To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed.
Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated.
Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05).
These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US.
Citations
Method: We investigated 28 patients with back and/or lower limb pain and weakness who were underwent lumbar spine operation. Seven patients who had undergone surgery due to spinal infection or fracture were excluded. Twenty-one patients included 7 female and 14 male patients with ages 20∼63 years, and the mean age was 44.4 years. The following data were evaluated: clinical symptoms, neurological examination, duration from operation to first visit, preoperative diagnosis, operation number and site, electrodiagnostic studies, radiologic studies (simple radiographs, epidurography, CT, MRI), and psychological evaluations (SCL-MPD).
Results: The time of the visit after the operation varied between one month and 15 years (mean 48.5 months). Electrodiagnostic study revealed lumbar radiculopathy in 18 patients and the most common level was at the fifth lumbar root. All eight patients who undergone epidurography showed filling defect or indentation. Psychologic evaluations were performed on five patients and they revealed high scores in depression and somatization.
Conclusion: Clinical and electrodiagnostic findings of lumbar radiculopathy, abnormal epidurographic findings and psychological results after lumbar disc operation were related to the causes of failed back surgery syndrome. (J Korean Acad Rehab Med 2003; 27: 388-393)
Objective: To evaluate the effect of local cooling on the parameters of electrodiagnostic study of the patients with carpal tunnel syndrome.
Method: Twenty subjects with carpal tunnel syndrome and fifteen normal subjects were enrolled. The latency and conduction velocity of median motor and sensory nerves at wrist and elbow were measured with the different skin temperature at 32oC as a baseline, and at 20oC after cooling of mid-palm area by cold water immersion.
Results: The distal motor and sensory onset latencies were prolonged, and the sensory nerve conduction velocity was decreased after local cooling in both the patients and normal control group (p＜0.01). The differences of distal motor and sensory onset latencies, and sensory nerve conduction velocity between before and after local cooling were statistically significant in patients group (p＜0.01) compared with control group.
Conclusion: These results showed that the patients with carpal tunnel syndrome reacts differently to temperature changes compared with normal control in electrodiagnostic study.
Objective: The purpose of this study was to evaluate the whole spine of the patients with chronic low back pain.
Method: The cervico-thoraco-lumbar spine were evaluated in 128 patients with chronic low back pain. We analyzed radiologic and clinical findings of the cervico-lumbar spine and electrodiagnostic findings.
Results: Most of all cases showed abnormal findings in plain radiography and electrodiagnostic study. The radiologic findings were as follow: cervical X-ray with straightening of cervical lordotic curve in 85 cases; thoracic X-ray with scoliosis in 55 cases; lumbar X-ray with disc space narrowing in 85 cases. The electrodiagnostic study revealed lumbosacral radiculopathy in 87 cases. There were significant positive relationship between increased lumbosacral angle and straightening of cervical lordotic curve, and between lumbar scoliosis and thoracic scoliosis.
Conclusion: Cervico-thoracic spinal abnormalities were shown in most of the patients with chronic low back pain. Therefore, The evaluation of whole spine would be needed comprehensive rehabilitation approach for the patients with chronic low back pain.
Benign focal amyotrophy (BFA) is a limited form of anterior horn cell disease with variable benign clinical appearance. Clinical symptoms of cold-sensitive BFA have been described but electrodiagnostic workup on these symptoms has not been done. A 28-year-old man suffering from cold-sensitive weakness and coordination disturbance of a hand underwent electrodiagnostic study while the subject was exposed to the cold. According to this study, the BFA with cold sensitivity may be classified as one type of BFA which can be confirmed by electrodiagnostic study.
Radical neck dissection(RND) has been a standard treatment for the head and neck cancer with metastasis to the cervical lymphatics. The sacrifice of the spinal accessory nerve innervating trapezius muscles creates a definite deficit of the shoulder function. Therefore, the modified radical neck dissection(MRND) preserving one or more structures of the spinal accessory nerve, internal jugular vein or sternocleidomastoid muscle was introduced to minimize the postoperative morbidities.
We studied the shoulder function by clinical examinations and electrodiagnosis for the various types of neck dissection in 39 cases of 24 patients and compared the results of each test according to the types of neck dissection.
Correlation between the clinical parameter and electrodiagnostic results showed a statistical significancy.
The functional results of trapezius muscle in the group of modified radical neck dissection were better than those of the radical neck dissection. The fact that 80% of the cases in the RND group presented incomplete denervation of the trapezius muscle, suggests the innervation of other nerves to this muscle.
Forty five percents of the cases in the MRND group which presented partial denervation of the trapezius muscle, might be due to the damages during operations.
To preserve the spinal accessory nerve, a careful manipulation of the nerve is required. Further studies including an anatomic dissection and intraoperative electrophysiologic evaluation of the trapezius muscle should be performed for the better rehabilitation outcomes.
Due to lack of evidences on the central and peripheral mechanisms of electrical stimulation in vivo, the purpose of this study was to investigate the influence of afferent stimuli, transcutaneous electrical nerve stimulation and microcurrent, on the electrodiagnostic study of normal subjects.
Electrodiagnostic study was performed before and after the application of afferent stimulion of the right popliteal fossa on 30 healthy female volunteers. After the transcutaneous electrical nerve stimulation, latencies of SEP, H-reflex, and F-wave, and H-amplitude changed significantly(p＜0.01). After the microcurrent stimulation, latencies of SEP, H-reflex, and F-wave, and motor nerve conduction velocity changed significantly(p＜0.01).
The results of this study prove that transcutaneous electrical nerve stimulation and microcurrent may cause changes of the anterior horn excitability and the conduction of the nervous system in vivo. Microcurrent may have a different mechanism of action compared to transcutaneous electrical nerve stimulation by having more localized inhibitory effects on the peripheral nerve. However, further investigation is needed to assess their mechanisms of action and the precise relevance of stimulation parameters.
The medical records of twenty-one patients with suprascapular nerve palsy were reviewed retrospectively. Nine patients had isolated suprascapular nerve lesions and twelve patients accompanied axillary nerve lesions. In trauma cases, combined nerve lesions were common and severe. In three cases isolated suprascapular nerve lesions were noted spontaneously. Isolated infraspinatus muscle lesions were noted in four cases which were due to compressions of suprascapular nerves at the spinoglenoid notch, and in one case from ganglionic cyst was diagnosed by ultrasonography. At initial examination, three patients showed complete and eighteen patients showed incomplete lesion. Eight patients with incomplete lesion and one patient with complete lesion were followed up. Seven patients with incomplete lesion showed regeneration between 1∼7 months after injury. Therefore electrodiagnostic study is necessary to evaluate severity and level of nerve lesion and regeneration.
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