No description available.

There have been reports on the use of Ultrasound (US) for monitoring fracture repair and for measuring muscle volume. Change in muscle mass is a useful bio-marker for monitoring the use and disuse of muscle, and the affects of age, disease and injury. The main modality for imaging bone is X-ray and for muscle volume Magnetic Resonance (MR). Previous studies have shown US to have advantages over X-ray and MR. US can image all stages of the fracture repair process and can detect signs of healing 4-6 weeks before X-ray allowing earlier detection of possible complications. Compared to MR, US is less resource intensive, easier to access and also has fewer exclusion criteria for patients. Despite these advantages, the limited field of view that US can provide results in high operator dependency for scan interpretation and also for length and volume measurements. Three-dimensional Ultrasound (3D US) has been developed to overcome these limitations and has been used to provide extended field of view images of the foetus and the heart and to obtain accurate volume measurements for organs. In this thesis it is hypothesized that 3D US can provide a more comprehensive method of imaging fracture repair than X-ray and is also a viable alternative to MR for determining muscle volumes in vivo. Initially, an electromagnetically (EM) tracked 3D US system was evaluated for clinical use using phantom-based experiments. It was found that the presence of metal objects in or near the EM field caused distortion and resulted in errors in the volume measurements of phantoms of up to ±20%. An optically tracked system was also evaluated and it was found that length measurements of a phantom could be made to within ±1.3%. Fracture repair was monitored in five patients with lower limb fractures. Signs of healing were visible earlier on 3D US with a notable, although variable, lag between callus development on X-ray compared to 3D US. 3D US provided a clearer view of callus formation and the changes in density of the callus as it matured. Additional information gained by applying image processing methods to the 3D US data was used to develop a measure of callus density and to identify the frequency dependent appearance of the callus. Volume measurements of the rectus femoris quadricep muscle were obtained using 3DUS from eleven healthy volunteers and were validated against volume measurements derived using MR. The mean difference between muscle volume measurements obtained using 3D US and MR was 0.53 cm3 with a standard deviation of 1.09 cm3 and 95% confidence intervals of 0.20 - 1.27 cm3 In conclusion, 3D US demonstrates great potential as a tool for imaging components of the musculoskeletal system and as means of measuring callus density.

No description available.

La dystrophie FacioScapuloHumérale (FSHD), décrite pour la première fois en 1885 par Landouzy Dejerine, est la première dystrophie musculaire de l’adulte en France affectant entre 4000 et 5000 personnes. La destruction progressive des fibres musculaires entraîne une atrophie et une faiblesse musculaires s’aggravant progressivement, avec cependant une grande variabilité intra-familiale du degré des atteintes. Une caractéristique de l’atteinte musculaire est généralement son asymétrie. Les premières manifestations concernent souvent les muscles du visage, les muscles de l’omoplate et des muscles perihuméraux. En progressant la pathologie va toucher d’autres territoires musculaires. Dans environ 10 à 15 % des cas, à un stade évolué, les patients sont contraints d'utiliser un fauteuil roulant. En dépit d’avancées majeures dans la compréhension du locus morbide, les mécanismes exacts responsables des défauts musculaires de la FSHD ne sont toujours pas compris et il n’existe aucune thérapie. Toutefois, il existe de plus en plus de données qui permettent une implication probable du stress oxydant dans cette pathologie. L’hypothèse selon laquelle les réponses antioxydantes sont altérées dans la FSHD s’appuie sur des dérégulations d’enzymes impliqués dans le stress oxydant. Une étude prospective réalisée sur des patients FSHD et des volontaires sains nous a ainsi permis de mettre en évidence une corrélation entre le stress oxydant systémique et musculaire et leurs déficits fonctionnels musculaires. Ces données nous ont conduit à la mise en place d’un essai clinique randomisé, contrôlé, en double aveugle contre placébo, visant à évaluer les effets d’une supplémentation en antioxydants chez 54 patients atteints de FSHD pendant 17 semaines. Cet essai a ainsi permis de montrer une augmentation significative de la force et l’endurance des quadriceps corrélée à une diminution du stress oxydant et une augmentation des défenses antioxydantes chez les patients atteints de FSHD. De nombreuses caractéristiques de la FSHD pourraient être causées et/ou exacerbées par des perturbations de la production des espèces radicalaires ou une réponse non adaptée à cette production. Aussi le premier objectif de ma thèse est de mener une étude comparative des profils d’oxygénation par spectroscopie dans le proche infrarouge de patients atteints de FSHD et sains. Le second objectif est d’évaluer l’effet de la supplémentation en antioxydant sur le volume des quadriceps par IRM et leur qualité musculaire déterminée par le ratio Force/Volume musculaire du quadriceps et d’évaluer les corrélations entre ces variables, la force et le stress oxydant. Les données obtenues ont permis de montrer une réduction de la capacité oxydative lors d’une contraction isométrique volontaire des quadriceps et ont permis d’étudier l’effet de la supplémentation sur les volumes et la qualité musculaire des quadriceps. Ces augmentations sont associées non seulement à une augmentation de la force des quadriceps mais aussi à une diminution du stress oxydant et une augmentation des défenses antioxydantes. L’ensemble de ces données montrent que le stress oxydant pourrait jouer un rôle important dans la FSHD et qu’une approche antioxydante semble adaptée à cette pathologie. Des analyses plus fines sur l’action des espèces réactives de l’oxygène (ROS) et leurs sources pourraient contribuer à une meilleure compréhension des bases physiopathologiques de la FSHD. / Facioscapulohumeral muscular dystrophy (FSHD), first described in 1885 by Landouzy Dejerine, is the most common inherited skeletal muscle disease of adult life affecting 4000 to 5000 persons in France. Progressive evolution of the disease leads to progressive weakness and atrophy of muscle fibers associated to a wide variability. The pattern of muscle weakness is often asymmetrical and the rate and extent of progression may vary considerably with sudden periods of unexplained rapid disease progression. This muscle disorder is characterized by progressive muscle weakness, beginning with facial muscles and the shoulder girdle, followed by the pelvic girdle and the muscles of the lower extremities. In 10 to 15% of cases, patients need to use a wheelchair. Despite major progress in the understanding of the genetic basis of FSHD, the exact mechanisms that lead to FSHD defects are not completely understood and no curative treatment is available. However, there is growing evidence that oxidative stress may contribute to FSHD pathology. The hypothesis that oxidative stress responses might be specifically altered in FSHD is supported by the deregulation of enzymes involved in oxidative stress.A prospective study realized with FSHD patients and healthy subjects unrevealed the correlation between systemic and muscular oxidative stress and functional muscle defects. Based on these data, we organized a randomized, double-blind, placebo-controlled pilot clinical trial in order to evaluate the effects of 17 weeks antioxidant supplementation in 54 FSHD patients. This clinical trial demonstrates a significant increase in muscle force and quadriceps endurance correlated to a decrease in oxidative stress and an increase in antioxidant defense in FSHD patientsFurthermore, many FSHD features may be caused or exacerbated by perturbations in the production of free radicals or inappropriate response to such stressors. Therefore the first objective was planned to investigate muscle oxygenation patterns during and after a MVCQ by near-infrared diffuse optical spectroscopy (NIRS). The second objective is to evaluate the effect of antioxidant supplementation on quadriceps volumes by IRM and determine the muscle quality using Strength/ Volume ratio of quadriceps muscles and correlate this variables with force and oxidative stress parameters.The major findings of this study show a significant decrease in oxidative capacity during voluntary isometric contraction in quadriceps and demonstrate the effect of supplementation on muscle volume and quality. Indeed, vitamin E, vitamin C, zinc and selenium supplementation improves muscle volume and quality of both quadriceps by enhancing the antioxidant defences and reducing oxidative stress.This increase are associated to increase in strength and decrease in oxidative stress and increase in antioxidant defences. Taken together, we show that oxidative stress plays an important role in FSHD and that an anti-oxidant strategy adapted to the FSHD-specific “oxidative stress” may be a relevant therapeutic approach for these patients. Further analyses of ROS production and sources could contribute to a better understanding of the pathophysiological mechanisms implicated in FSHD.

The computational musculoskeletal models that are used to study muscle moment-generating capacities of persons with movement disorders and planning treatment options must be accurate, and take into account the inter-individual variability of musculoskeletal geometry. In Paper I the methods of creating the subject-specific musculoskeletal model of the lower extremities from magnetic resonance images (MRIs) were developed. The subject-specific model was used to analyze hip, knee and ankle muscle moment arms (MALs) and muscle-tendon lengths (MTLs) during gait in a subject with unilateral cerebral palsy (CP), and to evaluate the accuracy of widespread and commonly-used scaled generic model. It was found that the scaled generic model delivered accurate values for changes in MTLs in most muscles. However, the scaled generic and the subject-specific lower extremity musculoskeletal models showed substantial differences in MALs calculated during gait. In Paper II subject-specific musculoskeletal models of nine subjects with unilateral CP were created to study muscles volumes, MTLs and MALs; and to examine the accuracy of MALs calculated by the scaled generic models. It was shown that the scaled generic model significantly underestimated hip MALs discrepancies between the affected and the non-affected sides of the lower extremities. However, it significantly overestimated hip adduction/abduction of gluteus maximus, gluteus medius, gluteus minimus, tensor fascia latae and biceps femoris long head; and hip flexion of adductor longus and rectus femoris in the affected and the non-affected sides. It was also found that muscle volumes and hip abduction MALs in gluteus medius and gluteus minimus, hip flexion MALs in iliacus and hip rotation in gluteus maximus were smaller in the affected side of lower extremities. MTLs in the affected and the non-affected sides throughout the range of hip motion were similar. This thesis suggests the need for the subject-specific musculoskeletal models that can account for variability of muscle attachments and musculoskeletal geometry of persons with movement disorders. Based on inaccuracies of the scaled generic model reported here, the generic models that are used to guide treatment decisions must be tested, and interpreted with care. / QC 20110901

Rotator cuff pathologies involving supraspinatus are a common cause of musculoskeletal morbidity and can lead to significant disability affecting the overall quality of life. Architectural parameters of the muscle directly influence its functional properties. Therefore, understanding of fiber bundle changes with surgery and different exercises can assist clinicians in planning better surgical and shoulder rehabilitative protocols. The first objective of this thesis was to systematically review human cadaveric studies of the normal supraspinatus architecture and highlight the key aspects that should be considered while performing studies of skeletal muscle architecture. The second objective was to understand the impact of surgical repair on the structural and functional recovery of the supraspinatus. The final objective was to provide a scientific rationale behind choosing an exercise to strengthen supraspinatus by investigating its muscle architecture. Study 1 systematically reviewed human cadaveric studies of the normal supraspinatus architecture. Results showed that the overall quality of majority of included is poor and there was a large range in the reported architectural values of the entire muscle. In conclusion, there were only a few studies providing the level of detail and quality suitable for advancing our understanding of shoulder biomechanics. Study 2 quantified and compared the fiber bundle architecture of the pathologic supraspinatus pre- and post-operatively at multiple time points. Results showed significant lengthening of fiber bundles after one month of surgery which then decreased significantly by 6 months of surgery. In contrast, an initial decrease followed by an increase in pennation angle overtime was found. The results suggest that the stretching applied to the tendon and muscle during repair could affect the length-tension relationship of the muscle, which in turn can compromise its function and may lead to inferior surgical outcomes. Study 3 compared the efficacy of three commonly prescribed supraspinatus strengthening exercises in the rehabilitation setting based on the architectural changes following resistance training. Results showed there was no change in FBL and increased strength after resistance training with prone horizontal abduction exercise. Findings suggest that prone horizontal abduction may be a more suitable exercise to strengthen supraspinatus.

Physiological cross sectional area (PCSA) is used to compare force-producing capabilities of skeletal muscles. PCSA has been defined as the summation of the cross sectional area of the fiber bundles composing the muscle. As PCSA cannot be measured directly from a specimen, a formula requiring averaged muscle architectural parameters has traditionally been used. The purpose of this study was to develop a finite element method (FEM) to calculate PCSA of extensor carpi radialis longus (ECRL) and brevis (ECRB) directly from digitized fiber bundle data obtained throughout the volume of the muscle and to compare the PCSAs calculated using the FEM and formula methods. Differences were found between the FEM and formula method for both muscles. The FEM provides an approach that takes into account architectural variances while minimizing the need for averaged architectural parameters.

Physiological cross sectional area (PCSA) is used to compare force-producing capabilities of skeletal muscles. PCSA has been defined as the summation of the cross sectional area of the fiber bundles composing the muscle. As PCSA cannot be measured directly from a specimen, a formula requiring averaged muscle architectural parameters has traditionally been used. The purpose of this study was to develop a finite element method (FEM) to calculate PCSA of extensor carpi radialis longus (ECRL) and brevis (ECRB) directly from digitized fiber bundle data obtained throughout the volume of the muscle and to compare the PCSAs calculated using the FEM and formula methods. Differences were found between the FEM and formula method for both muscles. The FEM provides an approach that takes into account architectural variances while minimizing the need for averaged architectural parameters.

Made available in DSpace on 2016-06-02T20:18:12Z (GMT). No. of bitstreams: 1 2959.pdf: 1881236 bytes, checksum: 0562673d7f2deff6e61218a2842d970d (MD5) Previous issue date: 2010-05-03 / Universidade Federal de Minas Gerais / This work consists of two studies. The aim of the first study was to investigate quadriceps and hamstring muscle volumes and strength deficits of the knee extensors and flexors in people with chronic hemiparesis compared to a healthy group. Fifteen individuals with chronic stroke and fifteen healthy individuals took part in this study. Motor function, quadriceps and hamstring muscle volume (MV), and maximal concentric and eccentric contractions of the knee extensors and flexors were obtained. The quadriceps muscle showed a reduction in MV. The peak torque of the paretic and non paretic limbs knee extensors and flexors was reduced in both contraction modes and velocities. There were significant correlations between motor function and strength deficits. With regard to muscle mass, there was a difference between quadriceps and hamstring response. There was no disuse atrophy; however this did not prevent extensor torque reduction. The aim of the second study was to investigate the effects of ground level gait training combining body weight support (BWS) and functional electrical stimulation (FES). Twelve people following chronic stroke. An A1-B-A2 system was applied; A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training associated to FES. The analyzed variables were: mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. Mean walking speed, stride length and speed increased. Regarding the ROMs, there was a significant increase for leg and thigh. There was not improvement in the variables measured during the FES phase. Ground level gait training using BWS was effective to improve some gait, and the association to FES did not provide any additional improvement in the measured parameters. / Esse trabalho é composto por dois estudos. O objetivo do primeiro estudo foi investigar os volumes dos músculos quadríceps e isquiotibiais e os déficits de força dos músculos extensores e flexores do joelho em hemiparéticos crônicos comparados a um grupo controle saudável. Quinze indivíduos com hemiparesia crônica e 15 indivíduos saudáveis fizeram parte do estudo. Foram obtidos: pontuação da função motora geral, volume muscular (VM) dos músculos quadríceps e isquiotibiais e contrações concêntricas e excêntricas dos músculos extensores e flexores do joelho. O músculo quadríceps do membro parético apresentou redução no VM comparado ao membro contralateral. Os picos de torque extensor e flexor dos membros parético e contralateral apresentaram-se reduzidos para ambos os modos de contração e ambas as velocidades e correlações entre a função motora e os déficits de força muscular foram encontradas. Observou-se que há diferentes respostas entre os músculos quadríceps e isquiotibiais com relação à massa muscular. Não foi observada atrofia muscular por desuso. Entretanto, esse fato não preveniu a redução do torque articular. O objetivo do segundo estudo foi investigar os efeitos de um treinamento de marcha, em piso fixo, associado ao suporte parcial de peso corporal (SPPC) e à estimulação elétrica funcional (EEF) do nervo fibular comum, em hemiparéticos crônicos. Participaram do estudo 12 hemiparéticos crônicos. O sistema adotado foi o A1-B-A2, no qual A correspondeu ao treinamento de marcha em piso fixo com SPPC e B ao mesmo treinamento associado à EEF. Foram analisadas: velocidade média de locomoção, comprimento do passo, comprimento, velocidade e duração da passada; duração dos períodos de apoio duplo inicial e final, apoio simples e balanço; ângulos máximos e mínimos e amplitude de movimento (ADM) dos segmentos pé, perna, coxa e tronco dos membros parético e não-parético. Houve um aumento na velocidade média e no comprimento e velocidade do ciclo. Com relação às ADMs, houve aumento significativo entre as avaliações para o segmentos: perna e coxa após. Não houve melhora nas variáveis mensuradas na fase de EEF. Concluímos que o treinamento com SPPC, em piso fixo, foi efetivo na melhora de alguns aspectos da marcha e a associação à EEF não promoveu melhora adicional dos parâmetros mensurados.

Abstract Achilles tendon rupture (ATR) conservative treatment result usually good clinical outcome, but despite the treatment method calf muscle strength deficit persist. Recent evidence suggests that surgery might surpass conservative treatment in restoring strength after ATR, but structural explanations for surgery-related improved strength remain uncertain. The purposes of this thesis were to compare calf muscle isokinetic strength recovery, calf muscle volume, fatty degeneration and AT elongation after conservative treatment or after open surgical repair of ATR. An additional aim was to assess the role of fascial augmentation in terms of calf muscle isokinetic strength recovery, AT elongation, calf muscle volume atrophy and fatty degeneration, and their relationship with calf muscle isokinetic strength in long-term follow-up after ATR surgery. Surgery resulted in 10% to 18% greater plantar flexion strength (P = 0.037) compared to conservative treatment. The mean differences between affected and healthy soleus muscle volumes were -18% after surgery and -25% after conservative treatment (P = 0.042). At 18 months, AT were, on average 19 mm longer in patients treated conservatively compared to surgery (P < 0.001). At 18 months, patients with greater (2–3) fatty degeneration had lower soleus muscle volumes and plantar flexion strength in the healthy leg. In long term, augmentation did not affect any of the strength variables, but the injured side showed 12% to 18% strength deficit compared with the healthy side (P < 0.001). The AT was, on average, 12 mm longer in the affected leg than in the healthy leg (P < 0.001). The mean soleus muscle volume was 13% lower in the affected leg than in the healthy leg (P < 0.001). The mean volumes of the medial- and lateral gastrocnemius muscles were 12% and 11% lower in the affected leg than in the healthy leg, respectively (P < 0.001). AT elongation correlated substantially with plantar strength deficit (ρ = 0.51, P < 0.001) and with both gastrocnemius (ρ = 0.46, P = 0.001) and soleus muscle atrophy (ρ = 0.42, P = 0.002). Calf muscle fatty degeneration was more common in the affected leg compared healthy leg (P ≤ 0.018). In conclusion, surgery of ATR restored calf muscle isokinetic strength earlier and more completely than conservative treatment. Conservative treatment resulted in greater soleus muscle atrophy and AT elongation compared surgery, which may partly explain the surgery related better strength results. Augmentation provided no long-term benefits compared with simple suturation, and a 12 to 18% plantar flexion strength deficit compared to the healthy side persisted. AT elongation may explain the smaller calf muscle volumes, greater fatty degeneration, and plantar flexion strength deficit observed in long-term follow-up after surgical repair of ATR. / Tiivistelmä Akillesjännerepeämän (ATR) konservatiivisella ja leikkaushoidolla hoidolla saavutetaan hyvät kliiniset tulokset. Viimeisimmät tutkimukset kuitenkin viittaavat leikkaushoidolla saavutettavan paremmat voimat kuin konservatiivisella hoidolla, mutta rakenteelliset selitykset leikkaushoidon paremmalle pohjelihaksen voimille ovat epäselviä. Työn tarkoituksena oli verrata pohjelihaksen isokineettisten voimien palautumista, pohjelihastilavuuksia, rasvadegeneraatiota ja akillesjänteen (AT) pidentymistä ATR:n konservatiivisen- ja leikkaushoidon jälkeen. Tarkoituksena oli arvioida lihaskalvovahvikkeen merkitystä pohjelihaksen isokineettisten voimien palautumisessa pitkäaikaisseurannassa. Lisäksi tutkimme AT pidentymisen, pohjelihastilavuuksien ja rasvadegeneraation suhdetta pohjelihaksen isokineettisiin voimiin ATR:n leikkaushoidon jälkeen 14 v seurannassa. Leikkaushoidolla saavutettiin 10–18 % paremmat pohjelihaksen voimat verrattuna konservatiiviseen hoitoon. Leikkaushoidon jälkeen soleuslihasten tilavuuksien puoliero terveen jalan hyväksi oli 18 % ja konservatiivisen hoidon jälkeen 25 %. 18 kk kohdalla konservatiivisesti hoidettujen AT oli 19 mm pidempi verrattuna leikkauksella hoidettuihin. 18 kk kohdalla potilaat, joilla vamma jalan soleuslihaksen rasva-degeneraatio oli korkea (2–3), kärsivät suuremmasta soleuslihaksen atrofiasta ja pohjelihaksen voima puolierosta. Voimat eivät muuttuneet 12 kk ja 14 v kontrollien välillä. Lihaskalvovahvikkeella ei ollut merkitystä voimien palautumisessa pelkkään suoraan ompeluun verrattuna, mutta vammapuoli jäi 10–18 % heikommaksi verrattuna terveeseen jalkaan. Vammajalan akillesjänne oli 12 mm pidempi terveeseen jalkaan verrattuna. Vammajalan kolmipäisen pohjelihaksen tilavuus oli 11–13 % pienempi verrattuna terveeseen jalkaan. Akillesjänteen pituus korreloi pohjelihaksen voimapuolieron sekä pohjelihasatrofian kanssa. Akillesjännerepeämän leikkaushoidolla pohjelihaksen isokineettiset voimat palautuvat nopeammin ja täydellisemmin kuin konservatiivisella hoidolla. Leikkaushoitoon verrattuna konservatiivinen hoito johtaa suurempaan soleuslihaksen atrofiaan ja akillesjänteen pidentymään, mikä selittää osittain leikkaushoidon paremmat voimatulokset. 14 v seurannassa lihaskalvovahvikkeesta ei ole etua akillesjännerepeämän leikkaushoidossa. Akillesjännerepeämän leikkaushoidosta huolimatta potilaalle jää terveeseen jalkaan verrattuna 10–18 % pohjelihasten voimapuoliero. Akillesjänteen pidentyminen mahdollisesti selittää pohjelihasten atrofian, rasvadegeneraation ja pysyvän pohjelihasten voimapuolieron akillesjännerepeämän leikkaushoidon jälkeen 14 v seurannassa.