Presencia de cresta ósea en la epífisis proximal de la tibia: propuesta para su incorporación en la terminologia anatomica / Presence of a bony crest in the proximal epiphysis of the tibia: proposal for its incorporation in the terminologia anatomica

RESUMEN: La Terminologia Anatomica (TA) presenta las estructuras anatómicas en un lenguaje unificado para todas las estructuras del cuerpo humano. Sin embargo, hay características como algunos accidentes óseos que no se han considerado en las actualizaciones de la TA, ya sean epónimos que no se han relacionado con términos actuales o estructuras descritas clásicamente, como es el caso de una característica ósea que se observa y palpa fácilmente en la epífisis proximal de la tibia, a nivel del cóndilo lateral, uniendo el tubérculo anterolateral de la tibia con la tuberosidad de la misma. Esta característica corresponde a una elevación lineal, descrita como lugar de inserción del tracto iliotibial y del músculo tibial anterior. Basado en lo anterior, se analizaron 65 tibias de individuos Chilenos, adultos, de ambos sexos, 60 pertenecientes a la Universidad de La Frontera y 5 a la Universidad San Sebastián, considerando como criterio de inclusión la integridad del tejido compacto en la epífisis proximal. La revisión de las muestras reveló la presencia de una elevación lineal en el 100 % de los casos, uniendo la tuberosidad de la tibia con el tubérculo anterolateral (Gerdy), no observándose elevación similar desde la tuberosidad de la tibia en dirección al cóndilo medial. Esta elevación es utilizada como referencia en la palpación durante la evaluación de la rodilla. Por las evidencias presentadas, consideramos que esta elevación debe considerarse en la TA como una característica más de la tibia, en base a su disposición lineal y elevada, además de su dirección oblicua desde la tuberosidad de la tibia al tubérculo anterolateral de la misma, por lo que proponemos denominarla como cresta anterolateral de la tibia (Crista anterolateralis tibiae).

SUMMARY: Anatomical Terminology (AT) presents anatomical structures in a unified language for all structures of the human body. However, there are characteristics such as some bone accidents that have not been considered in the TA updates, whether they are eponyms that have not been related to current terms or classically described structures, as is the case of a characteristic bone that is easily observed and palpated in the proximal epiphysis of the tibia, at the level of the lateral condyle, joining the anterolateral tubercle of the tibia with the tuberosity of the tibia. This characteristic corresponds to a linear elevation, described as the insertion site of the iliotibial tract and the tibialis anterior muscle. Based on the above, 65 tibiae from Chilean individuals, adults, of both sexes, 60 belonging to the Universidad de La Frontera and 5 from the Universidad San Sebastián were analyzed, considering as an inclusion criterion the integrity of the compact tissue in the epiphysis proximal. The review of the samples revealed the presence of a linear elevation in 100 % of the cases, joining the tibial tuberosity with the anterolateral tubercle (Gerdy), not observing similar elevation from the tibial tuberosity in the direction of the medial condyle. This elevation is used as a reference for palpation during knee evaluation. Based on the evidence presented, we consider that this elevation should be considered in TA as one more characteristic of the tibia, based on its linear and elevated disposition, in addition to its oblique direction from the tibial tuberosity to the anterolateral tubercle of the tibia, for what we propose to call it the Crista anterolateralis tibiae (anterolateral crest of the tibia).

Surgical Repair of Tibialis Anterior Muscle Herniation Using a Synthetic Mesh That Was Beneath the Fascia after a Military Training Program: A Case Report

Tibialis anterior muscle herniation is the most common type of skeletal muscle herniation of the lower legs. The treatment of muscle herniation relies on the patient's symptoms. For patients with chronic large fascial defects, fascial grafting with synthetic mesh can be considered. In this case of a patient who was exposed to excessive strain on his lower legs during a military training program, the use of a secure repair technique with synthetic mesh was required. This paper presents a case of tibialis anterior muscle herniation that was treated successfully with a monofilament knitted polypropylene mesh covered by the tibialis anterior fascia. The advantages of this technique include early rehabilitation and an early return to work. No significant difference in the clinical results compared to other methods were observed and there were no complications. The military training program appeared to have aggravated the patient's symptoms of tibialis anterior muscle herniation. On the other hand, larger scale study will be needed to determine if this program actually affects the clinical outcomes.

Analysis of Contractile Properties in Gastrocnemius, Tibialis Anterior Muscle of Amateur Male Soccer Players Using Tensiomyography

BACKGROUND: Tensiomyography (TMG) is a relatively new technique that assesses the contractile properties of muscles in response to a single electrical stimulus. This study aimed to evaluate the contractile properties of the gastrocnemius and tibialis anterior (TA) muscles in amateur soccer players using TMG. METHODS: We recruited 41 male soccer players (high school group, n=21; college group, n=20). The gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and TA muscles of both lower extremities were assessed using TMG. The maximal displacement (Dm), delay time, contraction time (Tc), sustained time, and half-relaxation time were obtained and compared between the two groups. RESULTS: First, both groups showed low Dm for the GM and TA muscles, which indicated high stiffness of the muscle tone. Second, the Tc and contraction velocity (Vc) were high for all muscles, except for the GL showing lower speed than the other muscles, which represented the sports-specific characteristics of the soccer players. Third, there were no significant differences in the measurement variables between the dominant and non-dominant sides, except for the Tc of the GM in high school athletes and Vc of the TA in college athletes. CONCLUSIONS: These results reflected the sports-specific needs and characteristics of soccer players. A risk of injury is associated with a high degree of stiffness, and various methods for preventing it should be considered.

Efeitos do kinesio taping na dinâmica articular durante a marcha de pacientes após acidente vascular encefálico / Effects of kinesio taping in joint dynamics during gait in patients after stroke

Objetivo: Analisar os efeitos do kinesio taping® na dinâmica articular durante a marcha de pacientes hemiparéticos após acidente vascular encefálico (AVE). Métodos: Foi realizado um ensaio piloto com 14 participantes pós-AVE, alocados nos grupos intervenção (n = 7) e sham (n = 7). Foram analisados os ângulos articulares do tornozelo, joelho e quadril, durante as fases de balanço inicial e médio e contato inicial da marcha, antes da aplicação do taping e 24 horas após. A satisfação do paciente também foi analisada. Resultados: Não houve diferença entre os grupos nas angulações do tornozelo [balanço inicial (DM = -0,47º, IC95% -14,37 a 13,42); balanço médio (DM = -1º, IC 95% -14 a 12); contato inicial (DM = 1,22º, IC 95% -11,5 a 13,97)]; joelho [balanço inicial (DM = 5,66º, IC 95% -12,27 a 23,58); balanço médio (DM = -1,94º, IC 95% 23,6 a -19,76)]; quadril [balanço inicial (DM = 1,97º, IC 95% -6,98 a 3,03); balanço médio (DM = 0,68º, IC 95% -7,57 a 8,9); contato inicial (DM = 0º, IC 95% - 3,7 a 3,6)]. O grupo intervenção apresentou 10,5 vezes mais chances (OR = 10,5, IC 95% 0,4 a 267,1) de observar diferença quando o taping é aplicado em comparação ao grupo sham. Conclusão: Não houve diferença nas angulações do tornozelo, joelho e quadril durante a marcha, 24 horas após a aplicação do kinesio taping® em pacientes hemiparéticos. (AU)

Objective: To analyze the effects of Kinesio taping® in the joint dynamics during gait in hemiparetic patients after stroke. Methods: We conducted a pilot study with 14 participants after stroke allocated into intervention group (n = 7) and sham group (n = 7). We measured the joint angles of ankle, knee and hip during gait analysis at initial swing, mid swing and initial contact, without the application of taping and 24 hours after application. We also evaluated the patient's experience. Results: There was no difference between groups in the ankle angles [initial swing (DM = -0.47º, 95% CI -14.37 to 13.42); mid swing (DM = -1º, 95% CI -14 to 12); initial contact (DM = -1.22º, 95% CI -11.5 to 13.97)]; knee [initial swing (DM = 5.66º, 95% CI -12.27 to 23.58); mid swing (DM = -1.94º, 95%CI -19.76 to 23.6)]; hip [initial swing (DM = 1.97º, 95%CI -6.98 to 3.03); mid swing (DM = 0.68º, 95%CI -7.57 to 8.9); initial contact (DM = 0°, 95% -3.7 to 3.6)]. The chance to observe the difference when the taping is applied was 10.5 times higher (OR = 10.5, 95%CI 0.4 a 267.1) in the intervention group. Conclusion: There was no significant difference in angles of ankle, knee and hip during gait, 24 hours after Kinesio Taping® application in hemiparetic patients. (AU)

Tabialis Anterior Muscle Contraction On Driver’s Knee Angle Posture Less Than 101º For Foot Pressing And Releasing An Automotive Pedal

Proper driving requires a proper posture to bring comfort to drivers. A problem that commonly exists in driving is incorrect driving posture which can cause discomfort to the driver, especially when interacting with automotive pedals. Research on contraction of tibialis anterior (TA) muscle on driver's posture based on the knee angle less than 101º in a position of pressing and releasing a pedal was conducted to investigate and overcome this problem. This is a field experiment study and surface electromyography (sEMG) is used in collecting data on the TA muscle. The procedure of collecting data on the TA muscle before and after experiments follows the Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles (SENIAM) recommendations. The result of the experiment shows that there is a strong negative relationship between driver's postures in nature based on the angle of the knee with TA muscle contractions, where the Pearson correlation coefficient (r) is - .993. While the temporal analysis measurements based on Maximum Voluntary Isometric Contraction (MVIC) 60% in a position of releasing a pedal exceeding rms µV 39.38, are 39.71 and 40.25 respectively. On the other hand, MVIC 2% rms µV values: 1.19 and 1.2 are obtained in the position of pressing the pedal. The knee angle with TA muscle contractions is significant [F (1, 10) = 660, p<.05] contributing 98.5% variance (R2 = .985) in the driver's posture. A linear equations model has been developed to clearly illustrate the result. In conclusion, when the knee angle of the driver's posture is increased, the TA muscle contraction is decreased. The increase in the knee angle will directly provide comfort to the driver while interacting with the pedal; and this is due to the reduction of TA muscle contractions.

Anterior Tibial Muscle Hernia Treated with Local Periosteal Rotational Flap: A Case Report

Tibialis anterior muscle hernia is the most common hernia among lower extremity muscles. This condition can be diagnosed by physical examination and radiologic findings, especially by dynamic ultrasonography. There are surgical methods of treatment for muscle hernia, including direct repair, fasciotomy, fascial patch grafting using autologous fascia lata or synthetic mesh. We report a case of tibialis anterior muscle hernia treated with local periosteal rotational flap. Because there are several advantages to the local periosteal rotational flap, such as lack of donor site morbidity, lack of skin irritation, low cost, simplicity, and an easy approach, this technique could be an option for tibialis anterior muscle hernia.

Análise da fadiga muscular localizada em atletas e sedentários através de parâmetros de freqüência do sinal eletromiográfico / Analysis of localized muscular fatigue in athletes and sedentary subjects through frequency parameters of electromyographic signal

Embora a análise no domínio da freqüência do sinal eletromiográfico (EMG) seja empregada na caracterização do processo de fadiga muscular localizada, sua aplicação, especificamente a da freqüência mediana (Fmed), é pouco explorada no âmbito esportivo. O objetivo do presente estudo foi verificar a viabilidade da aplicação do sinal EMG, através de sua análise no domínio da freqüência, como parâmetro para determinação e diferenciação no comportamento da fadiga muscular localizada. Dois grupos de sujeitos, um caracterizado como atletas (n =12) e outro como sedentários (n =12), foram submetidos a análises baseadas em procedimentos executados em três diferentes situações experimentais, todos envolvendo a modalidade de exercício isométrico: i) teste máximo para determinação da contração isométrica voluntária máxima (CIVM); ii) teste de fadiga, sustentado por 35 seg. a 80 por cento da CIVM; iii) teste de recuperação, sustentado por 10 seg. a 80 por cento da CIVM; neste ultimo foi monitorado o comportamento da Fmed nos três primeiros (Fmedi) e três últimos segundos (Fmedf) do sinal EMG no músculo tibial anterior durante o teste de fadiga. Durante os 10 segundos do teste de recuperação foi calculada a Fmed referente a todo o período (Fmedr). parâmetro utilizado no cálculo do índice de recuperação muscular (IRM). Os resultados apontam que a Fmedf apresentou valor menor em relação à Fmedi em ambos os grupos (p < 0,05). Quando comparado com o grupo de sedentários, o grupo de atletas apresentou valores maiores de Fmedi e Fmedf (p < 0,05). O valor médio e desvio-padrão do IRM para o grupo de atletas foram de 62,1 por cento ± 28,7 e, para o grupo de sedentários, de 55,2 por cento ± 27,8 (p > 0,05). Dessa forma, os resultados apresentados neste estudo permitem inferir a viabilidade na aplicação de parâmetros no domínio da freqüência do sinal EMG para a determinação e diferenciação do comportamento da fadiga muscular localizada.

Although the analysis in the frequency domain of the Electromyographic Signal (EMG) has been used in the characterization of the localized muscular fatigue process, its application, specifically the Median Frequency (MF), is rarely explored in sports. The objective of this study was to verify the viability of the EMG signal application, through its frequency domain analysis, as a parameter for determination and differentiation of the behavior of localized muscle fatigue. Two groups of subjects, one characterized as athletes (n = 12) and the other as sedentary (n = 12), were submitted to analysis based on procedures from three different experimental situations, all involving isometric exercise modality: i) maximum test for determination of the Maximum Voluntary Isometric Contraction (MVIC); ii) fatigue test, 35 sec. sustained load of 80 percent of MVIC; iii) recovery test, 10 sec. sustained load of 80 percent of MVIC. In the latter, the MF behavior in the three first (Fmedi) and three last (Fmedf) seconds of the EMG signal of tibialis anterior muscle during the fatigue test have been monitored. During the 10 seconds of the recovery test, MF was calculated regarding the whole period (Fmedr); this parameter was used to calculate the Muscular Recovery Index (MRI). The results showed that Fmedf presented lower value in relation to Fmedi in both groups (p < 0.05). Additionally, the Fmedi and Fmedf values for the athlete group were higher in comparison to the sedentary group (p < 0.05). The MRI mean value and standard deviation for the athlete group were 62.1 percent ± 28.7 and for the sedentary group was 55.2 percent ± 27.8 (p > 0.05). Therefore, the results presented in this study allow inferring the viability in the application of the frequency domain parameters of the EMG signal for the determination and differentiation of localized muscle fatigue behavior.

Expressions of Nitric Oxide Synthases and Akt in the Tibialis Anterior Muscle of the Spontaneously Hypertensive Rat after Ischemic Preconditioning / 체질인류학회지

Nitric oxide (NO) generated during ischemic-reperfusion phase is known to activate various transcriptional factors. NO is generated by 3 nitric oxide synthase (NOS) isoforms, nNOS, iNOS, eNOS. Akt plays a important role of the cell survival. Ischemic preconditioning (IP) reduces ischemic injury by changing of the expression of the NOSs and Akt. The alterations of the NOSs is related to the development of hypertension, and hypertension has been known to induce the skeletal muscle changes including decreased fatigue resistance and contractile force. The purpose of this study was to observe the effect of IP on the expressions of the NOSs and Akt in the skeletal muscle of the spontaneously hypertensive rat (SHR). Nine weeks old male normotensive rat (Wistar-Kyoto rat, WKY) and SHR were divided into control and IP groups. The IP group was further divided into 3 or 10 cycles of IP. For IP, left common iliac artery was occluded 3 or 10 cycles of 5 min of ischemia/5 min of reperfusion using rodent vascular clamp. The animals were sacrificed at 0, 0.5, 1, 3 and 24 hours after reperfusion and the tibialis anterior muscles were removed. The expressions of nNOS, iNOS, eNOS, and Akt were examined with immunohistochemical methods and Western blot analysis. In the SHR, the expression of nNOS was decreased, iNOS was increased and the expressions of eNOS and AKT were decreased, compare to WKY. The expression of iNOS was increased, and nNOS, eNOS and Akt were decreased in SHR by 10IP. In summary, IP increased the expression of iNOS, and decreased the expression of eNOS and Akt in the SHR. It is suggested that hypertension may aggravate injury of the tibialis anterior muscle induced by repetitive ischemic conditioning.

O Efeito da crioterapia e compressão interminente no músculo lesado de ratos: uma análise morfométrica / The effect of intermittent cryotherapy and compression on muscle injuries in rats: a morphometric analysis

INTRODUÇÃO: Embora a crioterapia associada à compressão seja recomendada como tratamento imediato após lesão muscular, o efeito de sessões intermitentes desses procedimentos na área de lesão muscular secundária não é bem estabelecido. O objetivo deste estudo foi avaliar o efeito da aplicação intermitente de crioterapia e compressão (três sessões de 30 min a cada 1h30min) na área de lesão do músculo tibialis anterior direito (TAD) do rato. METODOLOGIA: A lesão muscular foi induzida por criolesão no TAD. Vinte e quatro ratos Wistar (340 ± 20g) foram divididos em quatro grupos experimentais: a) O grupo Lesão + Crioterapia (L+C) recebeu tratamentos intermitentes de crioterapia e compressão; b) O grupo Lesão + Placebo (L+P) recebeu tratamento placebo; c) O grupo Lesão (L) não foi submetido a nenhum protocolo de tratamento; e d) o grupo Crioterapia (C) que permaneceu intacto e foi submetido a tratamentos de crioterapia e compressão. Os animais foram sacrificados 24h pós-lesão, sendo os músculos seccionados em criostato e os cortes histológicos corados com Azul de Toluidina para posterior mensuração da área muscular lesada (morfometria). A análise estatística constou da ANOVA e do teste Tukey (p < 0,05). RESULTADOS: A morfometria aplicada 24 horas pós-lesão indicou redução significante da área de lesão muscular no grupo L+C (35,87 ± 4,9 por cento) quando comparado aos grupos L+P (46,4 ± 3,9 por cento; p= 0,001) e L (46,5 ± 4,1 por cento; p= 0,002). CONCLUSÃO: Três sessões de crioterapia e compressão foram eficientes na prevenção do aumento da área de lesão, enquanto somente a compressão não apresentou a mesma efetividade.

INTRODUCTION: Although cryotherapy associated with compression has been recommended as an immediate treatment for muscle injuries, the effect of intermittent sessions of these procedures in the area of secondary muscle injuries has not been clearly established. OBJECTIVE: To evaluate the effect of intermittently applying cryotherapy and compression (three 30-minute sessions at 90-minute intervals) on an injured area of the right tibialis anterior (RTA) muscle in rats. Method: An injury was induced in the RTA muscle by means of cryoinjury. Twenty-four Wistar rats (340 ± 20g) were divided into four experimental groups: a) Injury + Cryotherapy (I+C), which received intermittent cryotherapy and compression; b) Injury + Placebo (I+P), which received placebo treatment; c) Injury (I), which did not undergo any treatment protocols; and d) Cryotherapy, which remained intact and underwent cryotherapy and compression treatment. The animals were sacrificed 24 hours after the injury, and the muscles were sectioned in a cryostat. The histological sections were stained with toluidine blue for subsequent measurement of the area of the muscle injury (morphometry). The statistical analysis consisted of the ANOVA and Tukey tests (p < 0.05). RESULTS: The morphometric analysis 24 hours after the injury indicated that there had been a significant reduction in the area of the muscle injury in the I+C group (35.87 ± 4.9 percent), in comparison with the I+P group (46.4 ± 3.9 percent; p= 0.001) and the I group (46.5 ± 4.1 percent; p= 0.002). CONCLUSION: Three sessions of cryotherapy and compression were efficient in preventing an increase in the injured area, while compression alone did not achieve such effectiveness.

Diagnosis of Herniated Tibialis Anterior Muscle by Dynamic Ultrasonography: A Case Report / 대한정형외과학회잡지

Muscle herniation is a relatively common disorder in the extremities, particularly in the lower extremity where the tibialis anteior muscle is the most commonly affected. Usually muscle herniation is asymptomatic or mild but a few patients complain of cramping or severe pain. We report a case of a bilateral hernia of the tibialis anterior muscle that was confirmed by dynamic ultrasonography.

Age-related Alterations of Bcl-2, Bax and Apoptosis in Ischemic-reperfused Rat Tibialis Anterior Muscles / 체질인류학회지

Prolonged ischemic-reperfusion induces cellular damages and apoptosis in rat skeletal muscle. Such injury takes place in the phase of reperfusion following ischemia induction in part via regulating of apoptosis-related gene inductions. Among apoptosis-related gene products, Bcl-2 and Bax regulate the apoptotic response by inhibiting and promoting cell death, respectively. The present study was performed to examine the age-related alertation of expression of Bcl-2 and Bax along with apoptosis in rat tibialis anterior muscles following ischemia-reperfusion. 9 weeks, 30 weeks and more than 65 weeks old male Sprague-Dawley rats were divided into 2 groups such as controls, 4 hour ischemia. 4 hour ischemia group was divided into 3 subgroups based on reperfusion time. For ischemia, left commom iliac artery was occulded for 4 hours. The tibialis anterior muscles were removed 0, 3, and 24 hours after onset of reperfusion. Muscle samples were embeded in paraffin and 6 micrometer sections were made. The expression level of Bcl-2 and Bax were examed using immunohistochemical methods and apoptotic reactions was detected using TUNEL methods. The results obtained were as follows; 1. In control group, Bcl-2 and Bax were weakly immunostained in 9 weeks old rat tibialis anterior muscles. In 30 and 65 weeks old rat tibialis anterior muscles, Bcl-2 immunostaning was minimal. The level of Bax staining was increased in 30 and 65 weeks old rat tibialis anterior muscles, compared with those of 9 weeks old rats. The level of apopto-sis among different age groups were not altered. 2. In the 4 hour ischemia group, the level of Bax staining was correlated with the level of apoptosis in 9 weeks, 30 weeks and 65 weeks old rat tibialis anterior muscles. 3. The level of apoptosis was increased in older groups relative to younger groups in 4 hour ischemia. These results suggested that the level of apoptosis induced by ischemic-reperfusion in tibialis anterior muscle increase with ageing in rat tibialis anterior muscles, and that a increase of Bax expression is related to increased apoptosis.

Effects of intermittent-sprint training on histochemical properties of muscle fibres and dominant motor neurons in rats / 体力科学

The present study was undertaken in order to investigate effects of short-term, high intensity training on the total number and histochemical properties of fast tibialis anterior, slow soleus muscle fibres and their dominant motor neurons in male rats.<BR>The animals were subjected to 4 meters of sprint-running by the operant conditioning, 12 times a day interposed with 5 minutes rest periods for 14 weeks.<BR>This training had no effect on the total number and enzyme activities of muscle fibres and dominant neurons. However, hypertrophy of FOG and FG fibres in tibialis anterior muscle was caused by the training.<BR>The conclusion, therefore, is that short-term but high intensity training causes selec. tive hypertrophy of fast twitch muscle fibres, but does not have an influence on the histochemical properties of motor units because the training is far a short period of time.