Nerve Conduction Velocity Studies Research Articles

Nerve conduction velocity studies in diabetic peripheral neuropathy involving sural nerve—A meta-analysis

ABSTRACT Introduction: Diabetes mellitus (DM) poses a significant health burden globally, impacting millions due to its metabolic disruptions. Among its complications, diabetic peripheral neuropathy (DPN) is a prevalent concern, affecting sensory and motor nerves. While various diagnostic methods exist, discrepancies persist in prevalence estimates of DPN among diabetic populations. Objective: This meta-analysis aimed to assess the prevalence of DPN in individuals with DM, focusing on sural nerve conduction velocity (NCV) measurements. Additionally, the study explored how different evaluation techniques influenced prevalence estimates. Methods: A systematic literature search was conducted following PRISMA guidelines across multiple databases. Studies reporting sural nerve NCV measurements in diabetic patients were included. Data extraction, quality assessment, and statistical analyses were performed to synthesize findings. Results: Twenty-six studies met the inclusion criteria, providing insights into sural nerve NCV among diabetic individuals. Pooled analysis revealed a mean sural nerve NCV of 42.12 m/s (95% CI: 39.87-44.36), indicative of reduced conduction velocity in diabetic populations. Furthermore, sural nerve amplitude was significantly lower in diabetic individuals, with a pooled mean of 4.68 μV (95% CI: 3.11-6.25). Conclusion: Individuals with type 2 DM exhibit impaired sural nerve function, as evidenced by reduced NCV and amplitude measurements. Timely NCV assessment, alongside glycemic monitoring, is crucial for identifying and managing DPN to prevent further complications. Interventions addressing glycemic control, dietary regulation, and lifestyle modifications are recommended to mitigate the progression of neuropathy in diabetic populations.

Safety and effectiveness of ultrasound-guided single injection of 5% dextrose for median nerve hydrodissection in carpal tunnel syndrome

Background: In carpal tunnel syndrome (CTS), conservative management did not show satisfactory results, and some patients required revision surgery due to persistent or recurrent symptoms. Ultrasound (USG)-guided median nerve (MN) hydrodissection with a 5% dextrose injection is an advanced approach for treating symptoms of CTS. We prospectively investigated the patients to demonstrate the safety and effectiveness of this approach. Aims and Objectives: This study aims to evaluate the effect of USG-guided nerve hydrodissection using single injection of 5% dextrose on pain, MN conduction parameters, and functional status in patients with CTS of mild–to-moderate grade. The study also predicts about the safety of the procedure. Materials and Methods: A study was performed in the pain clinic of the tertiary care teaching institute of India for one year. The study included 15 patients diagnosed with mild-to-moderate CTS. The diagnosis was done on the basis of history, physical examination, and a nerve conduction velocity (NCV) study. Patients were given analgesics and NSAIDS and enrolled in the procedure. Parameters used for statistical analysis were Visual Analog Scale (VAS) scores, NCV study data (sensory conduction velocity [SNCV] and distal motor latency [DML]), and Boston carpal tunnel questionnaire (BCTQ) scores. Pre-injection parameters were compared with parameters 3 months after the injection to show the usefulness of this procedure. Results: A statistically significant reduction in VAS score was found in 74% of the cases (P<0.05). The nerve conduction study parameters have shown significantly higher SNCV and lower DML latency in 60% of cases (P=0.001 and P=0.001, respectively). Improved BCTQ scores were found in 80% of cases (for the symptom severity scale, P=0.001 and for the functional status scale, P<0.01). No complications such as allergic reactions, sensory loss, or paresis were recorded post-injection. However, transient injection site pain was present in all patients which did not last for more than 24 h. Conclusion: MN hydrodissection using a single injection of 5% dextrose under USG is a safe and effective approach offering pain relief, better MN conduction, and improved functional status in patients with CTS of mild-to-moderate grade.

SIRT3 alleviates painful diabetic neuropathy by mediating the FoxO3a-PINK1-Parkin signaling pathway to activate mitophagy.

Painful diabetic neuropathy (PDN) is a common complication of diabetes. Previous studies have implicated that mitochondrial dysfunction plays a role in the development of PDN, but its pathogenesis and mechanism have not been fully investigated. In this study, we used high-fat diet/low-dose streptozotocin-induced rats as a model of type 2 diabetes mellitus. Behavioral testing, whole-cell patch-clamp recordings of dorsal root ganglion (DRG) neurons, and complex sensory nerve conduction velocity studies were used to assess peripheral neuropathy. Mitochondrial membrane potential (MMP), ATP, tissue reactive oxygen species, and transmission electron microscopy were used to evaluate the function and morphology of mitochondria in DRG. Real-time PCR, western blot, and immunofluorescence were performed to investigate the mechanism. We found that damaged mitochondria were accumulated and mitophagy was inhibited in PDN rats. The expression of sirtuin 3 (SIRT3), which is an NAD+-dependent deacetylase in mitochondria, was inhibited. Overexpression of SIRT3 in DRG neurons by intrathecally administered LV-SIRT3 lentivirus ameliorated neurological and mitochondrial dysfunctions. This was evidenced by the reversal of allodynia and nociceptor hyperexcitability, as well as the restoration of MMP and ATP levels. Overexpression of SIRT3 restored the inhibited mitophagy by activating the FoxO3a-PINK1-Parkin signaling pathway. The effects of SIRT3 overexpression, including the reversal of allodynia and nociceptor hyperexcitability, the improvement of impaired mitochondria and mitophagy, and the restoration of PINK1 and Parkin expression, were counteracted when FoxO3a siRNA was intrathecally injected. These results showed that SIRT3 overexpression ameliorates PDN via activation of FoxO3a-PINK1-Parkin-mediated mitophagy, suggesting that SIRT3 may become an encouraging therapeutic strategy for PDN.

Nerve conduction velocity studies in infantile Krabbe disease demonstrate long term continued progression of peripheral demyelinating neuropathy after hematopoietic stem cell transplantation (HSCT)

Nerve conduction velocity studies in infantile Krabbe disease demonstrate long term continued progression of peripheral demyelinating neuropathy after hematopoietic stem cell transplantation (HSCT)

Serum Homocysteine and C-reactive Protein Levels in Diabetic Patients with Nerve Conduction Velocity Proven Neuropathy: A Cross-sectional Study

Introduction: Diabetic Neuropathy (DN) is a well known difficult to treat microvascular complication of diabetes. Based on Nerve Conduction Velocity (NCV) studies, DN has been classified into various types. Many possible aetiologies have been proposed. C-Reactive Protein (CRP) plays a role in the development of diabetic microvascular complications, while Homocysteine (Hcys) can harm the endothelium by inducing excessive sulfation of connective tissue. Aim: To study the levels of Hcys and CRP in NCV-proven patients with DN and to associate these levels with the type of DN. Materials and Methods: This was a cross-sectional study conducted at a semi-urban medical college hospital in Western Maharashtra, India, between February 2022 and May 2024. The study included 70 patients over 18 years of age with NCVproven DN in Type 2 Diabetes Mellitus (DM), in whom serum Hcys and CRP levels were evaluated. Data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: A total of 32 female participants (45.7%) and 38 male participants (54.3%). Among the study participants, 23 (32.9%) had a duration of diabetes of 5-10 years, and 47 (67.1%) had a mixed type of neuropathy. Elevated Hcys levels were observed in 18 (25.7%) participants, while 49 (70%) showed elevated CRP levels. CRP levels were raised in the mixed type of neuropathy, with 35 (71.4%) affected, while elevated Hcys levels were observed among the sensory neuropathies in 6 (33.3%) participants. Conclusion: No significant association was found between elevated Hcys and CRP levels and the type of neuropathy

Detecting Presence of Tarsal Tunnel Syndrome in Type II Diabetic Patients using Clinical, Radiological and Electrodiagnostic Studies: A Cross-sectional Study

Introduction: Diabetic foot is one of the most devastating complications of diabetes and is the leading cause of lower limb amputations. Patients with a long-standing history of diabetes mellitus often experience symptoms of pain, burning sensation, numbness, and paraesthesia in the heel and feet. These symptoms may be due to compression of the medial plantar nerve, a branch of the tibial nerve, within the tarsal tunnel. Aim: To evaluate the incidence of Tarsal Tunnel Syndrome (TTS) in patients suffering from Type 2 Diabetes Mellitus (T2DM). Materials and Methods: This study was a cross-sectional analysis conducted at the Army Hospital (Research and Referral) in New Delhi, India, from October 2019 to April 2021. A total of 30 consecutive diabetic patients presenting with pain, burning, numbness, and paraesthesia in the heel or feet, with or without ulcers, were included. All patients were clinically evaluated using three-point sensory testing, Tinel’s sign at the tarsal tunnel, and assessment for the presence of ulcers on the foot. All patients underwent Nerve Conduction Velocity (NCV) studies. Imaging studies in the form of Magnetic Resonance Imaging (MRI) were performed for a complete work-up of these patients and further diagnosis of TTS. The incidence of TTS was evaluated using clinical, radiological and electrodiagnostic studies. Results: Of the 30 patients enrolled, 20 were males (66.7%) and 10 were females (33.3%). The incidence of TTS among diabetic patients was found to be 14 (46.7%) based on electrodiagnostic criteria, 22 (73.3%) based on clinical evaluation, and 25 (83.3%) based on radiological findings. The mean HbA1c level was 8.5±1.04%. The most common imaging finding was oedema, observed in 83.3% of patients. Inflammation and ganglion cysts were seen in 13.3% and 10% of patients, respectively. Conclusion: TTS is difficult to diagnose. MRI is a useful imaging modality to support the diagnosis. Electrodiagnostic studies can help confirm the diagnosis.

Peripheral Neuropathy Resembling CIDP Following Exposure to Toxic Fumes in Shoe Factory: A Case Report

Abstract Different types of solvents and adhesives are used in a shoe factory. The toxic chemicals can cause acute and chronic effects on the central and peripheral nervous system. Here, we report a case of a 25-year-old young man working as a coloring and gluing worker in a shoe factory, who presented with progressive quadriparesis following exposure of six months. Some of his coworkers also developed a similar illness. Nerve conduction velocity studies of the patient showed combined sensory and motor demyelinating and axonal polyneuropathy. Cerebrospinal fluid (CSF) analysis was normal. With conservative management and physiotherapy, there is a gradual improvement of the condition in the patient who can ambulate independently now.

Determination of various etiological factors for diagnosis of non traumatic scapulo costal syndrome

Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated. Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations. Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment.

The correlation of the spinoglenoid ganglion cyst size with the electrophysiological alterations of suprascapular nerve and the rotator cuff muscle power

BackgroundAlthough various treatment options are available for spinoglenoid cyst, including conservative and surgical methods, there is no standard guideline for its surgical decompression. Thus, the purpose of the study was to correlate the size of the spinoglenoid notch ganglion cyst (GC) as revealed by magnetic resonance imaging (MRI) with electrophysiological alterations, muscle power, and pain severity, and to estimate a cut-off value of cyst size to perform a decompression. MethodsBetween January 2010 and January 2018, the patients with a GC at the spinoglenoid notch diagnosed on MRI, and who had a minimum follow-up of 2 years after the decompression were included. Maximum cyst diameter as measured on MRI was used for comparison. Electromyography (EMG) and nerve conduction velocity (NCV) studies were performed before the surgery. Peak torque deficit (PTD) percentage compared to opposite shoulder was calculated preoperatively and at 1 year after surgery. Pain severity was estimated using visual analogue scale (VAS) preoperatively. ResultsTen (50%) of 20 patients with GC > 2.2 cm and 1 (5.9%) of 17 patients with GC < 2.2 cm showed EMG/NCV abnormalities (p = 0.019). There was a correlation between the cyst size and the positive EMG/NCV findings (Correlation coefficient (CC) = 0.535, p < 0.001). The preoperative peak torque deficit on the external rotation was correlated with the positive EMG/NCV findings (CC = 0.373, p = 0.021). The PTD was improved significantly at 1 year postoperatively in patients with a GC size >2.2 cm (p = 0.029). The cyst size was not related to the preoperative pain VAS and muscle power. ConclusionsThe spinoglenoid cyst size >2.2 cm, but not pain severity or muscle power, correlates with the positive finding of EMG for compressive suprascapular neuropathy. The GC size >2.2 cm can be a reference to decide the need of decompression surgery. Level of evidenceIV, case series.

TU-220. Study of heart rate variability and nerve conduction velocity in prediabetics

TU-220. Study of heart rate variability and nerve conduction velocity in prediabetics

Guillain-Barré syndrom in a patient with Wegener’s disease, a rare case

Peripheral neuropathy may be reversible or permanent. Hence, we would like to present a 38-years-old man without any previous medical history admitted to ShahidSadoughi Hospital in Yazd in terms of reduced force of all four limbs, shortness of breath, cough and hemoptysis. Electromyography and nerve conduction velocity study was performed after the para-clinical examinations and Guillain–Barré syndrome was considered first diagnosis. Regarding the pulmonary symptoms, sinusitis and bilateral alveolar opacities, and positive anti-neutrophil cytoplasmic antibodies, Wegener's granulomatosis was suggested as a potential diagnosis and more steps were performed. This patient has been verified to have concurrent increasing limb weakness, also known as Guillain-Barré syndrome.

Circulating Growth Differentiation Factor 15 Is Associated with Diabetic Neuropathy.

Background: Growth differentiation factor (GDF15) is a superfamily of transforming growth factor-beta which has been suggested to be correlated with various pathological conditions. The current study aimed to investigate the predicted role of circulating GDF15 in diabetic metabolism characteristics and diabetic neuropathy. Methods: 241 diabetic patients and 42 non-diabetic subjects were included to participate in the study. The plasma GDF15 levels were measured using ELISA. Chronic kidney disease and albuminuria were defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline. The nerve conductive study (NCS) was performed with measurement of distal latency, amplitude, nerve conduction velocity (NCV), H-reflex, and F-wave studies. Results: The diabetic group had a significantly higher prevalence of chronic kidney disease and higher plasma GDF15 level. After adjusting for age and BMI, GDF15 was significantly positively correlated with waist circumference (r = 0.332, p = <0.001), hip circumference (r = 0.339, p < 0.001), HbA1c (r = 0.302, p < 0.001), serum creatine (r = 0.146, p = 0.017), urine albumin/creatinine ratio (r = 0.126, p = 0.040), and HOMA-IR (r = 0.166, p = 0.007). As to NCS, GDF15 was significantly correlated with all latency and amplitude of sensory and motor nerves, as well as F-wave and H-reflex latencies. The area under the curve (AUC) in predicting tibial motor nerve neuropathy (MNCV) in all subjects and in the diabetic group for GDF15 was 0.646 (p = 0.001) and 0.610 (p = 0.012), respectively; for HbA1c was 0.639 (p = 0.001) and 0.604 (p = 0.018), respectively. Predicting ulnar sensory nerve neuropathy for GDF15 was 0.639 (p = 0.001) and 0.658 (p = 0.001), respectively; for HbA1c was 0.545 (p = 0.307) and 0.545 (p = 0.335), respectively. Predicting median sensory nerve neuropathy for GDF15 was 0.633 (p = 0.007) and 0.611 (p = 0.032), respectively; for HbA1c was 0.631 (p = 0.008) and 0.607 (p = 0.038), respectively. Predicting CKD for GDF15 was 0.709 (95% CI, 0.648–0.771), p < 0.001) and 0.676 (95% CI, 0.605–0.746), p < 0.001), respectively; for HbA1c was 0.560 (95% CI, 0.493–0.627); p = 0.080) and 0.515 (95% CI, 0.441–0.588); p = 0.697), respectively. Conclusions: We suggest that there is a significant association between the increased serum GDF-15 level and metabolic parameters and diabetic neuropathy. Plasma GDF15 may be an independent predictor of diabetic neuropathy.

Common Peroneal Neuropathy Secondary to Repetitive Direct Blow Contusion Injuries in a Cheerleader: A Case Report

A 13-year-old female cheerleader presented with common peroneal neuropathy secondary to repetitive direct blow contusion injuries to the lateral leg, sustained during her role as a flyer in cheerleading. Symptoms resolved when removed from cheerleading activities. Nerve conduction velocity and needle electromyography electrodiagnostic test studies performed at presentation and during treatment confirmed improvement of the neuropathy. The use of a protective knee brace that provided cushion near the fibular head prevented recurrence after returning to cheerleading. An association between common peroneal neuropathy and cheerleading has not been documented in previous literature. Awareness of this association will help with diagnosis and prevention of injuries.

To Study the Correlation of Nerve Conduction Velocity Studies and The Outcome of Subjects with Bell’s Palsy on Sunnybrook Facial Grading Scale

Background: Due to limited literature, on the usage of Sunnybrook Facial Grading scale (SFGS), we attempt to address SFGS in measuring clinical outcomes and understand its correlation with NVCs to predict the recovery course. Objectives: 1. To correlate the findings of Nerve Conduction Velocity studies on SFGS in subjects with Bell’s palsy. 2. Also based on the correlation to find whether Nerve Conduction Velocity studies can be used as a prognostic indicator/tool in Bell’s palsy. Methodology: A total of 58 subjects with unilateral Bell’s palsy were selected for the study. Outcome measures, SFGS and NCVs were evaluated on the first day and 20th day. Results: Karl Pearson’s correlation coefficient showed a strong positive correlation between the amplitude of frontalis and mentalis muscle. Conclusion: A positive correlation of the amplitude of frontalis and mentalis muscle. KEYWORDS: Nerve Conduction velocity studies, Sunnybrook Facial Grading scale, Bell’s palsy, correlation and prognostic tool.

Potential association between serum 25-hydroxy vitamin D levels and symptomatic neuropathic pain in rheumatoid arthritis patients

Aim of the workTo study the effect of vitamin D levels on clinical and laboratory characteristics of rheumatoid arthritis (RA), and to evaluate a possible relationship with neuropathic pain (NP). Patients and methodsSixty RA patients with neuropathic pain symptoms and 60 healthy controls were included. All patients were assessed by Leeds assessment of neuropathic symptoms and signs (LANSS) to confirm the presence of NP, modified health assessment questionnaire (MHAQ), disease activity score (DAS-28) and visual analogue scale (VAS). Anti-cyclic citrullinated peptide (anti-CCP), glycolysated hemoglobin (HbA1C) and 25-hydroxy vitamin D levels were assessed. Nerve conduction velocity study (NCVS) was performed in those with confirmed NP. ResultsMean age of patients was 42.4 ± 10.9 years, disease duration 5.3 ± 4.2 years and 91.7% were females. RA patients showed significant lower vitamin D levels than controls (23.5 ± 14.03 ng/ml vs 37.8 ± 13.8 ng/ml; p < 0.001). There was a significant difference between RA patients with NP (n = 30; 18.3 ± 5.5 ng/ml), and patients without (n = 30; 28.8 ± 17.7 ng/ml) regarding 25-hydroxyvitamin D (p = 0.003), LANSS, VAS, MHAQ (all p < 0.001), DAS-28 and TJC (p = 0.04). Carpal tunnel syndrome (CTS) was found in 46.7%; 42.3% of the females and 75% of males, mononeuritis multiplex (MM) in 23.3%; 25% males and 23.1% females. Patients, with deficient vitamin D had either CTS or MM (85.7% each). RA patients with NP had significant delayed latency and reduction of conduction velocity of motor and sensory branches of median, ulnar and tibial nerves. ConclusionVitamin D deficiency could be a plausible cause for neuropathic pain in RA patients.

Guillian Barre syndrome epidemiology presentation and outcome

Background Guillain Barre syndrome (GBS) is most common cause of acute flaccid paralysis, affect peripheral nerves with distinctive features clinical, pathological and prognosis. Patient and methods this study is prospective of 60 patients admitted at al-kadymia teaching hospital from first January 2004 to end April 2009. Age includes 1 to ≤11 years. Diagnosis was by clinical examination and confirmed by CSF tests and nerve conduction velocity study. Results It was found that 32 patients were male and 28 were female. Cranial nerves involved in 30% of patients. Sensory symptoms found in 16%. CSF changes was seen in 85.5% patients. Antecedent events were found in 27 patients out of 60, 14 had history of upper respiratory tract infection 45%, 7 had gastroenteritis 11%, 6 patients had history of fever 3 weeks earlier 10% and 15 patients had complicated by respiratory failure managed by mechanical ventilators, During this study 4 patients had been died. Conclusions: Current study conclude about 45% of patients had history antecedent events in as upper respiratory tract infection , gastroenteritis and fever, so cerebrospinal fluid CSF cell in the majority of cases within normal range and mostly lymphocytes, Cranial nerves were affected in most patients without serious sequels so Steroid was not given to most of patients in our study without any significant effect on the course of disease , Hospitalization was range from 2 week to 4 week, Recovery was range from 4 to 12 week and Death rate was 6% .

Sono-Elastography in evaluation of the median nerve in carpal tunnel syndrome patients

Abstract Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. The diagnosis of CTS is based on a combination of characteristic symptoms and electrophysiologic abnormalities. Electrodiagnostic testing (EDT) is uncomfortable for patients, time consuming and expensive. Objective To evaluate the role of greyscale and strain elastography ultrasound imaging in diagnosing patients with CTS and controls in comparison with nerve conductive studies. Patients and Methods Type of Study: Descriptive, prospective study. Study Setting: The study will be conducted at Ain Shams University Hospitals, Radiodiagnosis department. Study Period: 6 months. Study Population: Patients with carpal tunnel syndrome diagnosed clinically and underwent nerve conduction velocity study. Results In this study 7 wrists were diagnosed with mild CTS, 5 wrists demonstrated moderate CT, whereas only 3 wrists revealed severe CTS. The mean CSA would have increased if the number of cases with severe CTS had been higher. CSA of the median nerve has been reported to increase with the severity of entrapment. The cut off point of the average CSA to differentiate between cases and controls was found &amp;gt; 8 with sensitivity of 93.33%, specificity of 80% and area under curve (AUC) of 91.3% while the best cut off point for Elasto score was found &amp;gt; 1 with sensitivity of 86.6%, specificity of 80% and area under curve (AUC) of 93.3%. Conclusion We concluded that sonoelastography is a sensitive tool for prediction of CTS and it’s severity in correlation to NCV.

Unique case of anterior interosseous nerve injury following distal volar radial plating: A case report

Trauma itself, surgery, nerve entrapments, amyotrophic neuropathy, or neuritis may result in anterior interosseous nerve (AIN) palsy. A 76-year-old woman who was operated for distal end radius fracture with plating was referred back referred back to the clinic by her general practitioner with complaints of inability to flex the interphalangeal joint of the thumb and index finger approximately 3 years after the index surgery. The proximal interphalangeal joint flexion (flexor digitorum superficialis) of the index finger was intact and the pinch power was reduced. She had normal function of her other forearm and hand muscles. Ultrasonography and nerve conduction velocity (NCV) studies were done to investigate further to rule out either tendon flexor pollicis longus (FPL) or nerve injury (AIN). NCV studies reported subacute denervation within the FPL. The patient recovered to near normal without any surgical intervention in 18 months. Literature reported various treatment options in the form of conservative as well as surgical depending on the cause and evidence of recovery.

English

BACKGROUND Chronic neck pain is one of the common and painful musculoskeletal conditions. Determining the prevalence of nerve impairment in chronic neck pain patients is faced with various challenges such as individual perception and coping patterns of pain and likelihood to seek and receive treatment. We wanted to determine the prevalence of nerve impairment in patients of chronic neck pain and estimate the occupation, age, and gender wise involvement of nerve impairment in chronic neck pain patients. METHODS Population in and around Karad diagnosed with chronic neck pain by an orthopaedician fulfilling the inclusion criteria with prior consent were taken for the study. In the first half of the study, participants were assessed based on a questionnaire and a clinical assessment using Upper Limb Tension Tests following which the participants were assessed using nerve conduction velocity studies. RESULTS Participants having chronic neck pain and showing nerve dysfunctions were 32.14 %. Based on F min, frequency of nerve dysfunction within age groups showed the highest percentage that was 10.72 % in the age group of 39 - 42 years. Higher involvement was observed in males than females which was 23.21 %. Occupation wise nerve involvement for nerve dysfunction showed physically demanding occupations which had higher percentage of 14.28 %. CONCLUSIONS This study shows large population of chronic neck pain with no symptoms of nerve involvement but having nerve dysfunction and were not receiving any treatment for their condition thereby allowing it to progress into a radiculopathy. KEY WORDS Chronic Neck Pain, NCV Study, Cervical Radiculopathy, F Min Latency

Pain P-PA001. Parsonage turner syndrome

Introduction . Parsonage Turner Syndrome (PTS) is a rare syndrome that may occur in healthy subjects. The clinical presentation might not be typical and risk factors attributed to the development of disease may not be easily depicted. We present a case of abrupt onset of unilateral shoulder pain, followed by progressive neurologic weakness. Result . A 54-year-old male presented with abrupt onset of shoulder pain mainly on the right side. Pain was felt in both shoulder and thigh which progressed to weakness, dysesthesia, and numbness in the right upper arm. In 4 days, he could barely lift his right upper arm. There was no history of trauma nor infection on the affected area. On physical examination, there were limitation of shoulder abduction and external rotation. His right arm strength from proximal to distal was 1344. Other extremities showed no significant weakness. Sensory involvement did not match dermatomal and peripheral sensory distribution. Nerve Conduction Velocity (NCV) showed axonal motor neuropathy of right axillary nerve. Electromyography (EMG) showed no Motor Unit Action Potential (MUAP) on deltoid muscle. His CK was 457, and there was an increase in LDH and CRP. Cervical MRI was unremarkable. Steroids were immediately given, and the response was fast and satisfactory. After 1 day, his motor strength increased, and the pain subsided. EMG showed single MUAP on deltoid. After 10 days, his motor strength returned to near normal. NCV study showed decreased amplitude of right axillary nerve, and recruitment was slightly decreased on right deltoid muscle. He underwent physical therapy and was making marked progress. Conclusion . PTS generally involves one upper limb, and axillary nerve is one the most commonly involved. PTS should be considered as a differential diagnosis in cases of shoulder pain and arm weakness without any clear etiology.