Relationship between cranio-cervical flexion range of motion and pressure change during the cranio-cervical flexion test

The purpose of this study was to quantify the sagittal angular displacement of the head (cranio-cervical flexion) for the five incremental stages of the cranio-cervical flexion test (CCFT). Range of cranio-cervical flexion during the CCFT was measured using a digital imaging method in 20 healthy volunteer subjects. The intra- and inter-rater reliability of the digital imaging technique for the assessment of this movement were also examined. The results of this study demonstrated a linear relationship between the incremental pressure targets of the CCFT and the percentages of full range cranio-cervical flexion range of motion (ROM) measured in the supine lying position of the test using a digital imaging technique. A mean of 22.9% full range cranio-cervical flexion was used to reach the first pressure target of the CCFT followed by linear increments up to 76.6% for the last stage of the test. An increasing amount of cranio-cervical flexion ROM was used to achieve the five successive stages of the CCFT reflecting an increasing contractile demand on the deep cervical flexor muscles. Excellent inter-rater (ICC = 0.994) and intra-rater reliability (ICC = 0.988-0.998) were demonstrated for the angular measurements using this digital imaging technique. (C) 2003 Elsevier Science Ltd. All rights reserved.

An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion

Background and Purpose. This study evaluated an electromyographic technique for the measurement of muscle activity of the deep cervical flexor (DCF) muscles. Electromyographic signals were detected from the DCF, sternocleidomastoid (SCM), and anterior scalene (AS) muscles during performance of the craniocervical flexion (CCF) test, which involves performing 5 stages of increasing craniocervical flexion range of motion-the anatomical action of the DCF muscles. Subjects. Ten volunteers without known pathology or impairment participated in this study. Methods. Root-mean-square (RMS) values were calculated for the DCF, SCM, and AS muscles during performance of the CCF test. Myoelectric signals were recorded from the DCF muscles using bipolar electrodes placed over the posterior oropharyngeal wall. Reliability estimates of normalized RMS values were obtained by evaluating intraclass correlation coefficients and the normalized standard error of the mean (SEM). Results. A linear relationship was evident between the amplitude of DCF muscle activity and the incremental stages of the CCF test (F=239.04, df=36, P<.0001). Normalized SEMs in the range 6.7% to 10.3% were obtained for the normalized RMS values for the DCF muscles, providing evidence of reliability for these variables. Discussion and Conclusion. This approach for obtaining a direct measure of the DCF muscles, which differs from those previously used, may be useful for the examination of these muscles in future electromyographic applications.

EFEITOS DOS MÉTODOS DE ABATE DE BOVINOS NA EFICIÊNCIA DA SANGRIA

O objetivo do presente trabalho foi avaliar os efeitos dos métodos de abate de bovinos com insensibilização prévia através de marreta e pistola pneumática de penetração e sem insensibilização, realizada pelo método kasher, na eficiência da sangria. A eficiência da sangria foi avaliada pela determinação da hemoglobina no sangue e na carne. Foram utilizados 240 bovinos sãos, da raça Nelore, abatidos em matadouro-frigorífico sob Serviço de Inspeção Federal, sendo 60 animais abatidos pelo método judaico (kasher), 60 animais insensibilizados através de marreta, 60 animais insensibilizados através de pistola pneumática de penetração e 60 animais insensibilizados através de pistola pneumática de penetração seguida por estimulação elétrica. Foram colhidas amostras de sangue após a sangria dos animais e de carne, na porção torácica do músculo Longus colli, imediatamente após a chegada da carcaça à câmara frigorífica. Os animais abatidos pelo método kasher apresentaram menor teor de hemoglobina residual na carne e melhor eficiência da sangria. A utilização da estimulação elétrica imediatamente após a sangria dos animais atordoados por pistola pneumática, afetou negativamente a eficiência da sangria.

EFEITOS DOS MÉTODOS DE ABATE DE BOVINOS NA EFICIÊNCIA da SANGRIA

O objetivo do presente trabalho foi avaliar os efeitos dos métodos de abate de bovinos com insensibilização prévia através de marreta e pistola pneumática de penetração e sem insensibilização, realizada pelo método kasher, na eficiência da sangria. A eficiência da sangria foi avaliada pela determinação da hemoglobina no sangue e na carne. Foram utilizados 240 bovinos sãos, da raça Nelore, abatidos em matadouro-frigorífico sob Serviço de Inspeção Federal, sendo 60 animais abatidos pelo método judaico (kasher), 60 animais insensibilizados através de marreta, 60 animais insensibilizados através de pistola pneumática de penetração e 60 animais insensibilizados através de pistola pneumática de penetração seguida por estimulação elétrica. Foram colhidas amostras de sangue após a sangria dos animais e de carne, na porção torácica do músculo Longus colli, imediatamente após a chegada da carcaça à câmara frigorífica. Os animais abatidos pelo método kasher apresentaram menor teor de hemoglobina residual na carne e melhor eficiência da sangria. A utilização da estimulação elétrica imediatamente após a sangria dos animais atordoados por pistola pneumática, afetou negativamente a eficiência da sangria.

Influência do banho de aspersão ante-mortem na contaminação microbiana da carne bovina

To determine the effects of the pre-slaughter showering on some meat quality parameters, the bacterial changes in the Longus colli muscle and the contamination of the meat surface at three different points of the slaughter line were studied. Sixteen Nelore steers were slaughtered in a commercial slaughterhouse. Eight animals were submitted to pre-slaughter showering; a control group of eight animals were slaughtered without showering. Aseptic samples were collected for evaluations in the muscle depth, in the anterior portion of Longus colli muscle, just before chilling. The swab method was used for sampling carcass surface right after dressing, before carcasse washing, and at the beginning of chilling. Longus colli muscle samples were used to determine bacteria total count, psychrotrophic count and Enterobacteriaceae count, after 5, 24 and 48 hours from slaughtering, and in carcass surface, bacteria total count and psychrotrophic count. Multivariate methods were used to evaluate bacterial data the use of pre-slaughter showering did not affect the bacteria total counts, in the deep tissue. A significant growth of psychrotrophic bacteria was detected in both treatments. No significant differences (P>.05) were found in bacteria total count and psychrotrophic count between treatments. Also, no differences (P>.05) were detected between counts taken at different momments at the kill floor: skinning, before carcasse washing, and at the cooler, before chilling.

Influência do banho de aspersão ante-mortem na eficiência da sangria e em parâmetros bioquímicos da carne bovina

To determine the effects of the pre-slaughter showering on some meat quality parameters, the biochemical changes in the Longus colli muscle and the bleeding efficiency were studied. Thirty-six Nelore steers were slaughtered in a commercial slaughterhouse. Eighteen animals were submitted to pre-slaughter showering; a control group of eighteen animals were slaughtered without showering. Samples were collected for evaluations in the muscle depth, in the anterior portion of longus colli muscle,just before chilling. Bleeding efficiency was evaluated through the ratio of muscle haemoglobin/blood haemoglobin using blood samples taken five seconds after bleeding, and muscle sample taken before chilling. Longus colli muscle samples were also used to determine glycogen, glucose, pH and acidity, 5, 24 and 48 hours after slaughtering. Multivariate methods were used to evaluate biochemical data and the bleeding efficiency data analysis followed the randomized block design. Haemoglobin retained in the muscle and bleeding efficiency were not affected (P > .05) by pre-slaughter showering. The pre-slaughter showering did not affect (P > .05) the glycolysis. There was a significant effect of time in glycogen, glucose, pH and acidity, in the first 24 hours.

Unravelling the complexity of muscle impairment in chronic neck pain

Exercise interventions are deemed essential for the effective management of patients with neck pain. However, there has been a lack of consensus on optimal exercise prescription, which has resulted from a paucity of studies to quantify the precise nature of muscle impairment, in people with neck pain. This masterclass will present recent research from our laboratory, which has utilized surface electromyography to investigate cervical flexor muscle impairment in patients with chronic neck pain. This research has identified deficits in the motor control of the deep and superficial cervical flexor muscles in people with chronic neck pain, characterized by a delay in onset of neck muscle contraction associated with movement of the upper limb. In addition, people with neck pain demonstrate an altered pattern of muscle activation, which is characterized by reduced deep cervical flexor muscle activity during a low load cognitive task and increased activity of the superficial cervical flexor muscles during both cognitive tasks and functional activities. The results have demonstrated the complex, multifaceted nature of cervical muscle impairment, which exists in people with a history of neck pain. In turn, this has considerable implications for the rehabilitation of muscle function in people with neck pain disorders. (C) 2004 Elsevier Ltd. All rights reserved.

Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients

There has been little investigation into whether or not differences exist in the nature of physical impairment associated with neck pain of whiplash and insidious origin. This study examined the neck flexor synergy during performance of the cranio-cervical flexion test, a test targeting the action of the deep neck flexors. Seventy-five volunteer subjects participated in this study and were equally divided between Group 1, asymptomatic control subjects, Group 2, subjects with insidious onset neck pain and Group 3, subjects with neck pain following a whiplash injury. The cranio-cervical flexion test was performed in five progressive stages of increasing cranio-cervical flexion range. Subjects' performance was guided by feedback from a pressure sensor inserted behind the neck which monitored the slight flattening of the cervical lordosis which occurs with the contraction of longus colli. Myoelectric signals (EMG) were detected from the muscles during performance of the test. The results indicated that both the insidious onset neck pain and whiplash groups had higher measures of EMG signal amplitude (normalized root mean square) in the sternocleidomastoid during each stage of the test compared to the control subjects (all P

Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test

Study Design. Cross-sectional study. Objective. The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. Summary of Background Data. Individuals with chronic neck pain exhibit reduced performance on a test of craniocervical flexion, and training of this maneuver is effective in management of neck complaints. Although this test is hypothesized to reflect dysfunction of the deep cervical flexor muscles, this has not been tested. Methods. Deep cervical flexor electromyographic activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the superficial neck muscles ( sternocleidomastoid and anterior scalene). Root mean square electromyographic amplitude and craniocervical flexion range of motion was measured during five incremental levels of craniocervical flexion in supine. Results. There was a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain ( P = 0.002). However, the amplitude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task ( P < 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain. Conclusions. These data confirm that reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles and support the validity of this test for patients with neck pain.

Further evaluation of an EMG technique for assessment of the deep cervical flexor muscles

A novel surface electromyographic (EMG) technique was recently described for the detection of deep cervical flexor muscle activity. Further investigation of this technique is warranted to ensure EMG activity from neighbouring muscles is not markedly influencing the signals recorded. This study compared deep cervical flexor (DCF) muscle activity with the activity of surrounding neck and jaw muscles during various anatomical movements of the neck and jaw in 10 volunteer subjects. DCF EMG activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid, anterior scalene, masseter and suprahyoid muscles. Positioned in supine, subjects performed isometric cranio-cervical flexion, cervical flexion, right and left cervical rotation,jaw clench and resisted jaw opening. Across all movements examined, EMG amplitude of the DCF muscles was greatest during neck movements that would require activity of the DCF muscles, particularly during cranio-cervical flexion, their primary anatomical action. The actions of jaw clench and resisted jaw opening demonstrated significantly less DCF EMG activity than the cranio-cervical flexion action (p < 0.05). Across all other movements, the neighbouring neck and jaw muscles demonstrated greatest EMG amplitude during their respective primary anatomical actions, which occurred in the absence of increased EMG amplitude recorded from the DCF muscles. The finding of substantial EMG activity of the DCF muscles only during neck actions that would require their activity, particularly cranio-cervical flexion, and not during actions involving the jaw, provide further assurance that the majority of myoelectric signals detected from the nasopharyngeal electrode are from the DCF muscles. (C) 2005 Elsevier Ltd. All rights reserved.

Muscle Transplants for Facial Reanimation Rationale and Results of Insertion Technique Using the Palmaris Longus Tendon

Thirty-one patients with unilateral long-standing facial palsy underwent I-stage reanimation with free gracilis muscle transplant innervated by the masseteric branch of the trigeminal nerve. They were divided into 2 nonrandomized groups according to insertion technique: group 1 (9 patients), interrupted suture between the free flap and the orbicularis oris of the upper and lower lip on the paralyzed side; group It (22 patients), palmaris longus tendon graft placed between the gracilis free flap and the orbicularis oris of the upper and lower lip on the nonparalyzed side. Qualitative evaluation of the smile demonstrated better results in patients from group II. Comparing the position Of the Cupid`s bow at rest, pre- and postoperatively in each patient, we observed significant improvement of facial symmetry in both groups. During smile, however, there was a significantly higher rate of centralization of the Cupid`s bow in patients submitted to reanimation with the use of the palmaris longus tendon (group II).

A Posterior Interosseous Nerve Syndrome Associated With Spontaneous Rupture of the Extensor Pollicis Longus Tendon

Posterior interosseous nerve entrapment syndrome and spontaneous rupture of the extensor pollicis longus tendon are rare conditions. The authors describe the bizarre combination of a spontaneous rupture of the extensor pollicis longus tendon in a 82-year-old lady with a posterior interosseous nerve syndrome. As far as the authors know, this is the first description of such an association in the literature. Surgical exploration revealed compression of the posterior interosseous nerve at the proximal portion of the supinator muscle and at Henry's leash. The nerve was freed, and the tendon of the extensor index proprius was transferred to the extensor pollicis longus. Six months after the procedure, the patient had resumed her daily activities, showing a good functional result.

Salvage Flexor Hallucis Longus Transfer for a Failed Achilles Repair: Endoscopic Technique

Flexor hallucis longus (FHL) transfer is a well-established treatment option in failed Achilles tendon (AT) repair and has been routinely performed as an open procedure. We detail the surgical steps needed to perform an arthroscopic transfer of the FHL for a chronic AT rupture. The FHL tendon is harvested as it enters in its tunnel beneath the sustentaculum tali; a tunnel is then drilled in the calcaneus as near to the AT footprint as possible. By use of a suture-passing device, the free end of the FHL is advanced to the plantar aspect of the foot. After adequate tension is applied to the construct, the tendon is fixed in place with an interference screw in an inside-out fashion. This minimally invasive approach is a safe and valid alternative to classic open procedures with the obvious advantages of preserving the soft-tissue envelope and using a biologically intact tendon.

Traumatic rupture of both peroneal longus and brevis tendons.

Injuries of peroneal tendons are rare. Diagnosis of traumatic rupture is often late and presents as chronic ankle instability. A case of a complete traumatic rupture of both peroneal longus and brevis tendons with acute clinical and radiological diagnosis is presented. Surgical repair was performed by direct end-to-end suture on the 4th day after trauma, with excellent functional outcome at 1-year follow-up.