Kategoriarkiv: Thigh

KONDITION

STEP2

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR MUSCLE RUPTURE IN THE POSTERIOR THIGH
(RUPTURA MUSCULI)

STEP 2

The following rehabilitation program will cover the needs for the vast majority of children with muscle rupture in the anterior thigh. Older teenagers involved in sports at a high level can advantageously use the rehabilitation program for adults.
KONDITION
Unlimited: Cycling. Swimming. Jogging.

UDSPÆNDING
(5 min)

Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards.

STYRKE
(10 min)

Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee.

Lie on your back with a ball or firm round cushion under both feet. Roll the ball backwards and forwards in a steady pace while lifting your backside.

Stand by a chair with your weight on the healthy leg and a sandbag around the injured leg. Slowly bend and stretch in the injured leg’s knee.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated.

The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

STEP1

GENOPTRÆNING

TRAINING LADDER FOR CHILDREN AND ADOLESCENTS:
FOR MUSCLE RUPTURE IN THE POSTERIOR THIGH
(RUPTURA MUSCULI)

STEP 1

The following rehabilitation program will cover the needs for the vast majority of children with muscle rupture in the anterior thigh. Older teenagers involved in sports at a high level can advantageously use the rehabilitation program for adults.
KONDITION
Unlimited: Cycling. Swimming.

UDSPÆNDING
(5 min)

Lie on your back. Hold your knee and draw it up against your chest so that the muscles in the back of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

STYRKE
(10 min)

Lie on your back with the heel of the injured leg resting on the bench or a smooth floor. Bend and stretch the injured leg while keeping contact with the surface at all times.

Lie on your stomach on the floor with your arms above your head and with outstretched legs. Lift right arm and left leg together, changing to lift left arm and right leg together.

Lie on your back and bend the injured leg. Lift the healthy leg, and then raise your backside with the weight on the injured leg to be trained. Hold the position a few seconds and lower your backside again. Moving the injured leg further away from the body will increase the load.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated.

The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

examination-article1

SportNetDoc

MR imaging in the prognostication of hamstring injury. Work in progress.

Pomeranz SJ, Heidt RS Jr. Radiology 1993 Dec;189(3):897-900.

PURPOSE.
To correlate morphologic and magnetic resonance (MR) imaging findings in hamstring injury with short-term prognosis and convalescence interval (CI).

MATERIALS AND METHODS.
A retrospective study of 14 professional athletes with hamstring injury was performed. The injuries were categorized according to muscle group involved, percentage of cross-sectional area affected, location, and signal intensity on T1- and T2-weighted spin-echo images.

RESULTS.
Longer CIs (> 6 weeks) were seen in injuries with complete transection, greater than 50% cross-sectional muscle involvement, ganglionlike fluid collections (long T1 and T2), hemorrhagelike signal intensity (short T1 and T2), distal myotendinous junction tears, and deep muscular tears. Shorter CIs (< 5 weeks) were seen in superficial muscle injuries and muscle belly injuries that involved small cross-sectional areas of the muscle.

CONCLUSION.
Prediction of CI for high-performance athletes with complete hamstring injury may be accomplished with use of MR imaging and poor prognostic factors.

article6.2

SportNetDoc

Good results of fasciotomy in chronic compartment syndrome of the lower leg

Verleisdonk EJ, van den Helder CJ, Hoogendoorn HA, van der Werken C. Ned Tijdschr Geneeskd 1996 Dec 14;140(50):2513-7.

OBJECTIVE: To assess the results of fasciotomy in patients with a chronic compartmental syndrome. 

DESIGN: Retrospective study. 

SETTING: Department of Surgery, Central Military Hospital, Utrecht, the Netherlands. METHOD: Closed fasciotomy was performed in 81 patients (151 compartments) after standardized measurement of the pressure of the symptomatic compartment during exercise. The anterior compartment was affected 149 times and the lateral compartment twice. The pressure reading was repeated at least 3 months after the operation. All operated patients 6 months postoperatively were sent a written questionnaire inquiring about the results of the operation. 

RESULTS: Postoperative complications included a neurinoma (3 times) and a seroma (once). The mean postoperative intramuscular pressures were lower than the preoperative ones: the pressure at rest fell from 22.1 to 14.0 mm Hg (p < 0.05), the exercise pressure from 57.5 to 25.4 mm Hg (p < 0.01) and the relaxation pressure from 34.4 to 25.2 mm Hg (p < 0.05). Ten patients had an unchanged increased pressure after the operation, for which a second fasciotomy was performed 4 times. Attenuation of symptoms was reported by 59 patients (76%). Nine patients with poor results had already had a combination with some other hyperpressure injury before the operation. 

CONCLUSION: Closed fasciotomy in a demonstrated chronic compartmental syndrome in most cases gave good results, viz. attenuation of symptoms and a decrease of the intramuscular pressure, especially after exercise.

article6.1

SportNetDoc

Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg.

Howard JL, Mohtadi NG, Wiley JP. Clin J Sport Med 2000 Jul;10(3):176-84.

OBJECTIVE: To evaluate outcomes in patients who had a fasciotomy performed on their leg(s) for chronic exertional compartment syndrome (CECS). 

DESIGN: A retrospective descriptive cohort study. SETTING: Tertiary care sport medicine referral practice. 

PATIENTS: A consecutive series of 62 patients surgically treated for CECS from January 1991 to December 1997. 

MAIN OUTCOME MEASURES: A questionnaire was designed and developed to assess pain (using a 100 mm visual analogue scale), level of improvement, level of maximum activity, satisfaction level, and the occurrence of reoperations. 

RESULTS: Fifty patients had anterior/lateral compartment involvement, 8 patients had deep posterior compartment involvement, and 4 patients had anterior/lateral/deep posterior compartment involvement. The demographics of the 39 respondents and 23 nonrespondents were similar. The mean percent pain relief of respondents was 68% (95% CI [confidence interval] = 54% to 82%). There was no relationship between percent pain relief and the documented immediate post exercise compartment pressures. A clinically significant improvement was reported by 26 of 32 (81%) anterior/lateral compartment patients and 3 of 6 (50%) patients with deep posterior compartment involvement. Patient level of activity after fasciotomy was classified as equal to or higher than before the operation with a lesser degree of pain by 28 of 36 (78%) patients, while 8 of 36 (22%) patients reported lower activity levels than before the operation. Of the patients reporting lower activity, seven were due to exercise related pain in the post operative leg(s) and one was due to lifestyle changes. Thirty of 38 patients (79%) were satisfied with the outcome of the operation. Four of 62 patients (6%) failed the initial surgical procedure and required revision surgery for exercise-induced pain. In addition, one of these individuals also had a sympathectomy and another had a neurolysis performed at the time of revision surgery. Three of the 62 (5%) patients had subsequent operations for exercise-induced pain on different compartments than the initial surgical procedure. One individual had an unsuccessful operative repair of a posttraumatic neuroma. Postoperative complications were reported by 5 of 39 (13%) patients in the additional comments section of the questionnaire.

CONCLUSIONS: The majority of patients surgically treated for CECS experience a high level of pain relief and are satisfied with the results of their operation. The level of pain relief experienced by patients is not related to the magnitude of the immediate post exercise compartment pressures. Despite the possibility that some patients have less favorable outcomes, experience complications, or need subsequent operations, fasciotomy is recommended for patients with CECS as there is no other treatment for this condition.

article6

SportNetDoc

Intracompartmental pressure before and after fasciotomy in runners with chronic deep posterior compartment syndrome.

Biedert RM, Marti B. Int J Sports Med 1997 Jul;18(5):381-6.

Exercise induced pain in the posterior part of the leg is common among runners; the underlying reason for these complaints may be very different. The purpose of the present, controlled study was therefore 1. to confirm a clinically diagnosed deep posterior compartment syndrome by using intramuscular pressure measurements and 2. to evaluate the effect of a surgical release on clinical signs and intracompartment pressure values. Fifteen symptomatic runners with the clinical suspicion of a chronic deep posterior compartment syndrome and nine healthy recreational runners as controls were investigated. Intramuscular pressure was measured both at rest and up to two minutes post-exercise, using a pressure-monitor with a transducer. In symptomatic runners, the average pressure was preoperatively 5.6 mmHg (95%-confidence-interval [CI]: 3.4-7.6) at rest, rising to 18.5 mmHg (CI: 15.4-21.8) post-exercise. Corresponding values in healthy control runners were 5.1 mmHg (CI: 1.9-8.3) at rest, with a decrease induced by exercise to 2.8 mmHg (CI: -0.5-6.1). After fasciotomy of the deep posterior compartment in all fifteen symptomatic runners, average pressure values fell to 2.2 mmHg (CI: 1.0-3.4) at rest, and were further reduced after (now pain-free) exercise to 1.6 mmHg (CI: 0.6-2.6). The decrease between pre-operative and post-operative values was statistically highly significant (p < 0.0001 for values after running, p < 0.005 for values at rest). In conclusion, intracompartment pressure measurement is a useful technique to confirm the clinical diagnosis of deep posterior compartment syndrome prior to recommending surgery. Hereby, an exercise-induced rise in pressure of at least 10 mmHg, corresponding to a two- to threefold increase of values measured at rest, may be a more important diagnostic criterion than absolute levels of pressure measured before or after running.

article5.3

SportNetDoc

Acute compartment syndrome due to closed muscle rupture.

Gwynne Jones DP, Theis JC. Aust N Z J Surg 1997 Apr;67(4):227-8.

Acute compartment syndrome has multiple causes: fractures, crush injury, vascular trauma and burns. Exertional compartment syndrome may be acute (progressive) or chronic (usually reversible). The acute form usually occurs after intensive exercise. Closed muscle rupture is an uncommon cause with few reports. We report two cases, in the peroneal compartment of the leg and the flexor compartment of the forearm, to show that a high index of suspicion, allowing prompt diagnosis and fasciotomy, will enable a full recovery without complications.

article5.2

SportNetDoc

Acute compartment syndrome

Engelund D, Kjersgaard AG. Ugeskr Laeger 1991 Apr 15;153(16):1110-3.

The object of this article is to review the current knowledge about the acute compartment syndrome. The syndrome is caused by increased pressure in a muscle compartment and may result from several different conditions: fractures, contusions, haemorrhage, poisoning etc. The pathological physiology is complicated but the main theory is that progressive venous hypertension is involved and that this causes cessation of the microcirculation of the muscle concerned. The clinical diagnosis is described and pressure recording apparatus is reviewed. Treatment of the acute compartment syndrome consists of fasciotomy. Common sites are indicated and operative techniques suggested. Fasciotomy should be performed with compartmental pressures of about 30 mmHg. The untreated compartment syndrome will result in muscular fibrosis and nerve injury and will thus cause incapacitating conditions which may be avoided entirely if fasciotomy is performed in time.

article5.1

SportNetDoc

Acute exertional compartment syndrome of the medial foot.

Kissel CG. J Foot Ankle Surg 1996 Jan-Feb;35(1):19-22.

A review of compartment syndrome, both acute and chronic, is presented. The pathophysiology, anatomy, diagnosis, and treatment are presented in relation to a unique case report. The case is one of acute exertional compartment syndrome of the medial foot treated by fasciotomy. This condition is uncommon in both its nature and location.

article5

SportNetDoc

Intracompartmental pressure before and after fasciotomy in runners with chronic deep posterior compartment syndrome.

Biedert RM, Marti B. Int J Sports Med 1997 Jul;18(5):381-6.

Exercise induced pain in the posterior part of the leg is common among runners; the underlying reason for these complaints may be very different. The purpose of the present, controlled study was therefore 1. to confirm a clinically diagnosed deep posterior compartment syndrome by using intramuscular pressure measurements and 2. to evaluate the effect of a surgical release on clinical signs and intracompartment pressure values. Fifteen symptomatic runners with the clinical suspicion of a chronic deep posterior compartment syndrome and nine healthy recreational runners as controls were investigated. Intramuscular pressure was measured both at rest and up to two minutes post-exercise, using a pressure-monitor with a transducer. In symptomatic runners, the average pressure was preoperatively 5.6 mmHg (95%-confidence-interval [CI]: 3.4-7.6) at rest, rising to 18.5 mmHg (CI: 15.4-21.8) post-exercise. Corresponding values in healthy control runners were 5.1 mmHg (CI: 1.9-8.3) at rest, with a decrease induced by exercise to 2.8 mmHg (CI: -0.5-6.1). After fasciotomy of the deep posterior compartment in all fifteen symptomatic runners, average pressure values fell to 2.2 mmHg (CI: 1.0-3.4) at rest, and were further reduced after (now pain-free) exercise to 1.6 mmHg (CI: 0.6-2.6). The decrease between pre-operative and post-operative values was statistically highly significant (p < 0.0001 for values after running, p < 0.005 for values at rest). In conclusion, intracompartment pressure measurement is a useful technique to confirm the clinical diagnosis of deep posterior compartment syndrome prior to recommending surgery. Hereby, an exercise-induced rise in pressure of at least 10 mmHg, corresponding to a two- to threefold increase of values measured at rest, may be a more important diagnostic criterion than absolute levels of pressure measured before or after running.