Electromyographic Changes in Postmeniscectomy Patients

Weingarden, Saul I.

doi:10.1001/jama.1979.03290380024020

Cited by 74 publications

(11 citation statements)

References 7 publications

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“…The number of patients included was chosen based on earlier studies with EMG examinations where 20–25 patients had been included (Saunders et al 1979, Weingarden et al 1979, Dobner and Nitz 1982, Arciero et al 1996). …”

Section: Methodsmentioning

confidence: 99%

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field

Olivecrona¹,

Blomfeldt²,

Ponzer³

et al. 2013

Acta Orthopaedica

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Background and purpose Tourniquet-related nerve injuries remain a concern in orthopedic surgery. The cuff pressures used today are generally lower, and therefore a decreasing incidence of peripheral nerve injuries might also be expected. However, there have been few neurophysiological studies describing the outcome after bloodless field surgery. We describe the results of neurophysiological examinations and report the incidence of nerve injuries after total knee arthroplasty (TKA) in a bloodless field.Patients and methods This study was part of a prospective, randomized controlled clinical trial in patients scheduled for TKA in a bloodless field. 20 consecutive patients were enrolled. Electroneurography (ENeG) and quantitative sensory testing (QST) of thermal thresholds were performed on day 3. These tests were repeated 2 months after surgery when electromyography (EMG) with a concentric-needle electrode was also performed.Results The mean tourniquet cuff pressure was 237 (SD 33) mmHg. Electromyographic signs of denervation were found in 1 patient, who also had the highest cuff pressure in the study population (294 mmHg). The sensory nerve response amplitudes were lower in the operated leg on day 3; otherwise, the neurophysiological examinations showed no differences between the legs.Interpretation When low tourniquet cuff pressures are used the risk of nerve injury is minor.

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Section: Methodsmentioning

confidence: 99%

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field

Olivecrona¹,

Blomfeldt²,

Ponzer³

et al. 2013

Acta Orthopaedica

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“…Reported complications include: muscle damage observed histologically (12,23,36,38), functionally (8,24), and biochemically (2, 16,19,32,33); and vascular problems such as deep vein thrombosis (26), arterial thrombosis (9), false aneurysm (37), fractured vessel walls (15), and postischemic edema (16,25,39). Neurologic problems also attributed to tourniquet application include damage to ulnar (l), sciatic (28,34), femoral (34,40), and other nerves (1,25, 34,40).…”

Section: Local Compression Patterns Beneath Pneumaticmentioning

confidence: 99%

Local compression patterns beneath pneumatic tourniquets applied to arms and thighs of human cadavera

Hargens

McClure

Skyhar

et al. 1987

Journal Orthopaedic Research

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Distributions of tissue fluid pressure were examined beneath a standard pneumatic tourniquet in six upper extremities and six lower extremities of fresh human cadavera, disarticulated at the shoulder and hip, respectively. A standard 8-cm-wide tourniquet cuff was applied at mid-humerus or mid-femur position. Tissue fluid pressures were measured by 100-cm-long slit catheters inserted parallel to the bone at four tissue depths: subcutaneous, subfascial, mid-muscle, and adjacent to bone. All arms and thighs were studied at the following cuff pressures: 100, 150, 200, 250, 300, 400, and 500 mm Hg. Tissue fluid pressure was always maximal in subcutaneous tissue at mid-cuff. Transmission of cuff pressures to deeper tissues was significantly less (p less than 0.01) in the thighs with a girth of 40-52 cm than in the arms with a girth of 22-33 cm. At the four tissue depths studied, tissue fluid pressures fell steeply in a longitudinal direction near the cuff edge to levels near zero at points 1-2 cm outside each cuff edge. Our results suggest that wider cuffs are required on thighs than on arms to provide a bloodless field during limb surgery and to minimize underlying tissue injury associated with high cuff pressures. Our recommendation for wider tourniquet cuffs than those presently used during orthopaedic surgery is contrary to recent prevailing knowledge.

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“…Measures of atrophy, strength and functional mobility were not performed (38). The remainder of studies cited were conducted with younger adults during and after ACL reconstruction (6), with meniscectomy patients (39), with young patients having ORIF (19), and with subjects requiring surgery for femoral shaft fractures (control group) and tibial and ankle fractures (tourniquet group) (24) that reported changes in measures of pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

Dreyer

2016

Exercise and Sport Sciences Reviews

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Muscle atrophy after total knee arthroplasty (TKA) occurs at a rate of 1% per day for the first two weeks. Our hypothesis is that tourniquet-induced IR injury occurring during TKA influences metabolism and may contribute to atrophy. Identifying pathways that are up regulated during this critical “14-day window” after surgery may help us to delineate therapeutic approaches to avoid muscle loss.

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Electromyographic Changes in Postmeniscectomy Patients

Cited by 74 publications

References 7 publications

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field

Tourniquet cuff pressure and nerve injury in knee arthroplasty in a bloodless field

Local compression patterns beneath pneumatic tourniquets applied to arms and thighs of human cadavera

Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

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