David Peck

A small short muscle frequently acts across a joint in parallel with a vastly larger and longer muscle; therefore it should play a minimal role in the mechanical control of that joint. This study provides evidence suggesting that the small member of such a "parallel muscle combination" (PMC) may serve an important sensory feedback role. The spindle densities of large and small members of PMCs in man and the dog were determined and compared. Epaxial PMCs controlling canine intervertebral joints were dissected and tissue samples were embedded in paraffin, sectioned transversely to the muscles' long axis and, stained with hematoxylin-periodic acid-Schiff (PAS). Representative tissue sections were projected on to stereological grids and the percentage volume of spindles was determined. Data existing in the literature were used to ascertain spindle densities in human PMCs controlling joints in the cervico-occipital region and the extremities. The spindle density for each muscle in a group of PMCs controlling a particular motion was listed, and the mean spindle densities were determined for both the large and the small members of the group. Student's unpaired t test was used to determine the significance of the differences between mean spindle densities. Linear regression was calculated and the data were plotted graphically. In all PMCs examined, the spindle density of the small muscles was significantly higher than that of their large counterparts. It is therefore proposed that the small muscles of PMCs may function as "kinesiological monitors" generating important proprioceptive feedback to the central nervous system.

Slipped capital femoral epiphysis is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. It usually occurs in children eight to 15 years of age, and it is one of the most commonly missed diagnoses in children. Slipped capital femoral epiphysis is classified as stable or unstable based on the stability of the physis. The condition is associated with obesity and growth surges, and it is occasionally associated with endocrine disorders such as hypothyroidism, growth hormone supplementation, hypogonadism, and panhypopituitarism. Patients usually present with limping and poorly localized pain in the hip, groin, thigh, or knee. Diagnosis is confirmed by bilateral hip radiography, which needs to include anteroposterior and frog-leg lateral views in patients with stable slipped capital femoral epiphysis, and anteroposterior and cross-table lateral views in patients with the unstable form. The goals of treatment are to prevent slip progression and avoid complications such as avascular necrosis and chondrolysis. Stable slipped capital femoral epiphysis is usually treated using in situ screw fixation. Treatment of unstable slipped capital femoral epiphysis usually involves in situ fixation, but there is controversy about the timing of surgery, value of reduction, and whether traction should be used.

Apophyseal injuries, which are unique in the adolescent athlete, cause inflammation at the site of a major tendinous insertion onto a growing bony prominence. These injuries typically occur in active adolescents between the ages of eight and 15 years and usually present as periarticular pain associated with growth, skeletal immaturity, repetitive microtrauma and muscle-tendon imbalance. Common apophyseal injuries, and their sites, include Sever's disease (posterior calcaneus), Osgood-Schlatter disease (tibial tuberosity), Sindig-Larsen-Johansson syndrome (inferior patella), medial epicondylitis (humeral medial epicondyle) and apophysitis of the hip (iliac crest, ischial tuberosity). Conservative therapy, including rest, ice, compression, elevation, nonsteroidal anti-inflammatory agents, modification of the athlete's activity level and exercises for increased flexibility and strengthening, is usually effective.