Tenotomia do músculo flexor digital superficial e desmotomia acessória em equinos: goniometria radiometacarpiana, metacarpofalângica e interfalângica

The purpose of this study was to investigate the effects of the superficial digital tenotomy and the superior check ligament desmotomy on the radio-metacarpal, metacarpophalangeal, proximal and distal interphalangeal angles in horses. Under general anesthesia the superficial digital flexor tenotomy and superior check ligament desmotomy were performed, respectively, on the right and left forelimbs in nine horses. Before surgery and on 15th, 30th, and 60th postoperative days the radio-metacarpal, metacarpophalangeal, and proximal and distal interphalangeal angles were measured by radiographic examination. Tenotomy decreased significantly the metacarpophalangeal angle (mean ± standard deviation: preoperative – 140.7º ± 6.85; 60th day – 128.2º ± 5.93) and increased the distal interphalangeal angle (mean ± standard deviation: preoperative – 172.6 ± 1.87; 60th day – 167.6 ± 1.36). Desmotomy decreased the proximal interphalangeal angle (mean ± standard deviation: preoperative – 180.2º ± 5.43; 60th day- 197.3º ± 8.29). These surgical procedures did not change the radio-metacarpal angle. The superficial digital flexor tenotomy and the superior check ligament desmotomy cause different and significant changes in joint angles distal to the carpus.

Ultrasound Transient Shear Wave Elasticity Imaging for Tendon Tissue

Degeneration of tendon tissue is a common cause of tendon dysfunction with the symptoms of repeated episodes of pain and palpable increase of tendon thickness. Tendon mechanical properties are directly related to its physiological composition and the structural organization of the interior collagen fibers which could be altered by tendon degeneration due to overuse or injury. Thus, measuring mechanical properties of tendon tissue may represent a quantitative measurement of pain, reduced function, and tissue health. Ultrasound elasticity imaging has been developed in the last two decades and has proved to be a promising tool for tissue elasticity imaging. To date, however, well established protocols of tendinopathy elasticity imaging for diagnosing tendon degeneration in early stages or late stages do not exist. This thesis describes the re-creation of one dynamic ultrasound elasticity imaging method and the development of an ultrasound transient shear wave elasticity imaging platform for tendon and other musculoskeletal tissue imaging. An experimental mechanical stage with proper supporting systems and accurate translating stages was designed and made. A variety of high-quality tissue-mimicking phantoms were made to simulate homogeneous and heterogeneous soft tissues as well as tendon tissues. A series of data acquisition and data processing programs were developed to collect the displacement data from the phantom and calculate the shear modulus and Young’s modulus of the target. The imaging platform was found to be capable of conducting comparative measurements of the elastic parameters of the phantoms and quantitatively mapping elasticity onto ultrasound B-Mode images. This suggests the system has great potential for not only benefiting individuals with tendinopathy with an earlier detection, intervention and better rehabilitation, but also for providing a medical tool for quantification of musculoskeletal tissue dysfunction in other regions of the body such as the shoulder, elbow and knee.

An experimental study of low-level laser therapy in rat Achilles tendon injury

The aim of this controlled animal study was to investigate the effect of low-level laser therapy (LLLT) administered 30 min after injury to the Achilles tendon. The study animals comprised 16 Sprague Dawley male rats divided in two groups. The right Achilles tendons were injured by blunt trauma using a mini guillotine, and were treated with LLLT or placebo LLLT 30 min later. The injury and LLLT procedures were then repeated 15 hours later on the same tendon. One group received active LLLT (lambda = 904 nm, 60 mW mean output power, 0.158 W/cm(2) for 50 s, energy 3 J) and the other group received placebo LLLT 23 hours after LLLT. Ultrasonographic images were taken to measure the thickness of the right and left Achilles tendons. Animals were then killed, and all Achilles tendons were tested for ultimate tensile strength (UTS). All analyses were performed by blinded observers. There was a significant increase in tendon thickness in the active LLLT group when compared with the placebo group (p < 0.05) and there were no significant differences between the placebo and uninjured left tendons. There were no significant differences in UTS between laser-treated, placebo-treated and uninjured tendons. Laser irradiation of the Achilles tendon at 0.158 W/cm(2) for 50 s (3 J) administered within the first 30 min after blunt trauma, and repeated after 15 h, appears to lead to edema of the tendon measured 23 hours after LLLT. The guillotine blunt trauma model seems suitable for inflicting tendon injury and measuring the effects of treatment on edema by ultrasonography and UTS. More studies are needed to further refine this model.

Patellar Tendon Healing With Platelet-Rich Plasma A Prospective Randomized Controlled Trial

Background: The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing. Hypothesis: Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups. Results: Patellar tendon gap area was significantly smaller in the PRP group (4.9 +/- 5.3 mm(2); 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 +/- 4.4 mm(2); 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 +/- 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 +/- 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups. Conclusion: We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.

Plantar flexion force induced by amplitude-modulated tendon vibration and associated soleus V/F-waves as an evidence of a centrally-mediated mechanism contributing to extra torque generation in humans

Background: High-frequency trains of electrical stimulation applied over the human muscles can generate forces higher than would be expected by direct activation of motor axons, as evidenced by an unexpected relation between the stimuli and the evoked contractions, originating what has been called “extra forces”. This phenomenon has been thought to reflect nonlinear input/output neural properties such as plateau potential activation in motoneurons. However, more recent evidence has indicated that extra forces generated during electrical stimulation are mediated primarily, if not exclusively, by an intrinsic muscle property, and not from a central mechanism as previously thought. Given the inherent differences between electrical and vibratory stimuli, this study aimed to investigate: (a) whether the generation of vibration-induced muscle forces results in an unexpected relation between the stimuli and the evoked contractions (i.e. extra forces generation) and (b) whether these extra forces are accompanied by signs of a centrally-mediated mechanism or whether intrinsic muscle properties are the redominant mechanisms. Methods: Six subjects had their Achilles tendon stimulated by 100 Hz vibratory stimuli that linearly increased in amplitude (with a peak-to-peak displacement varying from 0 to 5 mm) for 10 seconds and then linearly decreased to zero for the next 10 seconds. As a measure of motoneuron excitability taken at different times during the vibratory stimulation, short-latency compound muscle action potentials (V/F-waves) were recorded in the soleus muscle in response to supramaximal nerve stimulation. Results: Plantar flexion torque and soleus V/F-wave amplitudes were increased in the second half of the stimulation in comparison with the first half. Conclusion: The present findings provide evidence that vibratory stimuli may trigger a centrally-mediated mechanism that contributes to the generation of extra torques. The vibration-induced increased motoneuron excitability (leading to increased torque generation) presumably activates spinal motoneurons following the size principle, which is a desirable feature for stimulation paradigms involved in rehabilitation programs and exercise training.

Model and control of tendon actuated robots

The use of tendons for the transmission of the forces and the movements in robotic devices has been investigated from several researchers all over the world. The interest in this kind of actuation modality is based on the possibility of optimizing the position of the actuators with respect to the moving part of the robot, in the reduced weight, high reliability, simplicity in the mechanic design and, finally, in the reduced cost of the resulting kinematic chain. After a brief discussion about the benefits that the use of tendons can introduce in the motion control of a robotic device, the design and control aspects of the UB Hand 3 anthropomorphic robotic hand are presented. In particular, the tendon-sheaths transmission system adopted in the UB Hand 3 is analyzed and the problem of force control and friction compensation is taken into account. The implementation of a tendon based antagonistic actuated robotic arm is then investigated. With this kind of actuation modality, and by using transmission elements with nonlinear force/compression characteristic, it is possible to achieve simultaneous stiffness and position control, improving in this way the safety of the device during the operation in unknown environments and in the case of interaction with other robots or with humans. The problem of modeling and control of this type of robotic devices is then considered and the stability analysis of proposed controller is reported. At the end, some tools for the realtime simulation of dynamic systems are presented. This realtime simulation environment has been developed with the aim of improving the reliability of the realtime control applications both for rapid prototyping of controllers and as teaching tools for the automatic control courses.

Reduced endurance of the cervical flexor muscles in patients with concurrent temporomandibular disorders and neck disability

Subjects with temporomandibular disorders (TMDs) have been found to have clinical signs and symptoms of cervical dysfunction. Although many studies have investigated the relationship between the cervical spine and TMD, no study has evaluated the endurance capacity of the cervical muscles in patients with TMD. Thus the objective of this study was to determine whether patients with TMD had a reduced endurance of the cervical flexor muscles at any level of muscular contraction when compared with healthy subjects. One hundred and forty-nine participants provided data for this study (49 subjects were healthy, 54 had myogenous TMD, and 46 had mixed TMD). There was a significant difference in holding time at 25% MVC between subjects with mixed TMD when compared to subjects with myogenous TMD and healthy subjects. This implies that subjects with mixed TMD had less endurance capacity at a lower level of contraction (25% MVC) than healthy subjects and subjects with myogenous TMD. No significant associations between neck disability, jaw disability, clinical variables and neck flexor endurance test were found.

Reconstruction of the medial patellofemoral ligament using the adductor magnus tendon: an anatomic study

The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks.

Electromyographic activity of the cervical flexor muscles in patients with temporomandibular disorders while performing the craniocervical flexion test: a cross-sectional study

Most patients with temporomandibular disorders (TMD) have been shown to have cervical spine dysfunction. However, this cervical dysfunction has been evaluated only qualitatively through a general clinical examination of the cervical spine.

[Influence of chronic, structural changes of the muscle-tendon unit on the indication and technique of rotator cuff reconstruction]

Rotator cuff lesions are common and the incidence increases with age. After tendon rupture of the rotator cuff, the muscle-tendon unit retracts, which is accompanied by muscle fatty infiltration, atrophy, and interstitial fibrosis of the musculature, thus, fundamentally changing the muscle architecture. These changes are important prognostic factors for the operative rotator cuff reconstruction outcome. Selection of the correct time point for reconstruction as well as the optimal mechanical fixation technique are decisive for successful attachment at the tendon-to-bone insertion site. Thus, knowledge of the pathophysiological processes plays an important role. The goal of this article is to establish a relationship between currently existing evidence with respect to the preoperatively existing changes of the muscle-tendon unit and the choice of the time for the operation and the operative technique.

Rotator cuff muscles lose responsiveness to anabolic steroids after tendon tear and musculotendinous retraction: an experimental study in sheep

Long-standing rotator cuff tendon tearing is associated with retraction, loss of work capacity, irreversible fatty infiltration, and atrophy of the rotator cuff muscles. Although continuous musculotendinous relengthening can experimentally restore muscular architecture, restoration of atrophy and fatty infiltration is hitherto impossible.

Hip pain in renal transplant recipients: symptomatic gluteus minimus and gluteus medius tendon abnormality as an alternative MRI diagnosis to avascular necrosis

OBJECTIVE: The purpose of this study was to review the diagnosis on MRI and radiography of 24 renal transplant recipients with hip pain suspicious for avascular necrosis and to investigate whether there is an association between kidney transplant patients with end-stage renal disease and symptomatic gluteus minimus and medius tendon abnormality. CONCLUSION: Symptomatic gluteus minimus and medius tendon lesions and abnormalities can occur in renal allograft recipients. The MRI findings of this entity allow an alternative diagnosis in this patient population.