112 C/in. Biomech. 1986: 1: No 2

determine the different responses that occurred when they were asked to stand on one leg. This has enabled us to define a standard method of performing the Trendelenburg test. and to interpret the test as a method of assessing hip abductor function.

The major pitfalls that result in misinterpretation, orfalse- positive responses, are pain, lack of cooperation from the patient, and impingement between the rib cage and the iliac crest. False-negative responses result from the patient using muscles above and below the pelvis, and from leaning beyond the hip on the standing side.

Hardcastle P, Nade S. J Bone Joint Surg 1985; 67B: 741-6

Lumbar paraspinal compartment syndrome-a case report with physiologic and anatomic studies A 24-year-old man presented with severe low-back pain and paraspinal muscle spasm after exertion. Elevation in temperature, white blood cell count, serum muscle enzymes, and urine myoglobin. as well as computer tomographic evidence of paraspinal muscle edema and necrosis. were present. No etiology could be documented. and the possibility of an acute exertional compartment syndrome was entertained. Subsequently. cadaveric dissections indicated that the erector spinae muscles are contained within a well- developed fascial sheath. Continuous slit catheter pressure measurements within this compartment in eight healthy male subjects were subsequently carried out. These indicated a physiologic behavior similar to other known compartments for which compartment syndromes have been described. Variation in intracompartmental pressure occurred as a function of body posture. erector spinae isometric contraction. and active intra-abdominal pressurization. We suggest this patient had a paraspinal compartment syndrome and have described pressure characteristics of this compartment in normal men.

Carr D. Gilbertson L. Frymoyer J. Krag M. Pope M. Spine 1985: 10: 81620

Electromyographic evidence of paraspinal muscle spasm during sleep in patients with low back pain Electromyogram (EMG) was recorded by surface electrodes from lumbar paraspinal muscles durin g a 24-h period using

Medilog 4 channel battery operated portable tape recorder. On replay records the total electrical activity amplitude and duration of the activity was evaluated. Nine patients with low back pain and unilateral or prevailing one-sided palpable paraspinal muscle spasm (PS) were studied. The control group consisted of 12 participants without pain or palpable spasm. Sustained electrical activity was documented during sleep in lumbar paraspinal muscles of patients with low back pain and palpable spasm. This study demonstrated that in normal subjects without low back pain there is no EMG activity in lumbar paraspinal muscles during sleep. The EMG activity in spasmotic muscles was statistically significantly higher than in the nonspasmotic control subjects without pain.

Fischer AA, Chang CH. Clin J Pain 1985: 1: 147-53

Objective assessment of spine function following industrial injury-a prospective study with comparison group and one-year follow-up 1985 Volvo Award in Clinical Sciences Objective functional capacity measurement techniques were used to guide a treatment program for a group of 66 chronic

back pain patients. These patients were compared with a group of 38 chronic patients who were not administered the treatment program. Outcome data were collected by telephone survey at an average 1 year follow-up. In addition, functional capacity measures were collected for treatment group patients on admission and follow-up evaluations. Results demonstrated that the functional capacity measures collected for the treatment group improved in approximately 80% of the patients. These changes were also accompanied by positive changes in psychologic measures. In addition. at 1 year follow-up, the treatment group had approximately twice the rate of patients who returned to work. relative to the comparison group. Additional surgery rates were comparable for both groups (6% in the treatment and 7% in the comparison group). but the frequency of additional health- care professional visits was substantially higher in the comparison group. The findings suggest that quantitative functional capacity measures can give objective evidence of patient physical abilities and degree of effort and can significantly guide the clinician in administering an effective treatment program.

Mayer TG. Gatchel RJ. Kishino N. Keeley J. Capra P. Mayer H. Barnett J. Mooney V. Spine 1985: IO: 482-93

Physical therapy for chronic low back pain: correlations between spinal mobility and treatment outcome Chronic low back pain in 1.51 men aged 54 to 63 years was treated for three weeks in a rehabilitation centre or ah outpatients at a health centre. Spinal mobility of forward and lateral Hexion. and rotation. were measured before and two months after treatment. The effects of the treatment on IOU back pain were recorded from questionnaires answered before and 2.6 and I:! months after treatment. A favourable outcome correlated significantly with an increase of spinal lateral Hexion (P<O.Ol) and rotation (Pc3.05). The hypothetical utility of mobilizing lateral Hexion and rotation exercises as part of the rehabilitation of patients with chronic low back pain is discussed.

Mellin G. Stand J Rehab Med 1985: 17: 163-h

Injury of the tibialis posterior tendon: a cause of acquired valgus foot in childhood Accidental division of the tibialis posterior tendon near the medial malleolus is easily overlooked and can. if left untreated, cause a painful planovalgus deformity of the foot. Two such patients are described. who had small wounds near the medial malleolus and in whom the tendon’s damage was not initially diagnosed. Both patients came later with a painful valgus Hat foot. Diagnosis of the lesion may be difficult because the inversion and supination action of the tibialis posterior tendon can be mimicked by the long Hexor tendons of the toes. A patient with an intact tibialis posterior tendon can invert and supinate the foot and then plantarnex and dorsiflex the toes with the foot held in that position. Damage to the tendon should be suspected in all penetrating wounds near the medial malleolus.

Citron N. Injury 1985; 16: 610-12

The accuracy of clinical examination of injury of the knee joint This study is an analysis of the clinical examination of 11X consecutive patients with severe, acute injury of the knee joint, that is, with intra-articular effusion or with clinical suspicion of ligamentous instability. Both the clinical examination and the examination under anaesthesia for