Defining tibial anterior muscle morphology in first-ever chronic stroke patients using three-dimensional freehand ultrasound.

BACKGROUND: Drop foot is common post-stroke, elevating fall risks and mobility limitations. It is caused by weakness and lack of control of the tibialis anterior muscle (TA), for which various rehabilitation treatments are used. A reliable objective estimate of changes in TA muscle morphology and composition can enhance treatment optimization. OBJECTIVES: We aimed to ascertain 3D freehand ultrasound (3DfUS) reliability in measuring TA muscle volume, length, and echo intensity in stroke patients and healthy controls and its validity by comparing these features across legs, between patients and controls, and between clinical subgroups (i.e. patients with and without ankle contracture, spastic muscle overactivity, and foot dorsiflexor paresis). METHODS: We included 9 stroke patients and 9 healthy controls to define reliability and 26 stroke patients and 28 healthy controls to define validity. For reliability, data were collected and processed by 2 different operators and processors. For inter- and intra-rater reliability, intra-class correlation coefficient (ICC) and standard error of measurement (SEM) were used. For validity, Wilcoxon-Signed-Ranked and Mann-Whitney U tests were used for comparisons between groups and subgroups. RESULTS: All measurements showed good to excellent inter- and intra-rater reliability (ICC: 0.816 to 0.997, SEM: 0.5% to 7.8%). Comparison analyses revealed no differences in muscle features among legs, groups, or subgroups. CONCLUSION: While the 3DfUS is a reliable method to define TA morphology and composition, its clinical validity needs further investigation into factors influencing muscle property changes across various age groups and post-stroke time points. MESH TERMS: Stroke; Skeletal muscle morphology; muscle composition; 3D freehand ultrasonography, Anterior Tibial Muscle.

Effect of Functional Electrical Stimulation on Muscle Mass, Fatigue, and Quality of Life in Older Patients With COVID-19: A Randomized Clinical Trial Study.

OBJECTIVE: This study aimed to evaluate the effects of functional electrical stimulation (FES) on muscle strength, fatigue, muscle mass, and quality of life (QoL) in older patients with COVID-19. METHODS: Older patients with COVID-19 were randomly divided into the following 2 groups: real FES (intervention group, n = 20) and sham FES (control group, n = 20). These patients received FES concurrent with the voluntary contraction of muscles for 10 consecutive sessions. Ultrasound imaging, pressure biofeedback, Chalder fatigue scale, and QoL were utilized to measure muscle mass, muscle strength, chronic fatigue, and QoL, respectively. Evaluations were performed at the beginning, immediately, and 1 month after the end of intervention. RESULTS: All variables showed statistically significant improvement immediately and 1 month after the intervention in the real FES group (P < .05). However, the tibialis anterior muscle mass and fatigue significantly improved immediately after the intervention in the sham FES group. However, the tibialis anterior and rectus femoris muscles strength and rectus femoris muscle mass were not significantly changed immediately and 1 month after the intervention (P > .05). There were significant differences in muscle mass, physical fatigue, muscle strength, and QoL between groups with more efficacy of real FES (P < .05). CONCLUSION: For this sample of patients, FES improved fatigue, muscle strength, muscle mass, and QoL in older adults with COVID-19.

Nerve transfer in the spastic equino varus foot: Anatomical feasibility study.

PURPOSE: We want to evaluate the feasibility of transferring a motor branch of the anterior tibial muscle (ATM) to the extensor digitorum longus (EDL) to evaluate this procedure in patients with spastic equinovarus foot (EVF) following post-stroke hemiplegia. METHODS: Ten cadaveric dissections from five fresh frozen human cadavers were performed to establish the anatomic feasibility of transferring a motor branch of the deep peroneal nerve, usually destinated to the ATM, to the branch of the EDL to manage spastic EVF. RESULTS: Six cases (60%) presented three branches destinated to the ATM, one case (10%) presented give branches, and three cases (30%) had four branches. In all specimens, the coaptation between the motor branch to the ATM, referred as the "effector" branch, and the branch of the EDL "receiver" branch was feasible without tension and did not require any intraneural dissection. CONCLUSION: This anatomical study confirms the feasibility of transferring a motor branch from the ATM to the EDL to correct a spastic EVF.

Effects of progressive functional ankle exercises in spastic cerebral palsy, plantarflexors versus dorsiflexors: a randomized trial.

Background/aim: Children with cerebral palsy (CP), even those who have very mild impairment, have lower muscle strength than their typically developing peers. The ankle dorsiflexors (DFs) and plantarflexors (PFs) of children with CP are especially weak. Weakness in the ankle muscles causes problems in functional skills, mobility, and balance in spastic CP (SCP). The aim of this study was to investigate the effects of progressive functional exercises (PFEs) on the DF, PF, or dorsi-plantar flexor (DPF) muscles in children with SCP, specifically, the functional mobility, balance, and maximum voluntary contraction (MVC), and compare the effects of strengthening these muscles individually or combined. Materials and methods: This randomized trial was conducted between December 1st, 2018, and May 15th, 2019, at Gazi University, Department of Physiotherapy and Rehabilitation. Randomly assigned into groups were 27 independently ambulant patients with unilateral/bilateral SCP, where PFEs were applied to the DF, PF, or DPF muscles. Muscle tone, balance, and functional mobility were assessed. The MVC was evaluated by surface electromyography. PFEs were performed 4 times a week, for 6 weeks. Results: The spasticity of the PF muscles decreased in all of the groups. PFE of the DF muscles led to an increase in ankle joint range of motion (ROM) and improved functional mobility (p < 0.05). PFE of the PF muscles resulted in improvements in balance and functional mobility (p < 0.05). PFE of the DPF muscles brought about improvements in balance but not in functional mobility (p < 0.05). No significant difference in the MVC was observed in any of the groups (p > 0.05). Conclusion: Gains are obtained according to the function of a muscle group. By training the DF muscles, it is possible to improve function and ROM. Furthermore, training the PF muscles led to improvements in balance and functional mobility, indicating that it is possible to bring about positive changes in spastic muscles. This study showed that muscle groups must be exercised according to the intended goal.

Anterior shin muscles CMAP measurements: Normal limits of symmetry and intra- and interobserver reliability.

OBJECTIVE: The normal limits of symmetry for the compound muscle action potential of the shin muscles (CMAPshin) have not been determined yet. The goal of this study is to provide extensive data on the limits of symmetry and the reliability of CMAPshin. METHODS: The study was conducted in normal healthy males and females. All subjects underwent CMAPshin measurements bilaterally. The median percent differences of right/left amplitude/area, with range of these measurements, were calculated. In addition, the intra- and interobserver reliability was examined in a separate population. RESULTS: The study group consisted of 58 healthy individuals. The median percent right/left difference for amplitude and area were respectively 7.2% (range 0-23.6%) and 5.4% (range 0.7-25.6%). Right/left difference of the amplitude/area of the CMAPshin greater than 24%/26% respectively can be considered as pathological. The Pearson correlation coefficients (r) for the intra-observer reliability amplitude/area are 0.905/0.882 and for the inter-observer reliability are 0.968/0.981. CONCLUSIONS: The results confirm symmetry and good intra- and interobserver reliability in CMAPshin measurements. SIGNIFICANCE: CMAPshin can be used in practice to estimate axonal loss in case of a foot drop. Data studies examining symmetry of CMAPshin can facilitate in the clinical interpretation of these nerve conduction studies.

Chronic exertional compartment syndrome as a cause of anterolateral leg pain.

Exercise-induced leg pain (ELP) and tightness may be caused by a chronic exertional compartment syndrome (CECS). Although CECS can develop in any muscle compartment, most individuals suffer from an anterior tibial muscle CECS (ant-CECS). Typically, a patient with ant-CECS experiences discomfort toward the end of sports activity or in the hours thereafter. Physical examination may reveal tenderness upon palpation of the anterior tibial muscle belly. The gold standard diagnostic tool is a dynamic intracompartmental pressure (ICP) measurement demonstrating elevated muscle tissue pressures. Duplex analysis and imaging may be indicated for exclusion of concomitant entities such as entrapment of the popliteal artery or nerves. Conservative treatments including modification of the patient's running technique can be successful. A fasciotomy must be considered in recalcitrant cases. Residual or recurrent disease may necessitate partial removal of the fascia. The aim of this overview is to discuss the management of CECS in the anterolateral portion of the leg.

Surface electromyogram features of the lower limb muscles in cerebral palsy children standing and walking on tiptoes / 中国组织工程研究

BACKGROUND: Under well-controlled conditions, changes in myoelectric signal activity can largely reflect muscle changes such as muscle function, muscle tension, muscle strength, and multi-muscle coordination, providing objective analysis of the muscle function. OBJECTIVE: To investigate the changes in surface electromyography (SEMG) of the lower limb muscles in cerebral palsy children standing or walking on tiptoes. METHODS: Using TELEMYO 2400R G2 SEMG telemeter produced by NORAXON Company in the United States, surface EMG features of bilateral anterior tibial muscles and medial gastrocnemius muscles were detected in 20 cerebral palsy children standing or walking on unilateral tiptoes. The myoelectric activity of the testicular muscles between the pointed and contralateral side was compared in all the subjects. The study protocol was approved by the Ethics Committee of Shanghai Ruijin Hospital, and all subjects and their guardians signed an informed consent prior to the participation in the study. RESULTS AND CONCLUSION: When the subjects were standing and walking normally, the average SEMG amplitude and average SEMG integral of the medial gastrocnemius at the tiptoe side were significantly lower than those at the contralateral side (P < 0.05); the mean and median frequencies of the anterior tibial muscles and medial gastrocnemius muscles at the tiptoe side were significantly higher than those at the contralateral side (P < 0.05). These findings indicate that there are abnormal SEMG signals in the anterior tibial muscles and medial gastrocnemius muscles at the tiptoe side in children with cerebral palsy, and the muscle activity of the lower limbs in such children is not balanced. Therefore, SEMG is of practical value in evaluating the functional status of the neuromuscular system in children with cerebral palsy.

[Chronic exertional compartment syndrome as a cause of anterolateral leg pain-German version]. / Chronisches belastungsbedingtes Kompartmentsyndrom als Ursache anterolateraler Beinschmerzen.

Exercise-induced leg pain (ELP) and tightness may be caused by a chronic exertional compartment syndrome (CECS). Although CECS can develop in any muscle compartment, most individuals suffer from an anterior tibial muscle CECS (ant-CECS). Typically, a patient with ant-CECS experiences discomfort toward the end of sports activity or in the hours thereafter. Physical examination may reveal tenderness upon palpation of the anterior tibial muscle belly. The gold standard diagnostic tool is a dynamic intracompartmental pressure (ICP) measurement demonstrating elevated muscle tissue pressures. Duplex analysis and imaging may be indicated for exclusion of concomitant entities such as entrapment of the popliteal artery or nerves. Conservative treatments including modification of the patient's running technique can be successful. A fasciotomy must be considered in recalcitrant cases. Residual or recurrent disease may necessitate partial removal of the fascia. The aim of this overview is to discuss the management of CECS in the anterolateral portion of the leg.

Clinical outcome after decompression of intraneural peroneal ganglion cyst and its morphologic correlation to postoperative nerve ultrasound.

OBJECTIVE: Intraneural ganglion cysts are rare and benign mucinous lesions that affect peripheral nerves, most frequently the common peroneal nerve (CPN). The precise pathophysiological mechanisms of intraneural ganglion cyst development remain unclear. A well-established theory suggests the spread of mucinous fluid along the articular branch of the peroneal nerve as the underlying mechanism. Clinical outcome following decompression of intraneural ganglion cysts has been demonstrated to be excellent. The aim of this study was to evaluate the correlation between clinical outcome and ultrasound-detected morphological nerve features following decompression of intraneural ganglion cysts of the CPN. METHODS: Data were retrospectively analyzed from 20 patients who underwent common peroneal nerve ganglion cyst decompression surgery at the Universität Ulm/Günzburg Neurosurgery Department between October 2003 and October 2017. Postoperative clinical outcome was evaluated by assessment of the muscular strength of the anterior tibial muscle, the extensor hallucis longus muscle, and the peroneus muscle according to the Medical Research Council grading system. Hypesthesia was measured by sensation testing. In all patients, postoperative morphological assessment of the peroneal nerve was conducted between October 2016 and October 2017 using the iU22 Philips Medical ultrasound system at the last routine follow-up appointment. Finally, the correlations between morphological changes in nerve ultrasound and postoperative clinical outcomes were evaluated. RESULTS: During the postoperative ultrasound scan an intraneural hypoechogenic ring structure located at the medial side of the peroneal nerve was detected in 15 (75%) of 20 patients, 14 of whom demonstrated an improvement in motor function. A regular intraneural fasicular structure was identified in 3 patients (15%), who also reported recovery. In 1 patient, a recurrent cyst was detected, and 1 patient showed intraneural fibrosis for which recovery did not occur in the year following the procedure. Two patients (10%) developed neuropathic pain that could not be explained by nerve ultrasound findings. CONCLUSIONS: The results of this study demonstrate significant recovery from preoperative weakness after decompression of intraneural ganglion cysts of the CPN. A favorable clinical outcome was highly correlated with an intraneural hypoechogenic ring-shaped structure on the medial side of the CPN identified during a follow-up postoperative ultrasound scan. These study results indicate the potential benefit of ultrasound scanning as a prognostic tool following decompression procedures for intraneural ganglion cysts of the CPN.

Concordance of the location of the innervation zone of the tibialis anterior muscle using voluntary and imposed contractions by electrostimulation.

BACKGROUND: The innervation zone (IZ) corresponds to the location of the neuromuscular junctions. Its location can be determined by using arranged surface linear electrode arrays. Typically, voluntary muscle contractions (VC) are used in this method. However, it also may be necessary to locate the IZ under clinical conditions such as spasticity, in which this type of contraction is difficult to perform. Therefore, contractions imposed by electrostimulation (ES) can be an alternative. There is little background comparing the locations of IZ obtained by two different types of contractions. OBJECTIVE: Evaluate the concordance between using voluntary and imposed contractions from electrostimulation in order to determine the location of the innervation zone of the tibialis anterior muscle in healthy volunteers. METHODS: The tibialis anterior (TA) muscle of sixteen volunteers (men: 8; women: 8; age: 22.1±1.4years, weight: 61.6±7.5kg, height: 167.1±7.5cm) were evaluated using a linear electrode array. The IZ of the TA muscle was located using two types of muscle contractions, voluntary (10% MVC) and imposed contractions by ES. The concordance between both conditions was evaluated using the Bland-Altman method and the concordance correlation coefficient (CCC). The analyses were applied to the absolute and relative positions to the length of an anatomical landmark frame. RESULTS: CCC for absolute position was 0.98 (p<0.0001, 95% CI [0.98-1.00], and CCC for relative positions also was 0.98 (p<0.0001, 95% CI [0.97-1.00]). The Bland-Altman analysis for absolute data showed an average difference of -0.63mm (SD: 4.1). Whereas, for adjusted data, the average difference was -0.20% (SD: 1.2). The power of the results, based on absolute data, was 98%, whereas for relative data, 82%. CONCLUSION: In healthy volunteers, there was a substantially concordance between the location of the IZ of the TA muscle derived from using contractions imposed by ES and the location derived from using VC.

Chronic Tibialis Anterior Tendon Rupture Treated with Semitendinosus Autograft: A Report of Two Cases / 대한족부족관절학회지

The tibialis anterior tendon functions as a major dorsiflexor of the ankle. A rupture in this tendon can cause serious problems in the ambulatory function. A closed traumatic rupture without open wound or an atraumatic rupture can delay diagnosis and treatment. There are not enough guidelines for an effective surgical treatment on this chronic condition. Herein, we report two cases of chronic tibialis anterior disruption successfully treated by semitendinosus autograft.

Tibialis anterior analysis from functional and architectural perspective during isometric foot dorsiflexion: a cross-sectional study of repeated measures.

BACKGROUND: The purpose of the present study is to establish the relationship and degree of contribution between torque and sonomiography variables (pennation angle - muscle thickness), and electromyography variables (EMGAreaUnderCurve - EMGMaximalPeak) of the tibialis anterior muscle during (TA) maximal and relative isometric foot dorsiflexion (IFD). Secondary aim: To determine the measurement's reliability. METHODS: Cross-sectional study. 31 participants (15 men; 16 women) performed IFD at different intensities (100, 75, 50, and 25 %) of the maximal voluntary contraction (MVC) (three times for each intensity). OUTCOME VARIABLES: To determine the torque, pennation angle, muscle thickness, EMGMaximalPeak, and EMGAreaUnderCurve. STATISTICAL ANALYSIS: In order to test the measurement's reliability, Cronbach's alpha and standard error of the measurement were determined. An inferential analysis was carried out using Pearson correlations(r). For each contraction intensity, a multiple regression analysis was performed, where the dependent variable was torque and the independent variables were EMGAreaUnderCurve, EMGMaximalPeak, muscle thickness and pennation angle. RESULTS: All outcome variables show excellent reliability. The highest correlation value was 0.955 (thickness 100 % - thickness 25 %). R (2) values ranged from 0.713 (100 % MVC) to 0.588 (25 % MVC). CONCLUSION: The outcome variables demonstrated excellent reliability in terms of measuring IFD at different intensities. The correlations between all outcome variables were moderate-to-strong. TA functional and architectural variables have a significant impact on the torque variance during IFD at different intensities.

Tibialis anterior partial rupture mimicking muscle hernia: a rare case report.

Rupture of tibialis anterior tendons is infrequently described in literature, and those described were around the ankle, either at the origin or in the tendon substance. To our known knowledge only very few cases of rupture of the tibialis anterior at musculotendinous junction were reported. We highlight the occurrence of rupture at the musculotendinous junction in tibialis anterior muscle after trauma, presenting as a soft tissue mass, the need to differentiate it from traumatic muscle hernia, mechanism of injury and its ultrasound and MRI findings.

Calcific Amyloidoma of Tibialis Anterior Muscle: Case Report / 대한정형외과학회잡지

Calcific amyloidoma of the soft tissue is quite rare and it is difficult to make a differential diagnosis from other lesions such as osteomyelitis or bone tumor. We encountered a case of a calcified amyloidoma found in the anterior tibial muscle that occurred more than 20 years after a proximal tibial fracture adjacent to the origin of the muscle. The features of the lesion resembled osteomyelitis. Satisfactory result was obtained by a thorough mass excision. We report this case with review of the relevant literature.