Differential effect of pancuronium at the adductor pollicis, the first dorsal interosseous and the hypothenar muscles. An electromyographic and mechanomyographic dose-response study

Cumulative dose-response curves were constructed from evoked compound electromyographic (EMG) recordings in man to compare the sensitivity to pancuronium of the adductor pollicis, the hypothenar and the first dorsal interosseous muscles. Also, the EMG and mechanomyography-based sensitivity of the adductor pollicis muscle were compared. The EMG and the mechanomyogram were evaluated in random sequence in each of 21 adult thiopental, fentanyl and diazepam anesthetized patients. The EMG-based ED50 were 36-38 micrograms.kg-1 with no differences between muscles. The EMG-based ED90 of the adductor pollicis and the hypothenar muscles were 62-65 micrograms.kg-1 compared to the 60 micrograms.kg-1 of the first dorsal interosseous muscle (P < 0.05). ED50 (34 micrograms.kg-1), and ED90 (56 micrograms.kg-1) obtained from the adductor pollicis mechanomyogram were significantly lower than those based on the EMG (P < 0.05). It is concluded that differences in sensitivity to pancuronium exist between the three muscles when evaluated from the EMG, and that the apparent sensitivity of a given muscle to a muscle relaxant may depend upon whether the response is evaluated using EMG or mechanomyography.     

Movement disorders in patients with peripheral facial palsy.

Acute unilateral facial paralysis is usually a benign neurological condition that resolves in a few weeks. However, it can also be the source of a transient or long-lasting severe motor dysfunction, featuring disorders of automatic and voluntary movement. This review is organized according to the two most easily recognizable phases in the evolution of facial paralysis: (1). Just after presentation of facial palsy, patients may exhibit an increase in their spontaneous blinking rate as well as a sustained low-level contraction of the muscles of the nonparalyzed side, occasionally leading to blepharospasm-like muscle activity. This finding may be due to an increase in the excitability of facial motoneurons and brainstem interneurons mediating trigeminofacial reflexes. (2). If axonal damage has occurred, axonal regeneration beginning at approximately 3 months after the lesion leads inevitably to clinically evident or subclinical hyperactivity of the previously paralyzed hemifacial muscles. The full-blown postparalytic facial syndrome consists of synkinesis, myokymia, and unwanted hemifacial mass contractions accompanying normal facial movements. The syndrome has probably multiple pathophysiological mechanisms, including abnormal axonal branching after aberrant axonal regeneration and enhanced facial motoneuronal excitability. Although the syndrome is relieved with local injections of botulinum toxin, fear of such uncomfortable contractions may lead the patients to avoid certain facial movements, with the implications that this behavior might have on their emotional expressions.     

A型肉毒毒素治疗痉挛性斜颈临床疗效观察

目的　探讨A型肉毒毒素 (BTXA)局部注射治疗痉挛性斜颈的疗效及安全性。方法　对 31例痉挛性斜颈患者采用肌电图定位引导进行局部注射BTXA治疗 ,注射剂量根据受累肌肉范围及痉挛程度。按Tsui量表评价疗效。结果　Tsui评分治疗前为 1 3 .62± 2 .1 5 ,治疗后为 4 .1 2± 1 .66。基本缓解 39% ,明显缓解 48% ,部分缓解 1 0 %。有效率为 87% ,作用持续时间平均为 (1 7.62± 4 .93)周。绝大多数病例重复注射同样有效。无全身副作用 ,局部副作用轻微。结论　BTXA治疗痉挛性斜颈是一种安全有效、简便易行的治疗手段 ,可作为痉挛性斜颈治疗的首选方法     

Sparing of the flexor carpi ulnaris in ulnar neuropathy at the elbow

A common misconception attributes sparing of the flexor carpi ulnaris (FCU) in ulnar neuropathy at the elbow (UNE) to its innervating branch arising "at or above the elbow." We examined the relationship of FCU branches to the medial epicondyle (ME) and humeroulnar aponeurotic arcade (HUA) in 30 cadaver elbows. In only three did the first FCU branch arise at or proximal to the ME. In 36 UNE cases with fibrillations in the first dorsal interosseous, the FCU was normal in 10, mildly abnormal in 11, and severely abnormal in 15. FCU involvement correlated with the severity of the neuropathy and with whether compression was retroepicondylar or at the HUA. We conclude that sparing of the FCU in UNE is unrelated to the level of origin of its innervating branch, but rather is related to the internal neural topography and to the severity and level of compression.     

Complete bilateral internal ophthalmoplegia as sole clinical sign of botulism: confirmation of diagnosis by single fibre electromyography

Summary A case of complete bilateral internal ophthalmoplegia as the sole clinical sign of botulism is reported. Diagnosis was immediately confirmed by single-fibre electromyography (SFEMG), which revealed abnormally high blocking (14.3%), contrasting with moderately increased jitter (mean consecutive difference in the extensor digitorum communis muscle, 43.9 s). After giving equine botulinum antitoxin and simultaneous forced emptying of the bowels, ocular symptoms completely disappeared within 2 days. Six days, 5 weeks and 6 months after the first SFEMG study, the jitter was still abnormal, even becoming more so with time. Blocking, however, was only rarely observed in the follow-up studies. It is concluded that SFEMG may serve as a useful and sensitive method for the rapid diagnosis of botulinum intoxication, even in cases where no clinical signs of general muscular weakness are apparent.This paper was presented in part at the Congress of the International Medical Society of Motor Disturbances (ISMD), Rome, Italy, 2–4 June 1988     

Reversal of profound paralysis: use of large doses of edrophonium to antagonize vecuronium and pancuronium induced neuromuscular blockade

The ability to evoke reversal of dense vecuronium- and pancuronium-induced paralysis (T1 10% of control) with edrophonium 1.0 mg.kg-1 was studied using train-of-four nerve stimulation and electromyographic monitoring. Two different end-points, train-of-four ratios of 0.5 and 0.7, were used to define "adequate reversal", and the results for both relaxants were compared. Reversal was reliable and rapid for vecuronium if either ratio was used with times of 2.8 (1.5) and 9 (3) min required to achieve ratios of 0.5 and 0.7, respectively. However, if the block was due to pancuronium, reversal was unreliable with 2 of 9 and 4 of 9 patients not achieving ratios of 0.5 and 0.7, respectively. Reversal was also markedly prolonged in this group with a mean time of 37 (23) min to achieve a ratio of 0.7, and in almost half these patients a supplementary dose of edrophonium was required.     

Neuromuscular function and mechanical efficiency of human leg extensor muscles during jumping exercises

The influence of prestretch amplitude on the mechanical efficiency was examined with 5 subjects, who performed 5 different series of vertical jumps, each of which differed with respect to the mechanics of the knee joint action during the prestretch (eccentric) phase of the contact on the floor. Electromyographic activity was recorded from the major extensor muscles during the entire work period of 1 min per series. In addition, expired air was collected during the test and recovery for determination of energy expenditure. Mechanical work was calculated from the vertical displacement of the body during the jumps. The results indicated that high net efficiency of 38.7% was observed in condition where amplitude of knee bending in eccentric phase was small. In large range motion the corresponding net efficiency was 30.1%. In jumps where no prestretching of extensor muscles ocurred the net efficiency was 19.7%. The high efficiency of small amplitude jumps was characterized by low myoelectrical activity of the leg extensor muscles during the positive (concentric) work phase. In addition, the small amplitude jumps had shorter transition time in the stretch-shortening cycle, high average eccentric force and high stretching speed. Therefore the results suggest that the restitution of elastic energy, which was also related to the length change and stiffness of the muscles during stretch, plays an important role in regulating the mechanical efficiency of work.     

Correlation-based decomposition of surface electromyograms at low contraction forces

The paper studies a surface electromyogram (SEMG) decomposition technique suitable for identification of complete motor unit (MU) firing patterns and their motor unit action potentials (MUAPs) during low-level isometric voluntary muscle contractions. The algorithm was based on a correlation matrix of measurements, assumed unsynchronised (uncorrelated) MU firings, exhibited a very low computational complexity and resolved the superimposition of MUAPs. A separation index was defined that identified the time instants of an MU's activation and was eventually used for reconstruction of a complete MU innervation pulse train. In contrast with other decomposition techniques, the proposed approach worked well also when the number of active MUs was slightly underestimated, if the MU firing patterns partly overlapped and if the measurements were noisy. The results on synthetic SEMG show 100% accuracy in the detection of innervation pulses down to a signal-to-noise ratio (SNR) of 10 dB, and 93±4.6% (mean± standard deviation) accuracy with 0 dB additive noise. In the case of real SEMG, recorded with an array of 61 electrodes from biceps brachii of five subjects at 10% maximum voluntary contraction, seven active MUs with a mean firing rate of 14.1 Hz were identified on average.     

男子下蹲式抓举技术动作的生物力学特征分析

目的研究不同抓举重量下男子抓举技术动作的生物力学特征。方法利用8通道EMG测量系统、三维测力平衡系统和数码摄像机,对上海市举重队现役男子举重运动员在不同重量下抓举过程中的8块具有代表性的浅层骨骼肌的表面肌电、足底反力和抓举视频做同步采集。结果不同抓举重量下举重运动员的足底反力变化曲线趋势一致,基于足底反力曲线中的特征点对抓举技术动作阶段可划分为7个阶段,预备阶段、伸膝提铃阶段、引膝提铃阶段、发力阶段、惯性上升阶段、下降定铃阶段和起立阶段。抓举过程中肌群活动的时间顺序为:背阔肌、竖脊肌、肌直肌、三角肌、肱三头肌、胫骨前肌、肱二头肌和斜方肌。其中,斜方肌的积分肌电值最大,背阔肌的积分肌电值最小。随着抓举重量的增加,肱三头肌和三角肌的积分肌电值增加最大。结论为提高举重运动员抓举项目的比赛成绩,运动员应该重视斜方肌、肱三头肌和三角肌的训练。     

Experimental muscle pain changes motor control strategies in dynamic contractions

This study investigated the effect of muscle pain on muscle activation strategies during dynamic exercises. Ten healthy volunteers performed cyclic elbow flexion/extension movements at maximum speed for 2 min after injection of (1) hypertonic (painful) saline in the biceps brachii, (2) hypertonic saline in both biceps brachii and triceps brachii, and (3) isotonic (nonpainful) saline in the biceps brachii muscle. Surface electromyographic (EMG) signals were collected from the upper trapezius, biceps brachii, triceps brachii, and brachioradialis muscles (to estimate EMG amplitude) and with an electrode arrays from biceps brachii (to estimate muscle fiber conduction velocity [CV]). In all conditions, the acceleration of the movement decreased throughout the exercise, and kinematic parameters were not altered by pain. With respect to the control condition, pain induced a decrease of the biceps brachii (mean ± SE, –23±4%) and brachioradialis (–10±0.4%) integrated EMG (IEMG) in the beginning of the exercise, and an increase (45±3.5%) of the upper trapezius IEMG at all time points during the exercise. The biceps brachii IEMG decreased over time during the nonpainful exercises (–11±0.6%) while it remained constant in the painful condition. Biceps brachii CV decreased during painful conditions (–12.8±2.2%) while it remained constant during the nonpainful condition. In conclusion, muscle pain changes the motor control strategy to sustain the required dynamic task both in the relative contribution between synergistic muscles and in the motor unit activation within the painful muscle. Such a changed motor strategy may be highly relevant in models of occupational musculoskeletal pain conditions.