RESUMO
INTRODUCTION: In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear. MATERIALS AND METHODS: A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system. RESULTS: The acromiohumeral distance significantly increased during NMES of the teres major (0.73 mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78 mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003). CONCLUSIONS: NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement.
Assuntos
Lesões do Manguito Rotador , Humanos , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/diagnóstico por imagem , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Terapia por Estimulação Elétrica/métodos , Fenômenos Biomecânicos , Amplitude de Movimento Articular , Úmero/fisiopatologia , Úmero/diagnóstico por imagem , Músculos Peitorais/fisiopatologia , Músculos Peitorais/diagnóstico por imagemRESUMO
OBJECTIVES: Physical biomarkers to stratify patients with lung cancer into subtypes predictive of outcome beyond tumor-related characteristics are underexplored. This study was designed to investigate the clinical utility of preoperative sarcopenia based on respiratory strength and pectoralis muscle mass to predict the risk of death. METHODS: This retrospective study included 346 consecutive patients undergoing curative-intent resection of non-small cell lung cancer from 2009 to 2013. Respiratory strength and muscle mass were assessed by peak expiratory flow rate and pectoralis muscle index (pectoralis muscle area/body mass index) using preoperative spirometry and chest axial images, respectively. Sarcopenia cutoff points were defined by gender-specific medians of peak expiratory flow rates and pectoralis muscle indices. Survival was compared between patients with sarcopenia and patients without. RESULTS: Sarcopenia was present in 98 patients (28.3%) and was significantly associated with advancing age (P < .001). Patients with sarcopenia exhibited worse 5-year overall survival compared with patients without sarcopenia (69.9% vs 87.2%, P < .001). Multivariate analysis revealed that sarcopenia was an independent adverse prognostic factor (hazard ratio, 1.88; 95% confidence interval, 1.09-3.24; P = .023) after adjustment for gender, age, smoking status, coronary heart disease, diffusing capacity for carbon monoxide, neutrophil-to-lymphocyte ratio, albumin, histologic type, and pathologic stage. CONCLUSIONS: Preoperative sarcopenia as identified by the criteria of low respiratory strength and reduced pectoralis muscle mass is significantly associated with poor overall survival. This may help to develop more individualized management strategies and optimize longitudinal care for patients.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Força Muscular , Músculos Peitorais/diagnóstico por imagem , Pneumonectomia , Respiração , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Pico do Fluxo Expiratório , Músculos Peitorais/fisiopatologia , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Polyphasic myodegeneration potentially causes severe physiological and metabolic disorders in the breast muscle of fast-growing broiler chickens. To date, the etiology of recent muscle myopathies, such as the white striping (WS) phenotype, is still unknown. White striping-affected breast meats compromise the water holding capacity and predispose muscle to poor vascular tone, leading to the deterioration of meat qualities. Herein, this review article provides insight on the complexities around chicken breast myopathies: (i) the etiologies of WS occurrence in chicken; (ii) the metabolic changes that occur in WS defect in pectoralis major; and (iii) the interactions between breast muscle physiology and vascular tone. It also addressed the effects of nutritional supplements on muscle myopathies on chicken breast meats. Moreover, the review explored breast muscle biology focusing on the early preparation of satellite and vascular cells in fast-growth chicken breeds. Transcriptomics and histological analyses revealed poor vascularity in breast muscle of fast growth chickens. Thus, we suggest in ovo feeding of nutrients promoting vascularization and satellite cells replenishment as a potential strategy to enhance endothelium-derived nitric oxide availability to promote vascularization in the pectoralis major muscle region.
Assuntos
Doenças Musculares , Músculos Peitorais , Doenças das Aves Domésticas , Animais , Galinhas , Carne/normas , Doenças Musculares/fisiopatologia , Doenças Musculares/veterinária , Músculos Peitorais/metabolismo , Músculos Peitorais/fisiopatologia , Doenças das Aves Domésticas/fisiopatologiaRESUMO
Breast-conserving surgery (BCS) and radiotherapy reduce breast cancer recurrence but can cause functional deficits in breast cancer survivors. A cross-sectional study quantified the long-term pathophysiological impact of these treatments on biomechanical measures of shoulder stiffness and ultrasound shear wave elastography measures of the shear elastic modulus of the pectoralis major (PM). Nine node-positive patients treated with radiotherapy to the breast and regional nodes after BCS and axillary lymph node dissection (Group 1) were compared to nine node-negative patients treated with radiotherapy to the breast alone after BCS and sentinel node biopsy (Group 2) and nine healthy age-matched controls. The mean follow-up for Group 1 and Group 2 patients was 988 days and 754 days, respectively. Shoulder stiffness did not differ between the treatment groups and healthy controls (p = 0.23). The PM shear elastic modulus differed between groups (p = 0.002), with Group 1 patients exhibiting a stiffer PM than Group 2 patients (p < 0.001) and healthy controls (p = 0.027). The mean prescribed radiotherapy dose to the PM was significantly correlated with passive shear elastic modulus (p = 0.018). Breast cancer patients undergoing more extensive axillary surgery and nodal radiotherapy did not experience long-term functional deficits to shoulder integrity but did experience long-term mechanical changes of the PM.
Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Músculos Peitorais/fisiopatologia , Ombro/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos , Neoplasias da Mama/fisiopatologia , Estudos Transversais , Módulo de Elasticidade , Feminino , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Músculos Peitorais/efeitos da radiação , Músculos Peitorais/cirurgia , Ombro/efeitos da radiação , Ombro/cirurgiaRESUMO
This study aimed to investigate the possible changes in anterior chest tightness after breast cancer surgery. We also try to investigate whether anterior chest tightness is associated with upper-limb dysfunction after breast cancer surgery. Eighty-three women who underwent breast cancer surgery were evaluated before and 2 weeks, 3 months, and 9 months after surgery. Anterior chest tightness was measured using the length of the pectoralis minor muscle through 2 methods (length from the coracoid process to the fourth rib and linear distance from the table to the posterior acromion with supine position). Shoulder range of motion and the K-DASH (Korean version of Disability Arm and Shoulder Questionnaire) score were measured to quantify functional performance of upper limb. Anterior chest tightness of patients with breast cancer significantly increased after surgery. Upper limb dysfunction was observed such as reduced shoulder range-of-motion and increased K-DASH score over time. Increase in chest tightness was correlated with shoulder range-of-motion reduction. Chest tightness was not correlated with K-DASH score directly. However, shoulder range-of-motion reduction was significantly correlated with K-DASH score. Chest tightness and upper limb dysfunction increased in breast cancer survivor. Increase in chest tightness after surgery is associated with upper limb dysfunction and careful attention is required.
Assuntos
Neoplasias da Mama/cirurgia , Músculos Peitorais/patologia , Complicações Pós-Operatórias/patologia , Parede Torácica/fisiopatologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Músculos Peitorais/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Articulação do Ombro/fisiopatologiaRESUMO
Background: Computed tomography (CT) is increasingly used in clinical research for single-slice assessment of muscle mass to correlate with clinical outcome and evaluate treatment efficacy. The third lumbar level (L3) is considered as reference for muscle, but chest scans generally do not reach beyond the first lumbar level (L1). This study investigates if pectoralis muscle and L1 are appropriate alternatives for L3. Methods: CT scans of 115 stage IV non-small cell lung cancer patients were analyzed before and during tumor therapy. Skeletal muscle assessed at pectoralis and L1 muscle was compared to L3 at baseline. Furthermore, the prognostic significance of changes in muscle mass determined at different locations was investigated. Results: Pearson's correlation coefficient between skeletal muscle at L3 and L1 was stronger (r=0.90, P<0.001) than between L3 and pectoralis muscle (r=0.71, P<0.001). Cox regression analysis revealed that L3 (HR 0.943, 95% CI: 0.92-0.97, P<0.001) and L1 muscle loss (HR 0.954, 95% CI: 0.93-0.98, P<0.001) predicted overall survival, whereas pectoralis muscle loss did not. Conclusion: L1 is a better alternative than pectoralis muscle to substitute L3 for analysis of muscle mass from regular chest CT scans.
Assuntos
Músculos do Dorso/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Músculos Peitorais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Músculos do Dorso/fisiopatologia , Composição Corporal , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Ensaios Clínicos Fase II como Assunto , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Vértebras Lombares , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Países Baixos , Músculos Peitorais/fisiopatologia , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Subpectoral implants for breast reconstruction after mastectomy requires the surgical disinsertion of the sternocostal fiber region of the pectoralis major. This technique is associated with significant shoulder strength and range of motion deficits, but it is unknown how it affects the underlying integrity of the shoulder joint or pectoralis major. The aim of this study was to characterize the long-term effects of this reconstruction approach on shoulder joint stiffness and pectoralis major material properties. Robot-assisted measures of shoulder strength and stiffness and ultrasound shear wave elastography images from the pectoralis major were acquired from 14 women an average of 549 days (range: 313-795 days) post reconstruction and 14 healthy, age-matched controls. Subpectoral implant patients were significantly weaker in shoulder adduction (p < 0.001) and exhibited lower shoulder stiffness when producing submaximal adduction torques (p = 0.004). The underlying material properties of the clavicular fiber region of the pectoralis major were altered in subpectoral implant patients, with significantly reduced shear wave velocities in the clavicular fiber region of the pectoralis major when generating adduction torques (p = 0.023). The clinical significance of these findings are that subpectoral implant patients do not fully recover shoulder strength or stability in the long-term, despite significant recovery time, and substantial shoulder musculature left intact. The impact of these procedures extends to the remaining, intact volume of the pectoralis major. Optimization of shoulder function should be a key aspect of the post-reconstruction standard of care. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1610-1619, 2019.
Assuntos
Mamoplastia/efeitos adversos , Músculos Peitorais/fisiopatologia , Articulação do Ombro/fisiopatologia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos RetrospectivosRESUMO
BACKGROUND/OBJECTIVE: The aim of this study was to evaluate with electromyography (EMG) the effect of lateral pectoral nerve sparing technique (LPNST) and radiotherapy (RT) on the lateral pectoral nerve (LPN) in patients applied with modified radical mastectomy (MRM). METHODS: The study included 66 patients who underwent MRM surgery. The patients were separated into 2 groups as those applied with LPNST and those who underwent standard surgery (Control group). Within these 2 groups, patients were again separated as those who received or did not receive RT. The EMG evaluations were made by a neurology specialist blinded to the patient groups. RESULTS: The mean age of the patients was 53.3 ± 10.6 years. Standard surgery was applied to 33 (50%) patients and LPNST to 33 (50%) patients, RT was applied to 32 (48.5%) patients and not to 34 (51.5%) patients. In the EMG evaluation, latency was 2.1 ms (1.4-3.2) in the LPNST and 3.7 ms (1.9-12.4) in the control (p <0.001) and amplitude values were 9650 mV (3120-36900) in the LPNST and 4780 mV (510-12.4) in the control (p <0.001). The latency values in the Control receiving and not receiving RT were 4.0 ms (1.9-12.4) and 2.6 ms (1.9-6.2) respectively (p <0.05). The latency values of the patients receiving and not receiving RT in the LPNST were 2.2 ms (1.8-3.2) and 2.0 ms (1.4-2.4) respectively (p <0.05). In the Control and LPNST Group, no significant difference was determined between receiving and not receiving RT groups in respect of amplitude values (p >0.05). CONCLUSION: The results of this study demonstrated that electromyographically the latency and amplitude values were better protected in the LPNST group. It was also seen that RT increased the formation of nerve damage in both groups.
Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia Radical/métodos , Tratamentos com Preservação do Órgão/métodos , Músculos Peitorais/inervação , Músculos Peitorais/fisiopatologia , Nervos Torácicos/fisiologia , Adulto , Idoso , Terapia Combinada , Eletromiografia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND/AIM: The recent development of acellular dermal matrix (ADM) devices has enhanced implant-based breast reconstruction surgery following conservative mastectomy for therapeutic and risk-reducing purposes leading to improved aesthetics. In the traditional sub-pectoral approach, coverage of the implant is provided by the pectoral muscles superiorly and the ADM inferiorly. The need to eliminate breast animation, reduce post-operative dysfunctional pain and the risk of capsular contracture, have stimulated surgeons to investigate the feasibility of placing the implant over the pectoralis major muscle with complete coverage with ADM thus inventing a novel pre-pectoral approach. MATERIALS AND METHODS: We reviewed the literature regarding this evolving technique of muscle sparing ADM-assisted implant-based immediate breast reconstruction. Also, we describe our technique, and present pictures of the post-operative result. RESULTS AND CONCLUSION: The early reported results of the pre-pectoral breast reconstruction approach are encouraging and confirmed the potential benefits of eliminating breast animation and reducing postoperative pain. However, most of these studies had a small sample size (<100 patients) and were retrospective in nature with a limited follow-up duration and lack of data regarding the objective aesthetic assessment and oncological outcome. Nevertheless, suitable patients undergoing conservative mastectomy and implant-based reconstruction should be offered this option while further evaluation is being performed.
Assuntos
Derme Acelular , Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia/métodos , Adulto , Implante Mamário/métodos , Implantes de Mama , Neoplasias da Mama/fisiopatologia , Estética , Feminino , Humanos , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/cirurgia , Músculos Peitorais/fisiopatologia , Músculos Peitorais/cirurgiaRESUMO
BACKGROUND: Enhancement of arm adductor activity during abduction (ie, adductor co-contraction), may be effective in the treatment of subacromial pain syndrome (SAPS). We assessed whether an increase of adductor co-contraction is associated with a favorable course of SAPS. METHODS: At baseline and after nearly 4 years of follow-up, electromyography of the latissimus dorsi (LD), teres major (TM), pectoralis major, and deltoid muscle was obtained during isometric abduction and adduction tasks in 26 patients with SAPS. Changes in co-contraction were assessed with change in the activation ratio (ΔAR). The AR ranges between -1 and 1, where lower values indicate more co-contraction. Clinical course was determined from an anchor question (reduced, persistent, or increased complaints), the visual analog scale for pain (VAS), and the Western Ontario Rotator Cuff score (WORC). RESULTS: In patients indicating persistent complaints (31%), the VAS and WORC remained stable. In patients who indicated reduced complaints (69%), the VAS reduced (z score, -3.4; P = .001) and WORC increased (z score, 3.6; P < .001). Unchanged ARs associated with complaints persistence, whereas decreased AR of the LD (ΔARLD, -0.21; 95% confidence interval [CI], -0.36 to -0.06) and TM (ΔARTM, -0.17; 95% CI, -0.34 to -0.00) coincided with reduced complaints. There was a significant between-group difference in ΔARLD (-0.35; 95% CI, -0.60 to 0.10) and ΔARTM (-0.36; 95% CI, -0.66 to -0.05). CONCLUSIONS: Increased co-contraction of the LD and TM is associated with a favorable course of SAPS. This may be explained by widening of the subacromial space accomplished by adductor co-contraction.
Assuntos
Músculo Deltoide/fisiopatologia , Contração Muscular/fisiologia , Músculos Peitorais/fisiopatologia , Dor de Ombro/terapia , Músculos Superficiais do Dorso/fisiopatologia , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Dor de Ombro/fisiopatologia , Resultado do TratamentoAssuntos
Broncoscopia/efeitos adversos , Rigidez Muscular/induzido quimicamente , Bloqueio Neuromuscular/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , gama-Ciclodextrinas/efeitos adversos , Androstanóis/efeitos adversos , Relação Dose-Resposta a Droga , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Masculino , Músculos Peitorais/efeitos dos fármacos , Músculos Peitorais/fisiopatologia , Aspiração Respiratória/diagnóstico por imagem , Músculos Respiratórios/efeitos dos fármacos , Músculos Respiratórios/fisiopatologia , Rocurônio , Sugammadex , Parede Torácica/efeitos dos fármacos , Parede Torácica/fisiopatologia , gama-Ciclodextrinas/administração & dosagemRESUMO
Proximal humerus fracture after pectoralis major tendon repair has been recently reported. Although this complication is rare, it may be possible to decrease such risk using newer techniques for myotenodesis. This study was designed to evaluate various unicortical stress risers created at the proximal humeral metadiaphysis during myotenodesis for repair of pectoralis major ruptures. A simulated pectoralis major myotenodesis was performed using fourth-generation Sawbones (N=30). Using previously described anatomic landmarks for the tendinous insertion, 3 repair techniques were compared: bone trough, tenodesis screws, and suture anchors (N=10 each). Combined compression and torsional load was sequentially increased until failure. Linear and rotational displacement data were collected. The average number of cycles before reaching terminal failure was 383 for the bone trough group, 658 for the tenodesis group, and 832 for the suture anchor group. Both the tenodesis and the suture anchor groups were significantly more resistant to fracture than the bone trough group (P<.001). The suture anchor group was significantly more resistant to fracture than the tenodesis group (P<.001). All test constructs failed in rotational stability, producing spiral fractures, which incorporated the unicortical defects in all cases. When tested under physiologic parameters of axial compression and torsion, failure occurred from rotational force, producing spiral fractures, which incorporated the unicortical stress risers in all cases. The intramedullary suture anchor configuration proved to be the most stable construct under combined axial and torsional loading. Using a bone trough technique for proximal humerus myotenodesis may increase postoperative fracture risk. [Orthopedics. 2017; 40(5):e801-e805.].
Assuntos
Úmero/cirurgia , Músculos Peitorais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Fraturas do Ombro/prevenção & controle , Tendões/cirurgia , Idoso , Fenômenos Biomecânicos , Cadáver , Epífises/cirurgia , Feminino , Humanos , Úmero/fisiopatologia , Masculino , Procedimentos Ortopédicos , Músculos Peitorais/fisiopatologia , Procedimentos de Cirurgia Plástica , Ruptura/cirurgia , Ombro/cirurgia , Âncoras de Sutura , Técnicas de Sutura , Traumatismos dos Tendões/cirurgia , Tendões/fisiopatologia , Tenodese/instrumentação , Tenodese/métodosRESUMO
BACKGROUND: Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle. OBJECTIVES: The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation. METHODS: Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery. RESULTS: Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up. CONCLUSIONS: Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss.
Assuntos
Implante Mamário/métodos , Dissecação , Imageamento por Ressonância Magnética , Força Muscular , Músculos Peitorais/cirurgia , Adolescente , Adulto , Brasil , Implante Mamário/efeitos adversos , Dissecação/efeitos adversos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Músculos Peitorais/diagnóstico por imagem , Músculos Peitorais/fisiopatologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Software , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Pectoralis major repair is increasing in frequency due to the uptake of weight training. Chronic tendon injuries tend not to have as favourable outcomes. We report our outcome of chronic pectoralis major ruptures following surgical repair. Retrospective analysis of 8 patients who were weightlifters, treated for primary pectoralis major repair by one surgeon. Surgical repair was direct via suture anchors and one additionally required fascia lata graft due to tendon retraction. Outcome was assessed by comparing strength to the contralateral pectoralis muscle and the Oxford Shoulder Score. All patients were male with mean age of 36 years. Mean delay to surgery was 25.6 months. Mean followup was 19.6 months and mean Oxford Shoulder Score was 43.7. Six out of eight patients had full strength compared to the contralateral side. Complications included visible skin tethering not associated with weakness, stiffness associated with weakness and a seroma at fascia lata donor site. This is the largest documented study of Chronic Pectoralis Major repair showing excellent outcomes with repair, even if delayed.
Assuntos
Força Muscular , Músculos Peitorais/lesões , Músculos Peitorais/cirurgia , Ruptura/cirurgia , Levantamento de Peso/lesões , Adulto , Doença Crônica , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Peitorais/fisiopatologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Ruptura/etiologia , Ruptura/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: Biomechanical models are often used to estimate the muscular demands of various activities. However, specific muscle dysfunctions typical of unique clinical populations are rarely considered. Due to iatrogenic tissue damage, pectoralis major capability is markedly reduced in breast cancer population survivors, which could influence arm internal and external rotation muscular strategies. METHODS: Accordingly, an optimization-based muscle force prediction model was systematically modified to emulate breast cancer population survivors through adjusting pectoralis capability and enforcing an empirical muscular co-activation relationship. Model permutations were evaluated through comparisons between predicted muscle forces and empirically measured muscle activations in survivors. FINDINGS: Similarities between empirical data and model outputs were influenced by muscle type, hand force, pectoralis major capability and co-activation constraints. Differences in magnitude were lower when the co-activation constraint was enforced (-18.4% [31.9]) than unenforced (-23.5% [27.6]) (p<0.0001). INTERPRETATION: This research demonstrates that muscle dysfunction in breast cancer population survivors can be reflected through including a capability constraint for pectoralis major. Further refinement of the co-activation constraint for survivors could improve its generalizability across this population and activities. Improving biomechanical models to more accurately represent clinical populations can provide novel information that can help in the development of optimal treatment programs for breast cancer population survivors.
Assuntos
Neoplasias da Mama , Doenças Musculares/fisiopatologia , Músculos Peitorais/fisiopatologia , Articulação do Ombro/fisiopatologia , Adaptação Fisiológica/fisiologia , Idoso , Fenômenos Biomecânicos , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Força Muscular/fisiologia , Doenças Musculares/etiologia , RotaçãoRESUMO
BACKGROUND: Arthrogryposis is the general term given to conditions characterized by multiple joint contractures resulting in substantial disability most frequently involving a child. Early muscle transfer reconstructive surgery reliably restores elbow flexion. In the present study, we aimed to determine which preoperative condition is best able to restore elbow flexion in patients with arthrogryposis. METHODS: We retrospectively reviewed five children (seven cases) who underwent elbow flexor reconstruction (Steindler flexorplasty, four cases; latissimus dorsi transfer, two cases; pectoralis major transfer, one case). Upper-extremity function was assessed on the basis of range of elbow extension and flexion and elbow flexor muscle power pre- and postoperatively. RESULTS: The mean postoperative active flexion and extension range of motion was 82.1° (60° to 100°) and -15.0° (-40° to 0°) respectively. Mean postoperative elbow flexor muscle power was graded as a 3.4 (2 to 4) as measured with the Medical Research Council (MRC) scale. The preoperative passive elbow flexion angle was found to correlate with postoperative muscle power (MRC) (r = 0.830, p = 0.042) and postoperative active elbow flexion angle (r = 0.902, p = 0.027). Age at operation was not found to correlate with postoperative muscle power (MRC) (r = -0.063, p = 0.878) or active elbow flexion angle (r = -0.134, p = 0.743). CONCLUSIONS: We found a positive correlation between preoperative passive elbow flexion/range of elbow motion and postoperative results including active range of motion and transferred muscle power. Diminished preoperative elbow flexion appeared to correlate with having a poor outcome. The present results suggest that choosing another muscle, such as the gracilis, may be beneficial for muscle transfer in more severe cases of arthrogryposis.
Assuntos
Artrogripose/cirurgia , Articulação do Cotovelo , Músculos Peitorais/transplante , Músculos Superficiais do Dorso/transplante , Artrogripose/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculos Peitorais/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Músculos Superficiais do Dorso/fisiopatologia , Resultado do TratamentoAssuntos
Denervação Muscular/métodos , Músculos Peitorais/fisiopatologia , Músculos Peitorais/cirurgia , Espasmo/terapia , Retalhos Cirúrgicos , Idoso de 80 Anos ou mais , Toxinas Botulínicas Tipo A/administração & dosagem , Humanos , Masculino , Fármacos Neuromusculares/administração & dosagem , Espasmo/etiologiaRESUMO
Only a few reports exist in the literature for sonographic assessment of the pectoralis major muscle. Presented is a case of pectoralis major muscle atrophy as a cause of persistent internal rotation weakness diagnosed via ultrasound in a patient with multiple previous surgeries and contraindication to magnetic resonance imaging because of a shoulder implant. This patient's physical examination suggested an abnormal contour of the pectoralis major muscle on contraction, so he was referred for diagnostic ultrasound. The ultrasound was key to guiding the management of this patient because surgical repair of a torn pectoralis major muscle was planned if this was found. No pectoralis major tear or rupture was seen on ultrasound, but there was evidence of pectoralis major muscle atrophy. Accordingly, surgery was avoided and the patient was able to continue with his physical therapy program.
Assuntos
Artroplastia de Substituição/efeitos adversos , Atrofia Muscular/diagnóstico por imagem , Músculos Peitorais/diagnóstico por imagem , Músculos Peitorais/fisiopatologia , Lesões do Manguito Rotador , Manguito Rotador/diagnóstico por imagem , Idoso , Artroplastia de Substituição/métodos , Humanos , Masculino , Atrofia Muscular/etiologia , Atrofia Muscular/patologia , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Manguito Rotador/cirurgia , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , UltrassonografiaRESUMO
BACKGROUND: Superior migration of the humeral head after massive rotator cuff tear (mRCT) is thought to lead to cuff tear arthropathy. Previous biomechanical studies have demonstrated the ability of the pectoralis major and latissimus dorsi (PM/LD) muscles to resist this migration. This study examined the role of PM/LD muscles on glenohumeral joint forces and acromiohumeral contact pressures in a mRCT model. METHODS: Six cadaveric shoulders were tested using a custom shoulder-testing system. Muscle insertions of the rotator cuff, deltoid, and PM/LD were preserved and used for muscle loading. Specimens were tested in 3 different humeral rotation positions at 0° abduction and 2 rotation positions at 60° abduction. Testing was performed for intact specimens, after supraspinatus removal, and after supraspinatus/infraspinatus/teres minor removal. PM/LD were loaded or unloaded to determine their effect. Humeral head kinematics, glenohumeral joint forces, and acromiohumeral contact area and pressure were measured. RESULTS: For the mRCT condition at 0° abduction, unloading the PM/LD resulted in superior shift of the humeral head. Acromiohumeral contact pressures were undetectable when the PM/LD were loaded but increased significantly after PM/LD unloading. After mRCT, superior joint forces were increased and compressive forces were decreased compared with intact; loading the PM/LD resolved these abnormal forces in some testing conditions. CONCLUSION: In mRCT, the PM and LD muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. Strengthening or neuromuscular training of this musculature, or both, may delay the progression to cuff tear arthropathy.