Pmax and VImax observed after training would result more from intramuscular modifications than from changes in muscular activity, except for eccentric condition at -30 degrees s(-1) where the torque gains could also be partly explained by a reduction in inhibition of the motor unit pool. PMID:15036395

  16. Flexor digitorum accessorius longus muscle in resistant clubfoot patients: introduction of a new sign predicting its presence.

    PubMed

    Shaheen, Samir; Mursal, Haitham; Rabih, Mohamed; Johari, Ashok

    2015-03-01

    Clubfoot, talipes equino varus (TEV), is a common congenital foot anomaly. Some cases are resistant to conservative treatment. Many causes of resistance have been reported, among these, the presence of anomalous muscles; however, the effect of the presence of anomalous muscles on the outcome of conservative management is not well studied. These aberrant muscles are discovered during the extensive surgical release as an abnormal finding. The aim of this work is to study the demographic characteristics of patients with resistant TEV that necessitated extensive soft tissue release at Sudan Clubfoot Clinic and to document the prevalence of flexor digitorum accessorius longus (FDAL) muscle in a large series of clubfoot patients treated by extensive surgery: posteromedial release. Also, we introduce a new observation as an indication by which the surgeon can predict the presence of FDAL. On the basis of an observation that there is a special posture of the big toe in extension in relation to other flexed toes associated with the presence of FDAL, records of patients of clubfoot treated by extensive surgery between 2007 and 2012 at the Sudan Clubfoot Project were reviewed. Demographic characteristics were studied. Only patients with idiopathic TEV were included. Resistant clubfeet necessitated extensive release in 261 patients, 197 males and 64 females. Their ages ranged between 1 day and 15 years at presentation. FDAL muscle was found in 48 patients (54 feet) out of 261 patients (411 feet, 13.14%). In 46 of the 48 patients (95.8%), the presence of the FDAL could be predicted by a sign. FDAL is prevalent in 13% of resistant TEV cases requiring extensive soft tissue release, and the surgeon can expect resistant clubfoot and predict the presence of the FDAL in over 95% before he operates by observing the Samir-Adam sign. PMID:25493703

  17. Effect of thoracic manipulation and deep craniocervical flexor training on pain, mobility, strength, and disability of the neck of patients with chronic nonspecific neck pain: a randomized clinical trial

    PubMed Central

    Lee, Kwan-Woo; Kim, Won-Ho

    2016-01-01

    [Purpose] To investigate the effects of thoracic manipulation and deep craniocervical flexor training on the muscle strength and endurance, range of motion, and the disability index of the neck of patients with chronic nonspecific neck pain. [Subjects and Methods] Forty-six patients with chronic neck pain participated. They received an intervention for 35 minutes a day, three times a week for 10 weeks. Subjects were randomly assigned to one control and two experimental groups: group A (thoracic manipulation combined with deep craniocervical flexor training, n=16), group B (deep craniocervical flexor training, n=15), and group C (active self-exercise as a control group, n=15). Muscle strength and endurance, pain, neck disability index, and range of motion of the cervical and thoracic spine were measured before and after the intervention. [Results] Group A showed significant increases in muscle strength, endurance, and cervical and thoracic range of motion, and significant decreases in the pain and neck disability index, compared with groups B and C. [Conclusion] Although deep craniocervical flexor training is effective at improving neck function, thoracic manipulation combined with deep craniocervical flexor training was a more effective intervention for pain relief and improving the range of motion, muscle function, and neck disability of patients with nonspecific chronic neck pain. PMID:26957752

  18. Biochemical, histologic, and biomechanical characterization of native and decellularized flexor tendon specimens harvested from the pelvic limbs of orthopedically normal dogs.

    PubMed

    Balogh, Daniel G; Biskup, Jeffery J; O'Sullivan, M Gerard; Scott, Ruth M; Groschen, Donna; Evans, Richard B; Conzemius, Michael G

    2016-04-01

    OBJECTIVE To evaluate the biochemical and biomechanical properties of native and decellularized superficial digital flexor tendons (SDFTs) and deep digital flexor tendons (DDFTs) harvested from the pelvic limbs of orthopedically normal dogs. SAMPLE 22 commercially supplied tendon specimens (10 SDFT and 12 DDFT) harvested from the pelvic limbs of 13 canine cadavers. PROCEDURES DNA, glycosaminoglycan, collagen, and protein content were measured to biochemically compare native and decellularized SDFT and DDFT specimens. Mechanical testing was performed on 4 groups consisting of native tendons (5 SDFTs and 6 DDFTs) and decellularized tendons (5 SDFTs and 6 DDFTs). All tendons were preconditioned, and tension was applied to failure at 0.5 mm/s. Failure mode was video recorded for each tendon. Load-deformation and stress-strain curves were generated; calculations were performed to determine the Young modulus and stiffness. Biochemical and biomechanical data were statistically compared by use of the Wilcoxon rank sum test. RESULTS Decellularized SDFT and DDFT specimens had significantly less DNA content than did native tendons. No significant differences were identified between native and decellularized specimens with respect to glycosaminoglycan, collagen, or protein content. Biomechanical comparison yielded no significant intra- or intergroup differences. All DDFT constructs failed at the tendon-clamp interface, whereas nearly half (4/10) of the SDFT constructs failed at midsubstance. CONCLUSIONS AND CLINICAL RELEVANCE Decellularized commercial canine SDFT and DDFT specimens had similar biomechanical properties, compared with each other and with native tendons. The decellularization process significantly decreased DNA content while minimizing loss of extracellular matrix components. Decellularized canine flexor tendons may provide suitable, biocompatible graft scaffolds for bioengineering applications such as tendon or ligament repair. PMID:27027838

  19. PERFORMANCE OF HIGH SCHOOL FOOTBALL PLAYERS ON CLINICAL MEASURES OF DEEP CERVICAL FLEXOR ENDURANCE AND CERVICAL ACTIVE RANGE OF MOTION: IS HISTORY OF CONCUSSION A FACTOR?

    PubMed Central

    Ruediger, Thomas; Alsalaheen, Bara; Bean, Ryan

    2016-01-01

    Background More than one million adolescent athletes participated in organized high school sanctioned football during the 2014-15 season. These athletes are at risk for sustaining concussion. Although cervical spine active range of motion (AROM) and deep neck flexor endurance may serve a preventative role in concussion, and widespread clinical use of measurements of these variables, reference values are not available for this population. Cost effective, clinically relevant methods for measuring neck endurance are also well established for adolescent athletes. Purpose The purpose of this study was to report reference values for deep cervical flexor endurance and cervical AROM in adolescent football players and examine whether differences in these measures exist in high school football players with and without a history of concussion. Methods Concussion history, cervical AROM, and deep neck flexor endurance were measured in 122 high school football players. Reference values were calculated for AROM and endurance measures; association were examined between various descriptive variables and concussion. Results No statistically significant differences were found between athletes with a history of concussion and those without. A modest inverse correlation was seen between body mass and AROM in the sagittal and transverse planes. Conclusion The results of this study indicate that the participants with larger body mass had less cervical AROM in some directions. While cervical AROM and endurance measurements may not be adequate to identify adolescents with a history of previous concussions among high school football players. However, if a concussion is sustained, these measures can offer a baseline to examine whether cervical AROM is affected as compared to healthy adolescents. Level of Evidence 2c PMID:27104049

  20. The effect of orthopaedic shoeing on the force exerted by the deep digital flexor tendon on the navicular bone in horses.

    PubMed

    Willemen, M A; Savelberg, H H; Barneveld, A

    1999-01-01

    This study quantifies both the intended effect of orthopaedic shoeing to decrease the load on the navicular bone and the eventual undesired effects on gait performance. The compressive force exerted by the deep digital flexor tendon on the navicular bone and on the quality of the trot and redistribution of forces over the flexor tendons and the suspensory ligament were studied as a function of orthopaedic shoeing in 12 sound Dutch Warmblood horses. A modified CODA-3 gait analysis system and a force plate were used to quantify objectively the load on the lower limb. The quality of the trot was assessed using the same gait analysis system while the horses were trotting on the treadmill. The effects of shoes with heel wedges and egg-bar shoes were compared to flat shoes and unshod feet. When heel wedges were applied, the maximal force on the navicular bone was reduced by 24% (P<0.05) in comparison with flat shoes. Egg-bar shoes did not reduce the force on the navicular bone, but in unshod feet this force appeared to be 14% lower (P<0.05) compared to flat shoes. Egg-bar shoes cause the horse's trot to be slightly less animated (P<0.05), compared to flat shoes and shoes with heel wedges. It is concluded that shoes with heel wedges reduce the force on the navicular bone as a result of a decreased moment of force at the distal interphalangeal joint in combination with a decreased angle between the deep digital flexor tendon distally and proximally of the navicular bone. Therefore it can be expected that in horses suffering from navicular disease, heel wedges will have the expected beneficial effect on the pressure on the navicular bone, while the effect of egg-bar shoes remains doubtful. PMID:9952326

  1. Are Repeated Single-Limb Heel Raises and Manual Muscle Testing Associated With Peak Plantar-Flexor Force in People With Inclusion Body Myositis?

    PubMed Central

    Shrader, Joseph A.; Davenport, Todd E.; Joe, Galen; Rakocevic, Goran; McElroy, Beverly; Dalakas, Marinos

    2014-01-01

    Background Repeated heel raises have been proposed as a method of ankle plantar-flexor strength testing that circumvents the limitations of manual muscle testing (MMT). Objective The study objective was to examine the relationships among ankle plantar-flexion isometric maximum voluntary contraction (MVC), repeated single-limb heel raises (SLHRs), and MMT in people with myositis. Design This was a cross-sectional study with a between-group design. The ability to complete 1 SLHR determined group assignment (SLHR group, n=24; no-SLHR group, n=19). Methods Forty-three participants with myositis (13 women; median age=64.9 years) participated. Outcome measures included MVC, predicted MVC, Kendall MMT, and Daniels-Worthingham MMT. Results The Kendall MMT was unable to detect significant ankle plantar-flexor weakness established by quantitative methods and was unable to discriminate between participants who could and those who could not perform the SLHR task. Ankle plantar-flexion MVC was not associated with the number of heel-raise repetitions in the SLHR group (pseudo R2=.13). No significant relationship was observed between MVC values and MMT grades in the SLHR and no-SLHR groups. However, a moderate relationship between MVC values and MMT grades was evident in a combined-group analysis (ρ=.50–.67). Limitations The lower half of both MMT grading scales was not represented in the study despite the profound weakness of the participants. Conclusions Both Kendall MMT and Daniels-Worthingham MMT had limited utility in the assessment of ankle plantar-flexor strength. Repeated SLHRs should not be used as a proxy measure of ankle plantar-flexion MVC in people with myositis. PMID:24309617

  2. Giant cell tumour of tendon sheath with simultaneous two tendon involvement of the foot treated with excision of the tumour and reconstruction of the flexor retinaculum using tibialis posterior tendon in a paediatric patient: A rare case report.

    PubMed

    Tiwari, Vivek; Ansari, Tahir; Mittal, Samarth; Sharma, Pankaj; Nalwa, Aasma

    2015-12-01

    Giant cell tumour of tendon sheath is a benign soft tissue tumour arising from the tendon sheath. The involvement of foot and ankle by such tumours is relatively rare. Children are not commonly afflicted by this condition. All such tumours are reported to arise either from a single tendon sheath or one joint. We report a case of giant cell tumour of tendon sheath in a 12-year-old child, arising simultaneously from the tendon sheaths of tibialis posterior and flexor digitorum longus tendons, as well as extending into the ankle joint. It was treated by complete excision of the mass along with the tendon sheaths with reconstruction of the flexor retinaculum. The location of the tumour, age of the patient, diffuse nature of the tumour and novel technique of reconstruction of the flexor retinaculum make this case extremely rare and the first to be reported in literature. PMID:26564735

  3. Flexor Tendon Injuries

    MedlinePlus

    ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ...

  4. Dasty3, a WEB framework for DAS

    PubMed Central

    Villaveces, Jose M.; Jimenez, Rafael C.; Garcia, Leyla J.; Salazar, Gustavo A.; Gel, Bernat; Mulder, Nicola; Martin, Maria; Garcia, Alexander; Hermjakob, Henning

    2011-01-01

    Motivation: Dasty3 is a highly interactive and extensible Web-based framework. It provides a rich Application Programming Interface upon which it is possible to develop specialized clients capable of retrieving information from DAS sources as well as from data providers not using the DAS protocol. Dasty3 provides significant improvements on previous Web-based frameworks and is implemented using the 1.6 DAS specification. Availability: Dasty3 is an open-source tool freely available at http://www.ebi.ac.uk/dasty/ under the terms of the GNU General public license. Source and documentation can be found at http://code.google.com/p/dasty/. Contact: hhe@ebi.ac.uk PMID:21798964

  5. Nonoperative, dynamic treatment of acute achilles tendon rupture: influence of early weightbearing on biomechanical properties of the plantar flexor muscle-tendon complex-a blinded, randomized, controlled trial.

    PubMed

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch; Dippmann, Christian; Ebskov, Lars; Troelsen, Anders

    2015-01-01

    Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle-tendon complex in patients randomized to early weightbearing or non-weightbearing in the nonoperative treatment of Achilles tendon rupture. A total of 60 patients were randomized to full weightbearing from day 1 of treatment or non-weightbearing for 6 weeks. After 6 and 12 months, the peak passive torque at 20° dorsiflexion, the stiffness during slow stretching, and the maximal strength were measured in both limbs. The stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was significantly increased (p = .024) in the non-weightbearing group at 12 months. The peak passive torque was significantly lower for the affected limb at 6 months (91%; p = .01), and the stiffness was significantly lower for the affected limb during the early part of dorsiflexion at 6 (67%; p < .001) and 12 (77%; p < .001) months. In conclusion, an increased stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was found in the non-weightbearing group. The altered stiffness and strength in the affected limb could affect the coordination of gait and running. PMID:25618802

  6. Physik gestern und heute Das Eiskalorimeter

    NASA Astrophysics Data System (ADS)

    Heering, P.

    2003-07-01

    Kalorimetrische Messungen gehören heute zum experimentellen Standardrepertoire im Bereich der Thermodynamik und der physikalischen Chemie. Das erste Gerät für derartige Messungen entwickelten Ende des 18. Jahrhunderts die französischen Wissenschaftler Antoine Laurent Lavoisier und Pierre Simon de Laplace.

  7. GHRSST-14 DAS-TAG Report

    NASA Technical Reports Server (NTRS)

    Armstrong, Edward; Piolle, Jean Francois

    2013-01-01

    The DAS-TAG provides the informatics and data management expertise in emerging information technologies for the GHRSST community. It provides expertise in data and metadata formats and standards, fosters improvements for GHRSST data curation, experiments with new data processing paradigms, and evaluates services and tools for data usage. It provides a forum for producer and distributor data management issues and coordination.

  8. BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

    PubMed Central

    Severo, Antônio Lourenço; Arenhart, Rodrigo; Silveira, Daniela; Ávila, Aluísio Otávio Vargas; Berral, Francisco José; Lemos, Marcelo Barreto; Piluski, Paulo César Faiad; Lech, Osvandré Luís Canfield; Fukushima, Walter Yoshinori

    2015-01-01

    Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques

  9. Artificial gravity as a countermeasure to microgravity: a pilot study examining the effects on knee extensor and plantar flexor muscle groups.

    PubMed

    Caiozzo, V J; Haddad, F; Lee, S; Baker, M; Paloski, William; Baldwin, K M

    2009-07-01

    The goal of this project was to examine the effects of artificial gravity (AG) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) group (n = 7) and 2) an AG group (n = 8), which was subjected to 21 days of 6 degrees head-down tilt bed rest plus daily 1-h exposures to AG (2.5 G at the feet). Centrifugation was produced using a short-arm centrifuge with the foot plate approximately 220 cm from the center of rotation. The torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre- and posttreatment. Muscle biopsy samples obtained from the vastus lateralis and soleus muscles were used for a series of gene expression analyses (mRNA abundance) of key factors implicated in the anabolic vs. catabolic state of the muscle. Post/pre torque-velocity determinations revealed greater decrements in knee extensor performance in the BR vs. AG group (P < 0.04). The plantar flexors of the AG subjects actually demonstrated a net gain in the torque-velocity relationship, whereas in the BR group, the responses declined (AG vs. BR, P < 0.001). Muscle fiber cross-sectional area decreased by approximately 20% in the BR group, whereas no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity were higher in the AG group, whereas catabolic markers were elevated in the BR group. Importantly, these patterns were seen in both muscles. We conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading. PMID:19286573

  10. Does Strand Configuration and Number of Purchase Points Affect the Biomechanical Behavior of a Tendon Repair? A Biomechanical Evaluation Using Different Kessler Methods of Flexor Tendon Repair

    PubMed Central

    Kalaci, Aydiner; Sevinç, Teoman Toni; Esen, Erdinc; Komurcu, Mahmut; Yanat, Ahmet Nedim

    2008-01-01

    This study compares the mechanical properties of modified Kessler and double-modified Kessler flexor tendon repair techniques and evaluates simple modifications on both methods. Forty fresh sheep flexor tendons were divided equally into four groups. A transverse sharp cut was done in the middle of each tendon and then repaired with modified Kessler technique, modified Kessler with additional purchase point in the midpoint of each longitudinal strand, double-modified Kessler technique, or a combination of outer Kessler and inner cruciate configuration based on double-modified Kessler technique. The tendons were tested in a tensile testing machine to assess the mechanical performance of the repairs. Outcome measures included gap formation and ultimate forces. The gap strengths of the double-modified Kessler technique (30.85 N, SD 1.90) and double-modified Kessler technique with inner cruciate configuration (33.60 N, SD 4.64) were statistically significantly greater than that of the two-strand modified Kessler (22.56 N, SD 3.44) and modified Kessler with additional purchase configuration (21.75 N, SD 4.03; Tukey honestly significant difference test, P < 0.000). There were statistically significant differences in failure strengths of the all groups (analysis of variance, P < 0.000). With an identical number of strands, the gap formation and ultimate forces of the repairs were not changed by additional locking purchase point in modified Kessler repair or changing the inner strand configuration in double-modified Kessler repair. The results of this study show that the number of strands across the repair site together with the number of locking loops clearly affects the strength of the repair; meanwhile, the longitudinal strand orientation and number of purchase points in a single loop did not affect its strength. PMID:18780108