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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Extensor hallucis longus is also associated with multiple named accessory bellies or tendons. One of these accessory muscles is referred to as extensor ossis metatarsi hallucis or extensor ossis primi metatarsi (Macalister 1875; Lambert 2016). It may present as a slip of extensor hallucis longus or as a distinct accessory muscle (Macalister 1875; Hallisy 1930; Lambert 2016). It may also present as a slip from tibialis anterior or extensor digitorum longus (Macalister 1875; Lambert 2016). This muscle usually inserts onto the distal part of the first metatarsal (Hallisy 1930; Lambert 2016). It may also present only as a tendon originating from the annular ligament with no belly (Macalister 1875).
Compartment Syndrome
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
This presentation is typical of compartment syndrome, which can be associated with tibial fractures. I would reassess the patient. The predominant presenting feature of compartment syndrome is pain out of proportion to that which would be expected from the injury alone. Paresthesiae, pallor, paralysis and pulselessness may all be additional late signs. Compartment syndrome is a clinical diagnosis but if there is doubt as to the diagnosis, I might consider compartment pressure monitoring. Increased opioid consumption is a warning sign. Pain is exacerbated by passive stretch of the muscles in the affected compartment, in this case, the extensor hallucis longus, toe extensors and tibialis anterior. Having confirmed the diagnosis clinically I would consent and mark the patient to undergo emergent fasciotomies and intramedullary nailing of the fracture at the same sitting.
Tethered cord syndrome
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Shokei Yamada, Brian S. Yamada, Daniel J. Won
A 14-year-old girl was known as an infrequent voider in early infancy. At 3 years of age, toilet training was successful except for occasional enuresis. A the age of 7, enuresis became frequent and progressed to total incontinence, associated with a lack of urgency or sensation of a full bladder. Urinary loss was related to overflow and to stress or Valsalva maneuvers, requiring continuous pad protection. On examination, minimal suprapubic pressure would express urine. Two small dimples in the sacral area and pes cavus were noted. Neurologic find ings included weakness of extensor hallucis longus, bilaterally hypoactive Achilles tendon reflex, and analgesia in the perianal area. Postvoid urinary residual was greater than 200 mL. The urine was sterile. Plain films revealed spina bifida at S1 through S5. VCUG showed bilateral promptly functioning kidneys, a cellule and diverticula formation in the bladder, right vesicoureteral reflux, and a large postvoid residual. A myelogram showed LMMC in the sacral level with a cord tip at the S2 level. Surgical repair of a large transitional LMMC consisted of removal of the entire fibroadipose mass, with dissection from the caudal end of the spinal cord. Within 1 week after the operation, the patient began to regain bladder control without evidence of stress incontinence. VCUG clarified resolution of the reflux and a normal residual urine. This patient underwent 18 urologic procedures from the age of 7 to 14 to manage her neurogenic bladder and vesicoureteral reflux. Redox studies showed postuntethering metabolic improvement.
Partial talar replacement with a novel 3D printed prosthesis
Published in Computer Assisted Surgery, 2023
Yidong Cui, Bin Chen, Gang Wang, Juntao Wang, Ben Liu, Lei Zhu, Qingjia Xu
The patient was placed on the operating table in the supine position. General anesthesia was administered by the anesthetic team. An incision was made between the extensor hallucis longus and the tibialis anterior tendon. The joint of the tibial-talus articular joint was then clearly exposed. It was seen that the lesion area of the talus was covered by chondroid tissue. Following the removal of the chondroid tissue, a defect remained in the medial talar trochlea. The ankle was placed in the extreme plantarflexion position by the assistant. Osteotomy was then performed according to the 3D design. The damaged medial talus trochlea was removed slice by slice using the oscillating saw until the talar prosthesis is matched with the rest of joint articular. Soft tissue and ligaments were reserved. After resection of the affected medial talus trochlea, a trial talar prosthesis was implanted with manual traction. The articulation range of motion was assessed through plantarflexion, dorsiflexion, inversion, and eversion. An X-ray was used to determine the fitness. Finally, a 3D printed talus prosthesis was implanted and fixed with two 3.5 mm screws through the pre-drilled hole in the prosthesis (Figure 6). The incision was closed layer by layer. The duration of operation was 1.5 h and the blood loss was about 50 ml.
Postoperative Focal Lower Extremity Supplementary Motor Area Syndrome: Case Report and Review of the Literature
Published in The Neurodiagnostic Journal, 2021
Nicholas B. Dadario, Joanna K. Tabor, Justin Silverstein, Xiaonan R. Sun, Randy S. DAmico
Surgical resection during stage II proceeded without complication. The entirety of the left frontal region as well as a portion of the involved superior sagittal sinus was resected. Again, the lateral and inferior and posterior margins of the tumor were noted to have infiltrated the pia arachnoid of the underlying brain. These regions were carefully resected. The patient awoke with mild language deficits including persistent repetition, paraphasic errors and word finding difficulty which resolved prior to discharge. Post-operative brain MRI demonstrated resection of the bifrontal disease with known residual within the posterior superior sagittal sinus. The diffusion-weighted images demonstrated multiple punctate areas of diffusion abnormality within the high frontal and parietal lobes with corresponding ADC drop-off compatible with mild ischemic changes or devitalized tissue along the regions of brain invasion. Post-operative MRI of the lumbar spine confirmed no spinal pathology capable of producing an isolated foot drop. Post-operative EEG again demonstrated no focal seizure activity although the patient did suffer post-operative epileptiform events involving speech arrest ultimately controlled on anticonvulsants. His left foot began functioning on approximately post-operative day 7 with initial extensor hallucis longus movement progressing to dorsiflexion and plantarflexion abilities prior to discharge on post-operative day 11.
Posterior and anterior epidural and intradural migration of the sequestered intervertebral disc: Three cases and review of the literature
Published in The Journal of Spinal Cord Medicine, 2022
Daphne J. Theodorou, Stavroula J. Theodorou, Yousuke Kakitsubata, Evangelos I. Papanastasiou, Ioannis D. Gelalis
A 33-year-old woman presented at the emergency department with a two-week history of persistent pain in the leg and dorsum of her left foot and mild low back pain, without any preceding trauma. She complained of subjective weakness of her left leg. She had no bladder or bowel symptoms and her medical history was unremarkable. On examination she had bilateral paravertebral muscle spasm. Straight leg-raising was positive at 30° on the left. The ankle reflex was decreased in her left lower extremity. Muscle testing showed weakness of the extensor hallucis longus and anterior tibial muscles. There was mild hypoesthesia involving the L4 dermatome on the left. Laboratory work-up was normal. MR imaging showed a degenerative and extruded intervertebral disc at L4–L5 and a small mass lesion in the dural sac exhibiting increased signal intensity on both the T1-weighted and T2-weighted images as compared to the disc (Fig. 2A). The lesion was better demonstrated on the axial MR images as an intradural mass occupying the posterior segment of the spinal cord on the right side (Fig. 2B). The lesion showed prominent enhancement after the administration of a gadolinium-containing contrast medium (Fig. 2C). The peripheral portion of the extruded disc displayed contrast enhancement and appeared to connect to the intradural mass lesion. On the axial MR images, there was peripheral, rim-like enhancement of the mass (Fig. 2D). Prompt surgery involving 2-level laminectomy to extend the exposure identified intradural migration of a herniated disc fragment, which was successfully removed with synchronous closure of the ventral dural defect. The patient recovered promptly.