The efficacy of forceful ankle and toe exercises to increase venous return: A comprehensive Doppler ultrasound study.

Objective Venous stasis is a risk factor for venous thromboembolism. We aimed to determine the efficacy of forceful foot exercises for actuation of the calf muscle pump to counteract stasis. Methods We examined 20 seated healthy subjects. The peak systolic velocity at the level of the popliteal vein was assessed by Doppler ultrasound. Results The mean peak systolic velocity measurements (in cm/s) were as follows: baseline = 5.6; ankle plantar flexion with toe flexion = 91.0; toe touch heel lift = 107.4; ankle dorsiflexion with toe extension = 193.6; isolated flexion of all toes = 118.8; ankle plantarflexion with 100 and 250 Newton forefoot force = 89.9 and 154.5, respectively. Conclusion All exercises achieved significant increases in peak systolic velocity compared to baseline. Ranking showed that forceful ankle dorsiflexion, plantarflexion with 250 Newtons and forceful flexion of all toes yielded the highest mean peak systolic velocity values (193.6, 154.5, and 118.8 cm/s, respectively).

Hyphenated history: Erb-Duchenne brachial plexus palsy.

Throughout history, the discoveries of their predecessors have led physicians to revolutionary advances in the understanding and practice of medicine. The result is a plethora of hyphenated eponyms paying tribute to individuals connected through time by a common interest. The history of Guillaume Duchenne de Boulogne, the "father of electrotherapy and electrodiagnosis," and Wilhelm Heinrich Erb, the "father of neurology," offers insight into the personal and professional lives of these astute clinicians and their collaborative medical breakthrough in the area of neurologic paralysis affecting the upper limbs.

Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study.

BACKGROUND: Radial epicondylitis (tennis elbow) is the most frequent type of myotendinosis. Patients can experience substantial loss of function, especially when this condition becomes chronic. A successful therapy has not yet been established. A preliminary study of injections of botulinum toxin A in patients with chronic epicondylitis has shown promising results. METHODS: In the present prospective, controlled, double-blinded clinical trial, 130 patients were examined at sixteen study centers. A single injection of botulinum toxin A into the painful origin of the forearm extensor muscles was performed. Follow-up examinations were performed at two, six, twelve, and eighteen weeks. Clinical findings were documented with use of a new clinical pain score and with a visual analogue scale. A global assessment of the result of treatment was also provided by the patient and the attending doctor. Strength of extension of the third finger and the wrist was evaluated with use of the Brunner method, and grip strength (fist closure strength) was measured with a vigorimeter. RESULTS: The group treated with botulinum toxin A was found to have a significant improvement in the clinical findings, compared with those in the placebo group, as early as the second week after injection (p = 0.003). Subjective general assessment also showed improvement in that group, compared with the placebo group, at six weeks (p = 0.001) and at the time of the final examination (at eighteen weeks) (p = 0.001). There was a consistent increase in fist closure strength in both the group treated with botulinum toxin A and the control group, but there was no significant difference between groups. As was expected as a side effect, extension of the third finger was observed to be significantly weakened at two weeks but this complication had completely resolved at eighteen weeks. CONCLUSIONS: We concluded that local injection of botulinum toxin A is a beneficial treatment for radial epicondylitis (tennis elbow). The treatment can be performed in an outpatient setting and does not impair the patient's ability to work.

Treatment of chronic plantar fasciitis with Botulinum toxin A: preliminary clinical results.

Based on recent results in chronic lateral epicondylitis we decided to investigate the efficacy of Botulinum toxin A (BTX-A) for treatment of chronic therapy resistant plantar fasciitis. Nine patients with an average duration of symptoms of 14 months and at least two prior conservative treatments received a one injection of 200 units of BTX-A (Dysport) subfascially into the painful area. The patients documented pain at rest and during weight-bearing after 2, 6, 10 and 14 weeks by a visual analogue scale. A significant reduction of pain during weight-bearing to about 50% was seen 6 weeks after injection. The effect was still present at the latest follow-up of 14 weeks. Similarly, the pain at rest was reduced to less than half of the initial value at any follow-up. All patients were satisfied and did not require further treatment.

Monitoring of Containment in Perthes' Disease: Can Ultrasonography be Helpful?

Background. Prevention of loss of containment has become an accepted principle in the treatment of Perthes' disease. The pre-requisite is early recognition. It is based on evaluation of plain radiographs and more recently, on the study of Magnetic Resonance (MR) images which allow discrimination of early cartilaginous changes. Ultrasonography (US) allows visualisation of the lateral cartilaginous portion of the femoral head and the acetabular rim including the labrum and measurement of femoral head protrusion/lateralisation. The purpose of this paper is to highlight its potential for monitoring of containment . Materials and methods. We present typical MR and US images to demonstrate the anatomic landmarks of the normal hip joint and to define the parameters of protrusion in Perthes' disease. We selected three illustrative cases that had undergone routine imaging of both hip joints by MR imaging and ultrasound for evaluation of containment. Radiographs of the hips were also available. In radiographs we assessed the coverage of the femoral head, i.e. containment, by the well established Acetabulum-Head Index (AHI) and in MR imaging by the Cartilaginous Acetabulum-Head Index (CAHI). In US we assessed the uncoverage, i. e. protrusion, by the Lateral Cartilage Distance (LCD). Changes in the important morphological MR containment features were also noted. Results. There was a significant increase in the LCD in all Perthes hips (6.2, 7.4, 11.6 mm) when compared to the unaffected side (5.2, 5.1, 4.1 mm) and also when compared to the published mean normal value (5.4 +/- 0.9 mm). Correspondingly, the CAHI values were significantly decreased (75, 69, 67% versus 87, 79, 81%), also in comparison to the published limits (77, 75, and 73% respectively). As for the AHI only the value of 71 % in the third case represented a definite decrease below published normal limits (86 and 80.7% respectively). In the 1st case we diagnosed adequate containment, in the 2nd containment at risk, and in the 3rd loss of containment. In the 2nd case the AHI of 90 % suggested adequate containment whereas considerable protrusion/lateralisation was evident in MR imaging and US. The CAHI was only 69%. It showed that assessment by plain radiographs is less reliable because the cartilaginous portion of the hip joint is not included in interpretation. We were able to demonstrate a good agreement between LCD and CAHI in our cases. Conclusion. US can be helpful for monitoring of containment in Perthes' disease allowing a closer follow-up and a reduction of serial radiographs and MR exams.