Electromyographic Examination Research Articles

The Carpal Tunnel Syndrome and the Double Crush Syndrome Hypothesis: Revisited

AbstractBackground: The commonest application of the double crush hypothesis is its association to median nerve entrapment at the wrist. The double crush concept has gained popularity because it provides a reason to evaluate the cervical spine and roots when treating carpal tunnel syndrome (CTS). It is more likely for CTS to occur as DCS rather than occurring by itself. Up to 90% of CTS patients are misdiagnosed, whereas only 10% have the problem at their wrists.Aim of Study: To examine the validity of DCS hypothesis in CTS patients, to support or disregard the theory.Patients and Methods: This study was conducted on 80 patients; 40 patients claiming failed carpal tunnel release operation (Group I) and 40 cases presenting with brachialgia (Group II). Diagnostic work up included neurological exam-ination, Phalen test, Tinel sign, electromyographic examination (EMG) and nerve conduction studies (NCS) and cervical MRI. Group I patients had undergone the EMG and NCS at our laboratory pre and post operatively.Results: EMG and NCS showed 10 cases with CTS (25%), 20 (50%) with DCS and 10 (25%) with cervical radiculopathy in group I, while group II patients showed 10 cases (25%) with CTS and 30 (75%) with DCS. In all patients, 50 cases (62.5%) showed DCS. On comparing the EMG and NCS preoperative results of Group (I), with their postoperative follow-up results, there was a high statistically significant difference (p-value <0.001) with 34 cases (85%) who showed improvement of the NCS results, while 6 cases (15%) deteri-orated postoperatively. There was a high statistically significant difference between both; CTS and DCS (p-value <0.001), denoting a positive correlation between the two syndromes.Conclusion: The DCS hypothesis was supported, while the concept of frequent failure of CTS release surgery was not supported for the benefit of DC hypothesis.

Evaluation of the effectiveness of the use of functional electrical stimulation after VII-XII anastomosis in patients with facial nerve damage of various etiologies

Surgical treatment of lesions of the facial nerve by an hypoglossal-facial anastomosis takes a long time to re-sprout of the nerve fibers to the facial muscles. The recovery time of facial function after surgical treatment of patients with paralysis of the facial nerve is long enough and can start from 6-8 months after surgery and last up to 2 years. Thus, all this time the mimic muscles are in a state of denervation. The purpose of this work was to determine the effect of electrical stimulation of facial muscles in patients with lesions of the facial nerve of different etiology after hypoglossal -facial anastomosis. Materials and methods: To evaluate the results of the use of early postoperative transcutaneus electrical stimulation, a low frequency FES was used, starting from the 2nd month after performing a XII-VII anastomosis. Assessment of the recovery of facial nerve function was performed 1 year after surgery. The study included 88 patients who underwent surgery to restore facial nerve function - hypoglossal -facial anastomosis. The survey was divided into 2 groups. The first (main) group consisted of 28 patients who underwent FES of facial muscles in the postoperative period, and the second group (comparison) consisted of 60 patients who underwent XII-VII anastomosis according to the following by the same method, but no further pharmacological or physiotherapeutic agents were used that could affect facial nerve regeneration. Results and discussion: According to this scale, the surveyed control group after 12 months. After the operation of XII-VII anastomosis according to the classical method, the following distribution was observed: The 1st degree of recovery of facial nerve function was not present in any of the patients, the 2nd degree had 2 (3.33%) patients, the thirds - 28 (46, 66%), IV - 20 (33,33%), V - 6 (10%) and VI - 4 (6,66%). In patients in the main group (where FES was used), distribution by degrees of recovery of facial nerve function on the House-Brackman scale after 12 months. after surgery it had the following character: II degree had 2 (6.45%) examined, III - 17 (54.83%), IV - 5 (22.58%), V - 2 (7.4%) and VI - 2 (7.4%). Conclusions: A statistically significant difference was observed in the postoperative period when comparing the mean M-responses of mimic muscles registered at different times after surgery in control subjects compared with patients in the main group in which FES was used. In addition, in the main group, a significantly larger number of patients reported a recovery of FN function to grade III-IV on the House-Brackman scale. Therefore, based on the results of the evaluation of the function of FN on the House-Brackman scale and electromyographic examination data in patients who underwent XII-VII anastomosis, it can be argued that with the use of FES in the postoperative period of recovery of facial nerve function is significantly faster and more complete in compared to the control group.

Change in the circulation and activity of the lower erector spinae muscles after repeated trunk extension movement.

The optimum repetition number of standing back-extension exercise (SBEE) effective for the prevention and improvement of low back pain (LBP) is unknown. To determine the effect of physiotherapy on LBP by investigating the optimum repetition number of SBEE via optical analysis and electromyographic (EMG) examination of the multifidus muscles. Hemodynamics and multifidus muscle activity were examined in 16 healthy adult men using near-infrared spectroscopy and surface EMG after performing repetitive SBEE. Oxidized hemoglobin (Oxy-Hb) levels significantly increased in the second extension phase but decreased in the third and subsequent extension phases; deoxidized hemoglobin (deOxy-Hb) levels increased in the third and subsequent extension phases. In the standing phase, no significant difference was observed; in the third and subsequent phases, Oxy-Hb levels decreased and deOxy-Hb levels increased. Muscular activity significantly decreased in the second standing phase but increased in the third and subsequent phases. No significant difference was observed in the extension phase with respect to the number of SBEE repetitions performed. In healthy individuals, hemodynamics improved up to second repetition of SBEE; subsequent repetitions may decrease hemodynamics because of increased activity of the multifidus muscles. In healthy individuals, hemodynamics improved up to second repetition of SBEE.

Soft tissue release combined with joint-sparing osteotomy for treatment of cavovarus foot deformity in older children: Analysis of 21 cases.

BACKGROUNDCavovarus foot is a common form of foot deformity in children, which is clinically characterized by an abnormal increase of the longitudinal arch of the foot, and it can be simultaneously complicated with forefoot pronation and varus, rearfoot varus, Achilles tendon contracture, or cock-up toe deformity. Muscle force imbalance is the primary cause of such deformity. Many diseases can lead to muscle force imbalance, such as tethered cord syndrome, cerebral palsy, Charcot-Marie-Tooth disease, and trauma. At present, many surgical treatments are available for cavovarus foot. For older children, priority should be given to midfoot osteotomy and fusion. Since complications such as abnormal foot length, foot stiffness, and abnormal gait tend to develop postoperatively, it is important to preserve the joints and correct the deformity as much as possible. Adequate soft tissue release and muscle balance are the keys to correcting the deformity and avoiding its postoperative recurrence.AIMTo assess the efficacy of soft tissue release combined with joint-sparing osteotomy in the treatment of cavovarus foot deformity in older children.METHODSThe clinical data of 21 older children with cavovarus foot deformity (28 feet) who were treated surgically at the Ninth Department of Orthopedics of Jizhong Energy Xingtai Mining Group General Hospital from November 2014 to July 2017 were retrospectively analyzed. The patients ranged in age from 10 to 14 years old, with an average age of 12.46 ± 1.20 years. Their main clinical manifestations were deformity, pain, and gait abnormality. The patients underwent magnetic resonance imaging of the lumbar spine, electromyographic examination, weight-bearing anteroposterior and lateral X-rays of the feet, and the Coleman block test. Surgical procedures including metatarsal fascia release, Achilles tendon or medial gastrocnemius lengthening, "V"-shaped osteotomy on the dorsal side of the metatarsal base, opening medial cuneiform wedge osteotomy, closing cuboid osteotomy, anterior transfer of the posterior tibial tendon, peroneus longus-to-brevis transfer, and calcaneal sliding osteotomy to correct hindfoot varus deformity were performed. After surgery, long leg plaster casts were applied, the plaster casts were removed 6 wk later, Kirschner wires were removed, and functional exercise was initiated. The patients began weight-bearing walk 3 mo after surgery. Therapeutic effects were evaluated using the Wicart grading system, and Meary’s angles and Hibbs’ angles were measured based on X-ray images obtained preoperatively and at last follow-up to assess their changes.RESULTSThe patients were followed for 6 to 32 mo, with an average follow-up period of 17.68 ± 6.290 mo. Bone healing at the osteotomy site was achieved at 3 mo in all cases. According to the Wicart grading system, very good results were achieved in 18 feet, good in 7, and fair in 3, with a very good/good rate of 89.3%. At last follow-up, mean Meary’s angle was 6.36° ± 1.810°, and mean Hibbs’ angle was 160.21° ± 4.167°, both of which were significantly improved compared with preoperative values (24.11° ± 2.948° and 135.86° ± 5.345°, respectively; P < 0.001 for both). No complications such as infection, skin necrosis, or bone nonunion occurred.CONCLUSIONSoft tissue release combined with joint-sparing osteotomy has appreciated efficacy in the treatment of cavovarus foot deformity in older children.

Evaluation of the Radioprotective Effects of Melatonin Against Ionizing Radiation-Induced Muscle Tissue Injury.

Radiotherapy (RT) is a treatment method for cancer using ionizing radiation (IR). The interaction between IR with tissues produces free radicals that cause biological damages.As the largest organ in the human body, the skeletal muscles may be affected by detrimental effects of ionizing radiation. To eliminate these side effects, we used melatonin, a major product secreted by the pineal gland in mammals, as a radioprotective agent. For this study, a total of sixty male Wistar rats were used. They were allotted to 4 groups: control (C), melatonin (M), radiation (R) and melatonin + radiation (MR). Rats' right hind legs were irradiated with 30 Gy single dose of gamma radiation, while 100 mg/kg of melatonin was given to them 30 minutes before irradiation and 5 mg/ kg once daily afternoon for 30 days. Five rats in each group were sacrificed 4, 12 and 20 weeks after irradiation for histological and biochemical examinations. Our results showed radiation-induced biochemical, histological and electrophysiological changes in normal rats' gastrocnemius muscle tissues. Biochemical analysis showed that malondialdehyde (MDA) levels significantly elevated in R group (P<0.001) and reduced significantly in M and MR groups after 4, 12, and 20 weeks (P<0.001), However, the activity of catalase (CAT) and superoxide dismutase(SOD)decreased in the R group and increased in M and MR groups for the same periods of time compared with the C group (P<0.001), while melatonin administration inverted these effects( P<0.001).Histopathological examination showed significant differences between R group for different parameters compared with other groups (P<0.001). However, the administration of melatonin prevented these effects(P<0.001). Electromyography (EMG) examination showed that the compound action potential (CMAP) value in the R group was significantly reduced compared to the effects in the C and M groups after 12 and 20 weeks (P<0.001). The administration of melatonin also reversed these effects (P<0.001). Melatonin can improve biochemical, electrophysiological and morphological features of irradiated gastrocnemius muscle tissues.Our recommendation is that melatonin should be administered in optimal dose. For effective protection of muscle tissues, and increased therapeutic ratio of radiation therapy, this should be done within a long period of time.

Examining and monitoring paretic muscle changes during stroke rehabilitation using surface electromyography: A pilot study.

Complex neuromuscular changes have been reported to occur in paretic muscles following stroke, but whether and how they can recover under rehabilitation therapy remain unclear. A tracking analysis protocol needs to be designed involving multiple sessions of surface electromyography (sEMG) examinations during the rehabilitation procedure. Following such a protocol, this pilot study is aimed to monitor paretic muscle changes using three sEMG indicators namely clustering index (CI), root mean square (RMS) and medium frequency (MDF). Initially, a single sEMG examination was performed on the abductor pollicis brevis (APB) muscle on both sides of 23 subjects with stroke and one side of 18 healthy control subjects. With these data to establish CI diagnostic criterion, the paretic muscles of all subjects with stroke showed a very board CI distribution pattern from abnormally low values through normality to abnormally high values. Afterwards, 9 out of 23 subjects with stroke had their paretic muscles examined at least twice before and after the treatment. Almost all paretic muscles had an increase of the RMS, a change of the MDF approaching to the value of the contralateral muscle, and a change of the CI returning to its normal range after common rehabilitation treatments. Finally, 4 of the 9 subjects with stroke participated into repeated examinations of their paretic muscles. The combined use of three indicators helped to reveal specific neuromuscular processes contributing to recovery of paretic muscles, due to their complementary diagnostic powers. Furthermore, neuromuscular processes were found to vary across subjects in type, order and timing during rehabilitation. In conclusion, given the 4 cases following the tracking analysis protocol, this pilot study preliminarily demonstrates usability of three sEMG indicators as tools for examining and monitoring stroke rehabilitation procedure in terms of improvements of paretic muscle changes. All the revealed complex neuromuscular processes imply the necessity of applying sEMG examinations in monitoring rehabilitation procedure, with the potential of offering important guidelines for designing better and individualized protocols toward improved stroke rehabilitation.

Wykorzystanie EMG-powierzchniowego w usprawnianiu pacjentów reumatycznych po endoprotezoplastyce stawu kolanowego (badania pilotażowe).

ObjectivesThe aim of the conducted research was to assess muscle performance in rheumatic patients qualified for knee arthroplasty before and after surgical treatment.Material and methodsPatients with the diagnosis of rheumatoid arthritis or a degenerative joint disease qualified for surgical treatment were examined. Three groups were analysed: 1) a control group, 2) a group of patients qualified for knee arthroplasty (G1), 3) a group of patients with one knee joint endoprosthesis qualified for the second surgery (G2). The study was carried out through a portable surface electromyography system from Noraxon U.S.A. INC., Clinical DTS and using surface electrodes. The surface electromyography (sEMG) examination was conducted twice: before and on the 10th day after the surgery. The study concerned the quadriceps femoris muscle, i.e. its straight and medial head in both lower limbs during isometric tension and active movement.ResultsThe comparison of the examined muscles’ activity in the control group revealed greatly increased activity during isometric tension than during active movement in both muscles. In the G1 group, the comparison of the average values of isometric tension of the examined muscles before the surgery showed slight differences between the healthy limb and the one qualified for the surgical treatment. After the surgery, significant asymmetry between the average values achieved by the healthy and the operated limb could be identified in both muscles. In the G2 group, muscle activity within the currently operated limb revealed only slight differences between the limbs before the surgery. After the surgery, there was an increase in muscle activity within the previously operated limb.ConclusionsConsiderably higher average values of muscle activity during the isometric tension, when compared to the active movement in a sitting position, indicate the necessity of more widespread use of isometric tension in rehabilitating patients after knee arthroplasty.

A mutation in the filamin c gene causes myofibrillar myopathy with lower motor neuron syndrome: a case report

BackgroundMyofibrillar myopathies (MFMs) are a genetically heterogeneous group of muscle disorders. Mutations in the filamin C gene (FLNC) have previously been identified in patients with MFM. The phenotypes of FLNC-related MFM are heterogeneous.Case presentationThe patient was a 37-year-old male who first experienced weakness in the distal muscles of his hand, which eventually spread to the lower limbs and proximal muscles. Serum creatine kinase levels were moderately elevated. Obvious neuropathic changes in the electromyographic exam and edema changes in lower distal limb magnetic resonance imaging were observed. Histopathological examination revealed the presence of abnormal protein aggregates and angular atrophy in some muscle fibers. Ultrastructural analysis showed inordinate myofibrillar structures and dissolved myofilaments. DNA sequencing analysis detected a heterozygous missense mutation (c.7123G > A, p.V2375I) in the immunoglobulin (Ig)-like domain 21 of FLNC.ConclusionsFLNC mutation c.7123G > A, p.V2375I in the immunoglobulin (Ig)-like domain 21 can be associated with distal myopathy with typical MFM features and lower motor neuron syndrome. Although electromyographic examination of our patient showed obvious neuropathic changes, MFM could not be excluded. Therefore, genetic testing is necessary to make an accurate diagnosis.

Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG.

Gradual impairment of nerve conduction is expected to be tightly associated with simultaneous gradual loss of vocal cord contractility, related to the fact that injured axons are connected to a defined number of muscle cells. In clinical studies, there is a time gap between observed adverse electromyographic (EMG) changes and examination of vocal cord function. This study evaluates the impact of intraoperative EMG changes on synchronous vocal cord contractility by simultaneous use of continuous intraoperative neuromonitoring (C-IONM) and accelerometry for registration of actual vocal cord function at a given change of EMG amplitude. EMG was obtained following vagus nerve stimulation by use of C-IONM. A vocal cord accelerometer probe that could be attached to the vocal cords was developed based on a LIS3DH ultra low-power high performance three axis linear accelerometer (STMicroelectronics, Geneva, Switzerland). Accelerometer data were registered continuously together with EMG data during traction injury of the recurrent laryngeal nerve (RLN) until an amplitude depression ≤100 μV. Six RLN from four immature domestic pigs were studied. Vocal cord contractility assessed by vocal cord accelerometry decreased in parallel with EMG amplitude, with significant correlations ranging from 0.707 to 0.968. Decrease of EMG amplitude during traction injury to the RLN injury is closely associated with a parallel drop in vocal cord contractility. NA Laryngoscope, 130:1090-1096, 2020.

Choosing the target wisely: partial tibial nerve transfer to extensor digitorum motor branches with simultaneous posterior tibial tendon transfer. Could this be a way to improve functional outcome and gait biomechanics?

The objective of this study was clinical assessment of the reduction of pathological motor phenomena with the recovery of long toe extensors, and evaluation of functional outcome with simultaneous nerve and tendon transfer in cases of common peroneal nerve (CPN) injuries. Seven male patients (mean age 26.4 years) received a partial tibial nerve transfer to the extensor hallucis longus muscle (MEHL) and extensor digitorum longus muscle (MEDL) motor branches, after a mean of 2.7 months following a traction-type injury to the CPN. Tibialis posterior muscle (MTP) tendon transfer through the interosseous route was performed on the same day. The follow-up period included a clinical neurological examination, a modified Stanmore System questionnaire (MSSQ), electromyographic examination of the interference pattern, and a video-based analysis of the gait biomechanics in the 3rd and 12th months. Video analysis of the gait investigated the presence or reduction of "stair-climbing maneuver" (SCM), foot slap (FS), and foot stability during the gait cycle. The average range of active dorsiflexion in the 3rd month was 0.85°. SCM accompanied walking in 6 patients (86%). FS accompanied walking in 3 patients (43%) and 3 patients (43%) avoided FS by planting the entire foot on the ground. All patients required orthopedic support (shoe inserts) to compensate for mediolateral foot instability. The average MSSQ score was 80.4 points. The average duration for the effective recovery of function (≥ 4 points on the Medical Research Council grading system) of long toe extensors was 11.2 months. The average range of active dorsiflexion in the 12th month increased to 4.4°. A reduction of FS was observed in 5 patients (71%). Excessive foot eversion was reduced in 4 patients (57%). Another 3 patients (43%) required no specific orthopedic shoe inserts. Reduction of pathological motor phenomena with recovery of the long toe extensors resulted in an increase of functional outcome. The average MSSQ score after 12 months was 92.4 points. Partial tibial nerve transfer to the motor branches of the extensor hallucis longus and the long toe extensors along with the simultaneous tibialis posterior tendon transfer produce the reduction of FS and bring mediolateral stability to the foot, i.e., improved gait biomechanics. The reduction of pathological motor phenomena at the time of recovery of the long toe extensors is reflected in an increase in patients' functional perception of the injured lower extremity during daily walking.

Phosphorus content of muscle tissue and muscle function in dairy cows fed a phosphorus-deficient diet during the transition period

Phosphorus (P) deficiency and hypophosphatemia are believed to be associated with muscle function disturbances in dairy cows, particularly around parturition. The objective of this study was to determine the effect of dietary P deprivation during late gestation and early lactation on muscle P homeostasis and muscle function in periparturient dairy cows. Thirty-six multiparous dairy cows in late gestation were randomly assigned either to undergo dietary P depletion or to be offered a diet with adequate P content from 4 wk before to 4 wk after parturition. Phosphorus-deficient rations for dry and lactating cows contained 0.15 and 0.20% P on a dry matter basis, respectively. Blood and muscle tissue for biopsy were obtained and electromyographic examinations were conducted on biceps femoris and intercostal muscles in regular intervals throughout the study. Muscle tissue was analyzed for the total P, adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, creatine phosphate, and tissue water content. Dietary P deprivation resulted in a pronounced and sustained decline of the plasma phosphate concentration, reaching a nadir at calving with mean values below 1.5 mg/dL and remaining below 2.0 mg/dL during the first 4 wk of lactation. Hypophosphatemia was not associated with signs of clinically apparent muscle weakness or disturbed muscle function and was not associated with a decline in the content of any of the studied P-containing compounds in muscle tissue. Accordingly, no association between plasma phosphate concentration and muscle tissue P content was found. Electromyographic examination identified subclinical effects on motor unit action potentials that are indicative of disturbed neuromuscular functionality. Increasing occurrence of pathologic spontaneous activity possibly resulting from membrane instability of nerve or muscle cells and suggestive of myopathy was also recorded as P deprivation progressed. These effects were predominantly observed in intercostal and to a lesser degree biceps femoris muscles. Electromyographic parameters affected by P deprivation were found to be associated primarily with the plasma phosphate and to a lesser extent with the amounts of energy storing P-containing compounds contained in muscle tissue. These results indicate that prolonged and pronounced dietary P deprivation in transition dairy cows leads to marked sustained hypophosphatemia without altering the muscle tissue P homeostasis or causing clinically apparent muscle function disturbances.

РОЗРОБКА БІОТЕХНІЧНОЇ ЕЛЕКТРОМІОГРАФІЧНОІ СИСТЕМИ

Chronic back pain is a common and serious problem, both from a medical and an economic point of view. The evaluation of the condition of the back muscles is carried out according to the results of an electromyographic examination during physical exercise. Electromyographic results are strongly correlated with the degree of tension and flexion of the muscle, and the quality of the physical exercise by the patient can be determined by the presence of pain or fear of pain. In this regard, it is proposed to supplement the electromyographic complex with blocks of control of the level of pain and degree of flexion of the back muscles. An electromyographic system is proposed for EMG recording in the «boat» position with control of the degree of flexion of the back muscles with parallel recording of the EEG signal to control the level of pain during exercise. To register fluctuations in the height of the patient's back deflection in the «boat» position, it is proposed to use an optocoupler - an electronic device consisting of a light emitter and a photodetector connected by an optical channel and combined into a common package. The control of the deviation of the back is necessary to maintain the same load while recording the EMG signal from the muscles of the lumbar spine in the «boat» position, since with a decrease in the height of the deviation the patient's muscles relax, and this affects the characteristics of the signal under study. In the article a block diagram of the biotechnical electromyographic system was developed. Such system will allow to objectify the assessment of the results of electromyography with parallel control of the level of pain and the degree of flexion of the back muscles in order to assess the degree of dysfunction of the back muscles and the quality of the therapeutic and surgical measures performed.

Клинико-рентгенологическая и электрофизиологическая диагностика острого спондилогенного этмоидита у детей

The authors performed a comparative electromyographic examination of the muscles of ethmoid labyrinth projection (the lower lid area of the orbicular muscle of the eye and the masticatory muscles on both sides in comparison with the probably intact anterior cricothyroid muscle). The population of analysis included 209 patients at the age of 0 to 18 years (most of the children aged 3 to 6 years), including 98 male patients (44%) and 111 female patients (56.0%). The patients were divided into 3 groups. The first group consisted of 109 people diagnosed with ethmoiditis, the second one comprised 70 children with “other ENT diseases”, the third one comprised 30 relatively healthy children. During the study, the authors compared clinical, radiological, electrophysiological (electromyographic) data and generated tactics of management of the children diagnosed with acute spondylogenous ethmoiditis with a birth injury of the cervical spine. The progress in general biological sciences, the accumulated data (the study of the mechanism of development of acute ethmoiditis, the nature of birth injuries with the cervical spine damage), the clinical features of spondylogenous ethmoiditis manifestations, the improvement of technical means of examination (of nasal cavity, nasopharynx), the use of X-ray, X-ray contrast method of maxillary sinus examination, the wide use of electromyographic method made it possible to establish the relation between the development of acute ethmoiditis in children resulting from the birth injuries of various degrees of severity; all these factors have predetermined the conduct of this study.

Клинико-рентгенологические параллели спондилогенных острых гаймороэтмоидитов у детей

The article presents a diagnostic algorithm for detecting the spondylogenic acute maxillary ethmoiditis in children based on: thorough obstetric history, neurological status of the child, otorhinolaryngological examination of ENT organs, X-ray examination of the cervical spine, X-ray computed tomography of the paranasal sinuses, as well as the electromyographic examination of the face muscles in paranasal sinuses projection (the lower lid part of eye circular muscle/ muscle of mastication in comparison with probably intact – anterior cricothyroid muscle). The clarification of X-ray electrophysiological semiotics of combined lesions of the paranasal sinuses in children with the birth injury of the cervical spine allowed us to identify the optimal diagnostic algorithm for spondylogenic acute sinusitis. We selected 102 patients aged 3 to 10 years, the average age was 4.73±1.99 years, including 44 males (43.13%) and 58 females (56.86%). The patients were divided into 3 groups. The first group, acute sinusitis, consisted of 40 people; the second one – recurrent sinusitis – of 31 patients; the third one – relatively healthy patients – of 31 children as well. The study compared clinical, radiological, electrophysiological (electromyographic) data to determine the tactics of further management, treatment, and prevention of patients with the diagnosis of acute maxilloethmoidal sinusitis associated with birth injury of the cervical spine.

Lidocaine injections and neck corset wearing improve dropped head syndrome in Parkinson's disease and related disorders

BackgroundPatients with Parkinson's disease and related disorders (PDRD) may exhibit dropped head syndrome (DHS), which does not yet have an effective treatment. ObjectivesTo evaluate the effect of combining lidocaine injection into the bilateral scalene muscles and neck corset wearing on dropped head syndrome. MethodsWe performed needle electromyography assessments of the scalene, sternocleidomastoid (SCM), levator scapulae, splenius capitis, and trapezius muscles. Patients received 2.5–5 ml injections of 1% lidocaine into both sides of the scalene muscles for 4/5 consecutive days and were instructed to wear a neck corset. We measured the neck flexion angle, which formed between the horizontal line and the straight line passing through the ear canal and orbital fossa, before (baseline) and after (Day 8 and Day 90) the intervention. ResultsSeven males and eight females (mean age, 68.9 years; range 56 to 85 years) who had PDRD with dropped head syndrome were enrolled in this study. Needle electromyography examination revealed abnormal discharge of the scalene muscles in all patients when the neck position was corrected; however, some patients did not show abnormal discharge of the SCM muscle. At Day 8, we observed an improvement of the neck flexion angle in 13 of the 15 patients, from an average of 27.7° ± 13.9° to 11.7 ± 14.6°. At Day 90, the average neck flexion angle was 15.3° ± 17.2°. ConclusionsCombining lidocaine injection into the scalene muscles and neck corset wearing is an effective treatment regimen for DHS in patients with PDRD.

Very Early Neurophysiological Study in Guillain-Barre Syndrome

Purpose: The diagnosis of Guillain-Barre syndrome (GBS) in the very early stage may be challenging. Our aim was to report the neurophysiological abnormalities in GBS within 4 days of clinical onset. We expected that GBS will be diagnosed by the assistance of neurophysiological study in the very early stage. Methods: We prospectively recruited patients with a diagnosis of GBS discharged from First Affiliated Hospital of Xi’an Jiaotong University and Xi Jing Hospital. Patients were classified into 3 groups according to the onset of symptoms to electromyography examination interval (OEI). The neurophysiological findings were carried out using standard procedures. All patients were examined by the same experienced neurophysiologist. Results: There were not significant group differences in abnormal rate, distal motor latency (DML), motor nerve conduction velocity (MNCV), F response (FR), compound muscle action potential (CMAP), conduction block (CB), sensory nerve action potential (SNAP), and sensory nerve conduction velocity among OEI ≤4 days, 4< OEI ≤10 days, and OEI > 10 days groups. Motor nerves were more affected than sensory nerves in neurophysiological presentation in very early stage patients. The difference of motor nerves and sensory nerves was statistically significant in lower limbs, but was not in upper limbs. In motor nerve conduction studies, the abnormal rate of DML, MNCV, FR, CB was more common seen in ulnar and peroneal nerve than median and tibial nerve, the abnormal rate of CMAP was the same in ulnar, median, peroneal and tibial nerve. In sensory nerve conduction studies, the abnormal rate of ulnar nerve and median nerve was higher than the superficial peroneal nerve and sural nerve. The OEI was not correlated with the SNAP decrease rate of median (r = 0.10, p = 0.23) and ulnar (r = 0.26, p = 0.06) but was statistically correlated with sural SNAP decrease rate (r = 0.29, p = 0.04). The sural-sparing pattern phenomenon was the most commonly discovered phenomenon in very early stage patients (OEI ≤4 days), followed by patients with 4< OEI ≤10 days, ultimately found in patients with OEI > 10 days. Conclusions: We suggest performing neurophysiological examination as soon as possible for suspected GBS patients, particularly focusing on multi-spots inspection of ulnar and peroneal nerves, and paying close attention to sural-sparing patterns.

Musculocutaneous neuropathy.

Isolated musculocutaneous neuropathy is uncommon. In this study we aimed to determine its causes and clinical presentation and interpret the electrodiagnostic findings associated with this condition. Our investigation was a retrospective review of patients diagnosed with musculocutaneous neuropathy at the Mayo Clinic (Rochester, Minnesota) electromyography (EMG) laboratory between 1997 and 2015. Thirty-two patients with musculocutaneous neuropathy and 5 patients with lateral antebrachial cutaneous neuropathy were identified. The most common cause was acute trauma or surgery (65%). Fourteen percent of the cases were idiopathic and 14% were inflammatory. Pain and sensory disturbance were more common presentations than weakness. Weakness from nerve injury was not noted in 2 patients, suggesting that other muscles may provide adequate elbow flexion/supination. The bilateral absence of lateral antebrachial cutaneous nerve sensory responses suggests an inflammatory cause. Musculocutaneous neuropathy usually results from trauma or iatrogenic injury. Nerve conduction studies alone are insufficient to confirm neuropathy, and needle EMG examination should be a routine part of the diagnostic evaluation. Muscle Nerve 58: 726-729, 2018.

A Novel Interpretation of Sample Entropy in Surface Electromyographic Examination of Complex Neuromuscular Alternations in Subacute and Chronic Stroke.

The objective of this paper was to develop sample entropy (SampEn) as a novel surface electromyogram (EMG) biomarker to quantitatively examine post-stroke neuromuscular alternations. The SampEn method was performed on surface EMG interference patterns recorded from biceps brachii muscles of nine healthy control subjects, fourteen subjects with subacute stroke, and eleven subjects with chronic stroke, respectively. Measurements were collected during isometric contractions of elbow flexion at different constant force levels. By producing diagnostic decisions for individual muscles, two categories of abnormalities in some paretic muscles were discriminated in terms of abnormally increased and decreased SampEn. The efficiency of the SampEn was demonstrated by its comparable performance with a previously reported clustering index (CI) method. Mixed SampEn (or CI) patterns were observed in paretic muscles of subjects with stroke indicating complex neuromuscular changes at work as a result of a hemispheric brain lesion. Although both categories of SampEn (or CI) abnormalities were observed in both subacute and chronic stages of stroke, the underlying processes contributing to the SampEn abnormalities might vary a lot in stroke stage. The SampEn abnormalities were also found in contralateral muscles of subjects with chronic stroke indicating the necessity of applying interventions to contralateral muscles during stroke rehabilitation. Our work not only presents a novel method for quantitative examination of neuromuscular changes, but also explains the neuropathological mechanisms of motor impairments and offers guidelines for a better design of effective rehabilitation protocols toward improved motor recovery.

The focus of the cervical radiculopathy by dermatomal pain in comparison with results of electrodiagnosis and imaging

Objectives The dermatomal pain related to a cervical radiculopathy is often misunderstanded by physicians because in most cases there is a discordance between it, imaging and electromyography (EMG). The aim of this study is to compare trajectory of dermatomal pain, imaging and EMG findings. Methods It's a retrospective study over a year that regrouped patients referred to the department of functional explorations of Sfax for electrodiagnostic test. These patients had clinical signs of cervical radiculopathy and underwent a cervical imaging (MRI or CT) that confirmed it. They underwent a nerve conduction study with a needle EMG examination that examined one muscle from the affected root and others upper and lower depending on its result and clinical finding. The Fisher's exact test was used for comparison of different clinical, imaging and EMG signs. Results Sixteen patients (sex-ratio 1/3) were collected with a mean age of 54.8 ± 11.15 year. These patients had not yet motor signs. In 6 patients the pain was not dermatomal. When the pain was dermatomal, there was a concordance between clinic and respectively imaging and EMG in 3 cases and 8 cases. Dermatomal pain was not correlated with imaging (P = 0.8) nor with EMG (P = 0.9). There was a correlation between imaging and EMG (P = 0.05). Conclusion Because the radiculopathy is due to a motor ventral nerve root compression, the most important symptom is the myotomal weakness [1] , [2] . However, dermatomal pain was the most sensitive symptom but less specific in Hassan's study [2] . In fact this symptom can be due to a combination of mechanical and inflammatory mechanisms. Imaging and EMG are often in concordance with the affected nerve root but EMG gives more evidence of the functional lesions and a more specificity [3] .

Clinical and genetic characterization of a Chanarin Dorfman Syndrome patient born to diseased parents

BackgroundChanarin Dorfman Syndrome (CDS) is a rare autosomal recessive disorder characterized by ichthyosiform non-bullous erythroderma and variable involvement of the liver and the neuromuscular system. In CDS patients, the accumulation of neutral lipids inside cytoplasmic lipid droplets has been demonstrated in different tissues. To date, ninety families with this disease have been described worldwide; most of them are from Mediterranean countries.Case presentationIn this report, we describe a consanguineous Turkish family with typical features of CDS. The parents are first cousins and are both diseased. At the age of eight, their child presented CDS with non-bullous congenital ichthyosiform erythroderma, hepatosteatosis, hepatomegaly and ectropion. Electromyographic examination is compatible with myopathy. A five-year-old cousin of the child is also affected by CDS. She was born to non-affected consanguineous parents. Mutation analysis of the ABHD5 gene revealed the previously reported mutation, N209X, which is the most frequent in Turkish patients. Lipid vacuoles, also known as Jordan’s anomaly, are detectable in their leucocytes.ConclusionsTo the best of our knowledge, this is the first report of a CDS family in which both parents and their child are affected by CDS. To date, the child does not present a more severe clinical phenotype compared with those of his relatives or other CDS patients of the same age. These findings suggest that high levels of triacylglycerol accumulation, that may be supposed to be present in high amount inside the ooplasm, did not affect embryo development and foetal growth.