Marie-Eve Isner-Horobeti

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.

Effect of a kneeling chair on lumbar curvature in patients with low back pain and healthy controls: A pilot study

BACKGROUNDnThe concept of an ideal sitting posture is often used in practice but lacks a basis in evidence.nnnOBJECTIVEnWe designed a cross-sectional, comparative, matched study to determine the effects of chair and posture on lumbar curvature in 10xa0patients with chronic non-specific low back pain (CLBP; meanxa0pain duration 24xa0±xa018xa0months) and 10xa0healthy matched controls.nnnMETHODSnPelvic incidence, sacral slope and lumbar curvature were measured on computed radiographs by 2xa0blinded clinicians for subjects in 2xa0postures (upright vs slumped sitting) and on 2xa0chairs (usual flat chair vs kneeling chair).nnnRESULTSnThe reliability of measures was excellent (intraclass correlation coefficient>0.9). As hypothesized, the expected sacral slope and lumbar lordosis changed between standing and sitting on a kneeling chair as compared with a usual chair (P<0.0001) and less in patients than controls (P=0.046) for lordosis only. In addition, as expected, changes were more pronounced with slumped than upright sitting (P<0.0001). An interaction between chairs and postures for lumbar lordosis (P=0.02) indicated more pronounced effects of the chair in slumped sitting. Therefore, lumbar lordosis was reduced less when sitting on a kneeling chair as compared with a usual chair.nnnCONCLUSIONSnAlthough healthy subjects showed more reduction in lordosis between standing and sitting, the chair effect was found in both CLBP patients and healthy subjects.

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.

Preseason isokinetic profile of knee flexors and extensors in 30 French elite professional basketball players

Objective Basketball is an aerobic-based anaerobic contact pivot sport with a high knee injury rate. Isokinetic assessment of knee extensor and flexor muscle is currently used in elite athletes for preseason evaluation with the aim of detecting muscular imbalance and preventing orthopedic or muscular injuries. However, only few studies have described isokinetic performances in elite basketball players. The aim of this study is to describe preseason isokinetic knee extensor and flexor muscle strength profile in professional basketball players. Material/patients and methods Thirty professional basketball players underwent a preseason isokinetic examination to evaluate the knee extensor and flexor concentric peak torque at 60°.s-1 and 240°.s-1 and flexor eccentric peak torque at 30°. s-1, using a ConTrex® dynamometer. Statistical analysis was performed with a paired Wilcoxon Signed-Rank Test. Results No systematic significant difference was found between dominant or non-dominant side for: knee extensor and flexor muscle strength and knee flexor/extensor strength conventional or mixed ratios. Average deficit for agonist muscle between dominant and non-dominant side wasxa0 Discussion, conclusion Isokinetic professional basketball players profile is unclear and the presence of a muscular strength asymmetry linked to the intensive basketball practice remains controversial. Although we observed a light trend in favor of the dominant lower limb in term of strength, our study showed no statistically significant difference between the dominant and non-dominant side, but the sample size was limited. A lot of players presented a strength imbalance and had a non-isokinetic compensating training but no isokinetic control. Further studies are needed to check if a compensating training could normalize isokinetic parameters and decrease injury rate in professional basketball players, who have a frequent history of knee injury.

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 [...]