Left Brachioradialis Research Articles

Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy.

The manuscript describes the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroid lobectomy. The patient is placed in the supine position with extension and fixation of the neck. One 20 mm transverse incision and two 5 mm incisions are made through the mucosa of the oral vestibule for camera and instrument placement after disinfection of the skin and oral cavity. The workspace is established and maintained by the skin suspension device, which is made of unabsorbable string (3-0) and rubber bands, and the CO2 insufflation pressure. Lobectomy using a medial-to-lateral technique and prophylactic ipsilateral central neck dissection is performed simultaneously on patients with papillary thyroid cancer (PTC). The specimen is extracted through the 20 mm incision. The parathyroid gland is immediately searched for in the specimen and auto-transplanted to the left brachioradialis. A drainage tube is inserted through the retractor hole into the bed of the thyroid gland, and absorbable sutures are used to close the mucosal incisions in the oral vestibule and the linea alba cervicalis. Prophylactics administered intravenously are recommended for the first 24 h after surgery, and oral antibiotics are used for 7 days postoperatively.

ANALYSIS OF THE EFFECTS OF WORKING POSITION ON MUSCLE FATIGUE DURING HEDGE PRUNING: A CROSS-SECTIONAL STUDY BASED ON CHINESE GARDEN WORKERS

Occupational health is still in the developmental stage in China. There is a lack of focus on garden workers. Hedge pruning is one of garden workers’ main tasks, a common operation form in modern landscaping. Garden workers who operate the hedge trimmer generally suffer from work-related musculoskeletal disorders (WMSDs). This study aims to demonstrate which working condition causes the most muscle fatigue, evaluate work fatigue accurately, and reduce WMSDs in garden workers. One hundred and twenty garden workers were studied during six hedge pruning conditions using surface electromyography (sEMG) and a motion capture system. The sEMG of the erector spinae, trapezius, biceps brachii and brachioradialis muscle, and kinematic parameters was measured during the operation. The average standardized sEMG values of upper-limb and trunk muscles in different working conditions were analyzed using single-factor analysis of variance. In the six working conditions, the trunk inclination angle was the largest (40–50∘) in horizontal pruning of short hedges, and the load of erector spinae (39.31–39.62%) was the highest in this condition. Operators’ arms were above shoulder height in high hedge pruning, the shoulder joint angle and the elbow joint angle were generally larger, the load of trapezius (49.33–55.65%), biceps brachii (46.50–52.35%) and right brachioradialis (52.35%) was the highest in horizontal pruning of high hedges, and the load of left brachioradialis (40.91%) was the highest in vertical pruning of high hedges. Awkward working postures can lead to problems such as overwork of upper-limb and trunk muscles, representing a risk that increases occupational illness, injuries and chronic diseases among garden workers. Preventive measures are required to reduce the occurrence of excessive local muscle load, and prevent the occurrence of occupational diseases.

Sensory and emotional responses to deep pressure stimulation at myofascial trigger points: a pilot study.

Although manual pressure, such as that used during a massage, is often associated with pain, it can simultaneously be perceived as pleasant when applied to certain body areas. We hypothesized that stimulation of myofascial trigger points (TPs) leads to simultaneous pain and pleasure. TPs are hyperirritable points located in the taut band of the skeletal muscle. In this study, we measured the muscle tone, muscle stiffness, and pressure pain threshold of TPs and control points in the left brachioradialis muscle of 48 healthy participants. We also applied deep compression to the two points and collected subjective data on pain, pleasantness, unpleasantness, and relief. Greater muscle stiffness was observed in the TPs versus control points (t = 6.55, p < 0.001), and the pain threshold was significantly lower in the TPs (t = -6.21, p < 0.001). Unpleasantness ratings after deep compression were significantly lower in the TPs compared with control points (t = -2.68, p < 0.05). Participants experienced greater relief at the TPs compared with control points (t = 2.01, p < 0.05), although the perceived pain did not differ between the two types of points. We compared the properties of TPs and control points, and found that deep compression at TPs was associated with higher muscle tone and stiffness, lower unpleasantness ratings, and higher relief ratings compared with the control points. These findings suggest that, at least for some TPs, pain and pleasantness are simultaneously elicited by deep pressure stimulation.

Autologous parathyroid gland in left-brachioradialis transplantation: A single-center study and long-term follow-up

Parathyroid gland transplantation into the sternocleidomastoid muscle is effective, but it is not possible to confirm transplant survival with this method. In this study, we evaluated parathyroid autotransplantation into the brachioradialis muscle and its survival rate. ObjectivesTo evaluate autologous parathyroid gland left forearm brachioradial muscle transplantation and its survival rate. Summary background dataThe most commonly used transplantation site is the sternocleidomastoid muscle, but transplant survival cannot be confirmed using this method. Autologous parathyroid gland left forearm brachioradial muscle transplantation solves this problem, and we evaluate the transplant survival using this method. MethodsWe followed-up patients who underwent thyroidectomy and autologous parathyroid left forearm brachioradial muscle transplantation in our center from September 2013 to January 2018. The last follow-up date was January 2021; all enrolled patients underwent at least 3 years of follow-up. We calculated the transplant survival rate at several time points. ResultsWe evaluated 238 transplanted cases, for which the long-term survival rate was 85.7% (204/238), and the short-term survival rate was 86.1% (205/238). Sixty-five cases had two parathyroid glands transplanted into the left forearm brachioradialis muscle. The long-term survival rate was 92.3% (60/65), and the short-term survival rate was 95.4% (62/65). ConclusionsAutologous parathyroid gland left brachioradialis transplantation is a reliable, measurable method with good survival rate, and we recommend this method for consideration for transplanting parathyroid glands in thyroidectomy.

Intra- and Inter-Day Reliability of the NIRS Portamon Device after Three Induced Muscle Ischemias.

(1) Background: Near-infrared spectroscopy (NIRS) is an innovative and non-invasive technology used to investigate muscular oxygenation. The aim of this study is to assess the within- and between-session reliability of the NIRS Portamon (Artinis, Elst, Netherlands) device following three sets of induced muscle ischemia. (2) Methods: Depending on the experimental group (G1, G2 or G3), a cuff was inflated three times on the left upper arm to 50 mmHg (G1), systolic blood pressure (SBP) + 50 mmHg (G2) or 250 mmHg (G3). Maximum, minimum and reoxygenation rate values were assessed after each occlusion phase, using a Portamon device placed on the left brachioradialis. Reliability was assessed with intraclass correlation coefficient (ICC) value and ICC 95% confidence interval (CI-95%), coefficient of variation (CV) and standard error of measurement (SEM) (3) Results: Our results showed a good to excellent reliability for maximums and minimums within-session. However, the reoxygenation rate within sessions as well as measurements between sessions cannot predominantly show good reliability. (4) Conclusions: Multiple measurements of maximums and minimums within a single session appeared to be reliable which shows that only one measurement is necessary to assess these parameters. However, it is necessary to be cautious with a comparison of maximum, minimum and reoxygenation rate values between sessions.

Exercise-induced Hypoalgesia Differ At Sites Local And Remote To The Exercising Muscle Group

Dysfunction of endogenous pain-inhibitory function such as exercise-induced hypoalgesia (EIH) may predict development of chronic pain conditions. While EIH has been shown to occur in both the exercised muscle group and in remote unexercised muscle group, few studies have compared the magnitude of EIH in an exercised muscle and remote muscle groups in the same individuals following the same exercise bout. PURPOSE: The purpose of the study was to examine the EIH response at four different sites following a bout of single legged isometric exercise. METHODS: Pressure pain thresholds (PPT) of 102 participants (50 females; 52 males) were assessed bilaterally in the vastus lateralis (VL) and brachioradialis (BR) using a pressure algometer before and after isometric knee extension at 25% of maximal voluntary contraction held until task failure using their dominant leg. The percent difference between post and pre measures was defined the EIH response. RESULTS: PPT’s increased in the left BR (18.1% ± 24.7; p<0.001, d=0.275), right BR (14.4% ± 26.1; p<0.001, d=0.233), non-dominant VL (17.4% ± 24.0; p<0.001, d=0.318) and the dominant VL (34.5% ± 28.3; p<0.001, d=0.643). There were no differences between the left and right BR and the non-dominant VL with regards to the EIH response (p>0.05), however the exercised leg demonstrated a greater EIH response compared to the remote, unexercised limbs (p<0.001). CONCLUSION: EIH occurred in all sites. However the EIH response in the exercised leg was significantly more robust than the remote, unexercised sites. This findings suggests the magnitude of EIH is determined by both local and systemic factors and this should be taken into consideration when comparing EIH among studies.

101 Amyotrophic Lateral Sclerosis (ALS) - Not Just a Motor Disease? Isolated Bitter and Sweet Taste Loss in ALS

Specific taste quality deficits in ALS has not heretofore been described. Case Study: A 71 year old right handed female presented with a two year course of progressive reduction in strength in her hands, arms and legs with difficulty tying shoe laces, opening jars, writing and walking. She described nocturnal muscle spasms involving all extremities. Gradually, over eight months prior to presentation, all food began to taste bad and horribly bitter. Associated with no appetite and a seven pounds weight loss. Abnormalities in Neurological examination: Cranial Nerve (CN) examination: CN IX and X: Gag absent bilaterally. Motor examination: Bulk: atrophy in thenar and hypothenar eminences and intrinsics in both upper extremities. Percussion induced fasciculation and myotonia in both shoulders and arms. Fasciculation of tongue with percussion myotonia of tongue. Strength: Intrinsic 4/5 in both upper extremities, 3/5 in abductor policis brevis bilaterally, 3/5 right gastrocnemius soleus, 4/5 bilateral anterior tibialis. Drift testing: left abductor digiti minimi sign. Gait: Heel and toe walking unstable with circumduction of left leg. Tandem gait unstable. Cerebellar: Holmes rebound phenomena positive in the left upper extremity. Deep tendon reflexes: 1+ left brachioradialis. 1+ left triceps. 3+ right ankle jerks. 0 left ankle jerk. Positive jaw jerk. Chemosensory Testing: Normosmia to: Alcohol Sniff Test (46), Pocket Smell Test (3/3) and Retronasal Smell Index (9). Taste Quadrant Testing: ageusia in the palate to sodium chloride and citric acid. Ageusia throughout the palate, tongue and whole mouth to sucrose and quinine hydrochloride. Fungiform papillae count: left 18, right 20 (normal). Lip biopsy (normal). MRI: T2 flair in bilateral corticospinal tracts, left greater than right in the spinal cord and the brain. EMG: fibrillation, positive waves with fasciculation in all four extremities. Voluntary contraction with polyphasic unstable motor unit action potentials. While Lang found no taste loss in ALS (Lang, 2011), Pelletier found reduction in intensity of taste to all modalities in different sectors of the tongue, but paradoxically demonstrated normogeusia in whole mouth taste perception (Pelletier, 2013). Pathological specimens of those with ALS revealed degeneration in the nucleus parabrachialis medialis and tractus trigeminothalamicus dorsalis (Oyanagi, 2015), suggesting that taste deficit may be due to central white matter abnormalities. Sweet taste is localized in the most posterior and rostral aspect of the right insular cortex, immediately adjacent to bitter (Prinster, 2017), suggesting a neighborhood effect phenomena. Weight loss in ALS may be due to sensory distortion and secondary impairment of appetite. It would be worthwhile to investigate those with ALS for evidence of otherwise overlooked gustatory deficits, correction of which may improve appetite and nutritional state.

Can Transcranial Magnetic Stimulation be used to detect potential spinal cord injury following thoracic endovascular aortic repair (TEVAR)? A preliminary study to characterise baseline motor evoked potentials in vascular disease patients

Background: Spinal cord injury (SCI) following TEVAR is a devastating complication. Transcranial Magnetic Stimulation (TMS) is a simple, safe and painless alternative to electrical neuromonitoring of the spinal cord and could be used post-operatively. The study aim was to determine the reliability of TMS motor evoked potentials (MEPs) in peripheral vascular disease (PVD) patients. The data is essential for the development of a late SCI TMS management protocol. Methods: 20 healthy controls (mean(±SD) age 28±7.7yrs) and 6 PVD patients (59±14.5yrs, mean VascuQol 4.0) were recruited. Twelve TMS stimuli were given every 10 minutes for one hour. MEPs were measured from two upper limb (left brachioradialis (LBR), abductor pollicis brevis (LAPB)) and three lower limb muscles (left vastus lateralis (LVL), tibialis anterior (LTA), adductor hallucis (LAH)). MEP amplitude, latency and variability were calculated and compared using one-way ANOVA. Results: MEP amplitudes in controls were not, in general, significantly different from those in patients, except for those in LBR - 0.42 vs 0.26mV (control vs patient) (p=0.04); LAPB - 1.91 vs 0.48mV, LVL - 0.31 vs 0.21mV, LTA - 0.67 vs 0.52mV, LAH - 1.07 vs 0.94mV (p>0.05). There were no differences in MEP latencies and variability; a combined muscles coefficient of variation was 0.29 vs 0.44 (p=0.06). Conclusion: The preliminary data show TMS-induced MEPs appear similar in size, latency and variability in healthy subjects and PVD patients, although data collection is ongoing. They provide evidence that TMS may be a reliable tool with which to monitor for SCI development following TEVAR.

Photoplethysmography for blood volumes and oxygenation changes during intermittent vascular occlusions

Photoplethysmography (PPG) is an optical technique that measures blood volume variations. The main application of dual-wavelength PPG is pulse oximetry, in which the arterial oxygen saturation (SpO_2) is calculated noninvasively. However, the PPG waveform contains other significant physiological information that can be used in conjunction to SpO_2 for the assessment of oxygenation and blood volumes changes. This paper investigates the use of near infrared spectroscopy (NIRS) processing techniques for extracting relative concentration changes of oxygenated (DeltaHbO_2), reduced (DeltaHHb) and total haemoglobin (DeltatHb) from dual-wavelength PPG signals during intermittent pressure-increasing vascular occlusions. A reflectance PPG sensor was attached on the left forearm of nineteen (n = 19) volunteers, along with a reference NIRS sensor positioned on the same forearm, above the left brachioradialis. The investigation protocol consisted of seven intermittent and pressure-increasing vascular occlusions. Relative changes in haemoglobin concentrations were obtained by applying the modified Beer–Lambert law to PPG signals, while oxygenation changes were estimated by the difference between red and infrared attenuations of DC PPGs (A_{Ox} = DeltaA_{IR} − DeltaA_R) and by the conventional SpO_2. The DeltaHbO_2, DeltaHHb, DeltatHb from the PPG signals indicated significant changes in perfusion induced by either partial and complete occlusions (p < 0.05). The trends in the variables extracted from PPG showed good correlation with the same parameters measured by the reference NIRS monitor. Bland and Altman analysis of agreement between PPG and NIRS showed underestimation of the magnitude of changes by the PPG. A_{Ox} indicated significant changes for occlusion pressures exceeding 20 mmHg (p < 0.05) and correlation with tissue oxygenation changes measured by NIRS, while SpO_2 had significant changes after 40 mmHg (p < 0.05). Relative changes in haemoglobin concentrations can be estimated from PPG signals and they showed a good level of accuracy in the detection of perfusion and oxygenation changes induced by different degrees of intermittent vascular occlusions. These results can open up to new applications of the PPG waveform in the detection of blood volumes and oxygenation changes.

Recalibration of oculomotor and cerebellar activity to reduce low back pain in a professional tennis player

Event Abstract Back to Event Recalibration of oculomotor and cerebellar activity to reduce low back pain in a professional tennis player Frederick R. Carrick1, 2*, Benjamin R. Behrendt1, 3 and Susan Esposito4 1 Carrick Institute for Graduate Studies, United States 2 Senior Research Fellow of Bedfordshire Centre for Mental Health Research in association with the University of Cambridge (BCMHR-CU), United Kingdom 3 NeuroWorks Healthcare LLC, United States 4 Life University, Department of Chiropractic Sciences, United States Background: On-going moderate low back pain (LBP) in a sixteen-year-old world class professional tennis player received neurological care at our clinic. Methods: MRI, CT, and X-RAY findings of his low back were inconclusive except for mild posterior disc bulging at L3/4, L4/5 and L5/S1. Neurological examination revealed abnormal cerebellar output and oculomotor breakdown. Notably, there was right hyperopia, which was reduced with vestibular-ocular head movements (VOR); left coractasia; left accommodation spasm; slower rightward saccades and hypermetric leftward saccades with irregular phase profile and normal re-fixation; initial gaze-shifting downward produced retrocolic activity during normal viewing and during tennis. Cerebellar findings included slower alternating hand movements on the left; sluggish myotatic stretch response (MSR) in his left brachioradialis and left achilles; a right patellar MSR which was pendular. He was treated with multi-axial rotation to affect the vestibular apparatus, brainstem and cortical connections, oculomotor therapy, laser therapy and manual manipulation of joint mechano-receptors. Results: After fourteen days in a multi-day treatment program aberrant eye movements improved: He was able to maintain gaze holding; pursuits at 0.01 Hz were within more normal range; optokinetic responses during saccades improved; his accommodation spasm was absent; spontaneous facial movement was abated; retrocolic neck reactions diminished; V:A ratios improved; low back pain was relieved. Conclusion: Intensive multi-day therapy which incorporates therapies (vestibular, occult-motor, mechanoreceptor stimulation) to improve the reflexogenic systems may help alleviate impairments in athletes. This tennis player’s symptoms were improved and he was able to return to play. The authors recommend further investigation into the utilization of a multi-modal vestibular, ocular and motoric programs to correct performance among athletes. Keywords: Tennis, Low Back Pain, vestibular therapy, Off Vertical Axis Rotation (OVAR), reflexogenic, oculomotor, Eye therapy Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Carrick FR, Behrendt BR and Esposito S (2015). Recalibration of oculomotor and cerebellar activity to reduce low back pain in a professional tennis player. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00045 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Prof. Frederick R Carrick, Carrick Institute for Graduate Studies, Cape Canaveral, FL, 32920, United States, drfrcarrick@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Frederick R Carrick Benjamin R Behrendt Susan Esposito Google Frederick R Carrick Benjamin R Behrendt Susan Esposito Google Scholar Frederick R Carrick Benjamin R Behrendt Susan Esposito PubMed Frederick R Carrick Benjamin R Behrendt Susan Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Isolated Hand Paralysis Due to Stroke in Precentral Knob Region (P02.191)

Objective: To document a rare presentation of stroke. Background Lhermitte described 9pseudoperipheral palsy9 as a weakness of fingers due to a CNS lesion, now thought to be 1% of all ischaemic strokes. Often misdiagnosed, the opportunities to identify and treat stroke risk factors are missed. Design/Methods: A 62 year-old male presented with difficulty of finger movements and wrist drop of left hand, for two days. Patient had history of hyperlipedemia. On exam, his blood pressure was 195/100mm Hg with normal vitals,left wrist drop, weak finger flexion,abduction and adduction, weak thumb extension flexion and adduction, with brisk left brachioradialis reflex. Rest of the neurological examination was normal. Results: Due to isolated hand weakness, we were tempted to think of peripheral lesion, however due to involvement of muscle supplied by radial, medial and ulner nerve and brisk brachioradialis reflex, MRI brain was done to look for central cause, which showed diffusion positive lesion in mid of the right precentral gyrus suggestive of acute stroke. Patient was managed for acute stroke and was discharged home with mild improvement of weakness. Conclusions: Functional MRI suggests that the w or E shaped area (the precentral knob) on the precentral gyrus in the axial plane is the hand area. Medial portion of the precentral knob representing topographically ulnar-sided fingers may correspond to the borderzone area between the middle cerebral artery (MCA) and the anterior cerebral artery, whereas the lateral portion representing radial-sided fingers is supplied by distal MCA branches. Cortical hand paralysis characteristically cause partial finger paralysis, producing pseudo-ulner or pseudoradicular pattern with difference in the severity of paralysis between the radial side and the ulnar side, important in differentiating cortical hand paralysis from subcortical lesions. Discrete functional cortical areas for each digit exist and are sequentially arranged, with considerable overlap of control of adjacent territory. Disclosure: Dr. Vyas has nothing to disclose. Dr. Staudinger has nothing to disclose. Dr. Hanson has nothing to disclose.

Allotransplantation of Cryopreserved Parathyroid Tissue for Severe Hypocalcemia in a Renal Transplant Recipient

We report the successful allotransplantation of cryopreserved parathyroid tissue to reverse hypocalcemia in a kidney transplant recipient. A 36-year-old male received a second deceased donor kidney transplant, and 6 weeks later developed severe bilateral leg numbness and weakness, inability to walk, acute pain in the left knee and wrist tetany. His total calcium was 2.6 mg/dL and parathormone level 5 pg/mL (normal 10-60 pg/mL). He underwent allotransplantation of parathyroid tissue cryopreserved for 8 months into his left brachioradialis muscle. Immunosuppression included tacrolimus (target C(0) 10-12 ng/mL), mycophenolate mofetil and steroids. Within 2 weeks, the left knee pain, leg weakness and numbness resolved, and by 1 month he could walk normally. After a peak at month 2, his parathyroid hormone (PTH) level fell to <10 pg/mL; therefore at month 3 he received a second parathyroid transplant from the same donor. Eight months later (11 months after initial graft) he has a total calcium of 9.3 mg/dL, PTH level 15 pg/mL and is clinically asymptomatic. The amount of parathyroid tissue needed to render a patient normocalcemic is not known. In our case, the need for second transplant suggests that the amount of tissue transferred for an allograft may need to be substantially greater than for an autograft.

Attenuated Skin Blood Flow Response to Nociceptive Stimulation of Latent Myofascial Trigger Points

Zhang Y, Ge H-Y, Yue S-W, Kimura Y, Arendt-Nielsen L. Attenuated skin blood flow response to nociceptive stimulation of latent myofascial trigger points. Objectives To investigate the effect of painful stimulation of latent myofascial trigger points (MTrPs) on skin blood flow and to evaluate the relative sensitivity of laser Doppler flowmetry (LDF) and thermography in the measurement of skin blood flow. Design Painful stimulation was obtained by a bolus injection of glutamate (0.1mL, 0.5M) into a latent MTrP located in the right or left brachioradialis muscles. A bolus of glutamate injection into a non-MTrP served as control. Pain intensity (visual analog scale [VAS]) was assessed after glutamate injection. Pressure pain threshold (PPT) was recorded bilaterally in the brachioradialis muscle before and after glutamate-induced pain. Skin blood flow and surface skin temperature were measured bilaterally in the forearms before, during, and after glutamate-induced pain with LDF and thermography. Setting A biomedical research facility. Participants Fifteen healthy volunteer subjects. Interventions Not applicable. Main Outcome Measures VAS, PPT, skin blood flow, and surface skin temperature. Results Glutamate injection into latent MTrPs induced higher pain intensity (F=7.16; P<.05) and lower PPT (F=11.41, P<.005) than into non-MTrPs. Glutamate injection into non-MTrPs increased skin blood flow bilaterally in the forearms, but skin blood flow after glutamate injection into latent MTrPs was significantly less increased at the local injection area or decreased at distant areas compared with non-MTrPs (all P<.05). Skin temperature was not affected after glutamate injection into either latent MTrPs or non-MTrPs (all P>.05). Conclusions The present study demonstrated an attenuated skin blood flow response after painful stimulation of latent MTrPs compared with non-MTrPs, suggesting increased sympathetic vasoconstriction activity at latent MTrPs. Additionally, LDF was more sensitive than thermography in the detection of the changes in skin blood flow after intramuscular nociceptive stimulation.

Fatiguing exercise attenuates pain-induced corticomotor excitability

The purpose of this study was to assess net corticomotor excitability during a painful stimulus before and after exercise. In the first study, 25 subjects participated in three sessions: one familiarization session and two experimental sessions. The two experimental sessions were randomized and involved measurement of pain perception before and after (1) a submaximal isometric fatiguing contraction with the left elbow flexor muscles and (2) 30min of quiet rest. Pain perception was assessed using a pressure device applied to the right index finger for 2min. Motor evoked potentials (MEPs) of the left brachioradialis muscle were measured following transcranial magnetic stimulation (TMS) which was delivered before, during, and after the 2min pain test. In the second study, 12 subjects participated in one session which involved application of TMS to elicit MEPs at the same time points as in study one, before and after a submaximal fatiguing contraction, but in the absence of pain. In the absence of the mechanical noxious stimulus, MEP amplitude was reduced following the fatiguing contraction and unchanged over this time period. In study one, pain threshold increased and pain ratings decreased following the isometric contraction but not after 30min of quiet rest. During application of the mechanical noxious stimulus to the right index finger, MEP amplitude of the left brachioradialis muscle increased indicating an increase in net corticomotor excitability. The pain-induced increase in MEPs was attenuated following the isometric fatiguing contraction and this occurred in parallel with the decrease in pain.

Nociceptive contribution to the evoked potentials after painful intramuscular electrical stimulation

Our study aimed at investigating the nociceptive contribution to the somatosensory evoked potentials after electrical intramuscular stimulation (mSEPs) at painful intensity. Scalp mSEPs were recorded in 10 healthy subjects after electrical stimulation of the left brachioradialis muscle at three intensities: non-painful (I2), slightly painful (I4) and moderately painful (I6). For each intensity, mSEPs were recorded in a neutral condition (NC) in which subjects did not have any task, and in an attention condition (AC) in which subjects were asked to count the number of stimuli. In both NC and AC, the N120 and P220 amplitudes were significantly higher at I6 than at I2. While the N120 amplitude did not vary between NC and AC, the P220 amplitude was significantly higher in AC than in NC at all stimulus intensities. Our results suggest that nociceptive inputs contribute to the N120 amplitude increase at painful stimulus intensity, while the P220 amplitude is more sensitive to changes of subjects’ attention level. Therefore, the N120 amplitude increase to moderately painful stimuli, as compared to non-painful stimuli, may represent a marker of the activation of the muscular thin myelinated afferents.

검도 머리치기 유형에 따른 상지의 근전도 비교 분석

The purpose of this study was to compare the EMG activities of four-forearm muscles during Kumdo head striking. The four skilled and unskilled Kumdo club members were selected from D university in B city. Investigated muscles were left brachioradialis, right brachioradialis and left flexor carpi radialis, right flexor carpi radialis. Raw EMG data were collected during the head striking motions and the average EMG were calculated by the frame width of 0.05s, and then the average %MVC were calculated. The average %MVC values of each muscle in each group were compared. The results are as follows. 1) In each group, there were no significant statistical differences between every muscle over the all phases. 2) There were significant differences, however, between skilled group and unskilled group. The former got higher average %MVC at left flexor carpi radialis and the latter at right brachioradialis in the ready phase and in the impact phase.

Different EEG topographic effects of painful and non-painful intramuscular stimulation in man.

To clarify the specific effects of muscle pain on electroencephalogram (EEG) activation in man, painful and non-painful sensations were produced by intramuscular injections of capsaicin and vehicle solution in the left brachioradialis muscle, with identical procedures in 15 male volunteers. Thirty-one channel EEG data acquired before, during and after the two injections were analysed and compared in respect of topography and power spectrum. Although the painful and non-painful muscular stimulations evoked similar EEG topographic patterns, statistics demonstrated that distinct EEG activation over different areas of the head were induced by the painful and non-painful stimulation compared with the baselines. The decreases in theta and alpha-1 (8-10.5 Hz) activity in central and posterior parietal parts were evoked by non-painful stimulation, but the decreases in alpha-1 and alpha-2 (11-13.5 Hz) activities in the posterior part of the head were induced by painful stimulation. The alpha-2 activity augmented during the waning pain following a decrease in the overt pain. Comparing the EEG changes between baseline, non-painful and painful stimulations as well as waning pain, we found that the increase in beta-2 activity during muscle pain was significant over the extensive areas of the head, whereas a significant increase in alpha-2 activity took place at the posterior part of the head during waning pain following a marked decrease in overt pain. These results may imply that the painful and non-painful muscular stimulations evoke distinct EEG activation in different neural networks of the human brain and the intensity of nociceptive input from muscle may encode the variety of topographic EEG changes.

Long-lasting effect evoked by tonic muscle pain on parietal EEG activity in humans

Objective: To explore EEG changes evoked by tonic experimental muscle pain compared to a non-painful vibratory stimulus. Methods: Thirty-one EEG channels were recorded before, during and after painful and non-painful stimulation. Pain was induced in the left brachioradialis muscle by injection of hypertonic (5%) saline. The vibratory stimulus was applied to the skin area overlying the brachioradialis muscle. The power of the major frequency components of the EEG activity (FFT, fast Fourier transform) was quantified and t-maps between the different experimental conditions were evaluated in frequency domain. Results: The main effect of muscle pain, compared to non-painful stimulation, was a significant and long-lasting increase of delta (1–3 Hz) power and an alpha-1 (9–11 Hz) power increase over the contralateral parietal locus. This finding could suggest a decreased excitability of the primary somatosensory cortex during muscle pain. The main effect of vibration, compared to its unstimulated baseline, consisted in an increase of beta-1 (14–20 Hz) power in the right frontal region. Conclusions: Our data demonstrate significant and specific topographic EEG changes during tonic muscle pain. Since these modifications differ from those produced by an unstimulated baseline and during non-painful tonic stimulation, they might reflect mechanisms involved in the processing of nociceptive and adverse tonic stimuli.

Modifications of Cutaneous, Subcutaneous, and Muscular Sensory and Pain Thresholds After the Induction of an Experimental Algogenic Focus in the Skeletal Muscle

Abstract After the induction of an experimental algogenic focus in the left brachioradialis muscle of 15 healthy subjects, the algosensitive thresholds of the cutaneous, subcutaneous, and muscular tissues are studied in the painful region by means of electrical stimulation. Statistical analysis of the results shows (a) normal sensory thresholds in the three structures; (b) significantly lowered pain thresholds in a limited ellipsoid area in the skin and subcutaneous tissue and in the whole painful area in the muscle. These results clearly indicate a hyperalgesic condition in the parietal layers of the area examined.

Parathyroid autotransplantation in renal osteodystrophy.

Severe renal osteodystrophy with metaphyseal fractures developed in two children with hypoplastic-dysplastic kidneys and chronic renal failure despite therapy with vitamin D, CaCO3, phosphate-binding agents, and protein restriction. Serum immunoreactive parathyroid hormone (iPTH) levels were elevated to 709 and 1,537 pg/mL (N = 255 +/- 92 pg/mL). Total parathyroidectomy and then autotransplantation of a small portion of parathyroids into the left brachioradialis muscle resulted in complete healing of renal osteodystrophy with the same dose of vitamin D. Serum iPTH and histological studies have demonstrated functioning parathyroid autotransplants, 19 and 20 months postoperatively in these two patients. Advantage of such a procedure over 3 3/4 parathyroidectomy is that this transplanted parathyroid tissue is easily accessible for partial removal in case of recurrence of uncontrollable hyperparathyroidism. We believe that total parathyroidectomy and autotransplantation can be successfully performed even in small children.