title: Does the rectus femoris nerve block improve knee recurvatum in adult stroke patients? A kinematic and electromyographic study.
abstract: Knee recurvatum (KR) during gait is common in hemiplegic patients. Quadriceps spasticity has been postulated as a cause of KR in this population. The aim of this study was to assess the role of rectus femoris spasticity in KR by using selective motor nerve blocks of the rectus femoris nerve in hemiparetic stroke patients. The data from six adult, post-stroke hemiplegic patients who underwent a rectus femoris nerve block for a stiff-knee gait were retrospectively analyzed. An extensive clinical and functional evaluation was performed and gait was assessed by motion analysis (kinematic, kinetic and electromyographic parameters) before and during the block realized using 2% lidocaine injected under a neurostimulation and ultrasonographic targeting procedure. The main outcome measures were the peak knee extension in stance and peak knee extensor moment obtained during gait analysis. No serious adverse effect of the nerve block was observed. The block allowed a reduction of rectus femoris overactivity in all patients. Peak knee extension and extensor moment in stance did not improve in any patient, but peak knee flexion during the swing phase was significantly higher after block (mean: 31.2° post, 26.4 pre, p < 0.05). Our results provide arguments against the hypothesis that the spasticity of the rectus femoris contributes to KR.
authors.affiliation: Service de médecine physique et de réadaptation neurologique, centre hospitalier universitaire de Nantes, hôpital Saint Jacques, 85 rue Saint Jacques, 44093 Nantes cedex, France. Electronic address: raphael.gross@chu-nantes.fr.
authors.forename: R
authors.initials: R
authors.lastname: Gross
authors.affiliation: Pôle d'activité médicale de Rééducation et Réadaptation, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Hospices Civils de Lyon, F-69230 Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, INSERM U1028, ImpAct, 16 avenue Lépine, 69676 Bron, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, CNRS, UMR5292, ImpAct, 16 avenue Lépine, 69676 Bron, France; Université Lyon 1, F-69000 Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Delporte
authors.affiliation: Pôle d'activité médicale de Rééducation et Réadaptation, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Hospices Civils de Lyon, F-69230 Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Arsenault
authors.affiliation: Pôle d'activité médicale de Rééducation et Réadaptation, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Hospices Civils de Lyon, F-69230 Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, INSERM U1028, ImpAct, 16 avenue Lépine, 69676 Bron, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, CNRS, UMR5292, ImpAct, 16 avenue Lépine, 69676 Bron, France; Université Lyon 1, F-69000 Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Revol
authors.affiliation: Service Anesthésie-Réanimations médicale et chirurgicale, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
authors.forename: M
authors.initials: M
authors.lastname: Lefevre
authors.affiliation: Service Anesthésie-Réanimations médicale et chirurgicale, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Chemin du Grand Revoyet, 69495 Pierre-Bénite, France.
authors.forename: D
authors.initials: D
authors.lastname: Clevenot
authors.affiliation: Pôle d'activité médicale de Rééducation et Réadaptation, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Hospices Civils de Lyon, F-69230 Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, INSERM U1028, ImpAct, 16 avenue Lépine, 69676 Bron, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, CNRS, UMR5292, ImpAct, 16 avenue Lépine, 69676 Bron, France; Université Lyon 1, F-69000 Lyon, France.
authors.forename: D
authors.initials: D
authors.lastname: Boisson
authors.affiliation: Université Lyon 1, F-69000 Lyon, France; Département de Neurochirurgie, hôpital neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Mertens
authors.affiliation: Pôle d'activité médicale de Rééducation et Réadaptation, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Hospices Civils de Lyon, F-69230 Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, INSERM U1028, ImpAct, 16 avenue Lépine, 69676 Bron, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, CNRS, UMR5292, ImpAct, 16 avenue Lépine, 69676 Bron, France; Université Lyon 1, F-69000 Lyon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Rossetti
authors.affiliation: Pôle d'activité médicale de Rééducation et Réadaptation, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap, Hospices Civils de Lyon, F-69230 Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, INSERM U1028, ImpAct, 16 avenue Lépine, 69676 Bron, France; Centre de Recherche en Neurosciences de Lyon, Lyon Neuroscience Research Center, CNRS, UMR5292, ImpAct, 16 avenue Lépine, 69676 Bron, France; Université Lyon 1, F-69000 Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Luauté
mesh_terms: D001696:Biomechanical Phenomena; D004576:Electromyography; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000534:rehabilitation*; D009407:Nerve Block / Q000379:methods*; D052097:Quadriceps Muscle / Q000294:innervation* / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D017211:Treatment Failure
keywords: Hemiplegia; Knee recurvatum; Nerve block; Rectus femoris; Spasticity