Effects of Lithotomy Position and External Compression on Lower Leg Muscle Compartment Pressure

2001 ◽  
Vol 95 (3) ◽  
pp. 632-636 ◽  
Author(s):  
Susanne D. Pfeffer ◽  
John R. Halliwill ◽  
Mark A. Warner
Keyword(s):  
Supine Position ◽  
Case Reports ◽  
Tibialis Anterior Muscle ◽  
Applied Pressure ◽  
Lower Leg ◽  
Lithotomy Position ◽  
External Compression ◽  
Extended Surgery ◽  
Intermittent Compression ◽  
Muscle Compartment

Background Case reports have suggested that externally applied pressure from antithrombosis devices may contribute to the development of compartment syndromes during extended surgery in the lithotomy position. The purpose of this study was to assess the effects of a pneumatic compression device on directly measured intracompartment pressure in the lower leg with the leg positioned in the lithotomy position. Methods In 25 conscious, healthy men and women, the authors measured pressure within the tibialis anterior muscle compartment with the leg supine and in the lithotomy position with and without intermittent compression. Three different devices were used to keep the leg in the lithotomy position, supporting the leg either behind the knee, under the calf, or at the ankle. Results The lithotomy position with support behind the calf or knee increased intracompartment pressure to 16.5+/-3.4 versus 10.7+/-5.8 mmHg supine (mean +/- SD; P < 0.05). The addition of intermittent compression decreased pressure to 13.4+/-5.1 mmHg during lithotomy (P < 0.05) and to 9.1+/-7.0 mmHg in the supine position (P < 0.05). In contrast, the lithotomy position with support near the ankle decreased intracompartment pressure to 8.7+/-5.6 versus 13.3+/-5.1 mmHg supine (P < 0.05). The addition of intermittent compression decreased pressure to 6.5+/-5.4 mmHg during lithotomy (P < 0.05) and to 10.3+/-4.7 mmHg in the supine position (P < 0.05). Conclusions These results show that the lithotomy position is associated with changes in intracompartment pressure that are dependent on the method of leg support used. Furthermore, they indicate that intermittent external compression can reduce intracompartment pressure in the lower leg. Therefore, increases in intracompartment pressure during surgery in the lithotomy position with the calf or knee supported may be one of the factors that contribute to the development of compartment syndrome. Further, use of intermittent external compression may significantly reduce this pressure increase.

Room G, 10/16/2000 9: 00 AM - 11: 00 AM (PS) Effects of Lithotomy Position and External Compression on Lower Leg Muscle Compartment Pressure 

2000 ◽  
Vol 93 (3A) ◽  
pp. A-1128
Author(s):  
Susanne D. Pfeffer ◽  
John R. Halliwill ◽  
Michael J. Joyner ◽  
David O. Warner ◽  
Mark  A. Warner
Keyword(s):  
Lower Leg ◽  
Lithotomy Position ◽  
Compartment Pressure ◽  
External Compression ◽  
Muscle Compartment ◽  
Leg Muscle

Effect of abdominal compression on maximum transdiaphragmatic pressure

1990 ◽  
Vol 68 (6) ◽  
pp. 2296-2304 ◽  
Author(s):  
D. R. Hillman ◽  
J. Markos ◽  
K. E. Finucane
Keyword(s):  
Applied Pressure ◽  
Abdominal Muscle ◽  
Inspiratory Effort ◽  
Neural Activation ◽  
Abdominal Compression ◽  
External Compression ◽  
Transdiaphragmatic Pressure ◽  
Trained Subjects ◽  
Maximum Effort ◽  
Residual Capacity

Transdiaphragmatic pressure (Pdi) is lower during maximum inspiratory effort with the diaphragm alone than when maximum inspiratory and expulsive efforts are combined. The increase in Pdi with expulsive effort has been attributed to increased neural activation of the diaphragm. Alternatively, the increase could be due to stretching of the contracted diaphragm. If this were so, Pdi measured during a combined maximum effort would overestimate the capacity of the diaphragm to generate inspiratory force. This study determined the likely contribution of stretching of the contracted diaphragm to estimates of maximum Pdi (Pdimax) obtained during combined inspiratory and expulsive effort. Three healthy trained subjects were studied standing. Diaphragmatic Mueller maneuvers were performed at functional residual capacity and sustained during subsequent abdominal compression by either abdominal muscle expulsive effort or externally applied pressure. Measurements were made of changes in abdominal (Pab) and pleural (Ppl) pressure, Pdi, rib cage and abdominal dimensions and respiratory electromyograms. Three reproducible performances of each maneuver from each subject were analyzed. When expulsive effort was added to maximum diaphragmatic inspiratory effort, Pdimax increased from 86 +/- 12 to 148 +/- 14 (SD) cmH2O within the 1st s and was 128 +/- 14 cmH2O 2 s later. When external compression was added to maximum diaphragmatic inspiratory effort, Pdimax increased from 87 +/- 16 to 171 +/- 19 cmH2O within the 1st s and was 152 +/- 16 cmH2O 2 s later.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals The Magnitude of Tissue Cooling During Cryotherapy With Varied Types of Compression

2010 ◽  
Vol 45 (3) ◽  
pp. 230-237 ◽  
Author(s):  
David Tomchuk ◽  
Mack D. Rubley ◽  
William R. Holcomb ◽  
Mark Guadagnoli ◽  
Jason M. Tarno
Keyword(s):  
Controlled Trial ◽  
Lower Leg ◽  
The Body ◽  
Acute Injury ◽  
Tissue Temperature ◽  
External Compression ◽  
Certified Athletic Trainers ◽  
Temperature Reduction ◽  
Surface Temperatures ◽  
Intramuscular Temperature

Abstract Context: Certified athletic trainers can choose different types of external compression (none, Flex-i-Wrap, and elastic wrap) when applying an ice bag to the body. However, which type facilitates the greatest magnitude of tissue cooling is unclear. Objective: To compare the effects of 2 common types of external compression on the magnitude of surface and intramuscular cooling during an ice-bag treatment. Design: Randomized controlled trial. Setting: University research laboratory. Patients or Other Participants: Fourteen college students (10 women, 4 men; age  =  22.4 ± 1.8 years, height  =  169.1 ± 8.2 cm, mass  =  73.3 ± 18.5 kg, skinfold  =  13.14 ± 1.61 mm) with previous cryotherapy experience and a posterior lower leg skinfold equal to or less than 15 mm. Intervention(s): On 3 different days separated by 24 to 48 hours, an ice bag was applied to the posterior lower leg surface of each participant for 30 minutes with no compression, with elastic wrap, or with Flex-i-Wrap. Main Outcome Measure(s): Posterior lower leg surface and intramuscular (2 cm) temperatures were recorded for 95 minutes. Results: At 15 minutes, the elastic wrap produced greater surface temperature reduction than no compression (P  =  .03); this difference remained throughout the protocol (P range, .03 to .04). At 30 minutes, surface temperatures were 14.95°C, 11.55°C, and 9.49°C when an ice bag was applied with no external compression, Flex-i-Wrap, and elastic wrap, respectively. Surface temperatures between Flex-i-Wrap and elastic wrap and between Flex-i-Wrap and no compression were never different. At 10 minutes, Flex-i-Wrap (P  =  .006) and elastic wrap (P < .001) produced greater intramuscular temperature reduction than no compression produced; these differences remained throughout the protocol. At 10 minutes, no compression, Flex-i-Wrap, and elastic wrap decreased intramuscular temperature by 1.34°C, 2.46°C, and 2.73°C, respectively. At 25 minutes, elastic wrap (8.03°C) produced greater temperature reduction than Flex-i-Wrap (6.65°C) (P  =  .03) or no compression (4.63°C) (P < .001 ). These differences remained throughout ice application and until 50 minutes after ice-bag removal. Conclusions: During an ice-bag application, external compression with elastic wrap was more effective than Flex-i-Wrap at reducing intramuscular tissue temperature. Elastic wraps should be used for acute injury care.

The Acute Effects of Different Intensity Whole-Body Vibration Exposure on Muscle Tone and Strength of the Lower Legs, and Hamstring Flexibility: A Pilot Study

2020 ◽  
pp. 1-7
Author(s):  
Tülay Çevik Saldıran ◽  
Emine Atıcı ◽  
Derya Azim Rezaei ◽  
Özgül Öztürk ◽  
Burcu Uslu ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Tibialis Anterior ◽  
Muscle Tone ◽  
Tibialis Anterior Muscle ◽  
Lower Leg ◽  
Whole Body ◽  
Moderate Intensity ◽  
Plantar Flexor ◽  
Vigorous Intensity ◽  
Hamstring Flexibility

Context: The research on the change in properties of the lower leg muscles by different intensity sinusoidal vertical whole-body vibration (SV-WBV) exposures has not yet been investigated. Objective: The purpose of this study was to determine effect of a 20-minute different intensity SV-WBV application to the ankle plantar flexor and dorsiflexor muscles properties and hamstring flexibility. Design: Prospective preintervention–postintervention design. Setting: Physiotherapy department. Participants: A total of 50 recreationally active college-aged individuals with no history of a lower leg injury volunteered. Interventions: The SV-WBV was applied throughout the session with an amplitude of 2 to 4 mm and a frequency of 25 Hz in moderate-intensity vibration group and 40 Hz in a vigorous-intensity vibration group. Main Outcome Measures: The gastrocnemius and tibialis anterior muscle tone was assessed with MyotonPRO, and the strength evaluation was made on the same lower leg muscles using hand-held dynamometer. The sit and reach test was used for the lower leg flexibility evaluation. Results: The gastrocnemius muscle tone decreased on the right side (d = 0.643, P = .01) and increased on the left (d = 0.593, P = .04) when vigorous-intensity vibration was applied. Bilateral gastrocnemius muscle strength did not change in both groups (P > .05). Without differences between groups, bilateral tibialis anterior muscle strength increased in both groups (P < .01). Bilateral gastrocnemius and tibialis anterior muscle tone did not change in the moderate-intensity vibration group (P > .05). Flexibility increased in both groups (P < .01); however, there was no statistically significant difference between the groups (d = 0.169, P = .55). Conclusions: According to study results, if SV-WBV is to be used in hamstring flexibility or ankle dorsiflexor muscle strengthening, both vibration exposures should be preferred. Different vibration programs could be proposed to increase ankle plantar flexor muscle strength in the acute results. Vigorous-intensity vibration exposure is effective in altering ankle plantar flexor muscle tone, but it is important to be aware of the differences between the lower legs.

Intramuscular Pressure in the Leg and Thigh Related to Tensile Strap Force During Knee Brace Wear

1998 ◽  
Vol 26 (4) ◽  
pp. 567-570 ◽  
Author(s):  
Olof Lundin ◽  
Jorma R. Styf
Keyword(s):  
Tibialis Anterior ◽  
Muscle Relaxation ◽  
Tensile Force ◽  
Tibialis Anterior Muscle ◽  
Blood Perfusion ◽  
Rectus Femoris ◽  
Intramuscular Pressure ◽  
Knee Brace ◽  
External Compression ◽  
Mean Values

The effects of a functional knee brace on intramuscular pressure in the leg and thigh were measured in eight subjects with a mean age of 32 years. Pressures in the tibialis anterior and rectus femoris muscles were recorded without a knee brace and with a brace applied with strap tensile force of 25 N, 50 N, and a force preferred by the subject. External compression caused by the brace significantly increased intramuscular pressures at rest and muscle relaxation pressure during exercise in the leg and thigh muscles. Pressure in the tibialis anterior muscle increased 3 to 10 times, to mean values between 17.5 and 41 mm Hg, depending on the tensile force of the straps used at brace application. Corresponding mean pressure values in the rectus femoris muscle were between 17.5 and 32.5 mm Hg. Mean pressures in the standing subject varied between 37 and 62 mm Hg. Our study showed that intramuscular pressure at rest and muscle relaxation pressure during exercise in the tibialis anterior and the rectus femoris muscles increased significantly in the braced limb. Local blood perfusion pressure in the supine subject decreased significantly, by 16% to 42%, in the compressed muscles.

scholarly journals Validation of an automated segmentation algorithm for lower leg MR images, applied to sodium quantification

2018 ◽  
Author(s):  
Jasmine M. Greer ◽  
Ping Wang ◽  
Serpil Muge Deger ◽  
Aseel Alsouqi ◽  
T. Alp Ikizler ◽  
...  
Keyword(s):  
Sodium Concentration ◽  
Lower Leg ◽  
Segmentation Algorithm ◽  
Automated Segmentation ◽  
Mr Images ◽  
Muscle Area ◽  
Imaging Protocol ◽  
Automated Algorithm ◽  
Muscle Compartment ◽  
Magnetic Resonance Imaging Protocol

AbstractObjectiveTo develop and validate an automated segmentation algorithm for the lower leg using a multi-parametric magnetic resonance imaging protocol.MethodsAn automated algorithm combining active contour and intensity-based thresholding methods was developed to identify skin and muscle regions from proton Dixon MR images of the lower leg. Tissue sodium concentration was then computed using contemporaneously acquired sodium images with calibrated phantoms in the field of view. Resulting sodium concentration measurements were compared to a gold standard manual segmentation in 126 scans.ResultsMost cases had no observable errors in segmentation of muscle and skin. Six cases had minor errors that were not expected to affect quantification; in the worst, 126 mm2 (2%) of a muscle area of 8,042 mm2 was misclassified. In one case the algorithm failed to separate the tibia from the muscle compartment. Correlation between automated and manual measurements of sodium concentration was R2 = 0.84 for skin, R2 = 0.99 for muscle. Additionally, the RMSE was 2.4mM for skin and 0.5mM for muscle; the observed physiological range was 8.5 to 37.4mM.ConclusionFor the purpose of estimating sodium concentrations in muscle and skin compartments, the automated segmentations provided equally accurate results compared to the more time-intensive manual segmentations. Sodium quantification serves as a biomarker for disease progression, which would assist with early diagnostic treatments. The proposed algorithm will improve workflow, reproducibility, and consistency in such studies.

scholarly journals Leg pain in neuropathic postural tachycardia syndrome is associated with altered muscle membrane properties

2021 ◽  
Author(s):  
Belén Rodriguez ◽  
Karin Jost ◽  
Lotte Hardbo Larsen ◽  
Hatice Tankisi ◽  
Werner J. Z’Graggen
Keyword(s):  
Supine Position ◽  
Healthy Subjects ◽  
Body Position ◽  
Lower Leg ◽  
Membrane Properties ◽  
Leg Pain ◽  
Muscle Membrane ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Muscle Excitability

Abstract Purpose In neuropathic postural tachycardia syndrome, peripheral sympathetic dysfunction leads to excessive venous blood pooling during orthostasis. Up to 84% of patients report leg pain and weakness in the upright position. To explore possible pathophysiological processes underlying these symptoms, the present study examined muscle excitability depending on body position in patients with neuropathic postural tachycardia syndrome and healthy subjects. Methods In ten patients with neuropathic postural tachycardia syndrome and ten healthy subjects, muscle excitability measurements were performed repeatedly: in the supine position, during 10 min of head-up tilt and during 6 min thereafter. Additionally, lower leg circumference was measured and subjective leg pain levels were assessed. Results In patients with neuropathic postural tachycardia syndrome, muscle excitability was increased in the supine position, decreased progressively during tilt, continued to decrease after being returned to the supine position, and did not completely recover to baseline values after 6 min of supine rest. The reduction in muscle excitability during tilt was paralleled by an increase in lower leg circumference as well as leg pain levels. No such changes were observed in healthy subjects. Conclusions This study provides evidence for the occurrence of orthostatic changes in muscle excitability in patients with neuropathic postural tachycardia syndrome and that these may be associated with inadequate perfusion of the lower extremities. Insufficient perfusion as a consequence of blood stasis may cause misery perfusion of the muscles, which could explain the occurrence of orthostatic leg pain in neuropathic postural tachycardia syndrome.

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