Unlock Your Hip Flexors
Free-muscle transfers provide reliable elbow flexion when treatment delay prevents direct graft or biceps neurotization and proximal muscle strength is insufficient to allow tendon transfers 4,15,34,36,37,44-49 . At times, a single transfer may also prove useful for other functions, including shoulder abduction, elbow extension, or finger flexion 15 . In the author's experience, 79 of the gracilis free-functioning muscle transfers for elbow flexion alone (single transfer Fig. 1) achieved at least M4 elbow flexion strength 15 .
Doi et al 17,21,23,55 have described a method to provide shoulder stability and function combined with active elbow flexion and extension, hand sensibility, and rudimentary hand grasp and release function in patients with four or five root avulsions. The double free-muscle transfer takes advantage of the length of the gracilis muscle and proximal location of its neurovascular pedicle to promote rapid reinnervation of the muscle while allowing for distal joint function. A direct neu-rotization of the spinal accessory nerve to a gracilis muscle fixed to the clavicle can produce elbow flexion and finger or wrist extension (Fig. 2), whereas the second transfer, secured to the second rib and neurotized to intercostal motor nerves, creates finger flexion (Fig. 3). The creative use of additional intercostal nerves for triceps function and sensory neurotization of the hand allows Fig. 1. The gracilis functioning free-muscle transfer for restoration of elbow flexion. The gracilis is fixed to...
And hypersensitivity following lower extremity osteotomy (44). Whereas dorsal midline lesions affect visceral inputs to the nucleus gracilis of the medulla (45), these lesions do not affect visceral inputs to the ventrolateral medulla (41). Hence, it would appear that the dorsal midline pathway is one of at least two ascending pathways important to the perception of visceral pain. Spinal neurons with viscerosomatic convergence and axonal extensions into the dorsal columns have been demonstrated for primates (46) and rats (30).
The green, brown and red algae had been extensively analyzed for antibacterial and antifungal activities. The active principles isolated from Symphyocladia gracilis, Rhodomela larix and Polysiphonia lanosa were 2,3-dibromobenzyl alcohol, 4,5-disulphate dipotassium salt (1 ), 2,3-dibromo-4,5-dihydroxybenzaldehyde (2), 2,3-dibromo-4,5-dihydroxybenzyl alcohol (3), 3,5-dibromo-p-hydroxybenzyl alcohol (4) and the 5-bromo-3,4-dihydroxybenzaldehyde (5). Virtually nothing is known about the physiological importance and the mechanism of biosynthesis of the bromo phenols. Their antialgal activity suggests that they may play a role in the regulation of epiphytes and endophytes. The bromo phenols may be biosynthesised through the shikimate pathway, and bromination may occur in the presence of suitable peroxide.17
Quadriceps femoris forms the prominent muscle mass on the anterior aspect of the thigh its insertion into the medial aspect of the patella can be seen to extend more distally than on the lateral side. In the well-developed subject, sartorius can be defined when the hip is flexed and externally rotated against resistance. It extends from the anterior superior iliac spine to the medial side of the upper end of the tibia and, as the lateral border of the femoral triangle it is an important landmark. medially the bulge which one feels is the semimembranosus insertion on which two tendons, semitendinosus laterally and gracilis medially and more anteriorly, are readily palpable.
The trunks of the plexus traverse psoas major and emerge from its lateral border. There are two exceptions the obturator nerve appears at the medial border of psoas tendon, and the genitofemoral nerve emerges on the anterior aspect of the muscle. muscular to the anterior compartment of the thigh (quadriceps, sarto-rius and pectineus) muscular to obturator externus, the adductor muscles and gracilis
Fasciculus gracilis Fig. 14 Major subdivisions of the spinal cord. The posterior columns consist of the fasciculus gracilis plus fasciculus cuneatus. The pathway for proprioception and stereognosis (also for the perception of vibration) initially remains on the same side of the spinal cord that it enters, crossing over at the junction between the spinal cord and brain stem. The synaptic areas just prior to this crossing are the nucleus cuneatus and nucleus gracilis (Fig. 16). Nucleus gracilis contains proprioceptive information from the lower part of the body, whereas nucleus cuneatus conveys information from the upper levels. Their corresponding spinal cord pathways are termed fasciculus gracilis (graceful, like a ballerina's legs) and fasciculus cuneatus (cunning, being closer to the brain). The fasciculus gracilis and fasciculus cuneatus are collectively termed the posterior columns (Fig. 14). A lesion of the posterior columns results in a decrease in conscious proprioception and...
The fourth ventricle of adult rats, minced into small fragments, and grafted into the dorsal funiculus at the C2 level in adult rat spinal cord from the same strain (i.e., a syngeneic transplant). At various times posttransplant, subsets of animals were evaluated histologically to confirm cell survival and determine any regenerative effect on the damaged spinal cord. Electron microscopy and fluorescence histochemistry showed that ependymal cells of the grafted CP survived well and induced a robust regeneration of the damaged axons of the spinal cord. Injections of horseradish peroxidase into the sciatic nerve labeled numerous regenerating fibers that extended from the fasciculus gracilis into the graft within 7-d posttransplantation. This effect was evident for at least 10 mo, with some axons elongating rostrally into the dorsal funiculus. Evoked potentials of long duration were recorded 5-mm rostral to the lesion in the rats 8-10 mo after grafting. These findings indicate that CP...
The iliac crest ends in front at the anterior superior spine from which the inguinal ligament (Poupart's ligament) passes downwards and medially to the pubic tubercle. Identify this tubercle by direct palpation and also by running the fingers along the adductor longus tendon (tensed by flexing, abducting and externally rotating the thigh) to its origin at the tubercle.
Caulerpa taxifolia collected from Porbunder, Gujarat, exhibited hypotensive and diuretic activities. Several species of Caulerpa have been investigated and bioactive principles, such as caulerpin and caulerpinin have been isolated from a number of them. Caulerpin produces mild anaesthetic action, difficulty in breathing, sedation and loss of balance. The toxic syndrome has been reported to be somewhat similar to that produced by ciguatera fish poisoning. The neurotropic activity of caulerpicin is thought to be of clinical value. Tropical green algae, and a few of their temperate relatives have yielded a number of bioactive metabolites and some of these are believed to be used by the algae as a chemical defence against herbivorous animals. The characteristic feature of these metabolites is the presence of a 1,4-diacetoxybutadiene moiety which has been found in more than half of the compounds reported so far. Dictyota atomaria collected from Okha, Gujarat, exhibited hypotensive...
Sarcopenia has been attributed to a reduction in muscle fibre number and size 55 . Type II (fast-twitch, white) fibres are more susceptible than type I (slow-twitch, red) to age-related fibre atrophy and loss 55 . The extent of sarcopenia is muscle-specific, with some muscles exhibiting substantial weight reductions with age (e.g. vastus lat-eralis, rectus femoris, soleus, plantaris, gastrocne-mius, and extensor digitorum longus). Other muscles show no such weight loss (adductor longus, epitrochlearis, and flexor digitorum longus).
Lumbar sympathectomy is carried out via an extraperitoneal approach. A paramedian or transverse midabdominal incision is used, the peritoneum exposed and peeled medially from the posterior abdominal wall. The ureter, which adheres to the peritoneum like a fly to fly-paper, is seen and carefully preserved. Psoas major comes into view with the genitofemoral nerve upon it, then the lumbar vertebrae, against which the sympathetic chain can be felt.
103 The psoas major muscle The psoas minor muscle The iliacus muscle p. 134 112 The adductor brevis muscle p. 145 113 The adductor longus muscle p. 146 114 The pectineus muscle p. 147 115 The gracilis muscle p. 148 117 The rectus femoris muscle p. 151 118 The sartorius muscle p. 152
These tract cells form the postsynaptic dorsal column pathway, which along with primary afferent axons, travels in the dorsal column and synapses in the dorsal column nuclei. The dorsal funiculus is subdivided into two components, one known as the fasciculus gracilis, containing the ascending afferents from levels caudal to the midthor-acic region, and the other fasciculus cuneatus, containing the ascending afferents that originate from midthoracic to upper cervical levels. The gracilis and cuneatus fasciculi terminate at the level of the lower medulla in the nucleus gracilis and the nucleus cuneatus, respectively, collectively known as the dorsal column nuclei. In an early report on visceral nociceptive fibers in the dorsal column, awake human subjects experienced unbearable, excruciating pain when the dorsal column or medial aspect of the nucleus gracilis was probed mechanically (75). The pain was referred to the sacral region and perineum....
Motions at the hip include flexion, extension, abduction, adduction, and rotation. Note that the hip can flex farther when the knee is also flexed. Rotation at the hip while the knee is flexed may be confusing at first when the lower leg swings laterally, the femur rotates internally. It is the motion of the femur at the hip joint that identifies these movements. Flexion. With the patient supine, place your hand under the patient's lumbar spine. Ask the patient to bend each knee in turn up to the chest and pull it firmly against the abdomen. Note when the back touches your hand, indicating normal flattening of the lumbar lordosis further flexion must arise from the hip joint itself.
Some muscles, like the human hamstrings, are long and slender. They have long parallelly arranged muscle fibers that contain many sarcomeres in series. They are capable of considerable shortening while maintaining the ability to generate sufficient force. Interestingly, there appears to be a limit to the length of individual muscle fibers one rarely comes across muscle fibers longer than 10 cm. Muscles whose fleshy belly exceeds this length, like the human and feline sartorius muscle (Loeb et al., 1987), have tendinous plates that interconnect muscle fibers in series. The exact reason for this design is thus far unclear. It has been suggested that it has to do with control problems involved in synchronizing the activation of sarcomeres in very long fibers, but it might also be a solution to ensure structural integrity of the muscle.
When patients are seen and treated promptly after injury, nerve transfers or grafts are used in panplexal injury to restore shoulder and elbow function, as described by Chuang and Songchar-oen elsewhere in this issue. Hand function, however, requires restoration of both grasp and release in addition to the positioning functions provided by reinnervated shoulder and elbow muscles. The proximal location of the obturator nerve branch to the gracilis muscle permits proximal (shoulder level) neurovascular connections for rapid reinnervation of nerve transfers. Its length (spanning the entire thigh from pubis to pes anserinus) allows distal tendon connections to hand and wrist motor nerves. Such a muscle, crossing shoulder, elbow, and wrist, has the potential to augment function of more proximal joints as well.
As with tendon transfers, free-functioning muscles transferred for a specific purpose should have strength and excursion comparable to the paralyzed muscle or muscles they are replacing and be under volitional control 19 . Other necessary qualities are an adequate blood supply through a single vascular pedicle and a single motor nerve appropriately placed to allow reinnervation by direct nerve transfer. It is also important that the muscle be expendable at its donor site. That is, harvest of the muscle should cause no significant loss of function. For the muscle to work properly, the reconstructive plan should include a means to restore antagonist function by some means as well, if function is to be optimal. Means, such as direct reinnervation, tendon transfer, or tenodesis, or even the use of another free muscle, may make this possible. Although several muscles have been used for functional purposes, the rectus femoris and graci-lis muscles are most commonly used...
3 The posterior columns comprise a medial and lateral tract, termed respectively the fasciculus gracilis (of Goll) and fasciculus cuneatus (of Burdach). They convey 1st order sensory fibres subserving fine touch and proprioception (position sense), mostly uncrossed, to the gracile and cuneate nuclei in the medulla where, after synapse, the 2nd order fibres decussate, pass to the thalamus and, after further synapse, 3rd order fibres are relayed to the sensory cortex. Some fibres pass from the medulla to the cerebellum along the inferior cerebellar peduncle.
Descends in a groove between psoas major and the sides of the lumbar vertebral bodies, overlapped by the abdominal aorta on the left and the inferior vena cava on the right. The chain then passes behind the common iliac vessels to enter the pelvis anterior to the ala of the sacrum and then descends medial to the anterior sacral foramina. The sympathetic trunks end below by meeting each other at the ganglion impar on the anterior face of the coccyx.
For complete avulsions of C5 through T1 treated before 1 year, the restoration of a hook grip can be attempted with a paradigm of multiple neurotizations, such as the following a phrenic nerve transfer to the suprascapular nerve, a spinal accessory nerve transfer to the musculocutaneous nerve with an interpositional graft, and a hemi-contralateral C7 nerve transfer to the median nerve for wrist and finger flexion and palmar sensation (Fig. 2). Additional techniques can be attempted, such as nerve transfer of the lateral cutaneous nerve to the branch to the extensor carpi radialis brevis. Intercostal nerves can be used to neurotize the triceps and power a free gracilis transfer for finger extension. With adequate recovery, a bone block opponensplasty can be added and static flexion of the metacarpopha-langeal joints can be provided.
It is well accepted that endothelium-derived hyperpolarizing factors (EDHFs) are important regulators of vascular tone in resistance-size arteries. However, the role of EDHFs in modulating vascular tone in the aging systemic circulation, especially in cerebral circulation, has received little attention. Interestingly, aging appears to significantly impair EDHF-mediated relaxations in isolated human gastroepiploic arteries, distal microvessels 160 , and gracilis arterial segments 161 . In contrast, the magnitude of EDHF-mediated relaxation of renal arteries from WKY rats appears unaffected by increasing age 162 .
Bell, A.S., Sommerville, C. and Gibson, D.I. (2002) Multivariate analyses of morphometrical features from Apatemon gracilis (Rudolphi, 1819) Szidat, 1928 and A. annuligerum (v. Nordmann, 1832) (Digenea Strigeidae) metacercariae. Systematic Parasitology, 51 121-133. Tolmacheva, T. and L fgren, A. (2000) Morphology and paleogeography of the Ordovician conodont Para-cordylodus gracilis Lindstr m, 1955. Journal of Paleontology, 74 1114-1121. Tolmacheva, T.Y. and Purnell, M.A. (2002) Apparatus composition, growth, and survivorship of the lower Ordovician conodont Paracordylodus gracilis Lindstr m, 1955. Palaeontology, 44 209-228.
The injection volume is an important parameter in quantitating samples by CE-LIF. Based on literature values, the calculated injection volume is 7. 1 nL when a sample is injected onto a 100 m i.d. capillary at 0.34 Pa for 10 s. The injection volume can be verified for each system by measuring the mass difference after injection by placing 20 mcL of hybridization sample in a microcuvet and weighing on a Sartorius BP 210D balance. After weighing, the microcuvette containing the sample is transferred to the auto-sampler tray and injected hydrodynamically at 0.34 Pa for 990 s (99 s x 10 injections, 99 s maximum injection time). The microcuvet is then re-weighed with a mean decrease in weight after injection of 707 ng (n 3). Since the hybridization solution was very dilute, it was assumed to have the specific gravity of water (1.00 g L), corresponding to a mean volume of 706. 86 nL 990 s injection or 7.14 nL 10 s injection (n 3).
FIGURE 4.11 (a) Hip joint forces and angular velocities at different parts of the walking cycle (after Graham and Walker 61 ). (b) Calculated ratio of velocity to force for the hip joint (from Figure 4.11a). FIGURE 4.11 (a) Hip joint forces and angular velocities at different parts of the walking cycle (after Graham and Walker 61 ). (b) Calculated ratio of velocity to force for the hip joint (from Figure 4.11a). In a simplified approach to examining the various regimes of lubrication that could exist in a human joint, it may be useful to look at Fig. 4.11a which shows the variation in force (load) and velocity for a human hip joint at different parts of the walking cycle (taken from Graham and Walker 61 ). As discussed earlier in this chapter, theories of hydrodynamic and elastohydrodynamic lubrication all include the hydrodynamic factor (nU W) as the key variable, where n fluid viscosity, U the relative sliding velocity, and W the normal load. High values of (n U W) lead to thicker...
As indicated above, the information available for clinical gait interpretation may include static physical examination measures, stride and temporal data, segment and joint kinematics, joint kinetics, elec-tromyograms, and a video record. With this information the clinical team can assess the patient's gait deviations, attempt to identify the etiology of the abnormalities, and recommend treatment alternatives. In this way, clinicians are able to isolate the biomechanical insufficiency that may produce a locomotive impairment and require a compensatory response from the patient. For example, a patient may excessively elevate a hip (compensatory) in order to gain additional foot clearance in swing which is perhaps inadequate due to a weak ankle dorsiflexor (primary problem). The knee kinematics and moments and associated electromyographic data shown in Fig. 8.5 were generated by an 11-year-old male with a diagnosis of cerebral palsy, spastic diplegia. Based on the limited knee range of...
3 During walking the pelvis swings from side to side by a rotatory movement at the lumbosacral articulation which occurs together with similar movements of the lumbar intervertebral joints. Even if the hip joints are fixed, this swing of the pelvis enables the patient to walk reasonably well.
The abdominal ureter lies on the medial edge of psoas major (which separates it from the tips of the transverse processes of L2-L5) and then crosses into the pelvis at the bifurcation of the common iliac artery in front of the sacroiliac joint. Anteriorly, the right ureter is covered at its origin by the second part of the duodenum and then lies lateral to the inferior vena cava and behind the posterior peritoneum. It is crossed by the testicular (or ovarian), right colic, and ileocolic vessels. The left ureter is crossed by the testicular (or ovarian) and left colic vessels and then passes above the pelvic brim, behind the mesosigmoid and sigmoid colon to cross the common iliac artery immediately above its bifurcation.
Smaller and slower growing species such as Nepenthes gracilis, N. ampullaria, and N. madagascariensis can be grown in containers as small as Vz gal. (2 1). We have used both sphagnum moss and sphagnum peat moss as the medium. Under our conditions the plants grew slower in sphagnum peat moss and, therefore, needed less pruning to contain them. Care must be exercised when growing in containers without drainage. The soil should be kept moist, but not water logged. If too much water is supplied, leave the top off the container to allow the excess water to evaporate. When the soil is moist in a covered container, the plants often will go months, in one case 8 months, before another watering is necessary. Once the plant reaches the top of the container, it is cut back by Vz-Vt, of its height and the plant will send up a new stem. The removed portion is used for cuttings to produce additional plants. Nepenthes alata, N. albo-marginata, N. ampullaria, N. bicalcarata, N. burkei, N. decurrens,...
Tribological processes are involved whenever one solid slides or rolls against another, as in bearings, cams, gears, piston rings and cylinders, machining and metalworking, grinding, rock drilling, sliding electrical contacts, frictional welding, brakes, the striking of a match, music from a cello, articulation of human synovial joints (e.g., hip joints), machinery, and in numerous less obvious processes (e.g., walking, holding, stopping, writing, and the use of fasteners such as nails, screws, and bolts).
The hip joint is deeply embedded in the pelvis, and is notable for its strength, stability, and wide range of motion. The stability of the hip joint, so essential for weight bearing, arises from the deep fit of the head of the femur into the acetabulum, its strong fibrous articular capsule, and the powerful muscles crossing the joint and inserting below the femoral head, providing leverage for movement of the femur. Bony Structures and Joints. The hip joint lies below the middle third of the inguinal ligament but in a deeper plane. It is a ball-and-socket joint note how the rounded head of the femur articulates with the cuplike cavity of the acetabulum. Because of its overlying muscles and depth, it is not readily palpable. Review the bones of the pelvis the acetabulum, the ilium, and the ischium and the connection inferiorly at the symphysis pubis and posteriorly with the sacroiliac bone.
Within the animal kingdom, the variety in muscle designs is stunning. There are bulky muscles (m. gluteus maximus), long slender muscles (sartorius), muscles with short fibers attached to long tendons (m. gastrocnemius), pennate muscles, etc. Muscle design is highly variable within an animal and also between species. It appears as if there is a specialized muscle design for each possible function (Otten, 1988). It is beyond the scope of this chapter to review all possible designs and functions, and therefore a few basic design principles of muscle will be discussed. Muscles are built from sarcomeres and as a consequence it has two basic design options to tune into functional demands. It can modify either the design or the arrangement of the sarcomeres. Both options appear to have been explored by Nature.
The human hip is a modified spherical (ball-and-socket) joint. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually perpendicular axes that intersect at the geometric center of rotation of the spherical head. The transverse axis lies in the frontal plane and controls movements of flexion and extension. An anterior posterior axis lies in the sagittal plane and controls movements of adduction and abduction. A vertical axis which coincides with the long axis of the limb when the hip joint is in the neutral position controls movements of internal and external rotation. Surface motion in the hip joint can be considered as spinning of the femoral head on the
Four powerful muscle groups move the hip. To remember these groups, try to picture where muscles need to cross joints to move limbs such as the femur in a given direction. The flexor group lies anteriorly and flexes the thigh. The primary hip flexor is the iliop-soas, extending from above the iliac crest to the lesser trochanter. The extensor group lies posteriorly and extends the thigh. The gluteus maximus is the primary extensor of the hip. It forms a band crossing from its origin along the medial pelvis to its insertion below the trochanter.
A strong dense articular capsule, extending from the acetabulum to the femoral neck, encases and strengthens the hip joint, reinforced by three overlying ligaments and lined with synovial membrane. There are three principal bursae at the hip. Anterior to the joint is the itiopectineal (or iliopsoas) bursa, overlying the articular capsule and the psoas muscle. Find the bony prominence lateral to the hip joint the greater trochanter of the femur. The large multilocular trochanteric bursa lies on its posterior surface. The ischiogluteal bursa not always present lies under the ischeal tuberosity, on which a person sits. Note their proximity to the sciatic nerve, as shown on p. 475.
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