Jehan Lecocq

Muscle oxygenation and intramuscular pressure related to posture and load in back muscles

BACKGROUND CONTEXTnThere is little information about the simultaneous changes of intramuscular pressure (IMP) and oxygen saturation (StO(2)) of the paraspinal muscle under various conditions of posture and load.nnnPURPOSEnTo measure simultaneously and compare IMP and StO(2) across a range of static trunk postures commonly observed during normal work tasks.nnnSTUDY DESIGNnA prospective study using a repeated-measure design in clinical setting.nnnPATIENT SAMPLEnSixteen healthy young men with no history of back pain.nnnOUTCOME MEASURESnSimultaneous measurements of IMP by a flexible slit catheter and StO(2) by near infrared spectroscopy of the multifidus muscle were performed.nnnMETHODSnThe two measures were taken in six static posture tasks: standing upright and bending forward with and without load (20kg), bending backward and during a sustained isometric contraction (ie, Sorensen test). To compare the influence of the tasks on IMP and StO(2) variables, a one-way variance analysis with repeated measures was used. Spearmans rank correlation coefficient (rho) was determined between the two variables for each posture task.nnnRESULTSnWe observed only a moderate but significant correlation between IMP and StO(2) values in upright standing and a trend in bending forward positions with load (p<.05). IMP increased in the bending backward position and showed the greatest increase during the Sorensen test. StO(2) decreased significantly during the Sorensen test, in the bending forward position with and without load bearing but did not in bending backward.nnnCONCLUSIONnThe simultaneous recording of IMP and StO(2) of the multifidus muscle allows a deeper insight of physiological events during various trunk postures. In the mutifidus muscle, there is no evident linear relationship between IMP and StO(2) values in various static postures of the trunk in young males. This preliminary study shows that IMP may play a role on StO(2) only in some circumstances, such as a prolonged endurance test or in a bending forward position with a significant load bearing.

Une complication inhabituelle de la coronarographie: la névralgie du nerf saphène interne

Alors que la litterature decrit de nombreuses causes possibles de lesions du nerf saphene interne au niveau du genou ou de la jambe, des lesions proximales de ce nerf, apres un stripping des varices, sont plus rares. Nous rapportons une observation dune lesion du nerf saphene interne apres un catheterisme arteriel femoral complique dun spasme arteriel. La symptomatologie douloureuse persista plus de 10 ans et seule la neurostimulation transcutanee permit une sedation. Aucune observation semblable na ete publiee jusqua ce jour malgre la frequence de ce geste. Pour expliquer cette nevralgie definitive, nous evoquons lhypothese dune ischemie nerveuse.

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

PURPOSEnFunctional 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.nnnMETHODSnWe 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.nnnRESULTSnRegular 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.nnnCONCLUSIONSnThis 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.

Could botulinum toxin be a treatment for functional popliteal artery entrapment syndrome? A preliminary study

Objective Functional popliteal artery entrapment syndrome (FPAES) is an uncommon cause of exercise-induced leg pain. Contrary to the anatomic type, there is no anatomical abnormality: entrapment is caused by hypertrophic gastrocnemius muscles (GCM). Even though arterial compression is purely functional, a surgical arteriolysis of popliteal artery is often proposed, in order to release the artery from adjacent structures. It is sometimes associated with myotomy. Studies on surgical treatment lack for cases. We hypothesize that botulinum toxin A (BoNT-A) injections in GCM could improve GCM-artery impingement by inducing localized and partial muscular atrophy and hypotonia. Material/patients and methods This retrospective study included patients with FPAES treated with BoNT-A. Clinical exam, ankle brachial pressure index after exercise, provocative tests in plantar or dorsal flexion of the ankle (Doppler ultrasonography, computed tomography or magnetic resonance angiography) were used for diagnostic. Other causes of leg pain were systematically excluded with further investigations, such as compartment pressure after exercise, low back and leg imagery. BoNT-A was injected in the proximal third of both heads of GCM, in two sites for each head, after location of the muscles by electrical stimulation. Investigations with provocative maneuvers were done after treatment. Results Eight patients (fourteen limbs) aged between 17 and 54xa0years old were included. One patient had previously unsuccessfully been treated by surgery. Mean follow up was 22.1xa0±xa021.2xa0months (6–74). Five patients had resolution of symptoms, during 70.6xa0±xa074.3 weeks (17–216). Two patients are currently still asymptomatic. Three patients relapsed. Adverse events were moderate systemic events (two patients) and subjective muscular weakness (two patients). Ankle brachial index, Doppler ultrasonography or tomography angiography improved or normalized in three patients, all successfully treated. Discussion/conclusion Long-lasting resolution of symptoms in five patients could indicate that BoNT-A injections reduce functional compression. However, treatment failed in three patients. Continuation of the study with more patients may indicate whether BoNT-A injections could be a treatment of FPAES, which has no appropriate treatment as of today.

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 [...]

Lipomatose épidurale et sciatalgie bilatérale. À propos d’un cas(revue de la littérature)

Resume La lipomatose epidurale ou lipodystrophie epidurale est une cause rare de compression medullaire ou radiculaire. Lee et al. [11] , des 1975, ont ete les premiers a rapporter l’association d’une lipodystrophie et d’un hypercorticisme induit. Depuis, une centaine d’observations ont ete publiees, liees le plus souvent a une corticotherapie. La graisse epidurale posterieure est un tissu de remplissage normalement present, mais qui peut devenir un element compressif en cas de canal lombaire etroit sans qu’il existe d’hypertrophie graisseuse. Nous rapportons le cas d’un patient obese qui presente une sciatalgie bilaterale liee, d’une part, a un canal lombaire etroit et, d’autre part, a une lipodystrophie.