BURP

Etsin tietoa tuosta BURP.ista minkä Esa Eskelinen myös Jeculle teki eli hauislihaksen kiinnityshaaran katkaisu. Suomenkielisiltä sivuilta en löytänyt mitään mutta mm. tälläisen tutkimuksen löysin:

Biceps Tendon Release

The biceps/brachialis muscles constitute a large muscular complex. The anatomic origin and insertion of the biceps and brachialis muscles are such that the muscular complex exerts considerable force on the medial compartment of the elbow. The force exerted by the biceps is continuous since it is a pennate muscle with central tendon. More importantly, because the insertion of the biceps/brachialis complex is at the ulnar tuberosity, a large polar (rotational) moment is exerted at the cranial segment of the medial coronoid just caudal and distal to the medial collateral ligament. The magnitude of the polar moment is a product of the moment arm (distance from the ulnar tuberosity to the tip of the coronoid) multiplied by the force created by the biceps/brachialis muscular complex. The polar moment rotates and compresses the craniolateral segment of the medial coronoid against the radial head. The compressive force is medial to lateral transverse to the long axis of the coronoid. A compressive force generates internal shear stress at an oblique angle to the applied compressive force. In this situation, maximal internal shear stress would be oblique to the long axis of the coronoid. Under the right circumstances, the polar moment and resultant compressive force produced by the biceps/brachialis complex may produce sufficient internal shear stress to exceed the material strength of the cancellous bone in the craniolateral segment of the medial coronoid. The result would be microfracture/fragmentation adjacent to the radial head at an oblique angle to the long axis of the medial coronoid. Interestingly, microfracture/fragmentation of the coronoid seen clinically is in the craniolateral segment of the medial coronoid adjacent to the radial head. This location corresponds to the plane of maximal shear stress generated by the compressive force exerted by the polar moment produced by contracture of the biceps/brachialis complex.
Figure 8: A portion of the biceps tendon inserts adjacent to the medial coronoid process.Figure 9: Red arrows denote compressive force generated by biceps/brachialis contraction. Yellow arrow denoted internal shear stress resulting from compressive force. Note this corresponds to the fissure line in the medial coronoid process.Figure 10: The ulnar insertion of the biceps tendon (BT) is transected arthroscopically as a means of reducing load in the medial compartment. The medial collateral ligament(MCL) is preserved.
Hulse et al. introduced a technique to reduce load in the medial compartment using a technique called biceps tendon release. This technique is typically used in dogs with mild to moderate cartilage wear in the medial compartment. Hulse’s technique decreases the load by moving the ulnar portion of the biceps tendon to a more lateral position. The transposition of the tendon reduces the polar moment between the medial coronoid process and the radial head. The biceps release procedure can be performed open or arthroscopically. The ulnar insertion of the biceps tendon can be released and left unattached or it can be transposed and reattached to the bone in a more lateral position. The long term fate of the tendon once released is currently unknown. Care should be taken not to accidentally severe the medial collateral ligament. Morbidity is extremely low following this procedure. Dogs are returned to normal activity approximately 4-6 weeks after surgery. Biceps tendon release can be performed bilaterally during the same anesthetic procedure.

Myös tämmöisen löysin:

The 2009 meeting of the Veterinary Orthopedic Society was held in Steamboat Springs, Colorado and featured a wide range of orthopedic presentations.
Fragmentation of the medial coronoid process of the ulna is a common cause of forelimb lameness in large breed dogs. Recently it has been suggested that this problem may be mistaken for shoulder pain in some patients (). This can occur because the biceps and brachialis muscles that originate in the shoulder region, have an insertion on the medial coronoid process. Contraction of this muscle group, as in some shoulder diagnostic manipulations, may actually press a fragmented medial coronoid against the radial head evoking a pain response (,). Dr. Noel Fitzpatrick has presented and published work on several approaches to this condition including humeral osteotomies designed to “off-load” the medial elbow compartment and subtotal coronoidectomy to remove abnormal bony tissue (). His presentation at VOS 2009 described surgical release of the biceps tendon in 49 elbows near its insertion on the ulna, parallel to the caudal border of the medial collateral ligament (). This preliminary study involved 39 dogs, 25 of which also received subtotal coronoidectomy, while 14 received only the biceps ulnar release procedure (BURP). Evaluation at a mean follow-up time of 83 weeks revealed statistically significant improvement based on clinician and owner subjective evaluation. Force plate data comparing BURP limbs with normal limbs in the same dog revealed no statistically significant difference. No adverse effects were associated with the procedure. The investigators acknowledge that the results are very preliminary and that case selection criteria have yet to be clearly defined; however, initial results are encouraging and the procedure warrants further investigation ().

Mitä minä nyt tuosta ymmärsin niin siitä hauiksesta on katkaistu yksi haara mikä aiheuttaa painetta juuri tuohon kyynärään. Koko lihasta ei siis ole poikkaistu. Alkuun luulin että sieltä on joku luu katkaistu ja olin ihan ihmeissään...Melko uusi tekniikka tämä, vaikutuksista ei ole tutkimustietoa juurikaan mutta pitäisi olla auttava siihen että niveliin ei rikkoa muodostuisi kun paine nivelessä vähenee. Mietin itse sitä että jääkö siitä jollain lailla heikompi tuon lihaksen katkaisun jälkeen mutta tuossa toisessa tutkimuksessa oli verrattu ja tassujen välistä eroa ei huomannut. Pääkohtia tekstistä lihavoin, tuskin noita kokonaan kukaan jaksaa lukea :) Vähän grousseja kuviakin mukana-musta ei kyllä ikinä tulisi minkäänlaista lääkäriä-uh. Heti rupeaa sattumaan omiinkin jalkoihin. Mutta siis erittäin rohkaisevaa tekstiä paranemisen ja ennusteen kannalta!

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