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Examination of a Child with Cerebral Palsy
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Tone is resistance felt to a passive stretch in a relaxed state of muscle activity and is best demonstrated by passive movement about a joint. The child is assessed in a relaxed state and can be examined in the parent’s lap. It may be increased in the form of spasticity, dystonia, or rigidity. The criteria described by Sanger et al.6 to assess hypertonia can be followed: Palpate the muscle to be examined to assess whether there is muscle contracture at rest.Define the available passive range of motion by moving the limb gently.Now move the limb at different speeds through the available range to look for catch, i.e., sudden resistance offered to the passive range and further possible slow stretch.Now the patient is asked to move the same joint on the other side and look for an alteration in resistance to movement or involuntary movement on the side being examined, which may indicate the presence of dystonia.
Neuromuscular disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Muscle contracture (as distinct from contraction) is the adaptive change which occurs when a normally innervated muscle is held immobile in a shortened position for some length of time. If a joint is held flexed for a long time, it may subsequently be impossible to straighten it passively without injuring the muscle. Active exercise will eventually overcome the muscle contracture, unless the muscle has been permanently damaged.
Malignant Hyperpyrexia
Published in Kate McCombe, Lara Wijayasiri, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 2, 2017
Kate McCombe, Lara Wijayasiri, Paul Hatton, David Bogod
Describe your subsequent management. Counsel the patient and their relatives about events and the implications of a potential diagnosis of MH.Document events in clinical notes and inform the GP.Suggest a MedicAlert bracelet.Patients must be referred to St James’s University Hospital MH investigation unit in Leeds, where a muscle biopsy will be taken for ‘in vitro muscle contracture testing’ (muscle tissue is exposed to caffeine and halothane, which reduce the threshold for muscle contraction).This is the gold standard diagnostic test for MH.
Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy
Published in Disability and Rehabilitation, 2023
Merve Tunçdemir, Sefa Üneş, Jale Karakaya, Mintaze Kerem Günel
Cerebral palsy (CP) is the most common cause of physical disability and motor impairment in childhood [1]. Some children have only motor disorder, while others have many other problems accompanied with motor disorder. Many impairments of body structure and function are observed that cause limitations in activities and participation in children with CP [2]. These body structure and function impairments are neuromuscular and musculoskeletal problems included spasticity, hypertonia, muscle weakness, incoordination, poor balance, muscle contracture and reduced selective motor control [3–5]. Spasticity, muscle contractures and muscle weakness are more often observed problems compared to loss of selective motor control in children with spastic CP. Therefore, they are more focused problems on assessment or treatment-oriented research [2,6,7]. However, loss of selective motor control affects motor functions quite negatively than other impairments [6,7].
Ultrasound imaging as an initial diagnostic method for intramuscular hemangiomas: a narrative review
Published in Postgraduate Medicine, 2022
Carmelo Pirri, Nina Pirri, Raffaele De Caro, Carla Stecco, Levent Özçakar
Intramuscular hemangiomas (IHs) can oft-times be overlooked in the differential diagnosis of musculoskeletal pain [6]. Herein, it is noteworthy that they usually present with chronic pain, swelling, a recent mass and loss of function (at late stages) [7,8]. Pain is reported by 60% of the patients and is exacerbated by physical activity of the involved muscle due to vasodilatation and increased local blood flow [7], leading to swelling and compressive pain. Relevant clinical signs (helpful in the diagnosis) would be isolated pulsations, enlargement of the extremities, compressibility, increased temperature, muscle contracture, tenderness to palpation, deformities (mainly in superficial IHs), skin discoloration, vascular noise, muscle weakness, (rarely) shunt of the blood flow, heart murmurs, and congestive heart failure [9,10].
The development of spasticity with age in 4,162 children with cerebral palsy: a register-based prospective cohort study
Published in Acta Orthopaedica, 2019
Olof Lindén, Gunnar Hägglund, Elisabet Rodby-Bousquet, Philippe Wagner
A spastic muscle will not stretch to the same degree as a muscle with normal tone. Therefore, spasticity may inhibit growth in the length of the muscle, resulting in the development of muscle contracture, with a decreasing range of joint motion (Rang et al. 1986). Both spasticity and contracture of the gastrosoleus muscle may result in toe walking. However, spasticity and contracture may also compensate for weakness of the gastrosoleus muscle. The combination of reduced muscle tone and increased body weight with age might result in a change from toe walking to a calcaneal or crouch gait with increased dorsiflexion of the ankle joint during mid-stance. As an effect functional gait can be compromised and a continuous deterioration in walking function in the adult with CP has been reported (Opheim et al. 2009). The pros and cons of spasticity and the need for spasticity-reducing treatment may thus vary with age.