High resolution muscle measurements provide insights into equinus contractures in patients with cerebral palsy

Muscle contractures that occur after upper motor neuron lesion are often surgically released or lengthened. However, surgical manipulation of muscle length changes a muscle's sarcomere length (L_s), which can affect force production. To predict effects of surgery, both macro‐ (fascicle length (L_f)) and micro‐ (L_s) level structural measurements are needed. Therefore, the purpose of this study was to quantify both L_s and L_f in patients with cerebral palsy (CP) as well as typically developing (TD) children. Soleus ultrasound images were obtained from children with CP and TD children. L_f was determined and, with the joint in the same position, CP biopsies were obtained and formalin fixed, and L_s was measured by laser diffraction. Since soleus L_s values were not measurable in TD children, TD L_s values were obtained using three independent methods. While average L_f did not differ between groups (CP = 3.6 ± 1.2 cm, TD = 3.5 ± 0.9 cm; p > 0.6), L_s was dramatically longer in children with CP (4.07 ± 0.45 µm vs. TD = 2.17 ± 0.24 µm; p < 0.0001). While L_f values were similar between children with CP and TD children, this was due to highly stretched sarcomeres within the soleus muscle. Surgical manipulation of muscle‐tendon unit length will thus alter muscle sarcomere length and change force generating capacity of the muscle. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:33–39, 2015.     

Abductor muscle necrosis due to iliopsoas bursal mass after total hip arthroplasty

Background

While symptomatic iliopsoas bursal lesions have been reported after total hip arthroplasty (THA), mass effect of the collection causing abductor muscle damage has not been reported in the literature.

Methods and Results

This report discusses the presentation, clinical findings, and operative management of a patient, status post metal-on-polyethylene THA, with a large psoas bursal collection with resulting abductor muscle injury and deep venous thrombosis from compression of the femoral vein. Despite the improved wear characteristics of modern-generation THA implants, physicians must be aware of the possibility of soft tissue irritation of the iliopsoas as a cause of soft tissue swelling, persistent pain, and potential adverse complications. It is also important to recognize the variety of effects and spectrum of severity for associated lesions, including muscle damage.

Conclusions

This report highlights the rare findings of abductor muscle necrosis, as well as acute thrombosis, related to iliopsoas bursitis. It also highlights a review of the available literature.