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Chang C-W, Chang K-Y, Chen Y-R, Kuo P-L. Electrophysiologic evidence of spinal accessory neuropathy in patients with cervical myofascial pain syndrome. Objective To evaluate whether or not spinal accessory neuropathy exists in patients with cervical myofascial pain syndrome (MFPS). Design Prospective study. Setting A neurophysiologic laboratory in a university hospital. Participants Patients with cervical MFPS (n=25) and healthy controls (n=20). Interventions Not applicable. Main Outcome Measures We performed nerve conduction studies (NCSs) in bilateral spinal accessory nerves, and electromyography and stimulated single-fiber electromyography in the trapezius muscles of all patients and controls. Parameters including nerve conduction velocities (NCVs), amplitudes and areas of compound muscle action potentials (CMAPs), and mean consecutive differences (MCDs) in single-fiber electromyography were measured, analyzed, and compared with the disease durations of the patients. Results Spinal accessory NCSs showed normative NCVs but with prominently reduced CMAP amplitude in the patients with cervical MFPS, which is recognized as an axonal neuropathy of the spinal accessory nerves. Electromyography showed prominent evidence of denervation and reinnervation patterns in 48% of the MFPS patients. The abnormal MCDs in single-fiber electromyography indicated a synaptic delay of motor endplates in the motor units, and may signify evolving instability of neuromuscular transmission in the spinal accessory nerves innervating trapezius muscles of the patients. Conclusions This study demonstrates electrophysiologic evidence of neuroaxonal degeneration and neuromuscular transmission disorder in a significant proportion of patients with cervical MFPS. We suggest that spinal accessory neuropathy may be associated with cervical MFPS.

The study of central nervous pathway conductions established clinical values both in afferent and efferent systems in recent decades. Somatosensory evoked potential was originally an estimated dysfunction of afferent sensory pathways in the spinal cord. However, it is limited in the evaluation of cord function in dorsal column. Motor evoked potential (MEP) study, developed by Merton and Morton 11) since 1980, has become a useful tool in evaluation of electrophysiologic function of motor pathways in central nervous diseases including spinal cord disorders. For measurement of spinal cord motor conduction velocity (SCMCV), invasive methods with direct spinal cord stimulations and recordings during spinal surgery have been introduced, however, they were not commonly applied in clinical practice. MEP study by pulse magnetic stimulation developed by Barker and coworkers 1) since 1985, moreover, offering advantages of non-invasive, painless and deep penetration of nerve tissues has the potentials in evaluating spinal cord dysfunction, brain diseases 12) and deep seated nerve pathology.

Background and PurposeThe purpose of this study was to compare the use of 3 mobilization techniques—end-range mobilization (ERM), mid-range mobilization (MRM), and mobilization with movement (MWM)—in the management of subjects with frozen shoulder syndrome (FSS).SubjectsTwenty-eight subjects with FSS were recruited.MethodsA multiple-treatment trial on 2 groups (A-B-A-C and A-C-A-B, where A=MRM, B=ERM, and C=MWM) was carried out. The duration of each treatment was 3 weeks, for a total of 12 weeks. Outcome measures included the functional score and shoulder kinematics.ResultsOverall, subjects in both groups improved over the 12 weeks. Statistically significant improvements were found in ERM and MWM. Additionally, MWM corrected scapulohumeral rhythm significantly better than ERM did.Discussion and ConclusionIn subjects with FSS, ERM and MWM were more effective than MRM in increasing mobility and functional ability. Movement strategies in terms of scapulohumeral rhythm improved after 3 weeks of MWM.

The phenol nerve block has been widely used in clinical practice for spasticity reduction, but the correlation between the dosage of phenol and its effectiveness has seldom been discussed. The objective was to determine the optimal duration of phenol in contact with the nervous tissue and to investigate the dose-response relationship of 5% aqueous phenol solution by percutaneous nerve block in rats. Group I (n = 8) received sciatic nerve block by bathing the nerves in phenol solution, and group II (n = 40) by injecting phenol percutaneously. Group IIa to IId received different volumes (0.80, 0.16, 0.08 and 0.04 ml) and group IIe received normal saline. Compound muscle action potential (CMAP) was measured pre-injection and at 90 and 270 sec after injection and after surgical exposure of the nerves. The duration of CMAP reduced by 10%, 25%, 50%, 75% and 100% after phenol injection was also recorded. The mean latency for the evoked response to subside in direct phenol application (group I) and percutaneous nerve block (group IIa) were 73.5 ± 5.9 and 62.4 ± 7.6 sec, respectively. There was no statistical difference for the time periods in the blocking effect elicited by phenol solution between these two methods. Ninety sec was set as the optimal duration for phenol to produce complete conduction blockage. Higher volume of phenol produced more significant blocking effect at 90 and 270 sec after injection. Percutaneous injection with 0.16 ml of phenol solution had the same blocking effect as 0.8 ml. The continuous injection model for percutaneous phenol block indeed used significantly more phenol than actually needed. Clinically, the progressive injection model can be used to minimize injection volume.

Estimating the focal size and position of a high-intensity focused ultrasound (HIFU) transducer remains a challenge since traditional methods, such as hydrophone scanning or schlieren imaging, cannot tolerate high pressures, are directional, or provide low resolution. The difficulties increase when dealing with the complex beam pattern of a multielement HIFU transducer array, e.g., two transducers facing each other. In the present study we show a novel approach to the visualization of the HIFU focus by using shockwave-generated bubbles and a diagnostic B-mode scanner. Bubbles were generated and pushed by shock waves toward the HIFU beam, and were trapped in its pressure valleys. These trapped bubbles moved along the pressure valleys and thereby delineated the shape and size of the HIFU beam. The main and sidelobes of 1.1- and 3.5 MHz HIFU beams were clearly visible, and could be measured with a millimeter resolution. The combined foci could also be visualized by observing the generation of sustained inertial cavitation and enhanced scattering. The results of this study further demonstrate the possibility of reducing the inertial cavitation threshold by the local introduction of shock wave-generated bubbles, which might be useful when bubble generation and cavitation-related bioeffects are intended within a small region in vivo.

Understanding the control of movement requires an awareness of how tasks constrain movements. The present study investigated the effects of two types of task constraints—spatial accuracy (effector size) and target location—on reaching kinematics. 15 right-handed healthy young adults (7 men, 8 women) whose mean age was 23.6 yr. ( SD = 3.9 yr.) performed the ringing task under six conditions, formed by the crossing of effector size (larger vs smaller size) and target location (left, right, or a central position). Significant main effects of effector size and target location were found for peak velocity and movement time. There was a significant interaction for the percentage of time to peak velocity. The findings suggested that task constraints may modulate movement performance in specific ways. Effects of effector size might be a consequence of feedforward and feedback control, and location effects might be influenced by both biomechanical and neurological factors.

Study design: A study of the clinical features, physical activity, muscle enzyme, electromyography and histopathological alternations of muscles in patients with post-polio syndrome (PPS). Objective: To assess the varied patterns of PPS in Taiwan. Setting: Taiwan. Methods: Thirty-one patients who fulfill the inclusion criteria of PPS were selected for study. Clinical features, physical activity scale, serum concentrations of creatine kinase, electromyography and histopathological alterations of muscles were assessed and correlated to the causes of PPS patients. Results: Patients with PPS in Taiwan are relatively young, with a mean age of 39.3 years. Elevated concentration of creatine kinase was found predominantly in male patients with higher physical activities. Electromyographic examinations as well as histological tests of affected muscles revealed prominent evidence of chronic and active denervation with reinnervation in PPS patients. Conclusion: Patients with PPS in Taiwan are young. Thus, PPS should not be attributed to aging. Physical attrition with degradation of nerve terminals is considered the main cause of this disease. Sponsorship: This study was supported by the National Science Council, Republic of China under grant no. NSC-83-0412-B002-302. Spinal Cord (2001) 39, 526–531.

We report a 47-year-old male stroke patient with nasopharyngeal cancer (NPC) and protein C deficiency. The patient was diagnosed with NPC and received a complete course of radiotherapy. Infarction stroke occurred 28 months after radiotherapy and magnetic resonance imaging of the brain confirmed the diagnosis. Carotid duplex sonography showed 50–79% stenosis in his left internal carotid artery. Coagulation profiles indicated protein C deficiency. After medical treatment and rehabilitation, the patient regained the ability to walk and he could perform most of his daily activities. Radiotherapy-induced carotid stenosis is an exacerbating feature of stroke in patients with protein C deficiency. We suggest early carotid duplex sonography and survey of the coagulation profile to prevent a stroke in patients with NPC.

Retrospective case study.Report a rare case of cervical myelopathy induced by calcium pyrophosphate dehydrate (CPPD) deposition in multiple cervical levels.An area teaching hospital in Taiwan.A patient with cervical myelopathy was evaluated by computerized tomography (CT) scan and magnetic resonance (MR) image. CPPD deposition known as pseudogout was diagnosed and approved by a polarized microscope.A prominent hypertrophy of ligmentum flavum and a retro-odontoid bulging mass induced cord compression were found in CT scan and MR image. CPPD deposition was confirmed by the histological examinations in the ligamentum flavum at the spinal levels of C3-C6. After decompression surgery of spine and comprehensive rehabilitation, the patient's neurological symptoms subsided and her neurological functions improved leading to a good prognosis.CPPD deposition in cervical spine occurring at multiple levels is rare. Image studies with CT scan and MR are complementary in the diagnosis of CPPD-induced myelopathy. Surgical decompression is always required and expected to have a good outcome.

Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops, shorten its duration. We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach (EMSMTA) in a subgroup of subjects with frozen shoulder syndrome (FSS). Based on the kinematics criteria from a prediction method, 34 subjects with FSS were recruited. Eleven subjects were assigned to the control group, and 23 subjects who met the criteria were randomly assigned to the criteria-control group with a standardized physical therapy program or to the EMSMTA group. Subjects attended treatment sessions twice a week for 8 weeks. Range of motion (ROM), disability score, and shoulder complex kinematics were obtained at the beginning, 4 weeks, and 8 weeks. Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria-control group at 4 weeks (mean difference=0.2 of normalized hand-behind-back reach) and 8 weeks (mean difference=22.4 degrees humeral external rotation, 0.31 of normalized hand-behind-back reach, 7.5 disability, 5 degrees tipping and 0.32 rhythm ratio). Similar improvements were found between the EMSMTA group and control group. The EMSMTA was more effective than a standardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method.

The Tromner sign is commonly used as a clinical neurological examination for upper motor neuron lesions above the fifth or sixth cervical segments of the spinal cord. This study aims to assess and quantify the Tromner signs utilizing electrophysiological test, and correlate to the severity of cord compression in cervical spondylotic myelopathy (CSM). We enlisted 46 CSM patients, and 30 healthy persons as controls. Manual Tromner and Hoffmann signs were tested in all subjects. By using a self-designed instrument, we performed electrophysiological assessments for the Tromner signs in patients and controls. Parameters of conduction latencies and amplitude of muscle action potentials were measured and compared with the cord compression ratios in CSM patients. The results showed a greater diagnostic sensitivity for the quantified Tromner signs in comparison to those of manual Tromner signs and Hoffmann signs. We found a positive correlation between the amplitude of muscle action potentials obtained in the Tromner signs and the cord compression ratios in the patients with CSM. In conclusion, the Tromner signs can be measured by electrophysiological assessments. We demonstrate a new quantification method for an established neurological sign. Not only is Tromner sign a highly sensitive test in clinical neurological examination, the electrophysiological assessment of this sign can also serve as an objective marker for evaluation of the severity of cervical cord compression.

The literature suggests a possible relationship between carrying angle and nontrauma-related ulnar neuropathy. To confirm that relationship, we asked whether carrying angle is a risk factor in patients with nontrauma-related ulnar neuropathy. We measured the carrying angles of the elbow in 36 patients with a clinically and electrophysiologically confirmed diagnosis of nontraumatic ulnar neuropathy at the elbow and in 50 healthy control subjects. Correlation analysis was performed between carrying angles and parameters of nerve conduction studies, including nerve conduction velocities and amplitudes of muscle and nerve action potentials. The mean carrying angle was greater in the patients than in the control subjects. Females had a greater carrying angle than males. We observed an inverse relationship between carrying angles and motor nerve conduction velocities at cross-elbow segments of the ulnar nerves and with sensory nerve conduction velocities of the distal ulnar nerves. An increased carrying angle of the elbow appears to be an independent risk factor of nontrauma-related ulnar neuropathy. Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

An analysis of secondary shoulder motions (humeral rotation, humeral head anterior/posterior translation, scapular tipping, and scapular upward/downward rotation) in subjects with anterior/posterior shoulder tightness provides the opportunity to examine the role of tightness as a means of affecting shoulder motions. Subjects with shoulder tightness (anterior, n =12; posterior, n =12) elevated their arms in the scapular plane. Three replicated movements were performed to the maximum motions. Kinematics data were collected by FASTRAK 3D electromagnetic system. To determine if a significant difference of the secondary motions existed between anterior/posterior shoulder tightness, two-factor mixed ANOVA models with the repeated factor of elevation angle (five elevation angles) and the independent factor of group were calculated. The relationships between the self-reported functional scores (Flexilevel Scale of Shoulder Function, FLEX-SF) and abnormal shoulder kinematics were assessed. For humeral head anterior/posterior translation, the subjects with posterior tightness demonstrated anterior humeral head translation (10mm, p =0.019) compared to subjects with anterior tightness. The subjects with anterior tightness demonstrated less posterior tipping (2.2°, p =0.045) compared to subjects with posterior tightness. The humeral anterior translation had moderate relationships with FLEX-SF scores ( r =−0.535) in subjects with posterior tightness. The scapular tipping had moderate relationships with FLEX-SF scores ( r =0.432) in subjects with anterior tightness. In conclusion, the secondary motions were different between subjects with anterior and posterior shoulder tightness. During arm elevation, less scapular posterior tipping and less posterior humeral head translation in subjects with anterior and posterior shoulder tightness, respectively, are significantly related to self-reported functional disability in these subjects.

Objective: To evaluate the change in motor evoked potential parameters following transcranial magnetic stimulation in patients with chronic complete thoracic cord injury. Design: A cross-sectional study. Subjects: Eighteen patients with chronic complete thoracic cord injury and 18 age- and sex-matched healthy controls were included in the study. The mean post-injury duration was 13.0 (standard deviation (SD) 6.0) years. Methods: The latency, amplitude, central conduction time and peripheral conduction time of motor evoked potentials from bilateral abductor pollicis brevis and first dorsal in terosseous muscles following transcranial magnetic stimulation were measured and compared between the patients and healthy controls. The predicting variables for central conduction time, including age, sex, height, illness duration and job activity, were analysed using a simple correlation and stepwise multiple regression model. Results: The patients with complete thoracic cord injury had longer central conduction time recording of the dominant hand in both abductor pollicis brevis and first dorsal interosseous muscles. The difference in latency approached significance between the patients and controls. There was no statistical difference in amplitude between them. Regression analysis demonstrated that patients who were older, less physically active and with longer illness duration showed prolonged central conduction time. Conclusion: The central conduction time in the dominant hand of chronic complete thoracic cord injury is prolonged. This study revealed motor reorganization of the central nervous system in complete thoracic cord injury. Decreased physical activity and prolonged illness may cause these changes.