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Open AccessArticle

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

1
Division of Pediatric Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
2
Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Incheon 21431, Korea
3
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
4
Medical course, University of Melbourne Melbourne Medical School, 3010 Melbourne, Australia
5
Department of Orthopaedic Surgery, Aswan University Hospital, Aswan University Faculty of Medicine, Aswan 81528, Egypt
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2096; https://doi.org/10.3390/jcm8122096
Received: 7 October 2019 / Revised: 11 November 2019 / Accepted: 29 November 2019 / Published: 1 December 2019
(This article belongs to the Section Orthopedics)
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; triceps surae; cerebral palsy; limited utility; the Silfverskiöld test architectural properties; triceps surae; cerebral palsy; limited utility; the Silfverskiöld test
MDPI and ACS Style

Park, K.-B.; Joo, S.Y.; Park, H.; Rhee, I.; Shin, J.-K.; Abdel-Baki, S.W.; Kim, H.W. Architecture of the Triceps Surae Muscles Complex in Patients with Spastic Hemiplegia: Implication for the Limited Utility of the Silfverskiöld Test. J. Clin. Med. 2019, 8, 2096.

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