Lateral Rotator Muscles Research Articles

The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study

Objectives: To study the effect of additional strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise rehabilitation programme for patients with the patellofemoral pain syndrome. Design: Randomized controlled pilot trial. Setting: Clinical setting with home programme. Participants: Fourteen patients with patellofemoral pain syndrome. Intervention: The subjects were randomly assigned to the intervention group (strengthening of quadriceps plus strengthening of hip abductor and lateral rotator muscles) or to the control group (strengthening of quadriceps). Both groups participated in a six-week home exercise protocol. Main outcome measures: The perceived pain symptoms, isokinetic eccentric knee extensor, hip abductor and lateral rotator torques and the gluteus medius electromyographic activity were assessed before and after treatment. Parametric and non-parametric tests were used to compare the groups before and after treatment with α=0.05. Results: Only the intervention group improved perceived pain symptoms during functional activities (P=0.02—0.04) and also increased their gluteus medius electromyographic activity during isometric voluntary contraction (P=0.03). Eccentric knee extensors torque increased in both groups (P=0.04 and P=0.02). There was no statistically significant difference in the hip muscles torque in either group. Conclusion: Supplementation of strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise programme provided additional benefits with respect to the perceived pain symptoms during functional activities in patients with patellofemoral pain syndrome after six weeks of treatment.

Late treatment of brachial plexus palsy secondary to birth injuries: rotational osteotomy of the proximal part of the humerus.

We retrospectively reviewed the results of rotational osteotomy that had been performed distal to the surgical neck of the humerus in twenty-two patients who had sustained an injury of the brachial plexus at birth. Eighteen patients had a lesion of the superior trunk of the brachial plexus (the fifth and sixth cervical nerve roots), and four had involvement of the entire brachial plexus. The patients ranged in age from four to seventeen years old (average age, ten years and three months old) at the time of the operation. The average duration of follow-up was fourteen years (range, two to thirty-one years). Preoperatively, the patients had been unable to perform self-care activities, such as grooming, feeding, and washing themselves, because of limited active external rotation or fixed internal rotation of the shoulder. All patients had decreased strength of the lateral rotator and abductor muscles and normal strength of the subscapularis and pectoralis major muscles. Radiographs showed some flattening of the humeral head, and four patients had posterior subluxation of the humeral head. A lateral rotational osteotomy of the proximal part of the humerus was performed between the insertions of the subscapularis and pectoralis major muscles. The site of the osteotomy was stabilized with catgut sutures in the periosteum in ten patients and with one or two staples in twelve. The extremity was immobilized in a plaster shoulder-spica cast for six weeks. At the latest follow-up evaluation, the average increase in active abduction was 27 degrees (range, 0 to 60 degrees) and the average increase in the arc of rotation was 25 degrees (range, 5 to 85 degrees). Supination of the forearm also had increased commensurate with the increase in external rotation. The appearance of the extremity had improved as well.

Test-Retest Reliability of Eccentric Peak Torque Values for Shoulder Medial and Lateral Rotation Using the Biodex Isokinetic Dynamometer

In order for the Biodex isokinetic dynamometer to be used in clinical research, it must be documented to be a reliable measurement tool. The purpose of this study was to determine eccentric peak torque test-retest reliability for glenohumeral medial and lateral rotator muscles using the Biodex isokinetic dynamometer. Eighteen healthy men and women volunteers ranging in ages from 18 to 30 who exhibited no prior history of glenohumeral injury were studied. The subjects were tested bilaterally for eccentric glenohumeral medial rotation (MR) and lateral rotation (LR) at 90 and 120 degrees/sec using 0 degrees of shoulder abduction so that the subject's arm was in contact with his or her trunk. Seven days following the initial test, a retest was administered using the identical protocol. Data collection of pretesting and posttesting was done using the IBM basic computer and the Biodex software program. Test data were analyzed using the intraclass correlation coefficient. The test-retest results indicated: dominant LR at 90 degrees/sec, r = 0.86, and at 120 degrees/sec, r = 0.83; dominant MR at 90 degrees/sec, r = 0.76, and at 120 degrees/sec, r = 0.77; nondominant LR at 90 degrees/sec, r = 0.76, and at 120 degrees/sec, r = 0.83; and nondominant MR at 90 degrees/sec, r = 0.75, and at 120 degrees/sec, r = 0.83. The results demonstrate the isokinetic eccentric mode of the Biodex dynamometer to be reliable for the test-retest measure of peak torque. These data may be used to support future clinical research of the eccentric isokinetic mode of the Biodex isokinetic dynamometer.

DISLOCATION AND DEFORMITY OF THE HIP IN CHILDREN WITH SPINA BIFIDA CYSTICA

1. Paralytic dislocation of the hip in spina bifida generally requires reduction and iliopsoas transfer. The muscle transfer ensures that the hip remains reduced, lessens the need for calipers and prevents progressive flexion deformity. In addition, varus and rotation osteotomy of the femur and innominate osteotomy are sometimes required. Varus and rotation osteotomy alone is indicated if the psoas is not strong enough for transfer. The age for reduction of dislocated hips and muscle transfer has been reduced to eight months as experience and confidence has been gained. 2. Flexion deformity is best prevented by early iliopsoas transfer. An anterior release operation is occasionally indicated when there is flexion deformity and a weak psoas muscle. This procedure, alone or supplemented by extension osteotomy, may be necessary to correct severe flexion deformity in children seen late. 3. Lateral rotation deformity of the hip may be caused by unbalanced iliopsoas action or the unbalanced action, or contracture, of the short lateral rotator muscles. If the deformity is sufficient to make the gait bizarre, or if it is difficult to fit a caliper, then soft-tissue operations as described are of value. 4. Abduction deformity can be corrected by division of the unopposed or contracted abductors.