scholarly journals Medial rotation deformity of the hip in cerebral palsy: Surgical treatment by transposition of gluteal muscles

2005 ◽  
Vol 133 (1-2) ◽  
pp. 36-40 ◽  
Author(s):  
Goran Cobeljic ◽  
Zoran Bajin ◽  
Zoran Vukasinovic ◽  
Aleksandar Lesic ◽  
Momirka Vukicevic
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
External Rotation ◽  
Gluteus Medius ◽  
Flexion Contracture ◽  
Femoral Neck Anteversion ◽  
Before And After ◽  
Medial Rotation ◽  
Lateral Rotation ◽  
The Difference

INTRODUCTION Medial rotation deformity of the hip is a problem to patients who are handicapped by cerebral palsy but able to walk, because the knees point inward during gait (?kissing patellae") and cause falls and frequent injuries. Knees and ankles are subject to stress and, therefore, they assume compensating positions. Lower legs assume position of valgus and external rotation, whereas feet rotate either inwards or outwards. Secondary deformities make gait more difficult and cause rapid tear of footwear. AIM The purpose of the paper was to retrospectively analyze the effects of transposition of the gluteus medius and minimus muscles, a procedure introduced for the first time in our country in order to correct the deformity. A new method of binding the muscles by wire was described. There had been no previous experience with this method. METHOD This operation was indicated in patients with spastic form of cerebral palsy, who were able to walk, who had difficulties in gait and whose lateral rotation was less than 10? along with the medial rotation of over 70? of the hip on the side of the deformity. Additional prerequisite for the operation was the absence of flexion contracture of more than 15? of either the hip or the knee on the side of deformity, as there is possibility of aggravation of the flexion hip deformity due to transposed gluteal muscles (now in front of the hip joint). Fifteen hips of 10 patients were operated on. Five patients were operated on bilaterally at one time. The average age was 8 (6-12) years. The majority of patients, 8 (80%) were aged between 6 and 8. The average follow-up was 5 years (3-8). The assessment of the results was based on the comparison of rotational abilities of both hips before and after the operation (in unilateral and bilateral deformities), as well as on individual complaints before and after the operation. In patients with unilateral deformity, their ?healthy" hips were the control hips. The analysis of the femoral neck anteversion before and after operation was performed. RESULTS Average values of medial and lateral rotation of the deformed hips before operation exhibited significant statistical difference when compared to control hips. The difference of average values of rotatory movements of control and operated hips was not statistically significant after operation. The difference of average preoperative values of the femoral neck anteversion in hips with deformity was statistically significant (49.40?4.63? compared to 32.8?3.1G). Postoperative average values of anteversion in operated and control hips were not statistically significant. The difference between average preoperative (49.40?4.63?) and postoperative (35.80?7.66?) values of the femoral neck anteversion was statistically significant. Excellent results were achieved in 5 (50%) patients, i.e. 8 (53.3%) hips; good results were achieved in 3 (30%) patients, i.e. 5 (33.3%) hips; poor result in 2 (20%) patients, i.e. 2 (13.3%) hips. All 5 patients who had undergone surgery of both hips had symmetric outcome. Three patients had excellent results, while two had good results. Patients with excellent and good results (80% of patients, 86.6% of hips) showed neither weakening of the operated hip abduction nor pelvic instability (positive Trendelenburgh hip test). No complications were recorded postoperatively. CONCLUSION Transposition of gluteal muscles can be recommended in patients under 10 years of age as there is still a chance for their femoral neck to change orientation, to decrease the anteversion and thus to achieve long-lasting effect. Fixation of transposed muscles by wire proved to be effective.

Hip Rotations’ Influence of Electromyographic Activity of Gluteus Medius Muscle During Pelvic-Drop Exercise

2017 ◽  
Vol 26 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Renan Lima Monteiro ◽  
Joana Hoverter Facchini ◽  
Diego Galace de Freitas ◽  
Bianca Callegari ◽  
Sílvia Maria Amado João
Keyword(s):  
Outcome Measures ◽  
Random Order ◽  
Gluteus Medius ◽  
Emg Activity ◽  
Neutral Position ◽  
Electromyographic Activity ◽  
Medial Rotation ◽  
Lateral Rotation ◽  
Tensor Fasciae Latae ◽  
Hip Rotation

Context:Pelvic-drop exercises are often used to strengthen the gluteus medius (GM) muscle with the aim of increasing or prioritizing its recruitment. However, the effect of hip rotation on the performance of the action of the GM is unknown.Objective:To evaluate the effect of hip rotation on the recruitment of the GM, tensor fasciae latae (TFL), and quadratus lumborum (QL).Method:Seventeen healthy subjects performed 2 sets of 4 repetitions of pelvic-drop exercise in random order with pelvic-drop lateral, medial, and neutral rotation of the hip.Main Outcome Measures:The electromyographic (EMG) activity of the GM, TFL, and QL was evaluated using surface electromyography.Results:There were significant increases in the activation of the GM with medial and neutral rotation compared with lateral rotation (P = .03, P = .01, respectively), and there was no difference between medial and neutral rotation (P = 1.00). There was no difference in EMG activity of the TFL and QL in any of the positions. The GM:TFL ratio was the same in all analyzed positions. Regarding the GM:QL ratio, there was a significant increase with medial rotation compared with lateral rotation (P = .02).Conclusions:Pelvic-drop exercises are more efficient for activating the GM when the hip is in medial rotation and neutral position.

scholarly journals Changes in Abduction and Rotation Range of Motion in Response to Simulated Dorsal and Ventral Translational Mobilization of the Glenohumeral Joint

2002 ◽  
Vol 82 (6) ◽  
pp. 544-556 ◽  
Author(s):  
Ar-Tyan Hsu ◽  
Tom Hedman ◽  
Jia Hao Chang ◽  
Chuong Vo ◽  
Larry Ho ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Glenohumeral Joint ◽  
Physical Therapists ◽  
Frozen Shoulder ◽  
Testing System ◽  
Before And After ◽  
Medial Rotation ◽  
Fresh Frozen ◽  
Lateral Rotation ◽  
Improved Function

AbstractBackground and Purpose. Translational mobilization techniques are frequently used by physical therapists as an intervention for patients with limited ranges of motion (ROMs). However, concrete experimental support for such practice is lacking. The purpose of the study was to evaluate the effect of simulated dorsal and ventral translational mobilization (DTM and VTM) of the glenohumeral joint on abduction and rotational ROMs. Methods. Fourteen fresh frozen shoulder specimens from 5 men and 3 women (mean age=77.3 years, SD=10.1, range=62–91) were used for this study. Each specimen underwent 5 repetitions of DTM and VTM in the plane of scapula simulated by a material testing system (MTS) in the resting position (40° of abduction in neutral rotation) and at the end range of abduction with 100 N of force. Abduction and rotation were assessed as the main outcome measures before and after each mobilization procedure performed and monitored by the MTS (abduction, 4 N·m) and by a servomotor attached to the piston of the actuator of the MTS (medial and lateral rotation, 2 N·m). Results. There were increases in abduction ROM for both DTM (X̄=2.10°, SD=1.76°) and VTM (X̄=2.06°, SD=1.96°) at the end-range position. No changes were found in the resting position following the same procedure. Small increases were also found in lateral rotation ROM after VTM in the resting position (X̄=0.90°, SD=0.92°, t=3.65, P=.003) and in medial rotation ROM after DTM (X̄=0.97°, SD=1.45°, t=2.51, P=.026) at the end range of abduction. Discussion and Conclusion. The results indicate that both DTM and VTM procedures applied at the end range of abduction improved glenohumeral abduction range of motion. Whether these changes would result in improved function could not be determined because of the use of a cadaver model.

scholarly journals Pre- and postoperative offset and femoral neck version measurements and validation using 3D computed tomography in total hip arthroplasty

2020 ◽  
Vol 9 (10) ◽  
pp. 205846012096491
Author(s):  
Mats Geijer ◽  
Sverrir Kiernan ◽  
Martin Sundberg ◽  
Gunnar Flivik
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Intraclass Correlation ◽  
Hip Osteoarthritis ◽  
Data Sets ◽  
Femoral Offset ◽  
Total Hip ◽  
Femoral Neck Anteversion ◽  
Before And After

Background Restoration of a correct biomechanical situation after total hip arthroplasty is important. Purpose To evaluate proximal femoral symmetry of acetabular and femoral offset and femoral neck anteversion pre- and postoperatively in hip arthroplasty by semi-automated 3D-CT and to validate the software measurements by inter- and intraobserver agreement calculations. Material and Methods In low-dose CT on 71 patients before and after unilateral total hip arthroplasty, two observers used a digital 3D templating software to measure acetabular offset, true and functional femoral offset, and femoral neck anteversion. Observer agreements were calculated using intraclass correlation. Hip measurements were compared in each patient and between pre- and postoperative measurements. Results Preoperatively, acetabular offset (2.4 mm), true (2.2 mm), and functional global offset (2.7 mm) were significantly larger on the osteoarthritic side without side-to-side differences for true and functional femoral offset or femoral neck anteversion. Postoperatively, acetabular offset was significantly smaller on the operated side (2.1 mm) with a concomitantly increased true (2.5 mm) and functional femoral offset (1.5 mm), resulting in symmetric true and functional global offsets. There were no differences in postoperative femoral neck anteversion. Inter- and intraobserver agreements were near-perfect, ranging between 0.92 and 0.98 with narrow confidence intervals (0.77–0.98 to 0.94–0.99). Conclusion Acetabular and concomitantly global offset are generally increased in hip osteoarthritis. Postoperative acetabular offset was reduced, and femoral offset increased to maintain global offset. 3D measurements were reproducible with near-perfect observer agreements. 3D data sets should be used for pre- and postoperative measurements in hip arthroplasty.

scholarly journals Medial rotation deformity of the hip in cerebral palsy: Surgical treatment by derotation femoral osteotomy

2004 ◽  
Vol 51 (3) ◽  
pp. 29-35
Author(s):  
Goran Cobeljic ◽  
I. Djordjic ◽  
Zoran Bajin ◽  
Zoran Vukasinovic ◽  
Aleksandar Lesic
Keyword(s):  
Cerebral Palsy ◽  
Excellent Result ◽  
Original Method ◽  
Precise Determination ◽  
Femoral Osteotomy ◽  
Before And After ◽  
Medial Rotation ◽  
Derotation Osteotomy

Medial rotation deformity of the hip is a problem to patients handicapped by cerebral palsy who are able to walk, because the knees point inward during gait ("kissing patellae") and cause falls and frequent injuries, knee and ankle distorsions. The deformity is a result of an increased femoral neck anteversion. The purpose of the paper is to present the results of an original method of precise determination of the degree of rotation for derotation femoral osteotomy. Indications for this operation were set in pa- tients with spastic form of cerebral palsy over 10 years of age, able to walk, who had difficulties in gait and whose lateral rotation was less than 15 along with the medial rotation of over 70 in the hip on the side of the deformity. Twenty hips in 17 patients able to walk were operated on. The average age was 21 (11 - 42), the average follow-up was 11 years (3-17). The assessment of the results was based on the comparison of the rotational abilities of the hip and individual problems before and after the operation. Excellent result was achieved in 12 (70.6%) patients i.e. 15 (75%) hips; good result was achieved in 3 (17.6%) patients i.e. 3 (15%) hips; unsuccessful result in 2 (11.8%) patients i.e. 2 (10%) hips. Complications aroused in 6 patients i.e. 6 (30%) hips. The conclusion is that derotation osteotomy of the femur is a successful procedure for the treatment of the medial rotation deformity of the hip in patients with the spastic form of cerebral palsy who are able to walk. The above mentioned indications must be respected and the original method of determining the degree of derotation applied. Due to a relatively high percentage of complications, e.g. osteitis, the operation is suggested to patients aged 10 to 15 when possible complications can more easily be cured.

scholarly journals The relationship among repeated sprint and change of direction abilities in football players with cerebral palsy

Kinesiology ◽  
2020 ◽  
Vol 52 (2) ◽  
pp. 208-216
Author(s):  
Matías Javier Henríquez ◽  
Marco Kokaly ◽  
Felipe Herrera ◽  
Raul Reina
Keyword(s):  
Cerebral Palsy ◽  
Lactate Concentration ◽  
Football Players ◽  
Sprint Time ◽  
Change Of Direction ◽  
Repeated Sprint Ability ◽  
Repeated Sprint ◽  
Before And After ◽  
The Difference ◽  
The Relationship

This study aimed to describe and determine relationships between repeated sprint and change of direction (COD) abilities in football players with cerebral palsy according to four sport classes (FT5 to FT8). Seventeen male football players with cerebral palsy took part in this study (23.0±4.7 years, 65.9±9.5 kg, 168.8±5.9 cm). The repeated sprint ability (6×40-m sprints with a 20-second recovery) was evaluated to determine the best sprint time, mean sprint time, and percentage of sprint decrement. The difference in lactate concentration was determined using blood samples taken three minutes before and after testing. The Illinois Agility Test (IAT) was also used to assess players’ change of direction ability. The FT8 players had better performance (p<.01) in the best sprint time, mean sprint time and in the IAT scores compared to the players of the sport classes FT5/6. Players of the sport class FT7 also reached higher performance in the IAT compared to the players of the sport classes FT5/6 (p<.05). A significant correlation was found between the best sprint time and mean sprint time (r=.94, p<.01), the best sprint time and the IAT (r=.62, p<.01), and between the best sprint time and the difference in lactate concentration (r=-.51, p<.05). The relationships between repeated sprint and change of direction abilities demonstrate the performance profile of para-footballers with cerebral palsy in those variables according to their sport classes, exhibiting lower performance than the values reported for regular football players.

Tem analysis of multiple-energy arsenic implanted and Rta'd silicon

1987 ◽  
Vol 45 ◽  
pp. 246-247
Author(s):  
R.A. Herring
Keyword(s):  
Device Fabrication ◽  
High Concentration ◽  
Tem Analysis ◽  
Defect Clusters ◽  
High Fluences ◽  
Small Defect ◽  
Before And After ◽  
The Matrix ◽  
The Difference ◽  
Factor Type

Rapid thermal annealing (RTA) of ion-implanted Si is important for device fabrication. The defect structures of 2.5, 4.0, and 6.0 MeV As-implanted silicon irradiated to fluences of 2E14, 4E14, and 6E14, respectively, have been analyzed by electron diffraction both before and after RTA at 1100°C for 10 seconds. At such high fluences and energies the implanted As ions change the Si from crystalline to amorphous. Three distinct amorphous regions emerge due to the three implantation energies used (Fig. 1). The amorphous regions are separated from each other by crystalline Si (marked L1, L2, and L3 in Fig. 1) which contains a high concentration of small defect clusters. The small defect clusters were similar to what had been determined earlier as being amorphous zones since their contrast was principally of the structure-factor type that arises due to the difference in extinction distance between the matrix and damage regions.

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