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Stump length and the thigh muscles strength of the amputated limb are among the major factors influencing outcome of prosthetic rehabilitation of trans-tibial amputees. In the present study the authors evaluated and compared the strength of quadriceps and hamstrings muscles of both limbs in trans-tibial amputees, as measured by means of an electrical dynamometer. The obtained results showed that the thigh muscles of the sound limbs are significantly stronger than those of the amputated limbs (p < 0.01). The results obtained for amputees with shorter stumps were compared with those with longer stumps. In the group of amputees (n = 9) with a stump shorter than 15.1 cm, values of peak torque (in isokinetic contraction) and maximal average torque (in isometric contraction) were significantly (p < 0.5) weaker when compared to those (n = 9) with a stump longer than 15.1 cm. The results obtained for amputees with a higher rate of thigh muscle atrophy were compared to those with lesser atrophy. In the group of amputees where muscle atrophy was accompanied by decrease in thigh girth of over 5.9 cm, muscles strength did not significantly decrease (p < 0.5) as compared to amputees where thigh girth decrease was less than 5.9 cm. It is concluded that atrophy of the thigh muscles of trans-tibial amputees is accompanied with a significant decrease in strength. In amputees with a short stump, the short lever action provided by the stump interferes with the ability of the thigh muscles to control the prosthesis efficiently during daily activities such as standing and walking.

Objective: To evaluate the effects of one 10-minute stretch on muscle stiffness in subjects with short hamstrings., Design: Randomized control trial., Setting: Laboratory for human movement sciences in the department of rehabilitation of a university hospital., Subjects: Sixteen students from the Department of Human Movement Sciences participated with informed consent in the experiment. Subjects were limited to men and women without a history of neurological and orthopedic disorders. To select subjects with short hamstrings, the finger-ground distance had to be greater than 0cm (unable to touch the floor when bending forward) and the manual leg lifting was not to exceed 80 degrees. One group of 10 subjects performed static stretching exercises during 10 minutes interspersed with relaxing, whereas the untreated group of 6 subjects was used as a control., Main Outcome Measures: The instrumental straight-leg-raising set-up enables the measurement of the force needed to lift the leg, range of motion (ROM), pelvic-femoral angle, and the electromyogram of the hamstrings. These variables provide information about the stiffness, elongation, and state of activity of the hamstring muscles. RESULTS. One 10-minute sport stretch resulted in a significant increase in passive muscle moment, ROM, and elongation of the hamstrings. There was no significant change in the course of the passive muscle stiffness curve with respect to the prestretch stiffness curve., Conclusions: One session of static stretching does not influence the course of the passive muscle stiffness curve. The increased ROM, i.e., the extensibility of the hamstrings, results from an increase in the stretch tolerance.

In amyotrophic lateral sclerosis the striated pelvic floor sphincter muscles are functionally uninvolved, and pathological studies have confirmed the relative resistance of the Onuf nucleus motor neurons. We have evaluated the external anal sphincter (EAS) muscle in 16 patients with ALS using single fiber EMG, and compared the results with the findings in the semimembranosus-semitendinosus (SM-ST) muscles that have innervation from the L-5, S-1, and S-2 segments. The results were compared with a group of controls matched for age and sex. None of the patients or controls had symptomatic sphincter involvement and none of the 4 women studied were parous. Eight patients with ALS showed an increased fiber density in the EAS; 6 had an abnormal neuromuscular jitter. In 1 there was fibrillation in the EAS. In the SM-ST muscle 11 patients showed an increased fiber density, and 7 had an abnormal neuromuscular jitter. In 3 patients with ALS in whom there were abnormal findings in the EAS the bulbocavernosus reflex and pudendal nerve evoked potentials were normal. Neurogenic change was more marked in the SM-ST than in the EAS muscle. These findings show that the EAS is not normal in ALS. However, the relative resistance of the EAS to ALS is sufficient to prevent incontinence, even in the longer-surviving older patients.

Surface electromyography of the quadriceps femoris muscle was performed in seven patients in order to determine the effect of extensive lengthening of the femur on the muscles that extend the knee. Electromyograms were made during sustained (thirty-second) isometric extension of the knee, at an angle of flexion of the knee of 30 degrees, while a load equal to 15 per cent of body weight was applied to the leg just proximal to the ankle. The average circumference of the thigh was smaller, the motor-unit recruitment of the muscles was slower, and the fatigability was greater on the involved side compared with the uninvolved side. The vastus medialis exhibited greater fatigability and slower motor-unit recruitment than the rectus femoris or the vastus lateralis. The atrophy index of the involved muscles correlated well with the muscle fatigability, the preoperative limb-length discrepancy, the percentage of lengthening, and the motor-unit recruitment. Analysis also revealed a correlation between muscle fatigability and the percentage of lengthening of the bone and between muscle fatigability and the preoperative limb-length discrepancy. The percentage of lengthening correlated with the extent of motor-unit recruitment. The results of this study suggest that the amount of damage to neuromuscular tissue varies according to the extent of the lengthening of the femur. Of all of the knee extensors, the vastus medialis was affected the most.

The alterations in thigh muscle properties of chondromalacia patellae patients during isometric and dynamic endurance tests were studied using a variokinetic knee testing system linked to surface EMG. A total of 41 patients (chondromalacia group) with arthroscopically certified chondromalacia of the patella were studied. The control group consisted of 31 healthy adult volunteers with no history of knee pain or trauma. Peak torque values were 21% (p < 0.01) and force output values 25% (p < 0.05) lower on the symptomatic side of the chondromalacia group than in the control group. The decrease in the ratio between integrated EMG (IEMG) and measured force were found in all parts of the quadriceps femoris muscle in patients with chondromalacia of the patella in isometric extension. No change in the normalized IEMG levels of the thigh muscles were found between chondromalacia patients and controls in dynamic endurance test. The severity of the chondromalacia of the patella did not affect the level of electromyographic activation in thigh muscles. The ratio of normalized EMG levels of vastus medialis and vastus lateralis did not differ between the groups. The present study showed that chondromalacia patellae patients have reduced force and electromyographic activation levels of quadriceps femoris muscle. Especially, the explosive strength of the quadriceps femoris muscle is reduced.

Our purpose was to evaluate a test battery for measuring progress and the effect of interventions in patients with hereditary motor and sensory neuropathy (HMSN types I and II). For this purpose differences in upper leg strength and functional abilities between patients and healthy persons were quantified. Twenty patients participated in the study. They were matched with healthy control subjects with respect to gender, age, body weight, and height. Because of the high reproducibility and sensitivity of the method, muscle strength was quantified as isokinetic and isometric knee torques on an isokinetic dynamometer. Isokinetic knee extension and flexion torques were recorded for three movement velocities (120, 60, and 30 degrees/sec). An extension endurance test was performed at 80% of maximum voluntary contraction. Time scored activities (for instance, stair climbing) that are mainly related to leg function were measured to determine functional abilities. The torques were lower (p < 0.009) and endurance was less (p = 0.03) for patients than for controls. Time scores were higher (p < 0.013) in patients. A strength reduction in the knee extensors and flexors and a decrease in functional abilities was found even in mildly affected patients. Torques and time scores were correlated, although correlation coefficients were rather low. Our results indicate that both types of test are useful for monitoring lower limb function in HMSN patients.

Lateral release (division of the lateral retinaculum of the patella) is a common operative procedure to improve alignment of the patella in patients with chondromalacia patellae. We investigated the effects of lateral release using clinical follow-up and studied the changes in the radiologic measurements of the patellar alignment and electromyographic function of the stabilizing muscles of the knee, as well as using muscle-force tests of the thigh. The study included 75 patients. Diagnostic arthroscopy was done for all patients. In 42 patients with obvious incongruency of the patellofemoral joint observed at arthroscopy, open division of the lateral patellar retinaculum was performed in addition to arthroscopy. Four years after surgery, the results showed that although division of the lateral retinaculum of the patella reduced lateral patellar tilting and lateral patellar displacement, the postoperative physical capacity of the patients was not improved. Lateral release did not impair the electrical activity of thigh muscles. The Lysholm scores of the lateral release group and the control group were equal after four years.

The purpose of the present study was to assess the relationship between hamstring strains and leg muscle strength. The bilateral isometric extensions and flexion maximum voluntary contraction (MVC) of knee and hip were measured among 64 collegiate track and field athletes (128 legs). The values of MVC per body-weight, flexion to extension ratio and bilateral legs imbalance index were calculated as the parameters for the investigation. The follow-up research was performed within the following two years. Among the 64 subjects (128 legs): 26 subjects (31 legs), 24.2 percent had suffered from hamstring strains. Then, the subjects were divided into injured (31 legs) and uninjured (97 legs) groups respectively. The parameters of the lower extremities measured at the beginning were compared for the two groups. The different rates of the hip flexion and knee extension of bilateral legs of the injured group were significantly higher than those of the uninjured group (p < 0.05). In the injured group, the value of MVC per body-weight of the knee flexor and the flexion-extension ratio were significantly lower than in the uninjured group (p < 0.05). In conclusion, the imbalance of the bilateral legs, the hamstring strength and the ratio of the flexor to extensor were shown to be parameters related to the occurrence of hamstring strains.

A bilateral comparison of the peak torque generated by the quadriceps muscles during isokinetic muscle action at a joint angular velocity of 180 deg/sec was undertaken in 17 subjects with chronic anterior cruciate ligament (ACL) deficiency. The results allowed subjects to be separated into minimal and maximal deficit groups. A frequency analysis of the electromyographic signals of the vasti lateralis obtained during the peak torque tests was then undertaken. The results showed that the median frequency of the ACL deficient limb in the maximal deficit group was significantly (p < 0.05) decreased compared to the median frequency of the uninvolved limb and both limbs of the minimal deficit group. These results suggested that type II muscle fibre atrophy had occurred. The frequency analysis of EMG may provide a noninvasive technique of measuring relative fibre atrophy differences between legs.

We assessed the isokinetic and isometric strength and power profile of the knees of 37 patients who had a previous grade II sprain (partial tear) of the anterior cruciate ligament. Of the 37 knees, 11 had an isolated partial anterior cruciate ligament rupture and 26 had a partial anterior cruciate ligament rupture combined with a partial medial collateral ligament rupture. The Cybex II isokinetic dynamometer was used in the measurements. Eight years after the injury, the mean strength deficit of the injured knees was minimal when compared with the uninjured side. In the hamstrings of both groups, the relative strength deficit increased significantly with a higher speed of isokinetic movement (P less than 0.05). Compared with the strength parameters (peak torques), the other functional parameters (total work, average power, and peak angular impulse) of the injured knees showed some, but not significantly greater, deficits (hamstrings, 7% to 10%; quadriceps, 4% to 10%). We found that the general thigh muscle function in knees with old grade II sprains of the anterior cruciate ligament appears adequate except in flexion where the strength deficits are significantly greater in higher speeds of isokinetic movement. Therefore, rehabilitation using high-speed flexion (and extension) exercises is recommended.

From January 1979 to April 1989, 19 neurosensory tensor fasciae latae flaps were used to cover ischial pressure sores in paraplegic patients. This flap provides protective sensation and improves the sensory control of the filling status of the rectum and the sitting control in a wheelchair. Patients were reexamined between 12 and 110 months; no recurrence or new pressure sores were seen. Indications, early and late complications, and evolution of the sensation are discussed.

A recent increase in the popularity of selective rhizotomy for reduction of spasticity in cerebral palsy has led to a demand for more objective studies of outcome and long-term follow-up results. The authors present the results of gait analysis on 14 children with spastic cerebral palsy, who underwent selective posterior rhizotomy in 1985. Sagittal plane gait patterns were studied before surgery and at 1 and 3 years after surgery using a digital camera system. The parameters measured included the range of motion at the knee and thigh, stride length, speed of walking, and cadence. The range of motion at the knee was significantly increased at 1 year after surgery and further improved to a nearly normal range at 3 years after surgery. In contrast, postoperative measurements of thigh range exceeded normal values at 1 year, but decreased toward normal range at 3 years. While improvements in range of motion continued between Years 1 and 3, the children developed a more extended thigh and knee position, which indicated a more upright walking posture. Stride length and speed of walking also improved, while cadence remained essentially unchanged. This 3-year follow-up study, the first to examine rhizotomy using an objective approach, has provided some encouraging results regarding early functional outcome.

We present an assessment of 200 patellar fractures treated mostly (175) by partial patellectomy. In 23 cases in which the quadriceps mechanism was 75% intact (MRC power approximately 4), the fractures were treated conservatively, with an overall acceptable result. The operative series with an average follow-up of 3 years has shown 80.3% excellent to good results. A classification of fractures of the patella, based on the anatomical fracture line and quadriceps functional loss as recorded in 690 case histories, is suggested.

Maximal static expiratory and inspiratory mouth pressures (PEmax and PImax) and quadriceps femoris muscle strength were measured in 25 patients aged 16-28 years with cystic fibrosis (mean FEV1 46% predicted). Mean (SD) PEmax was 64% (18%) predicted (below 75% predicted in 16 of the 25 patients), and PImax was 64% (24%) predicted (below 75% predicted in 14 patients). Quadriceps muscle strength was 68% (20%) predicted (below 75% predicted in 17 patients). The relatively small reduction in respiratory muscle strength in these patients was unlikely to have contributed appreciably to their respiratory problems.

Recent studies indicate that the hamstrings are essential antagonists in ACL deficient patients. In order to evaluate muscle coordination under physiologic conditions, nine patients with arthroscopically verified total ACL ruptures were compared with nine control volunteers. This comparison was made from electromyograms of the thigh muscles and heel contact recordings made while walking on a treadmill. While walking on a horizontal level, the patient's muscle activity did not differ from controls, but when the knee load was increased by walking uphill, the hamstring muscles in patients were activated significantly earlier than among controls. It is proposed that an altered muscle coordination is probably essential in ACL deficient patients to secure knee stability. This study suggests a new approach to investigate the coordination of muscles under physiologic conditions in ACL deficient patients, and may guide rehabilitation programs in the future.

There are several common findings and contradictions noted in the research related to thigh muscle reflex inhibition and sequelae that occur with knee joint injury. Reflex inhibition may be measured directly by electromyography, or the sequelae of reflex inhibition may be measured, as commonly occurs in the clinic setting. Electromyography is useful in determining the causes of reflex inhibition. The most frequently cited causes of thigh muscle reflex inhibition in knee injury are pain, joint effusion and knee immobilisation. The other measurement methods described vary from thigh circumference measurement to muscle biopsy. These methods are useful in determining the magnitude and duration of the deleterious sequelae that affect the thigh muscles after reflex inhibition. Finally, there is selectivity of reflex inhibition after knee joint injury: the quadriceps versus the hamstrings, the different components of the quadriceps muscle group, and the different types of muscle fibres. In light of these findings, several suggestions have been offered for prevention of reflex inhibition and for techniques that can be applied to rehabilitate the most affected muscle group: the quadriceps femoris. Techniques used to prevent or limit the amount of reflex inhibition include cryotherapy, transcutaneous electrical nerve stimulation, iontophoresis, phonophoresis, joint mobilisation, rest and proper positioning of the knee in rest and exercise. Electromyostimulation, electromyographic biofeedback and traditional exercise training are 3 methods used to rehabilitate the quadriceps.

The aim of this investigation has been to study the magnitude of the reduction of thigh muscle strength of below-knee amputees and to correlate the strength to the degree of atrophy and to the clinical function. Thirty-two below-knee amputees participated in examinations of the isometric and isokinetic knee extension and flexion strength using an isokinetic dynamometer (Cybex II). The atrophy was evaluated by measuring the mean muscle fibre area on muscle biopsies of the vastus lateralis and the cross-sectional area of the quadriceps and hamstring muscles measured with computed tomography. The isometric and isokinetic knee extension and flexion strength in the amputated leg with and without prosthesis was significantly lower than the strength in the non-amputated leg (p less than 0.01). Knee extension strength was significantly correlated to the mean muscle fibre area of the vastus lateralis. There was no correlation between strength and the cross-sectional area of the quadriceps muscles. There was, however, a significant correlation between the side differences (amputated leg versus non-amputated leg) in isometric knee extension and flexion strength and the side differences in cross-sectional areas. The reduction in isometric and isokinetic knee extension and flexion strength in the amputated leg both with and without prosthesis compared with the non-amputated leg was larger than the reduction in cross-sectional areas of the quadriceps and hamstring muscles and in muscle fibre areas of the vastus lateralis. This indicates that besides muscle atrophy changes in motor unit recruitment pattern may be of importance for the reduction in muscle strength. Isometric and isokinetic knee extension and flexion strength values in the amputated leg with prosthesis were significantly correlated to step length, maximal walking speed and circumference of the thigh. These results indicate that below-knee amputees with a better preserved thigh muscle strength have a good walking capacity.

An automated system designed and developed at this laboratory was used to measure spasticity in the thigh musculature of fifteen patients with hemiplegia. In addition, each subject was timed during a gait trial over a measured distance at maximum speed. Analysis of the data revealed no statistically significant correlation between spasticity in the thigh musculature and the gait speed of the subjects studied. Factors which may have contributed to the findings are mentioned.

Under some new points of view which were discussed in the former reports rheographical examinations of the thigh were performed. The results of examinations of 215 healthy test persons of male and female sex at the age of 15--75 years are reported and compared with the results of 52 angiological patients. The relative pulse volume, the angle of increase, the angle of the peak and the height of the peak were used as separation parameters. In contrast to the lower leg and to the foot in which the angular sum of the after-waves had proved as sharpest separation parameter for the angular sum of the after-waves of the rheogram of the thigh a profound age-dependent was found which much restricts the use for the routine work.

Reported are two cases of thigh compartment syndrome following application of a pneumatic antishock trouser suit. Both patients developed compartment syndromes after prolonged antishock suit use in the absence of any apparent leg trauma. We recommend that suit compartment pressures be no more than required to restore adequate blood pressure. The duration of application should be no longer than is clinically necessary. Patients with prolonged application (greater than 120 minutes) should be closely monitored for the development of compartment syndromes.

A retrospective study of 30 patients who met the clinical criteria for saphenous nerve entrapment at the adductor canal is described. Patients experienced symptoms, usually anterior knee pain, for an average of 36 +/- 7 months. Each patient received an average of 1.9 +/- 0.4 saphenous nerve blocks at the adductor canal during treatment. Baseline pain level (measured by the visual analog scale) was 6.4 +/- 0.3. Final pain level at followup was significantly decreased (2.8 +/- 0.5, P less than 0.001). Eighty percent of patients had improved after a series of blocks. Age, medications taken, number of blocks performed, and length of followup were unrelated to outcome. Length of symptoms did significantly correlate with final pain level (r = 0.39, P less than 0.05). The diagnosis of this syndrome, description of the saphenous nerve block at the adductor canal, and the possible etiology are presented.

The authors examined 20 subjects with infantile cerebral palsy, 10 of whom had patella alta, in order to evaluate any difference of extensor force of the quadriceps in the various degrees of flexion of the knee as compared with normal subjects. The objective was to reveal and measure any functional differences between the two groups.

The influence of electrocution on the evolution of rigor mortis was studied on rats. Our experiments showed that: (1) Electrocution hastens the onset of rigor mortis. After an electrocution of 90 s, a complete rigor develops already 1 h post-mortem (p.m.) compared to 5 h p.m. for the controls. (2) Electrocution hastens the passing of rigor mortis. After an electrocution of 90 s, the first significant decrease occurs at 3 h p.m. (8 h p.m. in the controls). (3) These modifications in rigor mortis evolution are less pronounced in the limbs not directly touched by the electric current. (4) In case of post-mortem electrocution, the changes are slightly less pronounced, the resistance is higher and the absorbed energy is lower as compared with the ante-mortem electrocution cases. The results are completed by two practical observations on human electrocution cases.