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Architecture of the Triceps Surae Muscles Complex in Patients With Spastic Hemiplegia: Implication for the Limited Utility of the Silfverskiöld Test

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Architecture of the Triceps Surae Muscles Complex in Patients With Spastic Hemiplegia: Implication for the Limited Utility of the Silfverskiöld Test

Kun-Bo Park et al. J Clin Med.

Abstract

The Silfverskiöld test has long been used as an important tool for determining the affected muscles of the triceps surae in patients with equinus deformity. However, the test may not reflect the altered interactions between the muscles of the triceps which are affected by spasticity. The purpose of this study was to compare the architectural properties of the triceps surae muscles complex using ultrasonography, between hemiplegic patients and typically-developing children. Specifically, we wished to examine any differences in the architecture of the three muscles with various angle configurations of the knee and ankle joints. Ultrasound images of the medial gastrocnemius, lateral gastrocnemius, and soleus were acquired from paretic (group I) and non-paretic (group II) legs of ten patients and the legs (group III) of 10 age-matched normal children. A mixed model was used to evaluate the differences in the measurements of muscle architecture among the groups and the effects of various joint configurations on the measurements within the muscles. Compared to the results of measurements in groups II and III, the fascicle length was not different in the medial gastrocnemius of a paretic leg but it was longer in the lateral gastrocnemius and shorter in the soleus; the pennation angle was smaller in both medial and lateral gastrocnemii and was not different in the soleus; and the muscle thickness was found to be reduced in the three muscles of the paretic leg. Contrary to the observations in both the medial and lateral gastrocnemii, the fascicle length was increased and the pennation angle was decreased in the soleus with an increase of knee flexion. Through the current simulation study of the Silfverskiöld test using ultrasonography, we found that the changes detected in the architectural properties of the three muscles induced by systematic variations of the position at the ankle and the knee joints were variable. We believe that the limited utility of the Silfverskiöld test should be considered in determining an appropriate operative procedure to correct the equinus deformity in patients with altered architecture of the muscles in conditions such as cerebral palsy, as the differing muscle architectures of the triceps surae complex may affect the behavior of the muscles during the Silfverskiöld test.

Keywords: architectural properties; cerebral palsy; limited utility; the Silfverskiöld test; triceps surae.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Ultrasonographic images of a lateral gastrocnemius (LG) of a paretic leg. A00, A15, and A30 represent ankle neutral, 15° of plantarflexion, and 30° of plantarflexion, respectively; while K00, K45, and K90 represent full knee extension, 45° of knee flexion, and 90° of knee flexion, respectively.
Figure 2
Figure 2
Schematic and real ultrasound images of the muscle architecture: fascicle length (Lf); pennation angle (Pa); and muscle thickness (T). On the right image: white solid lines indicate aponeuroses of the lateral gastrocnemius and white dashed lines indicate aponeuroses of the posterior soleus; and black dashed lines indicate fascicle length.
Figure 3
Figure 3
Fascicle length of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles at various configurations of the ankle and knee joint angles. The arrow indicates a significant increase in fascicle length. The symbols (=, >, <) indicate significant differences in fascicle length among the groups. A-10, A00, A15, and A30 represent 10° ankle dorsiflexion, ankle neutral, 15° plantarflexion, and 30° plantarflexion, respectively; while K00, K45, and K90 represent full knee extension, 45° knee flexion, and 90° knee flexion, respectively.
Figure 4
Figure 4
Pennation angles of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles at various configurations of the ankle and knee joint angles. The arrow indicates a significant increase in pennation angle. The symbols (=, >, <) indicate significant differences in pennation angle among the groups. A-10, A00, A15, and A30 represent 10° ankle dorsiflexion, ankle neutral, 15° plantarflexion, and 30° plantarflexion, respectively; while K00, K45, and K90 represent full knee extension, 45° knee flexion, and 90° knee flexion, respectively.
Figure 5
Figure 5
Muscle thickness of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles at various configurations of the ankle and knee joint angles. The arrow indicates a significant increase in muscle thickness. The symbols (=, >, <) indicate significant differences in muscle thickness among the groups. A-10, A00, A15, and A30 represent 10° ankle dorsiflexion, ankle neutral, 15° plantarflexion, and 30° plantarflexion, respectively; while K00, K45, and K90 represent full knee extension, 45° knee flexion, and 90° knee flexion, respectively.
Figure 6
Figure 6
Sonographic images of the lateral gastrocnemius. Pennation angle and muscle thickness in paretic legs (16° and 8 mm, respectively) were found to be decreased, compared to those in normal legs of typically developing children (22° and 12 mm, respectively) at the same joint angle.

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