The 'Entlastungsgang'. A hip unloading gait as a new conservative therapy for hip pain in the adult.

'Entlastungsgang' is a gait modification aiming to unload the hip joint by producing a modified Duchenne-limp (straight spinal column, additional lifting of the pelvis on the side of the swinging leg and a consecutive side shift of the pelvis) and a wide stance gait. Sixteen patients suffering from hip pain caused mainly by hip dysplasia were investigated. They received daily gait training for 12 h combined with intensive physical therapy as in-patients for 3-4 weeks. The external muscle torque acting on the hip joint was determined by 3D-gait analysis before, during and after the gait training. We found a reduction of the muscle torque after gait training to 77.2% of the initial value. At an average follow up of 12 months we found a persisting reduction of the muscle torque to 87. 0% at spontaneous gait that was further reduced to 81.3% of the initial value. The hip score for two components of the Merle d'Aubigne and Postel score for pain and walking was significantly improved from 7.4 to 10.8 points.

Influence of a high hip center on abductor muscle function.

In 20 anatomic specimens with an acetabular defect (type Paprosky 3b), an acetabular component was implanted in the position of a high hip center. The vertical migration of the hip center ranged between 13 and 35 mm. It was accompanied by a lateralization and ventral migration of between 5 and 25 mm. The influence on the different abductor muscles was calculated through computer model comparing muscle force and muscle length before and after implantation of a high hip center. The increase in length of the gluteus maximus muscle and the posterior part of the gluteus minimus muscle ranged between 1% and 6%, while all other evaluated abductor muscles were shortened from 3% to 16%. The effect of the simultaneous changes of the lever arms was an increase in necessary muscle strength for pelvic stabilization from 140% to 250% compared with the original estimated strength prior to implantation. This may lead to insufficiency of the abductor muscles after placement of a high hip center. On the basis of these findings, we do not recommend the implantation of an acetabular component in the position of a high hip center.

[Asymmetry of posture and truncal musculature following unilateral arm amputation--a clinical, electromyographic, posture analytical and photogrammetric study]. / Asymmetrie der Haltung und der Rumpfmuskulatur nach einseitiger Armamputation--eine klinische, elektromyographische, haltungsanalytische und rasterphotogrammetrische Untersuchung.

Unilateral upper limb amputation causes changes in statics of the spine. As a result asymmetrical posture of the spine, muscular asymmetries follow. In this study a population of upper limb amputees (above and below elbow amputees) is examined by clinical, electromyographical analysis and gait analysis. Upper limb amputations cause in correlation to weight loss a shift of the trunk to the side of the amputation, a scoliosis with a bowing to the side of the amputation, an elevation of the shoulder on the amputation side and a torsion of the trunk. Muscular asymmetries result from loss of function (muscles of the arm, M. latissimus, M. trapezius) and by shifting of the center of gravity. In order to get the center of gravity over the legs, the amputee compensates the loss of weight by shifting the upper trunk to the side of the amputation. As a result the shift of the segmental center of gravity at the lumber height to the side of the normal arm with muscular asymmetry in the erector trunci lumbalis results. As well we saw an overactivity of musculus glutaeus medius and resulting stress of the amputation sided hip joint. There was a remarkable difference between above and below elbow amputees caused by differences in weight loss. Muscular and static asymmetries in amputees who lost their arm only a short period before could be reduced by compensating the weight loss. Results for technical orthopaedic fitting and stress on gymnastic procedures to compensate these statistical problems are discussed.

[Ultrasonographic measurement of leg length and leg length differences]. / Die sonographische Beinlängen-und Beinlängendifferenzmessung.

A new diagnostic method for measuring the leg length and the leg length difference by means of ultrasound is presented. A special device for holding and moving the ultrasound transducer was constructed. The measuring points on the hip, knee and upper ankle can be visualised by means of a 5- or 7.5-MHz linear scanner. The measuring device gives the distance of the points in cm so that the difference correspond to the length of the leg, femur and tibia. Tests conducted on corpes and clinical examples show that ultrasound in combination with our special device is an ideal method for determining the exact lengths of the leg. The ultrasound measuring of the leg length offers a reliable, non invasive and easily performed method. Because ultrasound is not limited by radiation hazards, our technique can be used for clinical screening.

[An opto-electronic procedure for the analysis of movement and posture]. / Ein optoelektronisches Verfahren zur Bewegungs-und Haltungsanalyse.

The described procedure has been developed for the quantitative estimation of human postures and motions. The system is based upon the detection of the components of the force vector between the foot and the ground and also the position of the marked pints of rotation of the joints or of the markes above the spine. The course of this vector of force in conjunction with the distance of the pints of rotation permits conclusions to be drawn about stress of joints during walking or different posture.

[Gait analysis in cerebral palsy patients--correlations between disorders of muscle coordination and gait abnormalities]. / Ganganalyse beim Cerebralparetiker--Beziehungen zwischen Störungen der Muskelkoordination und Ganganomalien.

Electromyographic and gait investigations of 35 patients and 32 healthy persons were evaluated in order to get hints upon the origin of anomalous movements of the pelvis and the spine with following results: a. The amount of the spine motions of CP-patients is significantly greater than that of health persons. The motions of the pelvis of the patients also seems to be greater, but there is no significance. b. The average electromyographical activity of the hip abductors of CP-patients is not remarkably diminished, that of the hip adductors is not increased. We also found no signs of an atrophy of the hip adductors or a hypertrophy of the hip adductors. c. There is no correlation between the disturbances of coordination of the entire lower leg measured by electromyography and the amount of the pathologic motions. d. We found a distinct correlation between the disturbances especially of the hip ab- and adductors and the amount of the pathologic motions. This amount is the smaller, the worse is the coordination of these two groups of muscles. The topics a-c do not allow to find the origin of the Duchenne- and Trendelenburg limpings of CP-patients, topic d also gives explanation of this fact. In opposition we may suppose here that the bad timing of the coordination resp. the corresponding permanent electrical activity of the hip ab- and adductors has a stabilizing influence upon the pelvis and the spine. As the most probable origin of the increased Duchenne limping we not suppose the increased motions of the stance phase. Our following investigations will deal with this hypothesis.

[Etiology of hip dislocation in children with cerebral movement disorders and possibilities of conservative treatment using rotating and spreading plates and electrostimulation]. / Atiologie der Hüftverrenkung bei Kindern mit zerebraler Bewegungsstörung und Möglichkeiten konservativer Behandlung mit Dreh-, Spreizschalen und Elektrostimulation.

Dislocations of the hip associated with spastic paralysis are almost always found in severely disabled children. The onset is in infancy. Two methods, electrostimulation of the minor gluteal muscles and treatment with simple leg casts to correct the malposition, are described. Follow-up examinations showed that the treatment had had a positive effect on the hip condition in 33 of the 42 children treated with casts and 26 of the 32 children treated by electrotherapy. Electrotherapy is an innovation, since in the past it was considered contraindicated in these patients. However, it is based on the fact that the gluteal muscles do not normally show any spasticity. Irrespective of this, the treatment is long-term, and has to be continued for many years, a fact which makes greater demands on the cooperativeness of the family.

[Orthopedic surgery of the hand in patients with cerebral palsy (author's transl)]. / Operative Korrekturen an der Hand des Zerebralparetikers.

During the last 15 years surgical interventions on the hands of 47 patients with cerebral palsy were performed. Most suffered from hemiplegia. Electromyographic analysis of arm- hand function showed 1. Decrease in maximal activity 2. Impulse irradiation preferably to flexor muscles 3. Associated activation of the affected contralateral limb 4. Identical patterns of activity in flexion or extension intentions 5. Occasionally reflex activity surmounts voluntary activity 6. Tendency towards tonic activation. By questionnaires the patients were asked to report their own impressions on the results of surgery as to function and appearance of the operated limb. In 30 replies 22 patients reported good results in appearance as well as in function and felt the procedure recommendable. Another 7 patients rated the result as fair, with partial improvement of appearance, without functional deterioration. The only patient who felt his condition worse suffered from epileptic disorder and related increase of spasticity with deterioration of gait to hand surgery, which, however, was without realistic grounds. It is concluded that corrective surgery in the hands of cerebral palsied patients may be fairly rewarding.

[Investigation of gait of patients with idiopathic scoliosis and the influence of the Milwaukee brace on gait (author's transl)]. / Ganguntersuchung an Patienten mit idiopathischen Skoliosen und der Einfluss des Milwaukee-Korsetts auf das Gangbild.

We investigated 42 juvenile patients with idiopathic scoliosist, 37 of them were provided with a Milwaukee brace and treated physically. The electromyographic activity of the musculi erectores trunci and the musculi glutaei medii were recorded during walking and standing on one leg. Simultaneously the motions of the trunc and the pelvis in the frontal plane were registered and calculated. Results without the brace: During walking the activity of the erectors trunci predominates on the convex side of the curvature of the spine. This applies as to the functional curve. The M. glutaeus medius shows an increased activity on the contralateral side of the overhang of the trunc. The priodical shifts of the trunc to the right and to the left during walking decrease with increasing activity of the M. glutaeus medius. In this way, we show the stabilizing influence of this muscle upon the statics of the spine. This should be especially considered with regard to the physical treatment of the patients. Results with the brace put on: There is only little influence of the brace upon the electrical activity of the musculi erectores trunci: we could not detect any activating ore inactivating effect of the brace. The amplitude of the periodical shifts of the trunc and the perlvis during walking is reduced by the brace. At the same time we found a greater activity of the musculi glutaei medii than with the brace taken off. We suppose that the reduced shifts of the trunc and the pelvis involved by the brace force a greater activity of the glutaeus medius.

[Electromyographic study of movements in infants with cerebral palsy (author's transl)]. / Elektromyographische Studie des Bewegungsverhaltens bei Säuglingen mit zerebraler Bewegungsstörung

In 43 infants between 3 and 16 months old electromyographic studies were performed by recording movement patterns. Surface electrodes were fixed to the legs, recording the activities of adductors, small gluteal muscles, M. rectus and hamstrings. The impulses were fed into the computer. Synergistic and antagonistic muscles were compared by correlation analysis. Certain movement patterns were provoked by turning the infants from supine to the sides, pulling up to sitting, tilting sideways, vertical hanging and standing. Synergistic and antagonistic muscle groups were compared by correlation anaysis. Significant differences in motor behavior were shown to exist between spastic and healthy infants: The spastic infants showed widely spread synchronous innervations. Besides, comparison of mean activity values exposed a significant preponderance of mean activity values exposed a significant preponderance of adductor activity to gluteal activity in spastic infants. - In qualitative analysis by a rating system diagnostic differentiation of individual cases was possible. This proved of special value in infants with postural asymmetries or abnormal musculatur tone.