Symptomatic Arms Research Articles

THREE-DIMENSIONAL ANALYSIS OF SCAPULAR KINEMATICS DURING ARM ELEVATION IN BASEBALL PLAYERS WITH SCAPULAR DYSKINESIS: COMPARISON OF DOMINANT AND NON-DOMINANT ARMS

BackgroundThe knowledge of 3-dimensional (3D) scapular kinematics is essential for understanding the pathological lesions of shoulder and elbow in throwing athletes. To date, a number of studies about alterations of...

Ultrasound shear wave elastography in assessment of muscle stiffness in patients with Parkinson's disease: a primary observation

ObjectiveThe aim of this study was to assess the capability of ultrasound shear wave elastography (SWE) in evaluating the muscle stiffness in patients with Parkinson's diseases (PD). MethodsUltrasound SWE of the longitudinal biceps brachii was performed on 46 patients with PD and 31 healthy controls from May 2013 to October 2013. The stiffness of the biceps brachii muscles measured with quantitative Young's modulus (kPa) was compared between the remarkably symptomatic arms and mildly symptomatic arms in the PD and between PD and controls with unpaired t test. The correlation between the Young's modulus of the biceps brachii measured by SWE and motion scores assessed by unified Parkinson's disease rating scale (UPDRS) part III was analyzed by Pearson's correlation coefficient. The reliability of SWE in assessment of biceps brachii stiffness was tested using intraclass correlation coefficient (ICC). ResultsThe mean Young's modulus of biceps brachii in remarkably symptomatic arms, mildly symptomatic arms, and healthy controls was 59.94±20.91 kPa, 47.77±24.00 kPa, and 24.28±5.09 kPa, respectively. A significant difference in Young's modulus of biceps brachii was found between healthy controls and all PD patients (all P<.05); however, it was not between remarkably symptomatic and mildly symptomatic arms. A positive linear correlation was found between the Young's modulus of the biceps brachii and the motion score by UPDRS in patients with PD (r=0.646, P=.000). The ICC for interobserver and intraobserver variation in measuring Young's modulus of the biceps brachii with SWE was 0.74 (95% confidence interval 0.68–0.78) and 0.78 (95% confidence interval 0.75–0.82), respectively. ConclusionsSWE of the biceps brachii can be used as a quantitative assessment of muscle stiffness in the patients with PD.

Abstract 5238: Near-infrared fluorescence imaging of human lymphatics in healthy subjects and in cancer survivors

Abstract Near-infrared (NIR) fluorescence imaging was used to non-invasively image the (dys)function of the lymphatics in healthy control subjects and in subjects clinically diagnosed with unilateral lymphedema, a little understood disease characterized by chronic swelling and commonly observed in cancer survivors following therapeutic, complete nodal dissection. As part of an FDA approved feasibility trial and after informed consent, 24 control and 20 lymphedema (both hereditary and acquired) subjects received multiple intradermal injections of 25 µg of indocyanine green (total dose ≤ 400 µg) in bilateral arms or legs. The limbs were illuminated with NIR excitation light and the resulting fluorescent signal was imaged using custom, intensified CCD cameras. Lymphatic architecture and propulsive lymphatic flow from the injection sites to the nodal basin was observed. The apparent lymph velocities and propulsion periods were determined for the control subjects arms and legs as well as for the asymptomatic and symptomatic limbs of the lymphedema subjects. While the lymphatics of the control subjects consisted of well-defined vessels which propelled fluid from the injection sites to the regional nodal basin, diseased lymphatics exhibited distinct architectural malformations, such as (i) extravascular fluorescence in which the ICG diffused away from the injection site or leaked out of the lymphatic vessels, (ii) dense networks of lymphatic capillaries, (iii) tortuous lymphatic vessels, and (iv) lymphatic backflow and/or reflux. Statistical analyses of control subjects found subtle but significant differences in the left and right velocities in both arms (0.84 cm/s and 0.76 cm/s, p=8.1e-5) and legs (0.99 cm/s and 0.87 cm/s, p=0.032) but not in the periods of contralateral limbs. The difference in velocity in control arms (0.79 cm/s) and legs (0.94 cm/s) is small but significant (p=1.22e-7) while the difference in period is not. Significant differences in period exist between control (arms: 48.2 s; legs: 52.2 s) and both asymptomatic (arms: 39.6 s, p=2.68e-6; legs: 65.3 s, p=0.0022) and symptomatic (arms: 33.2 s, p=4.14e-5; legs: 72.1 s, p=0.00014) limbs. Significant differences were also found between the velocities in the control (0.94 cm/s) and both asymptomatic (0.83 cm/s, p=0.0084) and symptomatic (0.78 cm/s, p=0.0036) legs but not in the arms of control and lymphedema subjects. Results demonstrate that non-invasive NIR fluorescence imaging of microgram amounts of fluorophore can detect architectural and functional lymphatic abnormalities. The lack of significant differences between the velocities and periods of the asymptomatic and symptomatic limbs suggests that lymphedema may be a systemic disease regardless of onset etiology. Supported in parts by the American Cancer Society and the Longaberger Foundation (RSG-06-213-01-LR) and the National Institutes of Health (R01 HL092923 and U54 CA136404). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5238.

Abstract 4331: Assessment of cancer-related lymphatic impairment using NIR fluorescent imaging

Abstract The lymphatic system contributes a major pathway for cancer metastasis and, through lymph node biopsy, provides the primary prognostic factor guiding therapy post-operative cancer patients. However, survivorship and quality of life for cancer survivors who undergo lymph node dissection can be complicated by lymphedema (LE). The etiology of LE is unknown and in this study, we developed methods to image lymphatic structure and function and its response to LE treatment to gain new understandings of the disease. Twenty unilateral LE and 24 normal control subjects were recruited in an IRB and FDA approved, Phase 0 exploratory trial. Onset of LE occurred after cancer treatment in 13 of the 20 LE subjects. Total dose of less than 400 µg of indocyanine green was injected intradermally in bilateral arms or legs. Immediately after the injections, a diffused excitation light illuminated the limbs and NIR fluorescence images were obtained using custom-built imaging systems. Twenty-two of the 44 subjects received the only accepted, but controversial therapy for LE, manual lymph drainage (MLD). Images were obtained immediately before and after MLD. Apparent lymph velocities and periods between lymphatic propulsion events were computed from fluorescence images. Images show dramatically different architecture of lymphatics between control normal and LE subjects. Well defined and organized lymphatic structures as well as active propulsions of lymph “packets” were commonly seen in normal limbs. In LE limbs, however, extravascular dye accumulation, networks of lymphatic capillaries, tortuous lymphatic vessels, and fewer propulsions were seen. The results without or before MLD show that the apparent velocity and periods between propulsions in average are 0.79 cm/s and 48.2 s for control arms and 0.94 cm/s and 52.2 s for control legs; 0.90 cm/s and 33.2 s for symptomatic arms and 0.78 cm/s and 72.1 s for symptomatic legs in LE subjects; 0.79 cm/s and 39.6 s for asymptomatic arms and 0.83 cm/s and 65.3 s for asymptomatic legs in LE subjects. In addition, an increase in velocity and a decrease in propulsion period were seen in the improvement of lymphatic function following MLD in subjects who received treatment. MLD resulted in increased apparent lymph velocities in the symptomatic (+23%) and asymptomatic (+25%) limbs of LE subjects and in the control limbs (+28%) of normal subjects. The lymphatic propulsion periods decreased in the symptomatic (−9%) and asymptomatic (−20%) limbs of LE subjects, and in the control limbs (−23%). NIR fluorescent imaging allows the in vivo visualization of the lymphatics architecture and quantification of lymphatic function. It could be used not only to study the impairment of lymphatic function after cancer surgery but also to direct treatment of LE subjects. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4331.

Identification and Pathogenicity of Lasiodiplodia theobromae and Diplodia seriata, the Causal Agents of Bot Canker Disease of Grapevines in Mexico

Perennial cankers and consequent grapevine dieback are a major problem in vineyards of Sonora and Baja California, the most important grape-production areas of Mexico. In order to identify the canker-causing agents, symptomatic arms, cordons, and trunks were collected from 13 and 6 vineyards in Sonora and Baja California, respectively. Two Botryosphaeriaceae spp., Lasiodiplodia theobromae and Diplodia seriata, were isolated frequently from infected wood and identified based on morphological and cultural characters as well as analyses of nucleotide sequences of three genes, the internal transcribed spacer region (ITS1-5.8S-ITS2), a partial sequence of the β-tubulin gene, and part of the translation elongation factor 1-α gene (EF1-α). Although both L. theobromae and D. seriata were isolated from grapevine cankers in Baja California, only L. theobromae was found in vines in the Sonora region. Pathogenicity of both species was verified by inoculation of rooted cuttings and green shoots of Thompson Seedless and Chardonnay cultivars. Isolates of L. theobromae were more virulent, based on the extent of spread in the secondary wood and green tissue, than those of D. seriata. These findings confirm L. theobromae and D. seriata as the causal agents of dieback and canker formation of grapevines in northern Mexico.

Die Wertigkeit elektroneurographischer Messparameter in der Diagnostik der chronischen Ulnarisneuropathie am Ellenbogen

Ulnar neuropathy at the elbow (UNE) is the second most common compressive neuropathy of the upper limb. Besides clinical evaluation, electrodiagnostic studies are usually applied to confirm the diagnosis. However, there are certain limitations to the diagnosis of UNE by electrodiagnostic studies. In a prospectively performed study we compared the diagnostic value of the electrodiagnostic parameters to the symptoms and the clinical parameters for different degrees of sensory and motor dysfunctions. Between 2001 and 2003, 38 patients (mean age 53.9 +/- 8.8 years, 19 men and 19 women) were treated at our institution for UNE. For 34 (89%) patients complete electrodiagnostic studies were performed and for 25 patients there was also an electrodiagnostic evaluation of the asymptomatic contralateral arm. According to the symptoms and clinical parameters (grip and pinch grip, two-point discrimination), the patients were assigned to three stages (mild, moderate, and severe). Electrophysiological measurements for each stage were compared with one another. The diagnostic value for each electrophysiological parameter was evaluated in comparison to the normal limits of the "Deutsche Gesellschaft für Neurologie (DGN)" and the "American Association of Electrodiagnostic Medicine (AAEM)". In the 34 symptomatic arms the mean values for motor nerve conduction were: conduction velocity (MNCV) = 41.2 +/- 11.6 m/s; velocity change above-to-below-elbow segment = 12.8 +/- 7.7 m/s; CMAP = 9224 +/- 5514 microV; dL = 3.24 +/- 0.82 mg. For the moderate stages of nerve compression (n = 11) the mean values are: MNCV = 42.5 +/- 12.7; velocity change MNCV = 13.2 +/- 6.8; CMAP = 11 890 +/- 4750; dL = 2.97 +/- 0.57; for severe nerve compression (n = 23): MNCV = 40.6 +/- 11.0; change MNCV = 12.7 +/- 8.3; CMAP = 7948 +/- 5358; dL = 3.37 +/- 0.8. The difference for each parameter between the symptomatic and asymptomatic contralateral arm was statistically significant (p < 0.05) as it was for the difference of the parameters of the group with severe nerve compression in comparison to the asymptomatic arm. In the comparison of the moderate stage group with the asymptomatic arm there was only a significant difference for MNCV and there was no significant difference between the moderate and the severe group. In our study the calculated sensitivities for the electrodiagnostic studies were 76% for all symptomatic arms, 64% for the moderate group, and 83% for the severe nerve compression group. In all patients the MNCV was the most sensitive parameter. Electrodiagnostic studies were only able to reveal 3/4 of all patients with an affection of the ulnar nerve and only 2/3 of the patients with a moderate stage of ulnar nerve compression. Although important for the further therapy, a differentiation between a moderate and severe degree of nerve compression was not possible.

The effect of counterforce bracing on grip strength in tennis players with painful elbows

Counterforce bracing is considered to change the mechanical origin of the forearm extensors, thereby decreasing the force of internally generated muscle tension. A clinical study was conducted of 19 tennis players complaining of elbow pain. Seventeen had previously used some form of counterforce bracing for symptomatic pain relief. In those with symptomatic arms, no significant difference in grip strength with or without the brace was identified. Similarly, no significant differences were recorded in the non-symptomatic arms, with or without the brace There was also no significant difference between the symptomatic and non-symptomatic arms, when grip strength was compared with and without the brace. The frequent use of counterforce bracing suggests bracing may subjectively reduce symptoms of pain. However, the results of this study demonstrate that it has no effect on objective measures of grip strength.

A study of upper limb pain and paraesthesiae following neck injury in motor vehicle accidents: assessment of the brachial plexus tension test of Elvey.

The brachial plexus tension test (BPTT) appears to offer a means of examining the extensibility and mechanosensitivity of the neural tissues related to an upper limb. This test was used to evaluate possible cervical or brachial plexus neural involvement causing arm pain syndromes in 37 patients presenting for assessment following neck injury in motor vehicle accidents. The BPTT was considered positive in 55 of the 61 symptomatic arms. There were no false-positive responses in the 13 asymptomatic arms although a slight loss of extensibility was evident in five arms. Twenty patients without clinical evidence of current or previous neck pathology were similarly examined. There were no reports of pain on BPTT in this group. In 36 of the 40 arms a full range of extensibility was present. In the other four arms the loss of extensibility was slight. This study suggests that arm pain and paraesthesiae which follow neck injury in motor vehicle accidents arise from irritable cervical neural tissues. The study also highlights the persistent nature and widespread distribution of the pain in these patients.