A new test for estimating iliotibial band contracture

Severe rigid hip flexion-abduction contracture in cerebral palsy: a case report and review of the literature

INTRODUCTION

severe, rigid hip abduction deformity in individuals with cerebral palsy (CP) is an exceptionally uncommon condition. This posture hinders the positioning in the wheelchair and the completion of basic activities of daily living (ADL). Addressing such severe deformities can be quite challenging.

MATERIAL AND METHODS

a 14-year-old male, with spastic-dystonic quadriplegic CP, developed rigid and severe flexion-abduction contractures in both hips, characterized by 90 degrees of flexion and 100 degrees of abduction. These contractures severely impeded his ability to comfortably use a wheelchair and even pass through doorways. Performing basic ADLs became a significant challenge for both the patient and his caregivers.

RESULTS

the treatment approach involved a two-stage surgical procedure, one for each hip, with a two-month interval between them. An extensive release of the fascia latae, gluteus maximus, external rotators, and hip flexors; in combination with a proximal femur osteotomy were performed. To maintain the corrections achieved, long-leg casts connected with two bars were employed, followed by orthotic support and physiotherapy. Following the procedure, lower limb adduction was achieved, and the patient and caregivers were highly satisfied, as ADLs and basic caregiving had been greatly facilitated.

CONCLUSIONS

while the available literature on the management of severe rigid abduction hip contractures in non-ambulatory CP patients is limited, and treatment options are often complex, the present case underscores the effectiveness of a comprehensive approach involving soft tissue release and bone surgery. Achieving a more favorable wheelchair positioning and facilitating basic ADLs and care represents a significant success for patients and families.

Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics

Background

The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy.

Methods

To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously.

Results

We evaluated this automated system’s capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear.

Discussion

The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision.

Traumatic fibrotic myopathy of the tensor fascia lata muscle in a Whippet

A two-year-old female neutered Whippet was referred for evaluation of progressive right pelvic limb lameness. Clinical examination revealed a fibrous band palpable along the cranial aspect of the quadriceps muscle group, and signs of discomfort on extension of the right hip. Computed tomography and ultrasonographic examination revealed mineralization of the tensor fascia lata muscle with enthesophytosis of its origin. Surgical exploration confirmed a fibrous band affecting the cranial border of the tensor fascia lata muscle. Resection of the band resulted in complete resolution of clinical signs. Histopathology was consistent with a fibrotic myopathy. To the authors' knowledge, this is the first case of a fibrotic myopathy affecting the tensor fascia lata muscle in the dog.

Lateral hip pain in an athletic population: differential diagnosis and treatment options

CONTEXT

Historically, the term greater trochanteric pain syndrome has been used to describe a spectrum of conditions that cause lateral-sided hip pain, including greater trochanteric bursitis, snapping iliotibial band, and/or strains or tendinopathy of the abductor mechanism. Diagnosis of these conditions may be difficult because clinical presentations are variable and sometimes inconclusive. Especially difficult is differentiating intrinsic pain from pain referred to the greater trochanteric region. The purposes of this article are to review the relevant anatomy and pathophysiology of the lateral hip.

EVIDENCE ACQUISITION

Data were collected through a thorough review of the literature conducted through a MEDLINE search of all relevant papers between 1980 and January 2010.

RESULTS

Recent advances in imaging and an improved understanding of pathomechanics have helped to guide the evaluation, diagnosis, and appropriate treatment for patients presenting with lateral hip pain.

CONCLUSION

Various diagnostic tools and treatment modalities can be used to effectively manage the athletic patient presenting with lateral hip pain.

Angular deformities of the lower limb in children

Angular deformities of the lower limbs are common during childhood. In most cases this represents a variation in the normal growth pattern and is an entirely benign condition. Presence of symmetrical deformities and absence of symptoms, joint stiffness, systemic disorders or syndromes indicates a benign condition with excellent long-term outcome. In contrast, deformities which are asymmetrical and associated with pain, joint stiffness, systemic disorders or syndromes may indicate a serious underlying cause and require treatment.

Little is known about the relationship between sport participation and body adaptations during growth. Intense soccer participation increases the degree of genu varum in males from the age of 16. Since, according to some investigations, genu varum predisposes individuals to more injuries, efforts to reduce the development of genu varum in soccer players are warranted. In this article major topics of angular deformities of the knees in pediatric population are practically reviewed.

In-vivo glenohumeral translation and ligament elongation during abduction and abduction with internal and external rotation

Study Design

Basic Science. To investigate humeral head translations and glenohumeral ligament elongation with a dual fluoroscopic imaging system.

Background

The glenohumeral ligaments are partially responsible for restraining the humeral head during the extremes of shoulder motion. However, in-vivo glenohumeral ligaments elongation patterns have yet to be determined. Therefore, the objectives of this study were to 1) quantify the in-vivo humeral head translations and glenohumeral ligament elongations during functional shoulder positions, 2) compare the inferred glenohumeral ligament functions with previous literature and 3) create a baseline data of healthy adult shoulder glenohumeral ligament lengths as controls for future studies.

Methods

Five healthy adult shoulders were studied with a validated dual fluoroscopic imaging system (DFIS) and MR imaging technique. Humeral head translations and the superior, middle and inferior glenohumeral ligaments (SGHL, MGHL, IGHL) elongations were determined.

Results

The humeral head center on average translated in a range of 6.0mm in the anterior-posterior direction and 2.5mm in the superior-inferior direction. The MGHL showed greater elongation over a broader range of shoulder motion than the SGHL. The anterior-band (AB)-IGHL showed maximum elongation at 90° abduction with maximum external rotation. The posterior-band (PB)-IGHL showed maximum elongation at 90° abduction with maximum internal rotation.

Discussion

The results demonstrated that the humeral head translated statistically more in the anterior-posterior direction than the superior-inferior direction (p = 0.01), which supports the concept that glenohumeral kinematics are not ball-in-socket mechanics. The AB-IGHL elongation pattern makes it an important static structure to restrain anterior subluxation of the humeral head during the externally rotated cocking phase of throwing motion. These data suggest that in healthy adult shoulders the ligamentous structures of the glenohumeral joint are not fully elongated in many shoulder positions, but function as restraints at the extremes of glenohumeral motion. Clinically, these results may be helpful in restoring ligament anatomy during the treatment of anterior instability of the shoulder.

Electromyographic analysis of the rotator cuff and deltoid musculature during common shoulder external rotation exercises

STUDY DESIGN

Prospective single-group repeated-measures design.

OBJECTIVES

To quantify electromyographic (EMG) muscle activity of the infraspinatus, teres minor, supraspinatus, posterior deltoid, and middle deltoid during exercises commonly used to strengthen the shoulder external rotators.

BACKGROUND

Exercises to strengthen the external rotators are commonly prescribed in rehabilitation, but the amount of EMG activity of the infraspinatus, teres minor, supraspinatus, and deltoid during these exercises has not been thoroughly studied to determine which exercises would be most effective to achieve strength gains.

METHODS AND MEASURES

EMG measured using intramuscular electrodes were analyzed in 10 healthy subjects during 7 shoulder exercises: prone horizontal abduction at 100 degrees of abduction and full external rotation (ER), prone ER at 90 degrees of abduction, standing ER at 90 degrees of abduction, standing ER in the scapular plane (45 degrees abduction, 30 degrees horizontal adduction), standing ER at 0 degrees of abduction, standing ER at 0 degrees of abduction with a towel roll, and sidelying ER at 0 degrees of abduction. The peak percentage of maximal voluntary isometric contraction (MVIC) for each muscle was compared among exercises using a 1-way repeated-measures analysis of variance (P<.05).

RESULTS

EMG activity varied significantly among the 7 exercises. Sidelying ER produced the greatest amount of EMG activity for the infraspinatus (62% MVIC) and teres minor (67% MVIC). The greatest amount of activity of the supraspinatus (82% MVIC), middle deltoid (87% MVIC), and posterior deltoid (88% MVIC) was observed during prone horizontal abduction at 100 degrees with full ER.

CONCLUSIONS

Results from this study provide initial information to develop rehabilitation programs. It also provides information helpful for the design and conduct of future studies.