G. Muff

Botulinum Toxin as a Treatment for Functional Popliteal Artery Entrapment Syndrome.

PURPOSE Functional popliteal artery entrapment syndrome is responsible for exercise-induced muscle leg pain. This syndrome is caused, in most of the cases, by the excessive size of the gastrocnemius muscles. Currently, its treatment is based only on surgery with variable results. METHODS We report the case of a young professional soldier in a combat unit with bilateral functional popliteal artery entrapment syndrome that was confirmed by dynamic arteriography, magnetic resonance angiography, and ultrasonography and did not improve after bilateral popliteal arteriolysis without resection of the gastrocnemius medial head. Treatment by injecting botulinum toxin in the proximal part of the gastrocnemius muscles was proposed and carried out. RESULTS Regular follow-up (from 1 month to 3 yr after botulinum toxin treatment) showed the disappearance of exercise-induced pain and the improvement of the patients physical and sports performance. Results of follow-up ultrasonography during dynamic maneuvers at 2.5 months and 2 yr after botulinum toxin injection were normal. Neither adverse effects nor motor deficit of the gastrocnemius muscles was reported. CONCLUSIONS This case report suggests that botulinum toxin treatment could be an alternative to surgery for patients with functional popliteal artery entrapment syndrome. Botulinum toxin could reduce functional compression and, consequently, exercise-induced pain by decreasing the volume of the gastrocnemius muscle.

Use of botulinum toxin type A in symptomatic accessory soleus muscle: first five cases.

Symptomatic accessory soleus muscle (ASM) can cause exercise‐induced leg pain due to local nerve/vascular compression, muscle spasm, or local compartment syndrome. As intramuscular injections of botulinum toxin type A (BTX‐A) can reduce muscle tone and mass, we investigated whether local BTX‐A injections relieve the pain associated with symptomatic ASM. We describe five patients presenting peri/retromalleolar exertional pain and a contractile muscle mass in the painful region. Com‐pression neuropathy was ruled out by electromyo‐graphic analysis of the lower limb muscles. Doppler ultrasonography was normal, excluding a local vascular compression. ASM was confirmed by magnetic resonance imaging. After a treadmill stress test, abnormal intramuscular pressure values in the ASM, confirmed the diagnosis of compartment syndrome only in one patient. All five patients received BTX‐A injections in two points of the ASM. The treatment efficacy was evaluated based on the disappearance of exercise‐induced pain and the resumption of normal physical and sports activities. After BTX‐A injection, exertional pain disappeared and all five patients resumed their normal level of physical and sports performances. Neither side effects nor motor deficits were observed. BTX‐A is well tolerated in patients with ASM and could be used as a new conservative therapeutic strategy for the treatment of symptomatic ASM before surgery.

Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer.

[Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48−0.86) to 0.87 (95% CI, 0.75−0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2–4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from −0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option.

Les douleurs récurrentes d’effort de jambe chez le coureur à pied ? Du joggeur du dimanche au compétiteur marathonien

DefinitionLa douleur d’effort (DE) se caracterise par sa survenue lors d’activites physiques et par sa regression plus ou moins rapide a l’arret de l’effort et par son absence au repos. Cette DE a donc un caractere recurrent a chaque effort de meme type et peut donc souvent devenir chronique, ce qui n’exclut pas parfois une evolution aigue.Ces douleurs ne sont pas dues a un macrotraumatisme (entorse, dechirure musculaire, etc.) mais sont liees a des lesions microtraumatiques [...]