Passive Adduction Research Articles

Effect of Repetitive Passive Movement Before Motor Skill Training on Corticospinal Excitability and Motor Learning Depend on BDNF Polymorphisms.

A decrease in cortical excitability tends to be easily followed by an increase induced by external stimuli via a mechanism aimed at restoring it; this phenomenon is called “homeostatic plasticity.” In recent years, although intervention methods aimed at promoting motor learning using this phenomenon have been studied, an optimal intervention method has not been established. In the present study, we examined whether subsequent motor learning can be promoted further by a repetitive passive movement, which reduces the excitability of the primary motor cortex (M1) before motor learning tasks. We also examined the relationship between motor learning and the brain-derived neurotrophic factor. Forty healthy subjects (Val/Val genotype, 17 subjects; Met carrier genotype, 23 subjects) participated. Subjects were divided into two groups of 20 individuals each. The first group was assigned to perform the motor learning task after an intervention consisting in the passive adduction–abduction movement of the right index finger at 5 Hz for 10 min (RPM condition), while the second group was assigned to perform the task without the passive movement (control condition). The motor learning task consisted in the visual tracking of the right index finger. The results showed that the corticospinal excitability was transiently reduced after the passive movement in the RPM condition, whereas it was increased to the level detected in the control condition after the motor learning task. Furthermore, the motor learning ability was decreased immediately after the passive movement; however, the motor performance finally improved to the level observed in the control condition. In individuals carrying the Val/Val genotype, higher motor learning was also found to be related to the more remarkable changes in corticospinal excitability caused by the RPM condition. This study revealed that the implementation of a passive movement before a motor learning tasks did not affect M1 excitatory changes and motor learning efficiency; in contrast, in subjects carrying the Val/Val polymorphism, the more significant excitatory changes in the M1 induced by the passive movement and motor learning task led to the improvement of motor learning efficiency. Our results also suggest that homeostatic plasticity occurring in the M1 is involved in this improvement.

Anterolateral minimally invasive hip approach offered faster rehabilitation with lower complication rates compared to the minimally invasive posterior hip approach—a University clinic case control study of 120 cases

INTRODUCTION The surgical approach used in total hip arthroplasty (THA) has been identified as a factor affecting the outcome. In our University Hospital, the posterior surgical approach is the gold standard. The Rottinger approach is an anterolateral approach which is truly minimally invasive, as it does not vertically cut any muscle fibers. The objective of this study was to determine the difference in surgical outcomes between the posterior hip approach and the Rottinger approach which was newly adopted at our Hospital. METHODS In a retrospective study, a total of 120 patients underwent THA; 60 patients using the Rottinger approach by the young consultant surgeon and another 60 patients using the standard posterior approach by the senior orthopaedic surgeon. Patients have been controlled for age, gender, and ASA grades. All preoperative demographic data showed no significant difference between the control and study groups. The following parameters were analyzed: incision length, duration of the surgery, intraoperative blood loss, WOMAC index, Harris Hip Score, range of motion at 3 and 12 months after surgery, time of quitting the crutches, and willingness for the contralateral hip arthroplasty. RESULTS WOMAC index, surgical time, and incision lengths have been without significant difference in both approaches. Intraoperative blood loss was significantly lower in the Rottinger group (CI: - 10.903, - 0.064). Harris Hip score was significantly higher (CI: 4.564, 12.973) in the Rottinger group at 3 months, but similar (CI: - 3.484, 2.134) at 12 months follow-up. At 3 months, active flexion and extension were significantly higher in the Rottinger group (CI: 0.595, 8.239; 2.487, 4.480, respectively), and active abduction and passive adduction (CI: - 5.662, - 0.338; - 6.290, - 1.410, respectively) in the posterior approach group. Patients in the Rottinger approach group on average quit crutches 3 weeks earlier and had no postoperative dislocations compared to 2 dislocations in the control group. CONCLUSION The Rottinger approach offered faster rehabilitation with less need for crutches and with lower complication rates.

Computational frame of ligament in situ strain in a full knee model

The biomechanical function of connective tissues in a knee joint is to stabilize the kinematics-kinetics of the joint by augmenting its stiffness and limiting excessive coupled motion. The connective tissues are characterized by an in vivo reference configuration (in situ strain) that would significantly contribute to the mechanical response of the knee joint. In this work, a novel iterative method for computing the in situ strain at reference configuration was presented. The framework used an in situ strain gradient approach (deformed reference configuration) and a detailed finite element (FE) model of the knee joint. The effect of the predicted initial configuration on the mechanical response of the joint was then investigated under joint axial compression, passive flexion, and coupled rotations (adduction and internal), and during the stance phase of gait. The inclusion of the reference configuration has a minimal effect on the knee joint mechanics under axial compression, passive flexion, and at two instances (0% and 50%) of the stance phase of gait. However, the presence of the ligaments in situ strains significantly increased the joint stiffness under passive adduction and internal rotations, as well as during the other simulated instances (25%, 75% and 100%) of the stance phase of gait. Also, these parameters substantially altered the local loading state of the ligaments and resulted in better agreement with the literature during joint flexion. Therefore, the proposed computational framework of ligament in situ strain will help to overcome the challenges in considering this crucial biological aspect during knee joint modeling. Besides, the current construct is advantageous for a better understanding of the mechanical behavior of knee ligaments under physiological and pathological states and provide relevant information in the design of reconstructive treatments and artificial grafts.

The Correlation of the Limitations of Movement of the Shoulder Joint with the Functional Ability of Frozen Shoulder Patients at the Medical Rehabilitation Institute Dr. Mohammad Hoesin Palembang

Background: Frozen shoulder is a condition of the shoulder joint that experiences inflammation, pain, adhesions, atrophy and shortening of the joint capsule resulting in limited motion. In frozen shoulder patients, the limited range of motion of the shoulder joint can affect and reduce functional ability. This study aims to analyze the correlation between the limited area of motion of the shoulder joint with the functional ability of frozen shoulder patients at the Medical Rehabilitation Installation Dr. Mohammad Hoesin Palembang. Methods: This study was an observational analytic study, correlation test, with a cross sectional design. There were 29 frozen shoulder patients who met the inclusion criteria in the Medical Rehabilitation Installation Dr. Mohammad Hoesin Palembang in November 2018 was taken as a sample using consecutive sampling techniques. Functional ability was assessed using the quickDASH questionnaire and the area of motion was measured using a goniometer, then analyzed. Results: The results of the correlation test showed significant results between functional abilities and the area of motion of the shoulder joints. Active flexion (p = 0.000; r = -0.669), active extension (p = 0.004; r = -0.520), active abduction (p = 0.000; r = -0.663), active adduction (p = 0.022; r = -0.423 ), passive flexion (p = 0.001; r = -0.589), passive extension (p = 0.002; r = -0.543), passive abduction (p = 0.000; r = -0.676), passive adduction (p = 0.038; r = -0.388). Conclusion: There is a significant correlation between limited joint motion and functional ability in frozen shoulder patients at the Medical Rehabilitation Installation of Dr. Mohammad Hoesin Palembang.

Bio-Inspired Tendon-Driven Finger Design With Isomorphic Ligamentous Joint

This paper suggests a novel type of bio-inspired finger design in that the joints that compose the finger mimic the features of human finger joints. They have isomorphic structures but different movements, further, there is no friction between bones in the joint, and the joint has a compliance property in all the directions thanks to the elasticity of ligaments. In the proposed joints, a number of strings substitute the articular capsule and collateral ligaments based on the concept of a tensegrity structure. Ultimately, a compliant robotic finger based on the ligamentous structure of the human is proposed. In addition, adjusting the fixed positions of the strings without any structural change, the joint can have a rest position yielded from the elasticity of the strings, and thereby, the tendon is only needed to drive the finger. Especially, since the finger does not have any mechanical rotating parts such as bearings and bushes, it can freely operate even underwater. As the proposed finger design is a type of underactuated mechanism, it is able to realize active flexion, passive extension, and passive adduction and abduction.

The Correlation Between Limited Range of Movement And Functional Ability of Frozen Shoulder Patient at Medical Rehabilitation Department RSUPDr Mohammad Hoesin Palembang

Frozen shoulder is the inflammation of shoulder joint, marked by a painful, adhesive, atrophic and shortened joint capsule. As a result, movement range of the joint becomes limited. In frozen shoulder patients, the limitation can affect and lessen functional ability. Therefore, this study is aimed to analyze the correlation between the limited range of movement of shoulder joint and the functional ability of frozen shoulder patients in Department of Medical Rehabilitation of RSUP Dr. Mohammad Hoesin Palembang. This study is an observational analysis using correlation test with cross-sectional design. Twenty nine frozen shoulder patients in Department of Medical Rehabilitation of RSUP Dr. Mohammad Hoesin Palembang in November 2018 that met the inclusion criteria were taken as subjects of this study by using consecutive sampling technique. Functional ability was assessed with quickDASH questionnaire while shoulder joint range of movement with goniometry. Data analysis was conducted subsequent to the assessments. The result of correlation test between functional ability and shoulder joint range of movement is significant. The study findings include active flexion (p=0,000; r=-0,669), active extension (p=0,004; r=-0,520), active abduction (p=0,000; r=-0,663), active adduction (p=0,022; r=-0,423), passive flexion (p=0,001; r=-0,589), extension passive (p=0,002; r=-0,543), passive abduction (p=0,000; r=-0,676) and passive adduction (p=0,038; r=-0,388).There is a significant correlation between limited range of movement and functional ability in frozen shoulder patients from Department of Medical Rehabilitation of RSUP Dr. Mohammad Hoesin Palembang.

Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes

BackgroundBlood flow is essential in maintaining tissue health. Thus, compromised blood flow can prevent tissue healing. An adducted hallux, as seen inside a narrow shoe, may put passive tension on the abductor hallucis, compressing the lateral plantar artery into the calcaneus and restricting blood flow. The purposes of this study were to compare lateral plantar artery blood flow before and after passive hallux adduction and to compare blood flow with arch height.MethodsForty-five healthy volunteers (20 female, 25 male; age = 24.8 ± 6.8 yr; height = 1.7 ± 0.1 m; weight = 73.4 ± 13.5 kg) participated in this cross-over design study. Arch height index (AHI) was calculated, and blood flow measurements were obtained using ultrasound (L8-18i transducer, GE Logiq S8). The lateral plantar artery was imaged deep to abductor hallucis for 120 s: 60 s at rest, then 60 s of passive hallux adduction. Maximal passive hallux adduction was performed by applying pressure to the medial side of the hallux. Blood flow was calculated in mL/min, and pre-passive hallux adduction was compared to blood flow during passive hallux adduction.ResultsLog transformed data was used to run a paired t-test between the preadduction and postadduction blood flow. The volume of blood flow was 22.2% lower after passive hallux adduction compared to before (− 0.250 ± 0.063, p < 0.001). As AHI decreased, there was a greater negative change in blood flow. As baseline blood flow increased, there was also a greater negative change in blood flow.ConclusionsOur preliminary findings of decreased blood flow through passive hallux adduction indicate conditions that elicit passive hallux adduction (e.g. wearing narrow-toed shoes) may have important effects on foot blood flow. Individuals with lower AHI appear to have a greater risk of decreased blood flow with passive hallux adduction.

ACUTE EFFECTS OF MUSCLE ENERGY TECHNIQUE AND JOINT MOBILIZATION ON SHOULDER TIGHTNESS IN YOUTH THROWING ATHLETES: A RANDOMIZED CONTROLLED TRIAL

Posterior shoulder tightness (PST), defined as limited glenohumeral (GH) horizontal adduction and internal rotation motion, is a common occurrence in overhead athletes, particularly baseball and softball players, as a result of the extreme forces on the GH joint and the high number of throwing repetitions. Despite clinical evidence suggesting the use of joint mobilizations and muscle energy techniques (MET) for treating PST, there currently are no data examining the overall effectiveness of joint mobilizations and MET to determine optimal treatment for posterior shoulder tightness. To compare the acute effectiveness of MET and joint mobilizations for reducing posterior shoulder tightness, as measured by passive GH horizontal adduction and internal rotation ROM, among high school baseball and softball players. Randomized controlled study. Forty-two asymptomatic high school baseball and softball players were randomly assigned to one of three groups (14 MET, 14 joint mobilization, 14 control). Glenohumeral passive adduction and internal rotation ROM were measured in all participants in a pre-test post-test fashion. Between testing, the joint mobilization group received one application of GH posterior joint mobilizations. The MET group received one cycle of MET applied to the GH horizontal abductors. The control group received no intervention. Posttests measures were completed immediately following intervention or a similar amount of time resting for the control group and then again 15 minutes later. One-way analyses of covariance showed that the MET group had significantly more horizontal adduction ROM post-treatment compared to the control group (p = 0.04). No significant differences existed between groups in horizontal adduction (p > 0.16) or internal rotation (p>.28) or at the 15-minute posttests (p > 0.70). The results of this study indicate the application of MET to the horizontal abductors provides acute improvements to GH horizontal adduction ROM in high school baseball and softball players, while joint mobilizations provide no improvements. 1.

The position of sling immobilization influences the outcomes of anatomic total shoulder arthroplasty: a randomized, single-blind, prospective study

To date, no studies have been published that have assessed the optimal position of sling immobilization after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis. Thirty-six patients undergoing anatomic total shoulder arthroplasty for osteoarthritis were randomized to a neutral rotation sling versus an internal rotation sling. The primary outcomes assessed included the Disabilities of the Arm, Shoulder and Hand score; Western Ontario Osteoarthritis of the Shoulder score; Single Assessment Numeric Evaluation score; visual analog scale (VAS) scores for pain and satisfaction; compliance ratings; and radiographic and range-of-motion measurements. Primary outcomes were assessed at baseline and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. All patient-determined outcome scores for both groups revealed statistically significant improvements (P < .0001) from enrollment to final follow-up. There were statistically significant advantages to the neutral rotation sling group compared with the internal rotation sling group when we evaluated the improvements in (1) active external rotation (42° vs 25°, P = .03), (2) passive external rotation (44° vs 26°, P = .02), (3) passive horizontal adduction (7.7 cm vs 3.7 cm, P = .05), and (4) pain relief with passive adduction (VAS score, 6.2 cm vs 3.5 cm; P = .002). There was a trend toward greater improvements in the neutral rotation sling group when we measured (1) active horizontal adduction (8.3 cm vs 2.9 cm, P = .06) and (2) active internal rotation behind the back (18 cm vs 11.1 cm, P = .09). At 2 weeks, the neutral rotation sling group had significantly less night pain than the internal rotation sling group (mean VAS score, 18 mm vs 34 mm; P = .047). Neutral rotation sling use after anatomic total shoulder arthroplasty resulted in statistically significant improvements in external rotation and adduction, as well as decreased night pain, compared with an internal rotation sling.

Sex specific associations between biomechanical recovery and clinical recovery after total hip arthroplasty

BackgroundThere are sex-specific gait differences in men and women before and after total hip arthroplasty (THA) but we do not know their impact on clinical outcomes. The objective of this study was to identify sex-specific associations between pre- and postoperative changes in pain and function and (i) gait mechanics, (ii) passive range of motion, and (iii) abductor strength. MethodsPre- and one-year postoperative data were identified from a data repository (n = 124; 64 Women; Age 61 (SD 10); BMI 29 (SD 5)). We used linear regression analysis to identify sex-specific associations between Harris Hip Score pain and function subscores, and sagittal plane hip kinematics and 3D hip kinetics during gait, hip abductor strength, and passive hip range of motion (RoM). FindingsCombinations of biomechanical variables predicted up to 24% of the variation in pain improvement and up to 27% of the variation in functional improvement. In men, increased peak external rotation moments were associated with pain improvement. Passive flexion RoM and peak extension moments were associated with functional improvement. In women, increased passive adduction RoM and peak external rotation moments were associated with pain improvement. Peak adduction moments and passive flexion RoM were associated with functional improvement. InterpretationsThe different associations between improvement in clinical outcomes and improvement in gait, passive RoM, and abductor strength suggest that the biomechanical path to recovery may be different in men and women.

TESTING INFRASPINATUS AND DELTOID MUSCLES WITH NEW TECHNIQUE TO DECREASE DELTOID ACTIVITY DURING TESTING USING EMG ANALYSIS

Muscle strength testing of an injured infraspinatus muscle (IM) is confounded by actions of synergistic muscles such as the posterior deltoid (PD). The purpose of this study was to describe a condition for testing of the IM that results in less EMG activity of the PD musculature. The researchers hypothesized that greater inhibition of the PD could be achieved through active adduction (AA), creating reciprocal inhibition of the PD. Prospective cohort descriptive study. Thirty-four (19 females and 15 males) right-handed subjects between the ages of 22- 31 (mean 24.2 years + /- 6.2) with no previous history of shoulder surgery or pathology participated. Surface electrodes were placed over the muscle bellies of the IM and PD of the right shoulder along with a ground electrode over the C7 spinous process. EMG activity was recorded during resisted external rotation in four different testing conditions (seated active and passive adduction, and side-lying active and passive adduction). The order of test positions was randomly assigned, and each subject completed all four positions with appropriate rest. During AA conditions, subjects were asked to adduct the humerus against a sphygmomanometer (using 80% maximum force output) while maximal effort external rotation was manually resisted. PD activity was significantly less during AA than with no AA (p<0.05) in both test positions. No significant difference occurred between IM EMG activity in the various test conditions. The results of this study suggest that clinicians can reduce activity of the PD without reducing activity of the IM by using AA of the humerus before applying manual resistance to test the IM during manual muscle testing. 1b.

Effects of Passive Finger Movement on Cortical Excitability.

This study examined the effects of joint angle and passive movement direction on corticospinal excitability. The subjects were 14 healthy adults from whom consent could be obtained. We performed two experiments. In Experiment 1, we measured motor evoked potential (MEP) amplitude, F-wave and M-wave at 0° and 20° adduction during adduction or abduction movement, in the range of movement from 10° abduction to 30° adduction. In Experiment 2, MEPs were measured at static 0° and 20° adduction during passive adduction from 10° adduction to 30° adduction and static 20° adduction. MEP, F-waves and M-waves were recorded from the right first dorsal interosseous (FDI) muscle. Experiment 1 revealed significantly increased MEP amplitude at 0° during passive adduction compared to static 0° (p < 0.01). No other significant differences in MEP, M-wave and F-wave parameters were observed. In Experiment 2, MEP amplitude was significantly higher at 20° adduction during passive adduction compared with static 0° (p < 0.01). Based on these findings, it appears that fluctuations in MEP amplitude values during passive movement are not influenced by joint angle, but rather it is possible that it is due to intracortical afferent facilitation (AF) dependent on afferent input due to the start of movement and interstimulus interval (ISI) of transcranial magnetic stimulation (TMS).

Notes on the pelvic musculature of Emeus crassus and Dinornis robustus (Aves: Dinornithiformes)

Dinornis robustus and Emeus crassus display two variants of moa locomotor adaptations, Emeus being less cursorial. The number and topography of their pelvic muscles are similar and resemble that of Tinamiformes and geographically close Apterygiformes and Casuariiformes. Nevertheless, a number of features are probably peculiar to Dinornithiformes. The strong iliotibiales and iliofemoralis externus muscles, which prevent passive adduction of the femur, far surpass the bulk recorded for these muscles in other birds. The iliofemoralis internus muscle has a unique insertion to the cranial surface of the femur distal to the femoral head, although further inspection of mummified remains is required to prove this. The less modified pelvic muscles of moa in comparison with that of Apterygiformes, Casuariiformes, Rheiformes, and Struthioniformes are related to the retention in Dinornithiformes of the wide pelvis.

Die operative Versorgung der sekundären Coxarthrose bei kongenitaler Hüftluxation (Crowe Typ IV)

The aim of the therapy is mechanical and functional stabilization of high dislocated hips with dysplasia coxarthrosis using total hip arthroplasty (THA).Developmental dysplasia of the hip (DDH) in adults, symptomatic dysplasia coxarthrosis, high hip dislocation according to Crowe type III/IV, and symptomatic leg length inequality.Cerebrospinal dysfunction, muscular dystrophy, apparent disturbance of bone metabolism, acute or chronic infections, and immunocompromised patients.With the patient in a lateral decubitus position an incision is made between the anterior border of the gluteus maximus muscle and the posterior border of the gluteus medius muscle (Gibson interval). Identification of the sciatic nerve to protect the nerve from traction disorders by visual control. After performing trochanter flip osteotomy, preparation of the true actetabulum if possible. Implantation of the reinforcement ring, preparation of the femur and if necessary for mobilization, resection until the trochanter minor. Test repositioning under control of the sciatic nerve. Finally, refixation of the trochanteric crest.During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with maximum flexion of 70°. No active abduction and passive adduction over the body midline. Maximum weight bearing 10-15 kg for 8 weeks, subsequently, first clinical and radiographic follow-up and deep venous thrombosis prophylaxis until full weight bearing.From 1995 to 2012, 28 THAs of a Crow type IV high hip-dislocation were performed in our institute. Until now 14 patients have been analyzed during a follow-up of 8 years in 2012. Mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné score) in 86 % of patients. Good to excellent results were obtained in 79 % of cases. Long-term results are not yet available. In one case an iatrogenic neuropraxia of the sciatic nerve was observed and after trauma a redislocation of the arthroplasty appeared in another case. In 2 cases an infection of the THA appeared 8 and 15 months after index surgery. No pseudoarthrosis of the trochanter or aseptic loosening was noticed.

Diagnosis and Treatment of Abductor Hallucis Focal Dystonia With Botulinum Toxin Injection: A Case Presentation

treatment. Focal dystonia is a rare neurologic condition that often limits function and is charac terized by involuntary muscle contraction in a non velocity dependent manner. In the majority of cases, an underlying cause remains unclear. The term describes a heterogenous set of conditions that can affect almost any location in the body, including the cervical musculature, oromandibular and laryngeal muscles, and the muscles of the extremities. The incidence is estimated at 24 per million per year [3] and occurs most commonly in men [4]. The incidence of upper extremity focal dystonia appears to be much higher in professionals who perform skilled tasks with their hands, such as musicians, dentists, surgeons, and watchmakers. CASE PRESENTATION An 81 year old man was referred to our rehabilitation clinic with a chief concern of severe right hallux varus deformity and an associated abnormal gait pattern. He first noticed this 15 years before presentation and acknowledged its progression over time. He also had right medial knee pain with ambulation. The patient had a pair of custom shoes with an oversized medial aspect of the toe box to accommodate his toe deformity. Other than these custom shoes, he had not undergone any other treatment. He denied any history of stroke or upper motor neuron disorder. There was no history of traumatic foot or toe injury. Medical and surgical histories were negative for foot trauma or surgery, contralateral joint deformity, or movement disorder. Pertinent family history was a daughter with a similar deformity. Physical examination demonstrated a right hallux varus with an abduction angle of 58 � when sitting (Figure 1) and firm muscular resistance appreciated with slow passive adduction of the great toe. This deformity was accentuated when standing, with a relative increase in abduction angle. There was no dystonia appreciated in the foot or the ankle. Neurologic examination was otherwise normal. Gait with a single point cane in the left hand was wide based, with pronounced external rotation of the right foot. A radiograph of the foot demonstrated medial subluxation of the first proximal phalanx with respect to the first metatarsal head. Given the physical examination finding of firm muscular resistance with slow passive adduction, electromyography (EMG) assessment of the right abductor hallucis was performed. The EMG demonstrated abnormal involuntary dystonic activity (Figure 2). This was presumed to be the cause of the patient’s great toe deformity. Botu linum toxin injection is indicated to reduce dystonic activity at this muscle [5]. After

Case Report: Vocal cord collapse during phrenic nerve-paced respiration in congenital central hypoventilation syndrome

Objective: Phrenic nerve pacing can be used to treat congenital central hypoventilation syndrome (CCHS). We report how the lack of normal vocal cord tone during phrenic paced respiration can result in passive vocal cord collapse and produce obstructive symptoms. Methods: We describe a case of passive vocal cord collapse during phrenic nerve paced respiration in a patient with CCHS. As far as we know, this is the first report of this etiology of airway obstruction. The patient, a 7-year-old with CCHS and normal waking vocal cord movement, continued to require nightly continuous positive airway pressure (CPAP) despite successful utilization of phrenic nerve pacers. On direct laryngoscopy, the patient’s larynx was observed while the diaphragmatic pacers were sequentially engaged. Results: No abnormal vocal cord stimulation was witnessed during engaging of either phrenic nerve stimulator. However, the lack of normal inspiratory vocal cord abduction during phrenic nerve-paced respiration resulted in vocal cord collapse and partial obstruction due to passive adduction of the vocal cords through the Bernoulli effect. Bilateral phrenic nerve stimulation resulted in more vocal cord collapse than unilateral stimulation. Conclusions: The lack of vocal cord abduction on inspiration presents a limit to phrenic nerve pacers.

Structure, function and evolution of somatic musculature in Dasydytidae (Paucitubulatina, Gastrotricha)

The musculature of two species of the gastrotrich taxon Dasydytidae, Dasydytes (Dasydytes) goniathrix and Haltidytes crassus, was investigated and described using phalloidin staining, confocal microscopy and computer-aided three-dimensional data analysis. Dasydytidae is a peculiar taxon of freshwater Gastrotricha, containing species that are characterized by different adaptations to a semiplanktonic lifestyle, a rather uncommon feature among primarily benthic Gastrotricha. Like other dasydytid species studied so far, D. goniathrix and H. crassus possess a system of movable cuticular spines with an associated system of somatic oblique and segmented lateral muscles. The presence of other somatic (dorsodermal muscles R1 and R2) and visceral muscles (musculi ventrales, m. ventrolaterales, m. dorsales, m. helicoidales) known from a wide range of gastrotrich species was confirmed. Regarded from a functional perspective, the earlier proposed antagonistic role of oblique muscles (as spine abductors) and segmented lateral muscles (as adductors) is questioned for the species studied herein. Alternatively, our structural and behavioral observations suggest that muscular spine abduction in D. goniathrix is brought about by synergistic contraction of the musculi obliqua and m. laterales, and a passive adduction due to muscle relaxation and elastic recoil of the trunk and cuticle. For H. crassus, we hypothesize active muscular spine abduction by contraction of the musculi obliqua plus the last segment of m. laterales accompanied by severe cuticle deformations close to the spine insertions. Adduction is achieved by cuticle reformation due to elasticity and increase in tissue pressure brought about by muscle action, possibly of enforced dorsodermal muscles. The newly obtained and published muscular data of further gastrotrich species were gathered in a species-character matrix. Based on this data set, a maximum parsimony analysis of representatives of the Dasydytidae has been conducted. According to this analysis, there are three well-supported monophyletic lineages within likewise monophyletic Dasydytidae. The first lineage comprises the taxa Anacanthoderma, Stylochaeta and Chitonodytes, the second comprises Dasydytes, Setopus and Ornamentula, and the third represents the taxon Haltidytes. Relationships between these clades could be resolved but are only weakly supported. The new phylogenetic hypothesis is used to reconstruct the ancestral character pattern and to infer possible evolutionary transformations within the Dasydytidae.

Open Therapy of Femoroacetabular Impingement

ObjectiveElimination of an intraarticular femoroacetabular impingement conflict. Creation of a pain-free, normal range of motion of the hip.IndicationsFemoroacetabular impingement of any type (cam/pincer) and any localization (anterior/posterior).ContraindicationsAbsolute: advanced hip osteoarthritis, local infections around the hip.Relative: excessive acetabular retroversion with deficiency of the posterior wall.Surgical TechniqueLateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Detachment of the labrum. Trimming of the excessive acetabular rim. Refixation of the labrum. Creation of a sufficient femoral head-neck offset. Suture of the capsule. Refixation of the trochanter.Postoperative ManagementDuring hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90°. No active abduction and passive adduction over the body’s midline. Maximum weight bearing 10–15 kg for 6 weeks. Subsequently, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis until full weight bearing.ResultsShort- and mid-term results showed an improvement of the postoperative clinical score (Merle d’Aubigné Score) in 95% of all patients, depending on the individual degenerative joint alterations at the time of surgery. Good to excellent results were obtained in 91% of all cases. Cumulative 5-year survival was 91% (endpoint total hip arthroplasty or poor Merle d’Aubigné Score). Long-term results are not available yet.

Die operative Behandlung der Azetabulum-T-Fraktur über eine chirurgische Hüftluxation oder einen Stoppa-Zugang

Anatomic reduction and stable fixation by means of tissue- preserving surgical approaches. INDICATIONS Displaced acetabular fractures. Surgical hip dislocation approach with larger displacement of the posterior column in comparison to the anterior column, transtectal fractures, additional intraarticular fragments, marginal impaction. Stoppa approach with larger displacement of the anterior column in comparison to the posterior column. A combined approach might be necessary with difficult reduction. CONTRAINDICATIONS Fractures > 15 days (then ilioinguinal or extended iliofemoral approaches). Suprapubic catheters and abdominal problems (e.g., previous laparotomy due to visceral injuries) with Stoppa approach (then switch to classic ilioinguinal approach).Surgical hip dislocation: lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Reduction and fixation of the posterior column with plate and screws. Fixation of the anterior column with a lag screw in direction of the superior pubic ramus. Stoppa approach: supine position. Incision according to Pfannenstiel. Longitudinal splitting of the anterior portion of the rectus sheet and the rectus abdominis muscle. Blunt dissection of the space of Retzius. Ligation of the corona mortis, if present. Blunt dissection of the quadrilateral plate and the anterior column. Reduction of the anterior column and fixation with a reconstruction plate. Fixation of the posterior column with lag screws. If necessary, the first window of the ilioinguinal approach can be used for reduction and fixation of the posterior column.During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90 degrees . No active abduction and passive adduction over the body's midline, if a surgical dislocation was performed. Maximum weight bearing 10-15 kg for 8 weeks. Then, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis for 8 weeks postoperatively.17 patients with a mean follow-up of 3.2 years. Ten patients were operated via surgical hip dislocation, two patients with a Stoppa approach, and five using a combined or alternative approach. Anatomic reduction was achieved in ten of the twelve patients (83%) without primary total hip arthroplasty. Mean operation time 3.3 h for surgical hip dislocation and 4.2 h for the Stoppa approach. Complications comprised one delayed trochanteric union, one heterotopic ossification, and one loss of reduction. There were no cases of avascular necrosis. In two patients, a total hip arthroplasty was performed due to the development of secondary hip osteoarthritis.

Design of the predatory legs of water bugs (Hemiptera: Nepidae, Naucoridae, Notonectidae, Gerridae).

Functional comparative morphology of predatory legs in five species of water bugs (Ilyocoris cimicoides, Nepa cinerea, Ranatra linearis, Notonecta glauca, and Gerris lacustris) has been investigatd adn the following peculiarities of leg design were revealed. 1 Subcoxal articulation may be monoaxial (G. lacustris, N. glauca), or, in contrast to walking leg type, biaxial (N. cinerea, R. linearis, I. cimicoides); the first axis is oriented along the coxa (torsion axis), the second one is perpendicular to the first (non-torsion axis). 2 In contrast to walking leg type, which is characterized by cross suspension of the axis of coxal rotation in thoracal skeleton, this axis in G. lacustris is placed vertically. Non-torsion coxal axis in R. linearis is oriented strongly transversal. This axis directs the leg strike forward. 3 Legs in the majority of species are planar: Torsion axes of the coxa, femur, and tibia are placed in the same plane. Axes of rotation of consequent joints in I. cimicoides are reciprocally sloped. Therefore, the end of the leg outlines the spiral trajectory, when all angles of joints are opening (closing). This is an adaptation for clinging to the stems of water plants. 4 Passive adduction of the femur in the trochanter-femoral joint in N. glauca allows it to go around protuberances of the body wall, when the leg is sliding along them; recurrent femur movement during releasing from the obstacele is active due to the rt.fe muscle. 5 Only R. linearis has predatory legs, which permit the high-speed pursuit of potential prey; other species realize this function using the swimming legs, whereas the forelegs are used for the manipulation movements. 6 Muscle arrangement in the prothorax of different species reflects both leg construction and constructional constraints of body design. Powerful flexor muscles (co1, co2, co3, co5, fl.ti, et.ti in R. linearis; fl.ta, fl.ti in N. glauca; fl.ti in I. cimicoides) have long tendons and short muscle bundles, which originate on the leg wall. As a result, the powerful force is developed along the muscle tendon. 7 Some features of the predatory leg are common for the species studies: elongation of coxae, thickening of femora, and increase of the degree of junction of tibia and tarsus. The muscles, which move the distal segment of the leg, are reinforced and the sclerite of the fl.ti tendon is enlarged. The joint angle of the distal segment is increased to 120°. © 1995 Wiley-Liss, Inc.