Electromyographic Examination Research Articles

Changing the concept of surgical treatment of the brachial plexus traumatic injuries

Objective: the objective of this study was to retrospectively analyze the change in the surgical strategy (SS) of brachial plexus injuries (BPI), the outcomes of different SS and the factors that influenced the establishing process of a new SS in a single surgical centre in Kyiv, Ukraine. Materials and Methods. 148 patients (mean age 29.5) received 76 neurolysis (N), 14 grafting (G) and 58 nerve transfer (NT) surgeries after a mean 7.4 months following BPI. 29 patients received NT of n. phrenicus, 7 –ulnar nerve fascicles, 9 – lateral pectoral nerve, 7 – medial pectoral nerve to musculocutaneous nerve aimed to restore active elbow flexion. Six other patients received NT of ipsilateral extraplexal motor nerves. The follow-up period included neurological examination (MRC Scale), electromyographic examination and angular deviation in the elbow joint during recovered active elbow flexion. 148 patients were retrospectively divided into two groups A (102 patients, received surgeries from surgical team #1) and B (46 patients, received surgeries from surgical team #2). The SS used in each group and its change with time was analyzed during the 6-year span. Results. 41 patients (70.7%) showed recovery of effective power (Ep) (M4-5) of biceps brachii muscle (BB) after NT. 14 patients (18.4%) showed recovery of Ep of BB after N. 4 patients (28.6%) showed recovery of Ep of BB after G. Overall Group A patients received 55 NT, Group B – 3 NT. The number of NT among Group A patients increased in 2013-2019 from 31% to 100% with overall efficacy of NT increased from 50% to 83%. Conclusions. SS of BPI changed only for Group A patients – N was completely replaced by NT in 2019. For Group B patients N remained SS of choice. The establishing of new SS was influenced by four factors (time, anatomy of injury, donor nerves, radiological findings). The factors being processed, allowed us to define optimal time, effective donors and non-reliability of radiology at BPI. We state that it is only matter of own experience, based on the thorough analysis of the technique, that brings positive outcomes after new SS has been adopted.

Muscle activity alternations in preadolescent swimmers with shoulder pain

Background. Shoulder pain is the most often declared musculoskeletal injury among swimmers. It evolves due to overuse injuries and/or functional disorders, which may result from neuromuscular control deficits. The aim of this study was to check the epidemiology of shoulder pain in preadolescent swimmers and to check the muscle activity of serratus anterior and upper trapezius muscles comparing two groups of athletes. Material and methods. 22 swimmers from one team were divided in two groups: those with the history of shoulder pain and those without any previous syndromes. After functional examination of the shoulder region, we performed surface electromyography examination during the shoulder flexion in scapular plane. Results. 27% of the whole group reported at least one episode of shoulder pain. Con­cerning electromyography examination, we observed increased serratus anterior activity in symptomatic group (p-value=0,0245) Conclusions. 1. Preadolescent swimmers aged 10-14 present previous episodes of the shoulder pain but its prevalence is lesser comparing to the adult athletes. 2. Previous pain episodes may alter the electromyographic recording and may be considered as a protective mechanism but they can also change the shoulder mechanics.

Review of needle electromyography complications in thrombocytopenic cancer patients.

Needle electromyography (EMG) is understood to be a relatively safe procedure based on clinical experience. There are no evidence-based guidelines for EMG procedures in thrombocytopenic patients. The purpose of this study was to determine whether there is an increased risk of bleeding complications associated with needle EMG in patients with thrombocytopenia. This retrospective study included patients with a primary cancer and thrombocytopenia who underwent needle EMG between January 1, 2016 and October 30, 2020. Patients' medical records were reviewed for demographics; diagnoses; platelet counts within a 7-day period of EMG examination; concurrent use of anticoagulants or antiplatelet medications; number of sites sampled by needle EMG, including anatomical differentiation of paraspinal and both deep and superficial limb muscles; and associated complications not limited to bleeding within 30 days of EMG examination. The initial data search identified 198 patients with a documented diagnosis of thrombocytopenia; 124 met these criteria and were included in the study. A total of 1001 muscle sample sites were documented, with 111 sites in paraspinal muscles, 876 sites in superficial limb muscles, and 14 sites within deep limb muscles. Five patients were concurrently using therapeutic anticoagulation and 3 were using antiplatelet medications. There were no clinically significant complications, but five minor incidents were documented in the medical records within 30 days post-EMG examination. Our findings suggest that bleeding complications from standard needle EMG in oncology patients with documented thrombocytopenia are rare. Testing of high-risk muscles in this patient population appears to be safe.

Electromyography of Extrinsic and Intrinsic Ear Muscles in Healthy Probands and Patients with Unilateral Postparalytic Facial Synkinesis.

There are currently no data on the electromyography (EMG) of all intrinsic and extrinsic ear muscles. The aim of this work was to develop a standardized protocol for a reliable surface EMG examination of all nine ear muscles in twelve healthy participants. The protocol was then applied in seven patients with unilateral postparalytic facial synkinesis. Based on anatomic preparations of all ear muscles on two cadavers, hot spots for the needle EMG of each individual muscle were defined. Needle and surface EMG were performed in one healthy participant; facial movements could be defined for the reliable activation of individual ear muscles’ surface EMG. In healthy participants, most tasks led to the activation of several ear muscles without any side difference. The greatest EMG activity was seen when smiling. Ipsilateral and contralateral gaze were the only movements resulting in very distinct activation of the transversus auriculae and obliquus auriculae muscles. In patients with facial synkinesis, ear muscles’ EMG activation was stronger on the postparalytic compared to the contralateral side for most tasks. Additionally, synkinetic activation was verifiable in the ear muscles. The surface EMG of all ear muscles is reliably feasible during distinct facial tasks, and ear muscle EMG enriches facial electrodiagnostics.

Significance of Pure Sensory Manifestations in Estimating Electromyography Results in Cervical Radiculopathy

Background: The sensitivity of electromyography (EMG) in cervical radiculopathy (CR) is reportedly higher in patients with objective neurological findings, but many patients are sent to the EMG laboratory with only pain and paresthesias. Aims: We aimed to assess the diagnostic contribution of EMG in patients with sensory manifestations without objective neurological deficits. Settings and Design: The files of patients with neck pain radiating to the shoulder and arm on the same side referred to the EMG Laboratory were retrospectively evaluated. EMG findings of those with pure sensory manifestations were compared with the results obtained from patients with objective neurological deficits. Subjects and Methods: Patients with subjective sensory manifestations were separated into two groups according to the specificity of the presenting symptoms, who were compared with subjects with neurological findings in the upper extremity. Clinical diagnoses of the patients were compared with the electrodiagnostic testing results. Statistical Analysis: Categorical variables were analyzed with multi-span Chi-square test, while individual groups were compared utilizing Fisher's exact test. One-way analysis of variance was employed to assess the significance of group differences for quantitative values. Results: EMG rarely confirmed CR in patients with purely sensory symptoms. Some of these patients were found to have unexpected peripheral neuropathy syndromes. Both paraspinal and limb muscle EMG abnormalities indicative of CR were not only more common, but also helpful in localization in patients with objective clinical findings. Conclusions: CR patients presenting only with pain and paresthesias even in a specific dermatomal distribution usually demonstrate no abnormalities in EMG examination. However, some of these patients harbor unsuspected entrapment neuropathies.

Profile Of Children With Guillan Barre Syndrome In RSUP Haji Adam Malik Medan: Events In 5 Years

Background : Guillain-Barr? syndrome (GBS) is an acute demyelinating disease of the peripheral nervous system characterized clinically by flaccid paralysis. The mortality rate in children is about 3-5%. Early diagnosis and therapy important for patient's prognosis. Objective : The aim of this study was to acquaint the profile of children with Guillain-Barr? syndrome at the RSUP HAM Medan Hospital from 2016 to 2020. Methods : This study is a descriptive study with a retrospective design. The population and sample with total sampling of the children with GBS diagnosed at the HAM Medan Hospital recorded in the medical record from January 2016 to December 2020. The data were analyzed univariately and presented with a frequency distribution. Results: From this study, 41 children with GBS were found. There were 18 children (43.9%) with age between 10-14 year (female was 22 people (53.7%). Based on the Brighton Criteria for GBS children, most of the children was on level 2 that were 35 people (85 ,4%). From the results of the EMG (Electromyography) examination in GBS children, 24 people (58.5%). had the most types of GBS were Acute Motor Axonal Neuropathy (AMAN). There was no cytoalbumin dissociation was found on CSF analysis. Mostly 28 people had supportive therapy, that was the most used type of therapy. The disability scale shows that children who can walk with the help of a cane or supporting equipment (disability scale 3) was 26 people (63.4%). Based on the length of stay in the hospital, 26 children (63.4%) were treated for 8-14 days. Conclusion: Majority the case of GBS in the RSUP HAM Medan was similar previous studies. Our results can be used as baseline data for understanding the characteristics of GBS in Indonesia.

Russian-language dictionary of terms used in clinical electromyography and ultrasound examination of the neuromuscular system

Modern electrodiagnostics (ED) and ultrasound examination of the neuromuscular system dictates the need to use unified terminology in order to avoid inter-expert variability in describing the results of the study and drawing up a conclusion in accordance with international criteria. The results of a survey of clinical electromyography specialists and the methodology of translation of the latest version of the English-language glossary on electrodiagnostic medicine are presented.The purpose of the publication is to popularize the use of modern nomenclature among the professional community. An anonymous survey was conducted on the use of the most common terms ED. The translation of the latest English-language version of the glossary on ED and ultrasound examination of the neuromuscular system was carried out, followed by editing and discussion by an expert group. 236 people from 68 cities of Russia and neighboring countries took part in the survey. The survey results demonstrated maximum disunity, as well as conservatism in the use of terms. The nomenclature of ED terms was first compiled in 1980 by the American Association of Electromyography and Electrodiagnostics and subsequently regularly revised and supplemented in accordance with new data. The unification of terms is necessary for the standardization of conclusions, multicenter research and scientific publications.

Assessment of the bioelectric activity of the masticatory muscles in orthopedic treatment with partial removable plate prostheses

Relevance. According to a number of authors, it is known that full adaptation to complete removable dentures occurs within 3 months [3–5, 9]. The main criterion for patients getting used to removable dentures is the synchronization of the work of the masticatory muscles and, as a consequence, the normalization of the chewing function. The aim of the study was to evaluate the bioelectrical activity of the masticatory muscles in patients using the CSPP.Materials and methods. In patients of the control (n = 23) and main (n = 63) groups, electromyographic examination was performed using the electroneuromyographic system "Synapsis" (Neurotechnology, Russia). Registration of the bioelectric activity of the chewing muscles was carried out directly on the day of applying the prostheses, after 1 and 3 months, respectively.Results and discussion. The electromyographic indices of the masticatory muscles in the patients of the control group decreased within one month after the treatment and amounted to 231 ± 18.2 μV for the right and 229 ± 16.1 μV for the left proper chewing muscles. The values were also reduced for the right and left temporal muscles – 228 ± 15.2 μV and 225 ± 24.1 μV (p < 0.05). It should be noted that the electromyographic parameters in patients of the main group were comparable to the lower limit of the norm and amounted to 269 ± 16.5 μV and 256 ± 20.4 μV, respectively, after one month of treatment.Conclusions. In the treatment of dysfunction of the temporomandibular joint with the use of thermoplastic prostheses, an increase in the biopotentials of the masticatory muscles is observed. In the orthopedic treatment of patients with terminal dentition defects using thermoplastic prostheses, the electromyographic parameters of the masticatory muscles are most close to normal after 3 months of using these prostheses.

Paraneoplastic Optic Neuropathy as an Initial Clinical Manifestation of Small Cell Lung Cancer. A Case Report

Paraneoplastic optic neuropathy (PON) is a very rare condition. In this study, a case of PON is presented, with the first complaint by the patient being painless vision loss in one eye. In the follow-up of our case, optic neuropathy developed in the fellow eye. Electromyography examination performed due to diffuse body pain and motor loss in the left extremity was compatible with peripheral sensorimotor polyneuropathy. Lung biopsy was planned due to the EMG result and lymphadenopathy detection in thorax computed tomography (CT). The biopsy result of the patient was reported as nonspecific hyperplasia. As the patient’s complaints increased, a paraneoplastic antibody panel was requested and CV2 / CRMP5 antibody was found to be positive. Thereupon, as a result of the repeated biopsy, our patient was diagnosed with small cell lung cancer. We think that paraneoplastic optic neuropathy should be considered in the differential diagnosis in patients of advanced age, smokers, painless subacute vision loss, optic disc swelling, and research in this direction should be insisted on, as in our case.

Ultrasound-guided five-point injection of botulinum toxin for patients with trapezius hypertrophy

ObjectivesOur study aimed to explore the clinical therapeutic effects of ultrasound-guided five-point injection of botulinum toxin type A for patients with trapezius hypertrophy.MethodsTwenty female patients diagnosed with trapezius hypertrophy were enrolled in this study. The thicknesses of the trapezius muscle were measured by using the ultrasound scanner to locate the thickest point of trapezius, followed by labelling the other four points around the first point. Botulinum toxin type A was injected bilaterally (50 IU/side, 5 points/side) in the trapezius muscle of these patients. The surgery effects were evaluated by thicknesses of the trapezius muscle, intramuscular needle electromyographic and electroneurographic examinations, appearance changes and patients’ satisfactions.ResultsStatistically significant differences in thicknesses of the trapezius muscle were observed at 4 weeks (p < 0.001), 12 weeks (p < 0.001), 20 weeks (p < 0.001), 28 weeks (p = 0.011), 36 weeks (p = 0.022), and 44 weeks (p = 0.032) after surgery. The latencies of trapezius muscle became longer at 12 weeks after surgery (left: 2.40 ms, right: 2.53 ms vs. left: 1.75 ms, right: 2.00 ms). Electroneurographic results showed amplitude reduction of compound muscle action potentials (CMAPs) at 12 weeks after surgery (left: 1.91 uV, right: 3.10 uV vs. left: 15.00 uV, right: 15.40 uV). Obvious appearance changes were revealed at 12 weeks after surgery. All of 80% patients were very satisfied, 15% patients were relatively satisfied, and 5% patients were not satisfied with the surgery.ConclusionUltrasound-guided five-point injection of botulinum toxin type A might be effective for patients with trapezius hypertrophy.

CLINICAL-NEURO-PHYSIOLOGICAL CHARACTERISTICS OF MYOFASCIAL PAIN SYNDROME IN A PATIENT WITH LEFT HEMYPLEGIA AFTER INTRACEREBRAL HEMORRHAGIC STROKE

Myofascial pain syndrome (MFPS) is one of the most common comorbid pathological processes that develops in skeletal muscle in patients with stroke, which is manifested by local seals and pain in various parts of the muscle. Despite the fact that the interest in MFPS arose in the last century, the intimate mechanisms of its development and course remain to be fully explored. It was found that the main manifestations of MFPS were the presence of miofascial trigger point in the area of palpation of the corresponding muscle with local pain and hypersensitivity within the palpated cord-segmentes, the characteristic pattern of reflected pain and reflected autonomic phenomenon, local convulsive response during transverse palpation. It is accompanied by muscle fatigue and significant muscle weakness without severe atrophy. Attention is drawn to the clear recurrence-reproducibility of pain, ie the so-called "recognizable" pain. All of the above symptoms constitute a general pattern of the disease, which has diagnostic value and is proposed for use as prognostic parameters with the obligatory use of the results of electromyographic examination. Diagnosis of active and latent MTP was performed on the basis of generally accepted l signs. The greatest discomfort for the patient is the presence of active MTP with characteristic spontaneously reproducing pain. Latent MTP is detected in up to 90% of cases among healthy people, and adverse factors only contribute to their transition to an active state with a characteristic symptom complex. The presence of an active myofascial trigger point with a characteristic spontaneously reproducing pain is the most painful manifestation. Latent MTP is also detected in most cases among healthy people, and unfavorable factors only contribute to their transition to an active state with a characteristic symptom complex. The study of the number of turns of the adhesive part of the potential in the zone of active ICC showed that there is a concentration of fibers in the zone of one motor units (MU). The average value of this indicator increases in the early stages of the process by 2 times. Even a small degree of desynchronization of the potentials of individual MU causes an increase in the number of rounds, which reflects the number of fibers involved in the generation of MC PMU.&#x0D; Absence of spontaneous muscle fibers (MF) activity, registration of end plate (EP) activity, PMU parameters such as amplitude decrease, shift of neurohistogram of potential distribution by duration towards smaller values or high percentage of polyphasicity, due to increase in number of turns, and also change their adhesive part, increase of MF density in zone MTP - they all determine changes in structural and functional parameters by muscle type. The work is devoted to the clinical, neuro-physiological characteristics of a patient with MFPS on the background of intracerebral hemorrhage and left hemyplegia based on the analysis of the neuro-functional organization of the motor units of the back muscles. Substantiated genesis and possible mechanism of development and formation of myofascial trigger point in such patients.

Electromyography in Congenital Zika Syndrome.

Congenital Zika virus syndrome is a distinct pattern of birth defects in fetuses infected by the Zika virus. It presents a broad clinical spectrum that includes occurrences of microcephaly, hypertonia, dysphagia, hyperexcitability, seizures, and arthrogryposis. Imaging findings show neuronal migration disorders. Case reports have suggested that arthrogryposis has a neurogenic cause. We analyzed needle electromyography and nerve conduction examinations on 77 patients aged 2-24 months presenting highly probable congenital Zika virus syndrome, with or without arthrogryposis. All those with arthrogryposis presented with chronic muscle denervation in the electromyography examination. Similarly, children with single or reversible joint abnormalities at birth showed the same findings. Denervation in the paravertebral musculature was found in all of the children with diaphragmatic paralysis or thoracic deformities. We propose that congenital contractures associated with congenital Zika virus syndrome are caused by the malformation of upper and lower motor neurons during embryogenesis.

Nerves Transfer Procedure in Patients with Left Upper Extremities Weakness Following Gunshot Wounds: A Case Report

BACKGROUND: Gunshot wounds (GSWs) to the extremities can result in damage to the neurovascular structure which results in high morbidity and loss of function. According to the Centers for Disease Control report, the incidence of non-fatal GSWs has increased in the past decade. Trauma to the brachial plexus is a type of peripheral nerve trauma that is most difficult to treat due to its complex surgical procedures. Early exploration and reconstruction of peripheral nerve trauma are still being debated to this day. However, most recommend surgical exploration when the suspicion of neurovascular trauma is very high based on clinical findings. Nerve transfer is one of the recommended methods of nerve reconstruction even in pre-ganglionic lesions. We report a case of a patient with weakness of the upper limb after a gunshot wound to his left shoulder. Based on clinical considerations and investigations, nerve transfer procedure is carried out to restore patient’s shoulder function. CASE REPORT: Male, 32 years old, working as a policeman, complained difficulty on moving his shoulder for 3 months. Patients had a history of GSWs to the left shoulder which also results in a left clavicular fracture. First aid, debridement, and fracture management were performed at Bhayangkara Hospital, Palu. Physical examination revealed winging scapula positive on his left shoulder, shoulder abduction 5/1, and hypoesthesia at left C5 level. Electromyographic examination revealed lesions on the left posterior chord and left brachial plexus. Based on clinical findings and supporting examination, we performed nerve transfers procedure from the accessory nerve to suprascapular notch. In the previous study, 63% of cases GSWs associated with nerve dysfunction. About 75% of patients with nerve palsy are associated with nerve lacerations during surgical exploration. However, many surgeons continue to recommend early exploration after GSWs to the upper extremities, especially in patients who will undergo surgical treatment for other indications. Based on this, we suggest the probable cause of brachial plexus lesions in this case resulted from gunshot wound which injures the brachial plexus or as a complication from previous procedures. Surgery that is too early can interfere with the spontaneous reinnervation process, but late surgical procedures can result in failure of reinnervation. In general, optimal time is set between 3 and 6 months after trauma. Nerve transfer is one method of reconstructing peripheral nerve lesions that can be applied to pre-ganglionic or post-ganglionic lesions. CONCLUSION: This procedure has several benefits, namely, the proximity of the donor and the recipient nerve anatomy, shorter operating time and does not require grafts. Brachial plexus trauma due to trauma or non-trauma together has an impact on the patient’s quality of life. However, advances in surgical techniques and further understanding of nerve physiology have led clinicians and patients to better outcomes. The current trend of treatment strategies for brachial plexus trauma is surgical reconstruction with the nerve transfer procedure.

Relevant muscle selection for needle electromyography examination in polio survivors

Objectives: Needle electromyography (EMG) has an important role in the diagnosis of poliomyelitis. Since needle EMG is a painful and time consuming procedure, selecting the most effective muscles for needle EMG is important. We aimed to determine the clinically or subclinically affected regions in polio survivors by examining the minimum number of muscles with EMG. Methods: Polio survivors with weakness in at least one limb were included in this retrospective cohort study. The extremities were divided into two groups: 1) Group 1: The extremities with Medical Research Council score of ≤ 1 in at least one muscle, 2) Group 2: Clinically unaffected or mildly to moderately affected extremities that do not meet the criteria of Group 1. The needle EMG findings of the muscles were analyzed. Results: Twenty-nine polio survivors were included in the study. Needle EMG findings of 352 muscles were reviewed. Needle EMG findings in 57 lower extremities and thirty-two upper extremities were analyzed. There was no upper extremity meeting the criteria of Group 1. Thirty-eight lower extremities were included in Group 1. The amplitudes and durations of motor unit action potentials (MUAPs) were not different between the muscles of the Group 1 lower extremities (p &amp;gt; 0.05). Among the muscles of Group 2 upper and lower extremities, the amplitude and duration of MUAPs were higher in the deltoid and the vastus lateralis muscles compared to the other muscles, respectively (p = 0.002 and p = 0.003 for upper extremity muscles; p = 0.005 and p &amp;lt; 0.001 for lower extremity muscles). Conclusions: Using the needle EMG findings, an algorithm was made to determine the affected regions. Thus, the affected regions can be identified by applying needle EMG to a minimum number of muscles.

Asymmetrical activation and asymmetrical weakness as two different mechanisms of adolescent idiopathic scoliosis

There have been many studies on adolescent idiopathic scoliosis related abnormal muscle contractions of the spine. However, previous studies using surface electromyography to investigate paraspinal muscle asymmetry are controversial, lacking in clarity of results, and hindered by methodological limitations. The purpose of this study was to investigate the relationship between imbalance factors including surface electromyography activity according to the scoliosis curve type and leg length discrepancy and adolescent idiopathic scoliosis curve types. Seventy-nine patients with scoliosis were prospectively enrolled and were divided into five types: single thoracic, thoracolumbar, lumbar, double thoracic, and double major. Cobb angle and structural variables were measured. Surface electromyography examinations were conducted at the 7th, 12th thoracic erector spinae, 3rd lumbar erector spinae, and multifidus muscles during the superman position keeping prone spinal extension to lift the arms and legs off the floor. Whole spine radiographs were obtained to measure the Cobb angle, coronal imbalance, pelvic height and angle, and femoral head height. In the double major, thoracolumbar, and lumbar types, the mean root mean squared (RMS) EMG amplitudes were significantly higher on the convex side than the concave side (P < 0.005). In the DM type, the mean RMS EMG amplitudes of EST7 and ESL3 where the apex was located were significantly higher at the convex side than those of the concave side (P < 0.005, effect size (Cohen’s d) for EST7/ESL3: 0.517/0.573). The TL and L types showed a similar pattern. The mean RMS EMG amplitudes of the EST12 concave side and MuL3 and ESL3 concave sides were significantly lower than those of the convex side in the TL and L types, respectively (P < 0.008, effect size (Cohen’s d) for EST12/MuL3/ESL3: 0.960/0.264/0.448). Conversely, there were no significant differences in the single thoracic and double thoracic types. All structural variables (coronal imbalance, pelvic height and angle, and femur head height) were higher in the lumbar type, but only coronal imbalance was significantly different (P < 0.05). Different patterns of asymmetry of paraspinal muscles and structural variables were described based on the curvature of the spine. L type showed that EMG activity was asymmetric in the paraspinalis muscles where the apex was located and that structural asymmetry, such as coronal imbalance was significantly greater than other types. DM type showed similar paraspinalis asymmetry pattern to the ST type but there was no structural asymmetry in DM and ST types. TL type has the features of both thoracic and lumbar origins. Understanding these could contribute to the management in correcting scoliosis.

Development and Preliminary Validation of an Electromyography-Scoring Protocol for the Assessment and Grading of Muscle Involvement in Patients With Juvenile Idiopathic Inflammatory Myopathies

IntroductionWe performed a pilot study in order to investigate the feasibility of an electromyography (EMG)-scoring protocol for the assessment of disease activity in juvenile idiopathic inflammatory myopathies (JIIM). MethodsChildren with JIIM followed up in a tertiary-level care center underwent standardized clinical, laboratory, and EMG assessment. An EMG-scoring protocol was devised by a consensus panel including a pediatric neurophysiologist and two pediatric rheumatologists, based on a combined score obtained as the sum of (1) the presence of denervation signs (fibrillation potentials) and (2) motor unit remodeling (mixed pattern of short- and long-duration motor unit action potentials). The EMG-scoring protocol was then validated following the Outcome Measures in Rheumatoid Arthritis Clinical Trials filter for outcome measures in rheumatology and the consensus-based standards for the selection of health measurement instruments methodology. ResultsThirteen children (77% females) were included in the study, with a median age of 10 years (interquartile range: 7-17 years) and median disease duration of 11.8 months (interquartile range: 2.1-44.5). A total of 39 EMG examinations were evaluated. A strong positive association between a standardized tool for muscle strength assessment and the combined score was observed. No significant associations were found with both creatine kinase and erythrocyte sedimentation rate levels. DiscussionOur EMG-scoring protocol is the first standardized and reproducible tool for the neurophysiologic evaluation and grading of muscle involvement in patients with JIIM and could provide relevant additional information in the assessment and follow-up of these rare conditions.

Electromyographic Examination Of Hex Bar Deadlift Variations Differentiated By Starting Knee And Torso Angles

Electromyographic Examination Of Hex Bar Deadlift Variations Differentiated By Starting Knee And Torso Angles

Ultrasonography Assessment of Repaired Median Nerve

Background: Traumatic peripheral nerve injuries (PNIs) caused by penetrating and lacerated trauma are among the most prevalent microsurgical injuries. Post-treatment follow-up and prognosis of patients undergoing repair are often based on clinical examinations and electrodiagnostic findings. Therefore, a reliable, inexpensive, useful, and rapidly accessible diagnostic method is necessary during the patient's follow-up.Objectives: This study aimed to assess the relationship between ultrasound imaging and treatment outcomes in patients with median peripheral nerve injury.Methods: In this cohort study, 21 eligible patients with symptoms of acute median nerve injury (MNI) caused by penetrating trauma in microsurgery were studied from June 2018 to June 2019. The patients underwent ultrasonography three months after repair and were followed up for at least nine months. The outcomes of the treatment were compared with those obtained six months after ultrasonography.Results: In all studied patients, mean thicknesses of the repaired nerve on the distal and the proximal sides were 2.58±0.51 and 2.51±0.61 mm2, respectively; 12 cases (57.1%) recovered very well nine months after surgery and in nine cases (42.9%) no nerve recovery was observed based on clinical electromyography (EMG) examinations and nerve conduction velocity (NCV). The amount of neuroma formed at the repair site was lower in well-recovered patients (1.5±0.4 mm3) than those with no recovery (4.9±1.5 mm3). No re-rupture was observed at the repair site. Each group underwent two-four repairs of flexor tendons.Conclusion: Ultrasound can be used as an effective and non-invasive method for assessment of PNI and follow-up of reconstructive surgery.

Occupational shoulder disability: functional recovery after decompression and neurolysis of the upper brachial plexus and the long thoracic nerve.

This study aimed to assess the surgical outcomes of patients with work-related upper extremity musculoskeletal disorders (UE-MSDs) who failed conservative treatment. This was a retrospective study of 17 patients who had work-related UE-MSDs and underwent the following surgeries and follow-up evaluations: decompression, external and internal neurolysis of the upper trunk of the brachial plexus and the long thoracic nerve (LTN), and a partial resection of the anterior and middle scalene muscle. A detailed history of clinical presentation including pain, physical and clinical examinations of the extent of scapular winging (ESW), and upper extremity anatomical postures, such as active forward arm flexion and shoulder abduction, were recorded before and after 3 months of the surgery. Nerve conduction velocity and electromyography examination reports were obtained to assess the sensory or motor loss of the nerve injury before their operation. All 17 patients included in this report showed some improvement anatomically in the scapula appearance and functionally in their shoulder movements. More specifically, 9 (53%) patients got a restored to near healthy appearance of the scapula, and 11 (65%) patients recovered a full range of motion, 180° post-surgically. Overall, the mean shoulder flexion and abduction improved to 157±37.5° and 155±40.2° after the surgery from 106±30.2° and 111±34.8°, respectively (p < 0.0001). The ESW score also significantly improved from a mean of 1.5±0.51 to 3.5±0.71 (p < 0.0001). The post-surgical improvements were statistically highly significant (p < 0.0001). Decompression and neurolysis of the upper brachial plexus and the LTN, and the partial release of the scalene muscle contracture procedures have fostered improvements in the shoulder anatomical appearance and movements in all 17 patients. Int J Occup Med Environ Health. 2021;34(3):427-35.

Comparison of clinical outcomes between open and modified endoscopic release for carpal tunnel syndrome.

The aim of the present study was to investigate a novel technology, requiring only a single portal and no special equipment, to perform endoscopic treatment of carpal tunnel (CT) syndrome (CTS). This novel technique involves a surgical approach and standard operating procedures and is designed to minimize the potential for complications. Patients with CTS were randomly assigned using a computer-generated random allocation and stratified by site to either the modified endoscopic CT release (MECTR) group (n=48) or open CT release (OCTR) group (n=46). Various medical indexes were compared between the two groups, including operative time, hospitalization time, the time required to resume a normal life or work, intraoperative complications, incision infection rate, the amelioration of symptoms (Kelly grading), post-operative scar pain score, recovery of grip strength and pinch strength, two-point discrimination and the presence of sympathetic dystrophy. The results revealed that all patients had grade A wound healing and the symptoms were completely relieved. No significant differences were observed between the two groups with regards to the incision infection rate, intraoperative complications, grip strength, pinch strength, two-point discrimination, presence of sympathetic dystrophy and clinical symptom amelioration. In addition, compared with the OCTR group, the MECTR group had a decreased operative and hospitalization time, post-operative scar pain score and time required to resume a normal lifestyle. Post-operative electromyographic examination also revealed that the median nerve sensory conduction speed increased compared with that prior to surgery in both groups. In conclusion, the use of MECTR for the treatment of CTS achieved higher patient satisfaction, a shorter operative time and hospitalization time, an earlier return to work time or resumption of a normal life, as well as less post-operative scar pain compared with OCTR. Thus, these results suggested that MECTR may be an effective method for the treatment of idiopathic CTS. Trial registration no. ChiCTR2000041165, retrospectively registered 20th December 2020.