Citations
Citations
Citations
To investigate the diagnostic value of cross-sectional area (CSA) and wrist to forearm ratio (WFR) in patients with electro-diagnosed carpal tunnel syndrome (CTS) with or without diabetes mellitus (DM).
We retrospectively studied 256 CTS wrists and 77 healthy wrists in a single center between January 1, 2008 and January 1, 2013. The CSA and WFR were calculated for each wrist. Patients were classified into four groups according to the presence of DM and CTS: group 1, non-DM and non-CTS patients; group 2, non-DM and CTS patients; group 3, DM and non-CTS patients; and group 4, DM and CTS patients. To determine the optimal cut-off value, receiver operating characteristic (ROC) curve analysis was performed.
The CSA and WFR were significantly different among the groups (p<0.001). The ROC curve analysis of non-DM patients revealed CSA ≥10.0 mm2 and WFR ≥1.52 as the most powerful diagnostic values of CTS. The ROC curve analysis revealed CSA ≥12.5 mm2 and WFR ≥1.87 as the most powerful diagnostic values of CTS.
Ultrasonographic assessment for the diagnosis of CTS requires a particular cut-off value for diabetic patients. Based on the ROC analysis results, improved accurate diagnosis is possible if WFR can be applied regardless of presence or absence of DM.
Citations
To determine whether patients with lumbosacral (LS) radiculopathy and peripheral polyneuropathy (PPNP) exhibit sudomotor abnormalities and whether SUDOSCAN (Impeto Medical, Paris, France) can complement nerve conduction study (NCS) and electromyography (EMG).
Outpatients with lower extremity dysesthesia underwent electrophysiologic studies and SUDOSCAN. They were classified as normal (group A), LS radiculopathy (group B), or PPNP (group C). Pain severity was measured by the Michigan Neuropathy Screening Instrument (MNSI) and visual analogue scale (VAS). Demographic features, electrochemical skin conductance (ESC) values on hands and feet, and SUDOSCAN-risk scores were analyzed.
There were no statistical differences in MNSI and VAS among the three groups. Feet-ESC and hands-ESC values in group C were lower than group A and B. SUDOSCAN-risk score in group B and C was higher than group A. With a cut-off at 48 microSiemens of feet-ESC, PPNP was detected with 57.1% sensitivity and 94.2% specificity (area under the curve [AUC]=0.780; 95% confidence interval [CI], 0646–0.915). With a SUDOSCAN-risk score cut-off at 29%, NCS and EMG abnormalities related to LS radiculopathy and PPNP were detected with 64.1% sensitivity and 84.2% specificity (AUC=0.750; 95% CI, 0.674–0.886).
SUDOSCAN can discriminate outpatients with abnormal electrophysiological findings and sudomotor dysfunction. This technology may be a complementary tool to NCS and EMG in outpatients with lower extremity dysesthesia.
Citations
To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM).
A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%–5.9%; group 2, 6.0%–6.9%; group 3, 7.0%–7.9%; group 4, 8.0%–8.9%; and group 5, 9.0%–9.9%) and we investigated the difference in CRPS prevalence between the two groups.
Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (p<0.05) between the two groups but no significant differences in any other factors. Across the five HbA1c groups, there were significant differences in CRPS prevalence (p<0.01); specifically, it increased as HbA1c increased.
This study suggests that higher HbA1c relates to higher CRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes.
Citations
To evaluate the clinical differences between patients with diabetes mellitus (DM) who have asymptomatic carpal tunnel syndrome (CTS) and those who have symptomatic CTS.
Sixty-three patients with DM were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), nerve conduction studies (NCS), and ultrasonographic evaluation of the cross-sectional area (CSA) of the median nerve. According to the BCTQ responses and NCS results, the patients were divided into the following three groups: group 1 (n=16), in which NCS results did not reveal CTS; group 2 (n=19), in which NCS results revealed CTS but the group scored 0 points on the BCTQ (asymptomatic); and group 3 (n=28), in which NCS results revealed CTS and the group scored >1 point on the BCTQ (symptomatic). The clinical findings, NCS results, and CSA of the median nerve were compared among the three groups.
There were no significant differences in age, DM duration, glycated hemoglobin levels, and presence of diabetic polyneuropathy among the three groups. The peak latency of the median sensory nerve action potential was significantly shorter in group 1 than in groups 2 and 3 (p<0.001); however, no difference was observed between groups 2 and 3. CSA of the median nerve at the carpal tunnel in group 2 was significantly larger than that in group 1 and smaller than that in group 3 (p<0.05).
The results of our study suggest that the symptoms of CTS in patients with diabetes are related to CSA of the median nerve, which is consistent with swelling of the nerve.
Citations
To investigate the long-term outcomes of cardiac rehabilitation (CR) on exercise capacity in diabetic (DM) and non-diabetic (non-DM) patients with myocardial infarction (MI).
Of the MI patients who received hospital-based CR from February 2012 to January 2014, we retrospectively reviewed the medical records of the patients who continued follow-up through the outpatient clinic and community-based self-exercise after CR. A total of 37 patients (12 with DM and 25 without DM) were included in this study. Exercise capacity was measured by symptom-limited exercise tests before and after hospital-based CR and 1 year after the onset of MI.
Before the CR, the DM group had significantly lower exercise capacity in exercise times, peak oxygen consumption (VO2peak), and metabolic equivalent tasks (METs) than did the non-DM group. After the CR, both groups showed significantly improved exercise capacity, but the DM group had significantly lower exercise capacity in exercise times, submaximal rate pressure products (RPPsubmax), VO2peak, and METs. One year after the onset of the MI, the DM group had significantly lower exercise capacity in exercise times, RPPsubmax, and VO2peak than did the non-DM group, and neither group showed a significant difference in exercise capacity between before and after the CR.
As a result of continued follow-up through an outpatient clinic and community-based self-exercise after hospital-based CR in patients with MI, the DM group still had lower exercise capacity than did the non-DM group 1 year after the onset of MI, but both groups maintained their improved exercise capacity following hospital-based CR.
Citations
To elucidate the association between glycemic control status and clinical outcomes in patients with acute ischemic stroke limited to the deep branch of the middle cerebral artery (MCA).
We evaluated 65 subjects with first-ever ischemic stroke of the deep branches of the MCA, which was confirmed by magnetic resonance angiography. All subjects had blood hemoglobin A1c (HbA1c) measured at admission. They were classified into two groups according to the level of HbA1c (low <7.0% or high ≥7.0%). Neurological impairment and functional status were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM), Korean version of Modified Barthel Index (K-MBI), Korean version of Mini-Mental State Examination (MMSE-K), and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) at admission and discharge. Body mass index, serum glucose, homocysteine and cholesterol levels were also measured at admission.
The two groups did not show any difference in the NIHSS, FIM, K-MBI, MMSE-K, and LOTCA scores at any time point. Body mass index and levels of blood homocysteine and cholesterol were not different between the two groups. The serum blood glucose level at admission was negatively correlated with all outcome measures.
We found that HbA1c cannot be used for predication of clinical outcome in patients with ischemic stroke of the deep branch of the middle cerebral artery.
Citations
To demonstrate the prevalence and characteristics of subclinical ulnar neuropathy at the elbow in diabetic patients.
One hundred and five patients with diabetes mellitus were recruited for the study of ulnar nerve conduction analysis. Clinical and demographic characteristics were assessed. Electrodiagnosis of ulnar neuropathy at the elbow was based on the criteria of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM1 and AANEM2). The inching test of the ulnar motor nerve was additionally performed to localize the lesion.
The duration of diabetes, the existence of diabetic polyneuropathy (DPN) symptoms, the duration of symptoms, and HbA1C showed significantly larger values in the DPN group (p<0.05). Ulnar neuropathy at the elbow was more common in the DPN group. There was a statistically significant difference in the number of cases that met the three diagnostic criteria between the no DPN group and the DPN group. The most common location for ulnar mononeuropathy at the elbow was the retrocondylar groove.
Ulnar neuropathy at the elbow is more common in patients with DPN. If the conduction velocities of both the elbow and forearm segments are decreased to less than 50 m/s, it may be useful to apply the AANEM2 criteria and inching test to diagnose ulnar neuropathy.
Citations
To understand the injury pattern of contact burns from therapeutic physical modalities.
A retrospective study was done in 864 patients with contact burns who discharged from our hospital from January 2005 to December 2008. The following parameters were compared between patients with contact burns from therapeutic modalities and from other causes: general characteristics, burn extent, cause of burn injury, place of occurrence, burn injury site, treatment methods, prevalence of underlying disease, and length of hospital stay were compared between patients with contact burns.
Of the 864 subjects, 94 patients were injured from therapeutic modalities. A hot pack (n=51) was the most common type of therapeutic modality causing contact burn followed by moxibustion (n=21), electric heating pad (n=16), and radiant heat (n=4). The lower leg (n=31) was the most common injury site followed by the foot & ankle (n=24), buttock & coccyx (n=9), knee (n=8), trunk (n=8), back (n=6), shoulder (n=4), and arm (n=4). Diabetes mellitus was associated with contact burns from therapeutic modalities; the odds ratio was 3.99. Injuries took place most commonly at home (n=56), followed by the hospital (n=33), and in other places (n=5).
A hot pack was the most common cause of contact burns from therapeutic modalities, and the lower leg was the most common injury site. Injuries took place most commonly at home. The patients with contact burns from therapeutic modalities showed high correlation to presence of diabetes mellitus. These results would be helpful for the prevention of contact burns due to therapeutic modalities.
Citations
Method: Thirty three normal subjects and fourteen diabetic patients were participated. Plantar peak pressures in shoes were measured by pedarⰒ during a comfortable gait wearing two types of diabetic shoes, respectively. A shoes and B shoes were used in this study. Plantar pressure was analyzed by pedar C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe area) and M7 (4th, 5th toe area) zones respectively.
Results: Plantar peak pressures of diabetic patients without neuropathic and ischemic symptom were not different from normal subjects. In normal subjects, plantar peak pressure of B shoes were lower than A shoes at both T0, M3 and M5 zones and left M6 and M7 zones. Plantar peak pressures of A shoes was lower than B shoes at both M2 zones. In diabetic patients plantar peak pressures of B shoes was lower than A shoes at right M4 and left M5 zones.
Conclusion: There was no sgnificant difference between plantar peak pressures of normal subjects and diabetic patients without neuproathic and ischemic symptom. B shoes were better than A shoes to reduce plantar peak pressure. (J Korean Acad Rehab Med 2003; 27: 433-437)
Method: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus.
Results: HbA1c level had an inverse relation to CV of median motor nerve (β=1.272, p＜0.01), ulnar motor nerve (β=1.287, p＜0.01), posterior tibial nerve (β=0.982, p＜0.05), and deep peroneal nerve (β=1.449, p＜0.05).
Conclusion: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data. (J Korean Acad Rehab Med 2003; 27: 80-84)
Objective: Electrophysiologic study and 24 hours urine study were analysed in patients with diabetes mellitus in order to assess the correlation between the severity of the diabetic neuropathy and degree of microalbuminuria.
Method: Two hundreds forty one patients with diabetic neuropathy were included and divided into 3 groups - mild, moderate and severe groups. The latency and amplitude of the peroneal motor nerve, median and sural sensory nerves, F-wave of the peroneal nerve and H-reflexes were measured. Microalbuminuria and creatinine clearance with 24 hours urine were studied. The results of the nerve conduction study and the degree of microalbuminuria were evaluated for the correlation between the two signs.
Results: The degree of microalbuminuria significantly increased in accordance with the electrophysiologic severity of neuropathy (p＜0.05). The latencies and amplitudes of the peroneal motor, median and sural sensory nerves had significant correlation with the degree of microalbuminuria (p＜0.05).
Conclusion: The degree of microalbuminuria was significantly correlated with the electrophysiologic severity of diabetic neuropathy. The results suggest that pathogenesis of the neuropathy and nephropathy in patients with diabetes seem the same as microvascular and biochemical basis. (J Korean Acad Rehab Med 2002; 26: 555-561)
Objective: To evaluate the mixed nerve action potential of the medial and lateral plantar nerve conduction studies in diabetic patients with the various factors.
Method: 69 healthy adults without foot trauma as control group and 78 diabetic patients without foot trauma as subject group were studied. The study was performed by using the orthodromic surface stimulation and recording method of evaluating of the mixed nerve action potential of the medial and lateral plantar nerve conduction studies.
Results: The differences in the distal latency (p＜0.05), amplitude (p＜0.05) and nerve conduction velocity (p＜0.05) of the mixed nerve action potential of the medial and lateral plantar nerve conduction studies were statistically significant between the diabetic group and the normal control group. Same results also could be obtained in diabetic patients relating to longer duration of diabetes, presence of diabetic retinopathy, higher blood glucose level, longer duration of oral hypoglycemic agent and insulin treatment (p＜0.05).
Conclusion: The mixed nerve action potential of the medial and lateral plantar nerve conduction studies are useful for the detection of diabetic neuropathic foot.
Objective: This study was designed to evaluate the compressibility of heel pads in patients with diabetes mellitus.
Method: The subject were twenty control subjects and 20 patients with diabetes mellitus diagnosed at least 5 years previously, over the age of 40. The thickness of heel pads was measured by ultrasonography without pressure and with pressure of 1 kg, 2 kg and 3 kg at the line connecting the second toe and the mid-heel point. The ratio of the thickness of the heel pad with pressure of 1 kg, 2 kg, 3 kg and without pressure, R1 (ratio of the thickness of heel pad with 1 kg and without pressure), R2 (2 kg) and R3 (3 kg), was compared between controls and diabetics.
Results: There was no significant difference of heel pad thickness between controls and diabetics without pressure in sole. The diabetics had greater ratio, less compressibility than controls (p＜0.05). The ratio of the control group was R1; 0.67⁑0.07, R2; 0.53⁑0.07 and R3; 0.45⁑0.07, whereas that ratio of the diabetic group was R1; 0.80⁑0.09, R2; 0.68⁑0.09 and R3; 0.58⁑0.09.
Conclusion: The evaluation of compressibility of heel pad of the patients with diabetes mellitus compared with the control group will help to make a treatment of heel pain or discomfort.
Objective: To study the relationship between plantar pressure and diabetic foot ulcer and the assessment the usefulness of plantar pressure measurement in diabetic patients.
Method: The total 94 diabetic patients were enrolled in this study. The plantar pressure was measured by using EMED-SF. And the nerve conduction studies, physical examination, and history taking were done. Patients were divided into 3 subgroups, Group A: without neuropathy and past ulcer history (n=31), Group B: with neuropathy and without past ulcer history (n=44), Group C: with neuropathy and past ulcer history (n=19).
Results: 1) There were significant increase in the maximum peak pressure (MPP) and the pressure-time integral (PTI) values in the Group C as compared with the Group A and B (p＜0.05). 2) As compared among the groups for each areas, the MPP and the PTI significantly higher in group C for heel, medial fore-foot, and lateral fore-foot area than in another two groups (p＜0.05).
Conclusion: The high plantar pressure was significantly related with diabetic foot ulcer history. The plantar pressure measurement may be useful in diabetic patients as a predictive and management aids of diabetic foot ulcer.
Objective: To investigate the diagnostic value of ultrasonography for limited finger joint mobility in diabetes and association between limited finger joint mobility and the presence of diabetic chronic complications.
Methods: Ultrasonography were performed in 13 non insulin-dependent diabetes with limited finger joint mobility and 15 non insulin-dependent diabetes without limited finger joint mobility matched for similar ages, sexes and durations of diabetes. Controls consisted of 12 healthy volunteers with no evidence of diabetes mellitus.
Ultrasonography was used to measure flexor tendon and tendon sheath thickness of the third and fourth fingers in the volar aspect of both hands. We evaluated neuropathy, nephropathy and retinopathy in all diabetic patients and investigated association between limited finger joint mobility and the presence of diabetic chronic complications.
Results: Thickness of flexor tendon sheath of the third and fourth fingers were significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p＜0.01). Also, flexor tendon thickness of the third finger was significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p＜0.05). The diabetes with limited finger joint mobility had a significantly increased frequency of the diabetic chronic complications (p＜0.05).
Conclusion: In the diabetes with limited finger joint mobility, thickening of flexor tendon sheath and tendon were shown by ultrasonography. This finding suggests that ultrasonography can be used to diagnose limited finger joint mobility in the diabetes. Limited finger joint mobility is closely associated with diabetic chronic complications.
Objective: The purpose of this study was to evaluate the severity and frequency of osteoporosis of the foot in patients with diabetes mellitus using bone densitometry, and to determine whether plain radiologic evaluation can be used as a cheap and reliable screening of osteoporosis.
Method: We studied plain X-ray including AP and lateral views of the feet of the patients. Bone densitometry studies were performed on the feet of both diabetic and age-matched control groups.
Results: Forefoot bone densitometry scores were significantly lower in the male diabetic group compared to the control group (p＜0.05). Furthermore, the female diabetics had significantly lower bone densitometry scores for forefoot and hindfoot than the control group (p＜0.05). Bone densitometric evaluation of the diabetic patients' feet revealed scores significantly lower than those of the controls in cases which the radiologist interpreted as normal finding in plain roentgenogram alone (p＜0.05).
Conclusion: Plain radiologic studies of the feet in patients with diabetes mellitus are not effective in identifying osteoporotic change; thus, they should not be used as the screening method of diabetic foot lesions.
Objective: To assess the facial and trigeminal nerve involvement in diabetic patients using blink reflex study and direct facial motor conduction study.
Method: The subjects were 397 diabetic patients and 34 normal controls. Diabetic patients were subdivided into two groups based on the findings of nerve conduction studies of limb nerves.: Group I, patients with diabetic polyneuropathy; Group II, patients without diabetic polyneuropathy. The blink reflexes and direct facial motor responses and R1 latency/direct response latency (R/D) ratio were obtained in all the subjects. R1 latency was correlated to the findings of nerve conduction studies of limb nerves.
Results: 1) R1 latencies or R2 latencies were abnormally prolonged in 22.4% of Group I, 3.3% of Group II, and direct facial responses were abnormal in 11.8% of Group I, 2% of Group II. 2) There were no significant differences in R/D ratio between the two groups. 3) These findings suggest that not only the facial nerve, but also the trigeminal nerve or brain stem could be affected in diabetic patients with polyneuropathy.
Conclusion: In diabetic patients, blink reflex can provide useful information in determining the degree and distribution of cranial nerve and brain stem lesions.
Objective: The purpose of this study was to determine the relationship of abnormal parameters in commonly tested peripheral nerves and clinical findings in diabetic neuropathy.
Method: Parameters in tested peripheral nerves are all 18 as follows; Distal latency and amplitude of median motor, median sensory, ulnar motor, ulnar sensory, tibial motor, peroneal motor, and sural sensory (14) plus conduction velocity of median motor, ulnar motor, peroneal motor, and tibial motor (4). Person who had at least one abnormal parameter out of 18 parameters counted as abnormal group and then it was divided 3 groups depending on numbers of abnormal parameter as follows; one to two abnormal parameters as mild group, three to five as moderate group, and more than 6 as severe group.
Results: The factors which were correlated with number of abnormal parameters on nerve conduction study (NCS) were 1) duration of diabetes mellitus and 2) age of patients but not the level of HbA1c (p＜0.05). The involved nerves in the order of frequency were sural sensory (49.7%), peroneal motor (43.2%), median sensory (32.7%), ulnar sensory (31.2%), median motor (29.6%), and ulnar motor (23.1%). In persons having mild grade on NCS, amplitude of sensory nerve action potential (SNAP) was more frequently involved than distal latency of SNAP. Among the parameters, amplitude of median compound muscle action potential (CMAP), amplitude of ulnar CMAP, distal latency of ulnar SNAP and the amplitude and distal latency of tibial CMAP seemed to be less affected in diabetic neuropathy.
Conclusion: The amplitude of SNAP seemed to be valuable parameter in detection of early diabetic neuropathy.
Diabetic muscle infarction (DMI) is an unusual neuromuscular complication of diabetes mellitus. It tends to occur in young, poorly controlled, insulin dependent diabetic patient with end-organ complication. We report a 24-year-old woman with diabetic muscle infarction in both lower extremities. DMI began with an abrupt onset of pain, tenderness, swelling and formation of a firm mass. MRI revealed an increase in the signal intensity on T2 weighted image and SPECT showed an increased uptake of Tc-99m-pyrophosphate (PYP) in affected muscles. We report this case with review of the literature.
Objective: To assess the possibility of phrenic neuropathy in diabetic patients, and to define the factors that influence phrenic neuropathy in those patients.
Method: Seventeen diabetic patients and sixteen controls participated in this study. The fasting and postprandial 2 hours blood sugar levels, HbA1c study, motor and sensory nerve conduction study, pulmonary function test, and phrenic nerve conduction study were examined in all subjects. The neuropathic disability score (NDS) was measured for clinical assessment in diabetic patients.
Results: 1) The mean duration of diabetes was 12.3⁑7.7 years, and the mean NDS score was 3.2⁑3.8. 2) In pulmonary function test, FEV1 and FVC of diabetic patients were lower than controls (p＜0.05). 3) The prolonged latency and decreased amplitude of phrenic nerve were shown in diabetic patients compared with controls (p＜0.05). The FEV1 and FVC in the diabetics with phrenic neuropathy were lower than ones without phrenic neuropathy (p＜0.05). 4) The duration of diabetes, NDS are related to prolonged phrenic latency.
Conclusion: The diabetic patients with decreased pulmonary function with might be related phrenic neuropathy. The prolonged latencies of phrenic nerve were related with longer duration of diabetes and higher NDS score.
First
Prev
