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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.
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To determine which ultrasonographic measurement can be used as an indicator reflecting the severity of carpal tunnel syndrome (CTS), by comparing electrodiagnostic results with ultrasonographic measurements in females. Many previous studies have tried to reveal that the ultrasonography (US) can possibility be used for diagnosis and severity of CTS. However, the criteria are different by gender. Thus far, there have been many efforts towards providing patients with a CTS diagnosis and severity prediction using US, but studies' results are still unclear due to lack of data on gender differences.
We collected data from 54 female patients. We classified the severity of CTS according to electrodiagnostic results. Ultrasonographic measurements included proximal and distal cross-sectional areas of the median nerve and carpal tunnel.
The severity by electrodiagnostic results statistically correlated to the proximal cross-sectional area (CSA) of the median nerve and carpal tunnel. However, there was no relationship between the proximal and distal nerve/tunnel indexes and the severity by electrodiagnostic results.
In female patients with CTS, the proximal CSAs of the median nerve and carpal tunnel increase. They correlate with the severity by electrodiagnostic findings. The CSA of the proximal median nerve could be particularly used as a predictor of the severity of CTS in female patients. However, the nerve/tunnel index is constant, irrespective of the severity of CTS.
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To investigate the relationship between electrodiagnosis and various ultrasonographic findings of carpal tunnel syndrome (CTS) and propose the ultrasonographic standard that has closest consistency with the electrodiagnosis.
Ultrasonography was performed on 50 female patients (65 cases) previously diagnosed with CTS and 20 normal female volunteers (40 cases). Ultrasonography parameters were as follows: cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the levels of hamate bone, pisiform bone, and lunate bone; anteroposterior diameter (AP diameter) of the median nerve in the carpal tunnel; wrist to forearm ratio (WFR) of median nerve area at the distal wrist crease and 12 cm proximal to distal wrist crease; and compression ratio (CR) of the median nerve. Independent t-test was performed to compare the ultrasonographic findings between patient and control groups. Significant ultrasonographic findings were compared with the electrodiagnosis results and a kappa coefficient was used to determine the correlation.
CSA and FR of median nerve at the hamate bone level, CSA of median nerve at pisiform bone level, AP diameter of median nerve within the carpal tunnel, CSA of median nerve at the distal wrist crease and WFR showed significant differences between patient and control groups. WFR showed highest concordance with electrodiagnosis (κ=0.71, p<0.001).
These findings suggested the applicability of ultrasonography, especially WFR, as a useful adjunctive tool for diagnosis of CTS.
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To determine the prevalence and related characteristics of carpal tunnel syndrome (CTS) in orchardists and to investigate the association between electrodiagnostic severity and physical examinations.
Between July 2013 and September 2014, 377 subjects (174 men and 203 women) visited the Gyeongsang National University Hospital's Center for Farmer's Safety and Health. All the subjects underwent electrodiagnostic tests and physical examination, including Phalen's test, Tinel's sign, and Durkan's carpal compression test (CCT). The subjects were classified into 2 groups, the normal group and the CTS group, according to electrodiagnostic test results. To determine the related characteristics of CTS, potential variables, including age, sex, drinking, smoking, body mass index, waist circumference, and total work time, were compared between the 2 groups. The association between electrodiagnostic severity and physical examinations was analyzed.
CTS was diagnosed in 194 subjects based only on electrodiagnostic test results, corresponding to a prevalence of 51.5%. Among the variables, mean age (p=0.001) and total work time (p=0.007) were significantly correlated with CTS. With respect to the physical examinations, low specificities were observed for Tinel's sign, Phalen's test, and Durkan's CCT (38.4%, 36.1%, and 40.9%, respectively) in the subjects aged ≥65 years. In addition, Phalen's test (p=0.003) and Tinel's sign (p=0.032) in men and Durkan's CCT (p=0.047) in women showed statistically significant differences with increasing CTS severity. The odds ratio was 2.066 for Durkan's CCT in women according to the multivariate logistic regression analysis.
CTS prevalence among orchardists was high, and Durkan's CCT result was significantly quantitatively correlated with the electrodiagnostic test results. Therefore, Durkan's CCT is another reliable examination method for CTS.
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To investigate risk factors for diabetic peripheral polyneuropathy and their correlation with the quantified severity of nerve dysfunction in patients with diabetes mellitus (DM).
A total of 187 diabetic patients with clinically suspected polyneuropathy (PN) were subclassified into 2 groups according to electrodiagnostic testing: a DM-PN group of 153 diabetic patients without electrophysiological abnormality and a DM+PN group of 34 diabetic patients with polyneuropathy. For all patients, age, sex, height, weight, duration of DM, and plasma glycosylated hemoglobin (HbA1c) level were comparatively investigated. A composite score was introduced to quantitatively analyze the results of the nerve conduction studies. Logistic regression analysis and multiple regression analysis were used to evaluate correlations between significant risk factors and severity of diabetic polyneuropathy.
The DM+PN group showed a significantly higher HbA1c level and composite score, as compared with the DM-PN group. Increased HbA1c level and old age were significant predictive factors for polyneuropathy in diabetic patients (odds ratio=5.233 and 4.745, respectively). In the multiple linear regression model, HbA1c and age showed a significant positive association with composite score, in order (β=1.560 and 0.253, respectively).
Increased HbA1c level indicative of a state of chronic hyperglycemia was a risk factor for polyneuropathy in diabetic patients and a quantitative measure of its severity.
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To investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.
We retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.
Among the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).
Careful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.
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To evaluate the usefulness of various magnetic resonance imaging (MRI) findings in the prognosis of neurological recovery in paraplegics with thoracolumbar fracture using association analysis with clinical outcomes and electrodiagnostic features.
This retrospective study involved 30 patients treated for paraplegia following thoracolumbar fracture. On axial and sagittal T2-weighted MRI scans, nerve root sedimentation sign, root aggregation sign, and signal intensity changes in the conus medullaris were independently assessed by two raters. A positive sedimentation sign was defined as the absence of nerve root sedimentation. The root aggregation sign was defined as the presence of root aggregation in at least one axial MRI scan. Clinical outcomes including the American Spinal Injury Association impairment scale, ambulatory capacity, and electrodiagnostic features were used for association analysis.
Inter-rater reliability of the nerve root sedimentation sign and the root aggregation sign were κ=0.67 (p=0.001) and κ=0.78 (p<0.001), respectively. A positive sedimentation sign was significantly associated with recovery of ambulatory capacity after a rehabilitation program (χ2=4.854, p=0.028). The presence of the root aggregation sign was associated with reduced compound muscle action potential amplitude of common peroneal and tibial nerves in nerve conduction studies (χ2=5.026, p=0.025).
A positive sedimentation sign was significantly associated with recovery of ambulatory capacity and not indicative of persistent paralysis. The root aggregation sign suggested the existence of significant cauda equina injuries.
Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.
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To assess cough reflex sensitivity using the simplified cough test (SCT) and to evaluate the usefulness of SCT to screen for silent aspiration.
The healthy control group was divided into two subgroups: the young (n=29, 33.44±9.99 years) and the elderly (n=30, 63.66±4.37 years). The dysphagic elderly group (n=101, 72.95±9.19 years) consisted of patients with dysphagia, who suffered from a disease involving central nervous system (ischemic stroke 47, intracerebral hemorrhage 27, traumatic brain injury 11, encephalitis 5, hypoxic brain damage 3, and Parkinson disease 8). The SCT was performed using the mist of a 1% citric acid from a portable nebulizer. The time from the start of the inhalation to the first cough was measured as the cough latency. All the dysphagic patients underwent the videofluoroscopic swallowing study.
The cough latency was more significantly prolonged in the healthy elderly group than in the healthy young group (p<0.001), and in the dysphagic elderly group than in the healthy elderly group (p<0.001). The sensitivity and specificity of SCT were 73.8% and 72.5% for detecting aspiration in the dysphagic patients, and 87.1% and 66.7% for detecting silent aspiration in the aspirated patients.
Cough latency measured with the SCT reflects the impairment of cough reflex in healthy elderly and dysphasic subjects. The results of this study show that the SCT test can be a valuable method of screening aspiration with or without cough in dysphasic patients.
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To understand the quantitative correlation between the clinical severity and physical examinations along with the electrodiagnostic findings by subjects with carpal tunnel syndrome (CTS) and also the influence of diabetic polyneuropathy (DPN) on physical examinations by subjects with CTS.
Among 200 patients suffering from hand tingling sensations, 68 patients were diagnosed with CTS on at least one hand by nerve conduction tests. Therefore, the Phalen test (PT), hand elevation test (HET), Tinel sign (TS) results were recorded on both hands. The physical examination grades were compared with the electrophysiological CTS grades in 126 hands of 68 patients. Also the comorbidity effect of DPN to CTS was evaluated. For the evaluation of the severity correlations between CTS, PT, HET, and TS, the Spearman analysis was used. An attempt was started to create a formula which could depict the electrophysiological severity of CTS.
Out of the 68 tested subjects, 31 were diagnosed with both DPN and CTS, and 37 with CTS only. Both PT and HET correlated well with the severity of CTS where the correlation of PT was higher than that of HET. The formula were the motor distal latency (MDL)=(72.4-PT)/5.3 and MDL=(76-HET)/7.2. Both PT and HET showed in the presence of DPN a relatively higher relation with CTS without significance.
PT and HET would be useful screening tools for the diagnosis and treatment of CTS as the grade of PT and HET present the severity of CTS well. During this study, a formula was created expecting the severity of nerve conduction study with PT and HET through the time domain value of physical examinations.
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Medial antebrachial cutaneous (MABC) nerve injury associated with iatrogenic causes has been rarely reported. Local anesthesia may be implicated in the etiology of such injury, but has not been reported. Two patients with numbness and painful paresthesia over the medial aspect of the unilateral forearm were referred for electrodiagnostic study, which revealed MABC nerve lesion in each case. The highly selective nature of the MABC nerve injuries strongly suggested that they were the result of direct nerve injury by an injection needle during previous brachial plexus block procedures. Electrodiagnostic studies can be helpful in evaluating cases of sensory disturbance after local anesthesia. To our knowledge, these are the first documented cases of isolated MABC nerve injury following ultrasound-guided axillary brachial plexus block.
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To clarify the relationship of skin temperature changes to clinical, radiologic, and electrophysiological findings in unilateral lumbosacral radiculopathy and to delineate the possible temperature-change mechanisms involved.
One hundred and one patients who had clinical symptoms and for whom there were physical findings suggestive or indicative of unilateral lumbosacral radiculopathy, along with 27 normal controls, were selected for the study, and the thermal-pattern results of digital infrared thermographic imaging (DITI) performed on the back and lower extremities were analyzed. Local temperatures were assessed by comparing the mean temperature differences (ΔT) in 30 regions of interest (ROIs), and abnormal thermal patterns were divided into seven regions. To aid the diagnosis of radiculopathy, magnetic resonance imaging (MRI) and electrophysiological tests were also carried out.
The incidence of disc herniation on MRI was 86%; 43% of patients showed electrophysiological abnormalities. On DITI, 97% of the patients showed abnormal ΔT in at least one of the 30 ROIs, and 79% showed hypothermia on the involved side. Seventy-eight percent of the patients also showed abnormal thermal patterns in at least one of the seven regions. Patients who had motor weakness or lateral-type disc herniation showed some correlations with abnormal DITI findings. However, neither pain severity nor other physical or electrophysiological findings were related to the DITI findings.
Skin temperature change following lumbosacral radiculopathy was related to some clinical and MRI findings, suggesting muscle atrophy. DITI, despite its limitations, might be useful as a complementary tool in the diagnosis of unilateral lumbosacral radiculopathy.
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To evaluate the clinical significance of motor unit number estimation (MUNE) and quantitative analysis of motor unit action potential (MUAP) in carpal tunnel syndrome (CTS) according to electrophysiologic severity, ultrasonographic measurement and clinical symptoms.
We evaluated 78 wrists of 45 patients, who had been diagnosed with CTS and 42 wrists of 21 healthy controls. Median nerve conduction studies, amplitude and duration of MUAP, and the MUNE of the abductor pollicis brevis were measured. The cross sectional area (CSA) of the median nerve at the pisiform and distal radioulnar joint level was determined by high resolution ultrasonography. Clinical symptom of CTS was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ).
The MUNE, the amplitude and the duration of MUAP of the CTS group were significantly different from those found in the control group. The area under the ROC curve was 0.944 for MUNE, 0.923 for MUAP amplitude and 0.953 for MUAP duration. MUNE had a negative correlation with electrophysiologic stage of CTS, amplitude and duration of MUAP, CSA at pisiform level, and the score of BCTQ. The amplitude and duration of MUAP had a positive correlation with the score of BCTQ. The electrophysiologic stage was correlated with amplitude but not with the duration of MUAP.
MUNE, amplitude and duration of MUAP are useful tests for diagnosis of CTS. In addition, the MUNE serves as a good indicator of CTS severity.
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Method Twenty-four patients who had cervical disc herniation in magnetic resonance imaging (MRI) were evaluated. The patients were divided into 2 groups; patients with unilateral cervical radiculopathy in electrodiagnosis (RAD) and patients without definite radiculopathy (HIVD). Twenty six controls without disc herniation were also evaluated. Cervical multifidus muscles from C4-5 to C7-T1 levels were detected in T1 axial MRI, and total cross-sectional area (CSA) of multifidus muscle (TMA) and pure muscle CSA (PMA) were measured.
Results The ratios of TMA in involved side to TMA in uninvolved side (ITMA/UTMA) and PMA in involved side to PMA in uninvolved side (IPMA/UPMA) in HIVD and RAD groups was significantly lower than those in control group especially at C7-T1 level (p＜0.05). We divided the levels of cervical spine into three parts according to lesions found in MRI or electrodiagnosis; above lesion level, at lesion level and below lesion level. Abnormal cases of IPMA/UPMA were not different among levels in HIVD group, but RAD group showed that most of abnormal cases were below lesion (60%).
Conclusion Asymmetric multifidus atrophy was seen in patients with cervical disc herniation and radiculopathy. The ratio of pure muscle CSA between involved and uninvolved sides might be a useful parameter to differentiate patients with unilateral cervical radiculopathy from patients without radiculopathy.
Method Thirty-six Bell's palsy patients within four days of disease onset were recruited and disease severity was assessed using the House-Brackmann grading system on the first visit, on the second visit (14 days later) and one year later. TMS at the labyrinthine segment was performed only on the first visit, while ENoG was done on the first and second visit.
Results The amplitude ratio of magnetically evoked muscle responses between the affected side and the healthy side was correlated significantly with the clinical course and the final outcome which were documented using the House- Brackmann grade, whereas ENoG was not on the first visit. On the other hand, ENoG on the second visit was correlated significantly with the final outcome.
Conclusion In the early period of Bell's palsy, magnetically evoked muscle responses by TMS reflect neural insult more accurately than ENoG. TMS could be a useful measuring tool for the diagnosis and prognosis of Bell's palsy in the acute stage.
MethodThe adult patient who were admitted to the ICU and taken ventilator care with endotracheal intubation were included. The time after admission was 48 to 144 hours. In case of axonal neuropathy of peripheral nerve, if affected nerves were in different two limbs or different three nerves were affected, CIP was diagnosed. If some nerves got abnormal results but did not satisfied the above criteria, the patient was classified as peripheral neuropathy group. The days of using neuromuscular blockade, continuous insulin infusion, catecholamine, vasopressor, corticosteroid, benzodiazepine, parenteral nutrition and fact for continuous renal replacement therapy, SOFA (sequential organ failure assessment) score were evaluated to find the risk factors.
ResultsEighteen patients were included. Six patients were CIP and another six were peripheral neuropathy. Risk factors for CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition (p＜0.05). There was no difference on mortality rate among the three groups.
ConclusionThe result of early electrodiagnosis on ICU patients for CIP diagnosis revealed that risk factors of CIP were age, duration of intensive care, days of neuromuscular blockade and parenteral nutrition.
Method: Initial and follow up electrodiagnostic data of 100 patients who had been diagnosed as spina bifida were obtained retrospectively. Electrophysiological diagnosis and neurological level were investigated by the findings of needle electromyography. Each patients were divided into no change, improvement and deterioration group according to follow up study. The change of urodynamic study findings and clinical findings were also investigated. The recent functional outcomes and the presence of complications were evaluated by recent outpatient record.
Results: 56 patients had no change, 15 patients had improvement and 29 patients had deterioration electrophysiologically. The initial electrodiagnostic findings were associated with the functional outcomes in patients with spina bifida (p＜0.05). However, neurological level by electrodiagnostic findings cannot predict functional outcomes except ambulation activities. The change of electrodiagnostic findings of follow up study were related with the change of clinical findings statistically (p＜ 0.05).
Conclusion: Follow up electrodiagnostic study as well as initial study is necessary for the evaluation of the change of neurological states in the patients with spina bifida.
Method: We prospectively identified 322 hands from 172 subjects clinically from 5 tertiary hospitals. All subjects completed 6 clinical symptoms and 6 physical signs including 3 provocative tests. Each symptoms and signs were divided motor and sensory symptoms and signs, and the correlation between symptoms and signs and the results of motor and sensory conduction studies and needle electromyography were evaluated. The sensitivity and specificity of each valuable symptoms and signs for electrodiagnostic results were also assessed.
Results: Tingling sensation, nocturnal pain, worsening, and Phalen sign were correlated with motor conduction study, and falling tendency, abductor pollicis brevis weakness and atrophy, tingling sensation, hypoesthesia, and Tinel and Phalen signs were correlated with needle electromyography. The Phalen sign had the best sensitivity and specificity for median motor conduction study, and the best sensitive physical sign for needle electromyography.
Conclusion: Motor and sensory symptoms and signs were not correlated with motor and sensory conduction studies, but motor symptoms and signs were correlated with needle electromyography. The Phalen test was the most useful evaluating tool to diagnose CTS. (J Korean Acad Rehab Med 2003; 27: 361-368)
Objective: To assess the median nerve compression with ultrasonography before and after the carpal tunnel release and to assess the correlation between electrophysiologic findings and ultrasonographic findings of the median nerve.
Method: We studied 50 hands of 29 patients diagnosed as carpal tunnel syndrome electrophysiologically and 20 hands of 19 asymptomatic controls. We evaluated the flattening ratio and compression ratio through the short axis and long axis of the median nerve by ultrasonography before carpal tunnel release, 2 weeks and 3 months after release. The correlation of the
improvement between the eletrophysiologic findings and compression ratio was analyzed.
Results: The compression ratio of the median nerve was decreased significantly after carpal tunnel release, compared with that before release. The decrease of the compression ratio correlated with the improvement of the electrophysiologic findings significantly.
Conclusion: The ultrasonography is useful to follow up the median nerve after carpal tunnel release. (J Korean Acad Rehab Med 2002; 26: 172-176)
Objective: To evaluate the usefulness of the diagnostic ultrasound (US) to diagnose carpal tunnel syndrome (CTS) and the correlation between electrodiagnosis and US findings.
Method: Forty hands of 30 patients diagnosed with CTS by electrodiagnosis and 28 hands of 19 controls were examined with US. The 7.5 MHz probe of the US was used to view the median nerve in the carpal tunnel. The short and the long axis and the area at the two points, 2 cm proximal and 1 cm distal to the distal wrist crease were measured. The flattening and compression ratio and the ratio of the area in both groups were analysed. The correlation between the eletrodiagnostic severity and compression ratio were analyzed.
Results: The compression ratio of CTS was significantly increased comparing with that of control group. The compression ratio of severe CTS was significantly increased comparing with that of mild and moderate CTS.
Conclusion: These results suggest that US is useful in diagnosis of CTS.
Objective: To investigate the influence of electronic filter setting change on the parameters of motor and sensory nerve conduction studies.
Method: Median motor and sensory nerve conduction studies were performed in 25 neurologically healthy adult subjects with a mean age of 29 years (range, 20∼50). Compound muscle action potentials (CMAPs) and sensory nerve action potentials (SNAPs) were recorded after fixing the low frequency filter cutoff value of 1 Hz, 10 Hz, 100 Hz and 300 Hz and by changing high frequency filter cutoff level from 10 KHz to 0.5 KHz. Onset and peak latency, amplitude of CMAPs and SNAPs were measured and the area of CMAPs were also recorded. Dantec Counterpoint MK2 machine was used. Skin temperature was maintained at 34oC or above.
Results: As the high frequency filter was changed from 10 KHz to 0.5 KHz, the mean amplitude of SNAPs and CMAPs decreased by 33.5%, 3.3%, respectively. Onset and peak latency prolonged significantly below the high frequency filter level of 2 KHz (p＜0.01). When the low frequency filter was varied form 1 Hz to 300 Hz, large differences were seen in amplitude (69.7%) and area (86.5%) of CMAPs and amplitude of SNAPs (36.6%) (p＜0.01), but onset latency was not changed. Peak latency of CMAPs decreased by 20.8%, however, the peak latency of SNAPs reduced slightly (1.4%) (p＞0.01).
Conclusion: Significant alterations in parameters of CMAPs and SNAPs were produced by modification of filter setting. Optimum filter setting is recommended in nerve conduction study and filter parameters must remain constant when determining normal values and when performing serial studies on patients.
Objective: To evaluate the clinical and electrodiagnostic findings of ulnar neuropathy at the elbow.
Method: Sixty-two patients with ulnar neuropathy at the elbow were reviewed retrospectively to establish causes, severity and type of neuropathy, symptom, sign, operation name and operative findings.
Results: 1) Of total 62 cases, 41 were male and 21 were female and the most often were in their forties and fifties. 2) The main cause of the neuropathy is bone deformity caused by previous fracture or dislocation (43.6%). 3) The symptoms observed were motor weakness (66.1%), sensory change (79%) and muscle atrophy (35.5%). 4) Forty-nine cases showed abnormality in nerve conduction study and needle electromyography study, and 9 cases showed abnormality only in the needle electromyography study. 5) On needle electromyography, sparing of flexor carpi ulnaris was shown in 50 cases (80.6%). 6) Operative treatment was performed in 15 cases. Among them, electrodiagnostic and operative diagnosis coincided in only 12 cases (80%).
Conclusion: We conclude that above clinical and electrodiagnostic findings are useful for the diagonosis ulnar neuropathy at the elbow with consideration of etiology, localization and for the selection of operative treatment.
Objective: Carpal tunnel syndrome (CTS), a common entrapment neuropathy of the median nerve at the wrist, can be diagnosed clinically and electrophysiologically and treated successfully. The purpose of this study was to determine an association between clinical findings and the electrodiagnostic severity of this syndrome.
Method: Medical records of 313 patients with CTS which was confirmed based on clinical and electrophysiological findings were reviewed. Clinical symptoms and signs (thenar atrophy, sensory change, positive Tinel sign and Phalen test) and electrodiagnostic values were recorded. CTS severity was determined according to the modified Stevens' criteria. The relationship between electrodiagnostic severity and clinical findings was investigated and statistically analyzed using the ANOVA and chi square tests.
Results: The median motor and sensory latencies became prolonged and amplitudes decreased with worsening electrophysiological severity of CTS, and the differences between severity groups were statistically significant. The frequency of symptoms and signs obtained was significantly greater in the more severe CTS groups.
Conclusion: A positive correlation exists between the frequency of clinical findings and electrophysiological severity of CTS.
Objective: To know the category, incidence, severity and clinical correlation, we evaluate the patient with neuropathy due to electrical burn on the basis of the electrodiagnostic findings and clinical feature.
Method: We reviewed the electrodiagnostic findings of 30 patients who had been referred for the evaluation of the neuromuscular symptoms due to electrical burn. The clinical factors such as the input and output of the electrical current, current pathway, associated injury, neuromuscular symptoms and signs were investigated by the chart review and phone interview.
Results: 1) The 67% of the cases had the peripheral neuropathy and the 40% had the central nervous system lesion. 2) The median nerve was the most frequent injured nerve by electrical burn and then ulnar nerve was the next. 3) The 82% of the mononeuropathies were related to the entrance site of the electricity and the 35% were related to the exit site. 4) The central nervous system lesion was highly correlated with the current pathway through the head.
Conclusion: The mononeuropathy, one of the peripheral neuropathies is closely related to the entrance and exit site of electrical injury. The central nervous system lesion was highly related to the current pathway through the head.
We report a case of clinical features corresponding to Eosinophilia-Myalgia syndrome, with no causal relationship with L-tryptophan. Since the epidemic of L-tryptophan associated Eosinoghilia-Myalgia Syndrome in 1989, only 2% of the cases were found not to be related to L-tryptophan in America.
We believe that this is the first case report of Eosinophilin-Myalgia Syndrome not related to L-tryptophan in Korea.
Objective: To document the neurological recovery of the preganglionic lesion of brachial plexus, both clinically and electrodiagnostically.
Method: Sixteen male and three female patients were evaluated. Ages of the patients ranged from 1 to 45 years with the mean age of 25.2⁑14.3 years. We studied retrospectively the improvements of 43 injured nerves and its innervated muscles of 19 patients retrospectively according to the complete or incomplete nature of the injuries by the electromyographic findings. We compred the results of initial and final examinations by the electromyographic and clinical findings including a muscle strength test.
Results: In the complete injuries, 84.0% of the cases showed a minimal or no improvement in muscle strength whereas in the incomplete injuries, 88.2% of the cases showed a greater than moderate improvement in muscle strength.
The cases in which no compound muscle action potential could be evoked on the initial study, showed the improvements of greater than 3/5 muscle strength only in 20.0%. However 71.5% of cases with the initial amplitude between 0.1 & 0.5 mV and 100.0% of cases with the initial amplitude greater than 0.5 mV showed the muscle strength greater than 3/5.
Conclusion: The prognosis for the neurological recovery was significantly poor in the complete preganglionic lesions of brachial plexus injuries but in the incomplete lesions, the prognosis was extremely good. It would be crucial for the initial CMAP being greater than 0.5 mV to expect the recovery of muscle strength to the functional level. Rehabilitative or operative management should be instituted based on the electrodiagnostic findings.
The F wave has been thought to be useful in assessing the proximal neuropathy such as radiculopathy. However the sensitivity of F wave in radiculopathy is varying from 18% to 65%. The aim of this study is to compare the relative diagnostic value of 20 averaging technique and 20 sequential stimulation technique in recording the F waves and to determine the usefulness of F wave for the evaluation of radiculopathy.
Animals employed were rabbits that were divided into a study group of 17 rabbits(31 legs) and control group of 14 rabbits(25 legs). In the study group, the sciatic nerve was exposed after the dissection of gluteus maximus muscle and the nerve trunk was traced up to reach the spinal canal level. One of the two nerve roots composing the sciatic nerve was dissected randomly. F wave parameters were measured using both of 20 averaging technique and 20 sequential stimulation technique.
The parameters which showed significant change after the root dissection were the amplitude by employing 20 electronic averaging technique, and mean latency, minimal latency, mean amplitude by employing 20 sequential stimulation technique.
We concluded that 20 electronic averaging technique had no benefit over the 20 sequential stimulation technique and F wave measurement was not useful for the electrodiagnosis of radiculopathy because of the wide range of control values.
Vasculitis is a clinico-pathological process characterized by inflammation and necrosis of blood vessels. The clinical spectrum ranges from a primary disease process restricted to blood vessels in the absence of an underlying disease to a secondary component of the primary disease. We experienced a case of polyarteritis nodosa who complained of progressive pain and weakness in back and lower extremities. Polyarteritis nodosa should be considered as one of the causes of pain and weakness in back and extremities.
Twelve patients with lumbar arachnoiditis were investigated by means of magnetic resonance imaging. The results showed three groups of different anatomic features: The group I showed conglomeration of nerve roots residing centrally within the thecal sac. The group II demonstrated clumped nerve roots attached peripherally to the meninges. The group III showed increased soft tissue signal within thecal sac. The overall clinical manifestations and electromyographic findings were also investigated; Ten(83%) patients complained of increased, non-radicular, leg pain with activities, such as standing or walking. There were muscle spasms and cramps in the legs in seven(58%). There appears to be no specific clinical and electromyographic findings characteristic to each of the three groups, except that the group III showed more prominent clinical symptoms than those of the other two.
In conclusion, MRI is useful in establishing the diagnosis of lumbar arachnoiditis, as well as seperating three different anatomic features. And we found that increased, non-radicular pain with activities and muscle spasms and cramps appeared to be characteristic to lumbar arachnoiditis, and the group III showed more prominent clinical symptoms than the other two groups.
Early diagnosis of cerebral palsy may help to provide early therapeutic intervention.
The early treatment of cerebral palsy is critical in the prevention of deformity and promotion of normal movement patterns. However, it is difficult to identify those who are at substantial risk of cerebral palsy before the age of one, particularly in its mild and moderate forms. The purpose of this study was to analyze and establish an efficient early diagnostic tool for cerebral palsy. The subjects in this study were 247 infants selected from outpatients at the Rehabilitation Hospital of Yonsei University from December, 1987 to March, 1996. The infants had problems in motor development or a past history of perinatal risks and all were under one year of corrected age.
The assessments included a structured developmental history taken from the child's parents, evaluation of motor development status, and neurological examiniations including assessment of muscle tone, several primitive reflexes and Vojta's postural reactions. These infants were assessed every 2∼3 months. According to the findings of developmental milestones, muscle tone, and Vojta's postural reactions, we divided the patients into high and low risk groups.
The final diagnosis confirmed that 126 children had cerebral palsy, 43 children had other diagnoses while 78 children turned out to be normal.
We found that diagnosis of cerebral palsy during the first six months of postnatal period relied mainly on abnormal muscle tone, Vojta's postural reactions, developmental motor delay, a positive finding of asymmetric tonic neck reflex and a negative finding of optical righting reaction. The sensitivity and specificity of the evaluation methods were 91.1% and 66.7%, respectively in the first six months of postnatal period.
In conclusion, we have proved that the delayed motor development, abnormal muscle tone and abnormal Vojta's postural reactions are very valuable tools for the early diagnosis of cerebral palsy.
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