Sensory Conduction Research Articles

Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. METHODS Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. RESULTS A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). CONCLUSION Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.

Simulating perinodal changes observed in immune-mediated neuropathies: impact on conduction in a model of myelinated motor and sensory axons.

Immune-mediated neuropathies affect myelinated axons, resulting in conduction slowing or block that may affect motor and sensory axons differently. The underlying mechanisms of these neuropathies are not well understood. Using a myelinated axon model, we studied the impact of perinodal changes on conduction. We extended a longitudinal axon model (41 nodes of Ranvier) with biophysical properties unique to human myelinated motor and sensory axons. We simulated effects of temperature and axonal diameter on conduction and strength-duration properties. We then studied effects of impaired nodal sodium channel conductance and paranodal myelin detachment by reducing periaxonal resistance, as well as their interaction, on conduction in the 9 middle nodes and enclosed paranodes. Finally, we assessed the impact of reducing the affected region (5 nodes) and adding nodal widening. Physiological motor and sensory conduction velocities and changes to axonal diameter and temperature were observed. The sensory axon had a longer strength-duration time constant. Reducing sodium channel conductance and paranodal periaxonal resistance induced progressive conduction slowing. In motor axons, conduction block occurred with a 4-fold drop in sodium channel conductance or a 7.7-fold drop in periaxonal resistance. In sensory axons, block arose with a 4.8-fold drop in sodium channel conductance or a 9-fold drop in periaxonal resistance. This indicated that motor axons are more vulnerable to developing block. A boundary of block emerged when the two mechanisms interacted. This boundary shifted in opposite directions for a smaller affected region and nodal widening. These differences may contribute to the predominance of motor deficits observed in some immune-mediated neuropathies.NEW & NOTEWORTHY Immune-mediated neuropathies may affect myelinated motor and sensory axons differently. By the development of a computational model, we quantitatively studied the impact of perinodal changes on conduction in motor and sensory axons. Simulations of increasing nodal sodium channel dysfunction and paranodal myelin detachment induced progressive conduction slowing. Sensory axons were more resistant to block than motor axons. This could explain the greater predisposition of motor axons to functional deficits observed in some immune-mediated neuropathies.

Defective Conduction of Anorectal Afferents Is a Very Prevalent Pathophysiological Factor Associated to Fecal Incontinence in Women.

Background/AimsFecal incontinence (FI) is a prevalent condition among women. While biomechanical motor components have been thoroughly researched, anorectal sensory aspects are less known. We studied the pathophysiology of FI in community-dwelling women, specifically, the conduction through efferent/afferent neural pathways.MethodsA cross-sectional study was conducted on 175 women with FI and 19 healthy volunteers. The functional/structural study included anorectal manometry/endoanal ultrasound. Neurophysiological studies including pudendal nerve terminal motor latency (PNTML) and sensory-evoked-potentials to anal/rectal stimulation (ASEP/RSEP) were conducted on all healthy volunteers and on 2 subgroups of 42 and 38 patients, respectively.ResultsThe main conditions associated with FI were childbirth (79.00%) and coloproctological surgery (37.10%). Cleveland score was 11.39 ± 4.09. Anorectal manometry showed external anal sphincter and internal anal sphincter insufficiency in 82.85% and 44.00%, respectively. Sensitivity to rectal distension was impaired in 27.42%. Endoanal ultrasound showed tears in external anal sphincter (60.57%) and internal anal sphincter disruptions (34.80%). Abnormal anorectal sensory conduction was evidenced through ASEP and RSEP in 63.16% and 50.00% of patients, respectively, alongside reduced activation of brain cortex to anorectal stimulation. In contrast, PNTML was delayed in only 33.30%. Stools were loose/very loose in 56.70% of patients.ConclusionsPathophysiology of FI in women is mainly associated with mechanical sphincter dysfunctions related to either muscle damage or, to a lesser extent, impaired efferent conduction at pudendal nerves. Impaired conduction through afferent anorectal pathways is also very prevalent in women with FI and may play an important role as a pathophysiological factor and as a potential therapeutic target.

High-Frequency (10 kHz) Electrical Stimulation of Peripheral Nerves for Treating Chronic Pain: A Double-Blind Trial of Presence vs Absence of Stimulation

The study objectives were to perform a clinical audit of patients implanted with 10 kHz spinal cord (SCS) and peripheral nerve (PNS) stimulators for treating chronic pain and to investigate the effect of 10 kHz PNS on pain and other sensory modalities in a double-blind cross-over trial. Pain, disability, and medication status were audited for 12 months after stimulator implantation in 58 SCS patients and in 11 PNS patients with an electrode positioned along a branch of the occipital or trigeminal nerve (four patients), a limb nerve trunk (four patients), or the S1 nerve root, genito-femoral nerve or ileo-inguinal nerve (one patient each). In PNS patients, pain and other sensory modalities were also assessed double-blind before and after the stimulator was switched either ON or OFF for two hours (protocol 1) or four hours (protocol 2). Decreases in pain and disability after stimulator implantation were maintained in both groups at 3-6 months, but these decreases were greater in PNS than SCS patients. In PNS trial patients, pain increased after the system had been turned OFF overnight for at least 12 hours before testing. Pain did not change after two hours of PNS but had decreased significantly after four hours. Other sensory modalities were minimally affected either by two or four hours of stimulation. These findings suggest that PNS at 10 kHz decreases pain when conducted for at least four hours. Stimulation analgesia does not appear to be due to sensory conduction block.

Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.

Inguinal segmental nerve conduction of the lateral femoral cutaneous nerve in healthy controls and in patients with meralgia paresthetica

A common entrapment site of the lateral femoral cutaneous nerve (LFCN) is in the vicinity of the inguinal ligament. However the more distal segment of this nerve can also be affected. Electrophysiological evaluation of this nerve is difficult. Additionally, available methods have failed in the lesion localization of LFCN. In this study, we aimed to evaluate nerve conduction study in different segments of the LFCN. Nerve action potentials of the LFCN were recorded with distal surface electrodes from a relatively distant point (about 30 cm caudal to the spina iliaca anterior superior). An electrical stimulus was given both 10 cm distal to the SIAS and at the level of the SIAS. Inguinal segmental and distal sensory nerve conduction studies were performed on the LFCN. Thirty-eight healthy controls and 34 patients with meralgia paresthetica (MP) were analyzed by this method. All patients with MP showed electrophysiological abnormalities. Slowed sensory conduction on the inguinal channel (p:0.0001) and loss of response were the most frequent abnormalities (44.7% and 31.6%). In one patient, the only abnormality was slowed sensory conduction at the distal site. Our findings suggest that this technique can help in diagnosis and lesion localization in MP.

558-P: Rate of Progression of Utah Early Neuropathy Symptom Score in Diabetic Neuropathy

The Utah Early Neuropathy Scale (UENS) is a brief, validated exam scale focused on injury to small diameter nociceptive fibers. Twenty-four of 42 possible points are related to measurement of length dependent loss of pin sensation in legs and feet. While the UENS has been accepted as a standard clinical measure for diagnosis of small fiber neuropathy, its utility as a primary outcome measure in clinical trials has not been evaluated. Here we report natural history progression of the UENS. In an NIDDK DP3 single center study, 190 patients with diabetes were screened for neuropathy using Toronto criteria, then 83 found to have neuropathy were followed longitudinally at 9-month intervals for up to 27 months using a variety of clinical and ancillary measures, including the UENS. Among those with neuropathy, baseline UENS score significantly correlated with scores of symptom questionnaires including the Norfolk Quality of Life-Diabetes Neuropathy (NQoL-DN) and the NTSS-6; with nerve conduction study measures including sural sensory amplitude, peroneal amplitude and proximal conduction velocity; with intraepidermal nerve fiber density (IENFD) from distal thigh and distal leg 3m punch skin biopsies; but not with confocal corneal microscopy measures of nerve fiber length and density. Overall, 75 participants were followed for 9 months, and 56 for at least 18 months for a total of 149 9-month segments. UENS worsened (increased) 1.08 (+/- StDev 3.51) points per 9-month segment overall. For those followed at least 18 months, there was a 2.2 (+/-4.1) point increase over this period. Change in UENS significantly correlated with change in NQoL-DN and IENFD, among other measures. The UENS is an objective, responsive, validated clinical instrument for which a linear natural progression slope can be measured, and would be an appropriate primary endpoint in small fiber neuropathy clinical trials. Disclosure J. Singleton: None. P.E. Hauer: None. C. Revere: None. S.C. Foster-Palmer: None. A.B. Aperghis: None. A. Smith: Consultant; Self; Alexion Pharmaceuticals, Inc., Disarm, Regenesis. Funding National Institutes of Health (DP3DK104394)

Effect of vacuum-compression therapy for carpal tunnel syndrome as a part of physiotherapy - pilot study

Aims: The aim of this pilot study was to assess effect of combined kinesiotherapy and vacuum-compression therapy in patients with carpal tunnel syndrome. Methods: Ten patients (six women and four men, average age 55 ± 12.7 years) with a total of 18 hands, indicated for the surgical treatment of carpal tunnel syndrome underwent six individual kinesiotherapy sessions and ten applications of vacuum-compression therapy. The effect of the intervention was evaluated by electromyography and a visual analogue scale. Results: After the therapy, electromyography did not show a statistically significant difference in distal motor latency, sensory nerve action potential, and sensory conduction velocity of the nervus medianus. However, the visual analogue scale decreased significantly (P = 0.001). A statistically significant relationship was found after the therapy between the visual analogue scale score and the distal motor latency (r = 0.646, P = 0.005). Conclusions: After the therapy consisting of kinesiotherapy and vacuum-compression therapy, the typical symptoms of carpal tunnel syndrome decreased. We found great inter-individual differences in measurable parameters of the manifestations of carpal tunnel syndrome. Additionally, none of the patients opted for surgical treatment even one year after finishing the therapy.

P55-T Does sensory conduction block work in CIDP?–Based on serial electrophysiological studies

Background The presence of sensory nerve conduction block is not routinely assessed in the evaluation of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Whether this can be useful is not well known. Methods We respectively analyze the serial sensory conduction studies of 20 patients with the diagnosis of typical CIDP. Sensory nerve action potential (SNAP) amplitudes and sensory conduction velocities were recorded in the median, ulnar, tibial, peroneal and sural nerves. Follow-up studies were compared with the baseline to evaluate the variation of SNAP amplitudes in serial recordings. Results Four patients were excluded because of clinical aggravation, and the data of sixteen patients were analyzed, including serial sensory conduction studies in 136 nerves. The SNAPs in 82 nerves were absent at baseline, of which the SNAPs in 24 nerves reappeared during follow-up studies, with a mean amplitude of 3.23 ± 3.57 μ V. In the other 54 nerves, 36/54 (66.7%) SNAP amplitudes increased (median increased by 45%) compared to the baseline, and the improvement rates in 15 nerves were greater than 50%. The mean increase in median nerve was the highest (r = 56.64%), followed by tibial nerve (r = 46%), sural nerve (r = 38.75%), ulnar nerve (r = 28.4%), and peroneal nerve (r = 15.75%). Notably, 20/29 (68%) initially normal sensory nerves showed significant increase in SNAP amplitude (median increased by 37.5%), and the improvement rates in 6 nerves were greater than 50%. Conclusions We propose that conduction block may also exist in sensory nerves, segmental sensory conduction and follow-up studies may be of great value in evaluating patients with CIDP.

P17-S Repeated compression radial neuropathies caused by rope bondage

Rope bondage or shibari represents voluntary binding of a person with a rope and can lead to compression injury to peripheral nerves. We present a case of the radial nerve injury in suspension. A 29-year-old woman with a BMI of 17.5 was tied up with a 6-mm jute rope and suspended by the upper limbs, torso and hips for 25 min. The rope was placed in the middle third of the brachium. On removing the rope, she had a left wrist and a finger drop with decreased posterolateral hand sensation. Radial nerve conduction studies was performed on day 48. Compound muscle action potential was recorded from extensor digitorum communis. Conduction velocity was reduced to 19 m/s in the spiral groove segment, conduction block was 95.3%. Sensory conduction studies were normal. Clinical improvement began after 3 months with complete improvement after 5 months. Seventeen months after the recovery, this patient re-compressed both radial nerves after a similar suspension lasting about 8 min. The improvement began after one week and completed after 4 weeks. The third compression episode, that occurred three years after the first compression, lasted five minutes with clinical recovery in two minutes later. Nerve conduction studies demonstrated normal motor and sensory conduction velocities in radial, median, ulnar, peroneal, tibial and sural nerves. A high-resolution ultrasound examination showed a slight increase in the cross-sectional area of the left radial nerve in the spiral groove compared to the opposite side. Conclusion Rope bondage often causes injury to the radial nerve.

P39-S Multimodal evoked potentials in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

Background The central nervous system in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is involved in about 5% of patients. The aim of the study was the assessment of the prevalence of central sensory impairment, and its reliance on peripheral nerve damage in patients with CIDP. Materials and methods The study group consisted of 24 patients with mean age of 60.7, who fulfilled the diagnostic criteria of typical form of CIDP at the time of multimodal (visual - VEP, brainstem auditory - BAEP, somatosensory SEP) evoked potentials (EPs) study. Each patient underwent a neurological examination, as well as a CT/MRI scan of the head. The evoked potentials was conducted according to the International Federation of Clinical Neurophysiology (IFCN) guidelines. Results Mean latency of most components of EP were considerably prolonged in patients compared to the control group. Negative correlations of SNAP amplitudes and sensory conduction velocities in peripheral nerves were obtained for I-V and III-V inter-latencies BAEP, for N20, P16, P22 SEP and the central conduction time TT for all sensory fibers of the left upper limb nerves. Conclusions Correlations of SNAP and EP parameters indicate subclinical damage to the central sensory pathways. The CIDP pathomechanism is still unclear and needs further research.

P88-T Clinical and neurophysiologic characterization of the diabetic truncal mononeuropathy

Background Thoraco-abdominal or truncal nerves can be selectively affected in diabetic patients. The clinical picture shows predominantly sensory symptoms like pain, paresthesia, and occasional motor involvement. This mononeuropathy can be misdiagnosed with different thoracic-abdominal conditions (herpes zoster, angor pectoris, acute abdomen, intraabdominal tumours,…). It usually occurs between the 5th and 6th decades, with an insidious or subacute onset. We present a series of 4 cases in which electrodiagnostic testing was decisive for the diagnosis. Material and methods All the patients presented a long history of type 2 diabetes, and complained of poorly defined abdominal pain, without finding a cause that justified the symptoms in a prior extensive clinical investigation (including analytics and imaging studies). The neurophysiologic study consisted on motor and sensory conduction studies and quantitative needle electromyography of the rectus abdominis and external abdominal oblique muscles. Results In every case electromyography showed a subacute-chronic neurogenic pattern, characterized by complex and long-duration motor unit potentials, with an increased percentage of polyphasic potentials. In three cases we found spontaneous activity (fibrillation potentials or positive sharp waves). The study was compatible with the diagnosis of truncal neuropathy/radiculopathy. In half of the patients it was associated with a mixed sensory-motor polyneuropathy. Conclusions Truncal mononeuropathy in diabetic patients is most likely underdiagnosed, probably because the unspecific clinical presentation, including very variable sensory symptoms that mimic other conditions. Once the diagnosis of presumption is stablished, it is easily confirmed neurophysiologically, with electromyography being the technique that provides the most information for the diagnosis.

O-28 Simulated differential sensitivity of motor and sensory nerves for conduction block in immune-mediated neuropathies

Background Immune-mediated polyneuropathies affect myelinated nerve fibers, resulting in conduction slowing or block, with selective involvement of sensory and motor axons. The underlying mechanisms are not well understood. We studied the impact of putative mechanisms by focusing on nodal and paranodal dysfunction on saltatory conduction in a longitudinal myelinated axon model. Materials and methods We extended our longitudinal axon model, which consisted of 41 nodes of Ranvier, with biophysical characteristics unique for human myelinated motor or sensory axons. We studied the effects of impaired nodal sodium channel conductance, paranodal myelin loop detachment by reducing paranodal seal resistance, and their interaction on saltatory conduction in the nine middle nodes and surrounding paranodes. Results Physiological motor and sensory conduction velocities were approximately 48 m/s and 50 m/s, respectively. Progressive conduction slowing was observed when reducing maximum sodium channel conductance and reducing paranodal seal resistance. Conduction blocks eventually occurred at a 75% (motor) and 78% (sensory) reduction in maximum sodium channel conductance and at a 87% (motor) and 89% (sensory) reduction in paranodal seal resistance. A boundary of block emerged representing the severity levels where both interacting mechanisms induced a conduction block. Conclusion Using our longitudinal myelinated motor and sensory axon model, simulations support the view that biophysical differences between motor and sensory axons potentially contribute to a differential susceptibility for development of a conduction block in immune-mediated polyneuropathies.

P87-T Rapid recovery of motor and sensory conduction block in multifocal motor neuropathy

Background Multifocal motor neuropathy (MMN) almost purely involves motor nerve. About 20% MMN patients develop minor sensory symptoms in the course of disease. Material and method We reported a 62-year-old male who developed a slowly progressive asymmetrical limb weakness for five years. Motor nerve conduction studies showed definite CB in left median and ulnar nerves, and probable CB in right tibial nerve. Although the patient complained of no sensory symptom, sensory never conduction studies showed absent sensory nerve action potential (SNAP) for bilateral medial plantar and fibular nerves, left sural nerve and reduced amplitude for left median, ulnar and radial nerves. Conduction velocities were otherwise normal. One month after receiving intravenous immunoglobulin (IVIg), his weakness alleviated apparently. A substantial increase in motor amplitude recorded with stimulation at the PF indicated a partial reversal of CB. The SNAP amplitude of left median, ulnar and radial nerves increased more than 50% and the return of bilateral fibular nerve potentials provided evidence of reversible conduction failure in sensory nerves. We reviewed related literature for this performance. Result Three previously published studies reported such a decrease of SNAP amplitude in MMN patients. Such features suggest a more prominent axonal damage more than demyelination. The hyperpolarization of axolemma, resulting from axonal Na+/K+ pump inhibition at the lesion site and overactivity at the adjacent site may constitutes the prominent mechanism of CB. Conclusion Amplitude reduction of SNAP combined with motor CB, which recovered rapidly after IVIg, may suggest axonal damage rather than demyelination.

P16-S Isolated lower-leg pain and A-wave studies: A case report

An isolated lower-leg pain without neurological manifestations is an important problem in clinical practice. A-wave has been found in many cases but its significance remains unclear. We described a case of a 29-year-old woman, a bank employee, complaining of the lower-leg pain in the calf muscle on the left side. It continued over a year causing discomfort, excruciating muscle pain, accompanied by episodes of shooting pains that would appear in the morning and on sitting at desk at work for a long time. The pains disappeared during a walk. Intensity of the pain was 3.0 points when assessed on the visual analogue scale and 4.0 points on the DN4 questionnaire. Neurological investigations revealed only a Lasegue sign (60°) on the left side. Lumbosacral spine MRI showed a diffuse dorsal protrusion of the intervertebral discs L4-L5 2.1 mm, L5-S1 2.3 mm. Nerve conduction studies demonstrated normal motor and sensory conduction velocities in peroneal, tibial and sural nerves. No changes were recorded in the H-reflex studies. F-wave studies at distal and proximal point stimulation of the left tibial nerve showed the presence of the A-wave immediately before the F-wave. After month of regular visits to the swimming pool and the vascular medicines treatment, the patient observed that lower-leg pain significantly decreased. Conclusion The isolated lower-leg pain has been regarded as a neuropathic one with its source in the S1 root on the left side. This observation indicates clinical importance of studying and analyzing of A-waves in the lower limbs pain.

P20-S Is it necessary to do bilateral nerve conduction studies for electrodiagnosis of polyneuropathies?

Background Nerve conduction studies (NCS), particularly in lower extremities, are essential for diagnosis and classification of polyneuropathies. However, the necessity of performing NCS bilaterally in the diagnostic workup of suspected polyneuropathy is unclear. We aimed in this study to compare the frequency of abnormal NCS parameters in polyneuropathy between right and left lower extremities. Material and methods We included prospectively 313 consecutive patients referred with the suspicion of polyneuropathy. In all patients, peroneal and tibial motor and sural sensory NCS were examined bilaterally. Results were compared to laboratory controls. Results Of 313 patients, 219 (70%) were diagnosed with polyneuropathy (PNP+) and 94 (30%) had the polyneuropathy diagnosis rejected (PNP−). In the PNP+ group, there was no side differences in neither mean distal motor latency, motor conduction velocity, motor amplitude and F-wave latency for peroneal and tibial nerves, nor in sensory conduction velocity and sensory amplitude for the sural nerve (t-test, p 0.05). Conclusions Our study suggests that bilateral NCS in lower extremity motor and sensory nerves may not be necessary in the evaluation of suspected polyneuropathy. Further studies are required to examine the utility of bilateral NCS in the classification of polyneuropathies.

P72-S Recurrent proximal motor conduction blocks in a patient with relapsing-remitting predominantly motor form of CIDP

Background Chronic inflammatory demyelinating polyneuropathy (CIDP) is a clinically heterogeneous autoimmune disease. Motor-dominant form of CIDP is frequently presented as relapsing-remitting course. Although motor conduction blocks have to be the pathophysiological substrate in these cases, there is no many descriptions in literature. Material and Methods We report a male patient (63 years old) with relapsing-remitting-CIDP, with 4 episodes of acute motor weakness that responded well to endovenous inmunoglobulin treatment. Results Electrophysiological studies showed diffuse demyelinating changes in motor conduction studies in upper and lower limbs, and minor sensory conduction abnormalities. Relapsing-remitting motor conduction blocks were demonstrated in proximal segments of upper limb nerves, in parallel with improvement and worsening clinical changes. Conclusions Recurrent proximal motor conduction blocks are demonstrated in a patient with relapsing-remitting predominantly motor form of CIDP. Differential diagnosis and the pathophysiological basis is discussed.

Retrospective study on the impact of ulnar nerve dislocation on the pathophysiology of ulnar neuropathy at the elbow.

IntroductionHigh resolution ultrasonography (US) has been used for diagnosis and evaluation of entrapment peripheral neuropathy. Ulnar neuropathy at the elbow (UNE) is the second most common focal entrapment neuropathy. The ulnar nerve tends to move to the anteromedial side and sometimes subluxates or dislocates over the medial epicondyle as the elbow is flexed. Dislocation of the ulnar nerve during elbow flexion may contribute to friction injury. We aimed to investigate the effects which the dislocation of ulnar nerve at the elbow could have on the electrophysiologic pathology of UNE.MaterialsWe retrospectively reviewed 71 arms of UNE. The demographic data, electrodiagnosis findings and US findings of ulnar nerve were analyzed. We classified the electrodiagnosis findings of UNE into three pathologic types; demyelinating, sensory axonal loss, and mixed sensorimotor axonal loss. The arms were grouped into non-dislocation, partial dislocation, and complete dislocation groups according to the findings of nerve dislocation in US examination. We compared the electrodiagnosis findings, ulnar nerve cross sectional areas in US and electrodiagnosis pathology types among the groups.ResultsA total of 18 (25.3%) arms showed partial dislocation, and 15 (21.1%) arms showed complete dislocation of ulnar nerve in US. In the comparison of electrodiagnosis findings, the partial and complete dislocation groups showed significantly slower conduction velocities and lower amplitudes than non-dislocation group in motor conduction study. In the sensory conduction study, the conduction velocity was significantly slower in partial dislocation group and the amplitude was significantly lower in complete dislocation group than non-dislocation group. In the comparison of US findings, patients in partial and complete dislocation groups showed significantly larger cross sectional areas of the ulnar nerve. The comparison of electrodiagnosis pathologic types among the groups revealed that there were significantly larger proportions of the axonal loss (sensory axonal loss or mixed sensorimotor axonal loss) in partial and complete dislocation groups than non-dislocation group.ConclusionThe ulnar nerve dislocation could influence on the more severe damage of the ulnar nerve in patients with UNE. It might be important to evaluate the dislocation of the ulnar nerve using US in diagnosing ulnar neuropathy for predicting the prognosis and determining the treatment direction of UNE.

EFEKTIVITAS LOW POWER LASER TERAPI DAN PROPRIOCEPTIF NEUROMUSCULAR FACILITATION PADA ULKUS DIABETIKUM DERAJAT 2

Diabetic ulcers are one of the most severe complications of diabetes in people with diabetes mellitus. When examined through the International Classification of Function (ICF) approach, there are several problems associated with diabetic ulcers, including: the presence of pain, limited movement, open wounds, loss of sensory sensation or motor ability. There are some modalities can be used to help these problems, namely by using laser and therapeutic approaches such as the application of proprioceptive neuromuscular facilitation (PNF). The method of this paper is an article review by using secondary data taken from research journals which are related to the effectiveness of the use of low power laser therapy and proprioceptive neuromuscular facilitation in diabetic ulcer patients. The primary effect of laser usage on cell is increasing oxidative metabolism to produce more ATP, which ultimately leads to the normalization of cell function, pain relief, and wound healing. PNF is a method of enhancing neuromuscular movement and facilitation to facilitate muscle contraction. This method has the primary goal of achieving individual needs, and thus can perform functional movements, through facilitation, inhibition, strengthening and relaxation of muscle groups. Based on the literature review, it can be concluded that: (1) Low power laser therapy is effective in repairing wounds in patients with grade 2 diabetic ulcers, (2) Proprioceptive Neuromuscular Facilitation (PNF) is effective in improving sensory and motor neuronal conduction associated with ankle movement in grade 2 diabetic ulcers, and (3) The combination of low power laser therapy and Proprioceptive Neuromuscular Facilitation is effective in improving the limitations of motion and function of grade 2 diabetic ulcers.

Diffusiontensor MRI tractography in patients with children’s cerebral palsy: assessment of structural lesions of conduction tracts

Introduction. The application of diffusion-tensor (DT)-MRI tractography in patients with children S cerebral palsy (CP) allows to establish pathophysiological mechanisms of the development of motor and sensory impairments, to perform a clinical and neuroimaging comparison, as well as to determine correlations between lesions of the conduction tracts and neurological deficits. Aim. For the determination of changes in fractional anisotropy (FA) and mean diffusivity coefficient (MDC), obtained with DT-MRI in the corticospinal and sensory tracts, structures of the corpus callosum in spastic forms of CP. Materials and methods. There were examined 105 children with spastic forms of CP (spastic tetraparesis - 47, spastic diplegia - 38, hemiparetic form - 20) and 50 children without neurological deficit, at the age of 2-18 years. In all CP patients the severity of motor deficit was evaluated according to Gross Motor Function Classification System (GMFCS). DT-MRI was performed in all cases with the use of devices of General Electric (US), under magnetic field strength of 1.5T and 3T, with the calculation of the FA and the MDC in areas of interest - cerebral peduncles the brain stem, the posterior limb of the internal capsule, the genu and splenium of the corpus callosum, posterior thalamic radiation, postcentral gyrus, the thalamus. Results. There was established the distribution of children according to the GMFCS scale: I - 14 (13,4%), II - 19 (18,1%), III - 20 (19%), IV- 10 (9,5%), V- 42 (40%) cases. The severity of motor impairment on the GMFCS scale closely correlated with the values of FA and ADC in cerebral peduncles, posterior limb of the internal capsule, posterior thalamic radiance, genu of the corpus callosum. Conclusion. DT-MRI enables to assess adequately the changes in the white matter of the brain, structural andfunctional state of the motor and sensory conduction tracts, gives a possibility to predict the development of a child with CP.