Thigh Atrophy Research Articles

Spinal Cord Tumor‐Associated Syrinx Mimicking Abdominal Epilepsy

A 10‐year‐old child presented with recurrent abdominal pain. Abdominal epilepsy was suspected as conventional criteria for the diagnosis were met, including an apparent therapeutic response to anticonvulsant medication. Seven months later the patient developed recurrent abdominal pain, a gait disorder, and atrophy of the right thigh and calf. Magnetic resonance imaging of the spine revealed a thoracic syringomyelia. Anticonvulsant medications were discontinued and a syringoperitoneal shunt was placed with resolution of symptoms. This appears to be a previously undescribed presentation for syringomyelia and emphasizes the importance of considering alternative central nervous system disorders before the diagnosis of abdominal epilepsy is made.

The Long-term Follow-up of Ipsilateral Tibial and Femoral Diaphyseal Fractures

Twenty-nine of 45 patients who had ipsilateral femoral and tibial shaft fractures were evaluated clinically and roentgenographically to correlate treatment method with bony alignment and functional outcome. The results included: (1) limitation of sports activities in patients whose knee ligaments were injured, followed by both instability and thigh atrophy; (2) a direct relationship between the postunion malalignment of the tibia and ankle motion; and (3) a high rate of life threatening complications (thromboembolic, pneumonia, death) and a slower rate of tibial union associated with treatment by closed methods.

Toxicological studies with 6-mercaptopurine in neonates.

In previous studies, we found that Sprague-Dawley rats injected with 6-MP monohydrate at 2 mg base/kg sc daily from 2 to 22 days of age had atrophy of thigh and sublumbar muscles when killed at 16 months of age. The first sign of this muscle atrophy was detected grossly (flattened croup with or without paresis) at 12 months of age. In one experiment of the present work, using the same treatment in rats as above, we found that the earliest onset of muscle atrophy observed by light microscopy occurred at 2 months of age. By 4 months the atrophy could be detected grossly. The atrophy did not uniformly involve all muscles of the hindquarters; the thigh (especially the semitendinosus), leg (soleus but not the extensor carpi group), and lumbar vertebral (including the psoas) muscles were involved. Foreleg (biceps), intercostal, and tongue muscles as well as the sciatic nerve and internal organs appeared unaffected. In another experiment, weanling Sprague-Dawley rats given large daily doses of 6-MP from 25 to 45 days of age had normal muscles when killed at 8 months. In a third experiment, Wistar rats injected with 6-MP (2 mg base/kg sc) daily from 2 to 22 days of age and killed at 6 months had muscle atrophy similar to that seen in Sprague-Dawley rats. In the last experiment, mice and hamsters given large daily doses of 6-MP from 2 to 22 days of age had normal muscles when killed at 10 months. It appears from these results that the 6-MP-induced muscle atrophy occurs only after treatment during the neonatal period and that the atrophy may be species-specific.

Passive resistance of the human knee: The effect of immobilization

The effects of immobilization on both the circumferential dimensions of the lower limb, and the passive resistance of the knee to sinusoidal motion in the flexion-extension plane, were studied in patients immobilized after tibial fractures or ligamentous injuries of the knee. Immobilization resulted in a decrease of circumferential dimensions of the lower limb, indicating atrophy of thigh and calf musculature. The equilibrium angle of the knee, i.e. the angle at which the net passive moment equals zero, approached the angle of the knee during immobilization. At knee angles of 60° (the maximal angle imposed on the immobilized knee) and 45°, the resistance was increased, and at angles of 30° and 15°, the resistance was decreased. The passive resistances at ± 22.5, 15 and 7.5° relative to the equilibrium angle were all increased. A simple model, taking into account changes in the length of muscles at the anterior and posterior side of the knee, explains changes in passive resistance. The duration of immobilization for patients with ligamentous injuries of the knee was less than 50% of that for patients with tibial fractures, whose ankle joint was not immobilized, both resulted in a smaller muscular atrophy for patients with ligamentous injuries. Differences in passive resistance between unaffected and immobilized legs were the same in both groups of patients. Changes in passive resistance in the immobilized leg for those with ligamentous injury are probably not the effect of immobilization alone but the combined effect of immobilization and ligamentous lesions.

The results of arthroscopic partial meniscectomy.

Partial arthroscopic meniscectomy has been performed in the First Orthopedic Clinic of the University of Florence since 1981. We have reviewed the first 100 cases with an average follow-up of 18 months. The results were graded according to a numerical rating system and were satisfactory in 85% of the cases. The main advantage of this difficult technique is the fast recovery rate. Other advantages are the low morbidity and short hospital stay. When meniscectomy was performed in the ACL unstable knee, the results were inferior but still acceptable in terms of reduction of the mechanical symptoms. The influence of age, sex, medial or lateral meniscectomy, and type of tear was not statistically significant. Thigh atrophy or chondromalacia significantly decreased the knee score. We believe that the single most important technical factor is to make sure that a stable, well balanced and healthy rim is left in the knee.

The effects of electrical stimulation on the quadriceps during postoperative knee immobilization.

Immobilization of the knee after anterior cruciate ligament (ACL) reconstruction results in marked thigh atrophy and decrease in quadriceps strength that may prolong the rehabilitation program of the injured athlete. Fifteen male volunteers undergoing ACL reconstruction were divided into two groups, stimulation (during immobilization) and nonstimulation. Measurements of thigh circumference and isometric quadriceps strength were tested preoperatively, immediately after cessation of cast immobilization (6 weeks), and at 9 and 12 weeks postoperatively. The changes in circumference and strength between the first preoperative test and all subsequent tests were compared for statistical significance (Student's t-test, P less than 0.5) between the two groups. The decrease in quadriceps strength of the stimulation group during immobilization was significantly less than that of the nonstimulation group, although later differences between the two groups were not significant. There were no significant differences in thigh atrophy between the two groups. In conclusion, isometric quadriceps torque decreases resulting from immobilization can be significantly lessened by application of electrical stimulation during immobilization. Electrical stimulation to the quadriceps does not significantly alter thigh circumference changes that occur during immobilization.

Experimental Observations on the Effects of Leg Lengthening by the Wagner Method

A proximal tibial epiphysiodesis was successfully performed on the right hind legs of 23 young lambs, producing an average shortening of 12% of the total length of the tibia. A lengthener was attached to stainless steel pins which were then tapped into the shortened tibia prior to osteotomy. In 16 of the 23 animals it was possible to lengthen the shortened bone at a rate of 0.5 mm twice daily until the discrepancy was corrected. The gait was normal in most of the animals, all had full knee motion with no thigh atrophy, and 16 had limited hock (ankle) joint motion. Lengthening of the tibia by more than 11% consistently produced muscle changes in the leg and cartilage damage in the hock (ankle) joint. Any malalignment of the tibial fragments during lengthening intensified these changes.

Untreated ruptures of the anterior cruciate ligament. A follow-up study.

Fifty patients (fifty-three knees) with surgically verified ruptures of the anterior cruciate ligament were evaluated at an average of ten years after injury. There was a high incidence of anterior laxity, rotatory instability, and meniscal tears at follow-up. The roentgenographic incidence of osteoarthritis at follow-up was low. Patients who had regained normal thigh circumference had better results than those with thigh atrophy. Although few of the patients felt that the knee was completely normal, 72 per cent of the patients returned to strenuous sports and 47 per cent felt that they had no restrictions because of the knee. This study of untreated ruptures may provide a baseline for evaluation of procedures to repair or reconstruct the anterior cruciate ligament.

Osteoid osteoma of the hip in children.

In 31 children with osteoid osteoma lesions about the hip ranging in age from 2 to 16 years, there was an inordinate frequency of diagnostic delay with 16 patients having symptoms for more than 12 months. The clinical features were dominated by pain, limp, restricted hip motion and thigh atrophy. Twelve patients did not have classical night pain. Errors in diagnosis occurred in 22 instances. The roentgenographic appearance of most lesions consisted of a radiolucent central nidus encircled by sclerotic bone. Twenty-nine of the 31 patients were operated upon utilizing intra-operative roentgenograms and the nidus fully excised, with histological confirmation in 24 cases. All were relieved of preoperative symptoms. Two patients, who did not have surgical treatment, had pain for about one year and thereafter became pain free for 2 and 12 years. The sequelae observed at follow-up were meralgia paresthetica in 12 patients and mild asymptomatic leg length discrepancies in 7 patients. In view of these findings and since the process of apparent regression is slow and characterized by pain, blocked surgical excision of the lesion is the procedure of choice.

Cauda Equina Syndrome Due to Silent Rectal Carcinoma

THE EARLY MANIFESTATIONS of rectal carcinoma are frequently insidious in onset, with symptoms not directly referable to the rectum. Digital, proctoscopic and roentgen studies may fail to disclose the presence of a rectal tumor, unless these procedures are repeated (1). Anemia, weakness, weight loss, and ill-defined, non -localized bowel distress are the most common symptoms of these silent lesions. Even these complaints are not invariably present, as in the case to be described. Rectal carcinoma does not often metastasize to bone. Mayo and Schlicke found skeletal metastasis in only 1.2 per cent of a group of cases of carcinoma of the colon (2). There are no precise figures on the incidence of sacral involvement, but patients with advanced rectal carcinoma occasionally show evidence of direct extension to the sacrum and sacral nerve roots (3). The case to be presented is interesting in that the initial presenting problem was a cauda equina syndrome. The primary rectal carcinoma remained silent and unsuspected for a considerable period of time. In retrospect it seems that digital or proctoscopic examination should have led to a correct diagnosis. Case Report M. R., a 43-year-old white male, was admitted to the hospital in March 1947, on account of pain in the right gluteal region. His father had died of gastric carcinoma. The patient had been in excellent health until four months before admission, at which time he experienced a sudden onset of right lumbar pain. A month later he discovered a lump in the right gluteal region, which rapidly increased in size. Gradually motor power in the right leg was lost and difficulty in urination and defecation developed. The lump was exceedingly tender, and there was a burning sensation in the right perineal region. No history of blood in the stools was elicited. No significant weight loss occurred. The patient appeared to be well developed and only moderately ill, though he complained bitterly of pain in the right buttock. He was unable to stand and could barely maintain himself in a sitting position. He was most comfortable while lying on the left side with the right leg flexed. A bulging mass was present in the right gluteal region near the midline. It measured 12 em. in diameter and was hard, non-pitting, and tender to light palpation. Rectal examination was difficult, due to extreme tenderness. No irregularity of the rectal mucosa was felt, although a large mass could be palpated posteriorly. The remaining positive findings were neurological in character and included atrophy of the right posterior thigh and gluteal region, absence of the right ankle jerk, motor weakness of the right leg, impairment of all types of sensation on the right over the areas of distribution of the 5th lumbar nerve and all the sacral nerves, with similar though less severe impairment on the left. There were also hypesthesia of the skin of the penis and scrotum on the right and mild weakness of the anal sphincter.