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1.
Lesions at the volar aspect of the forearm may lead to isolated paralysis of the anterior interosseous nerve, which is a purely motor branch of the median nerve. The same syndrome may result from circumscribed damage at the level of the upper arm. Two patients are reported with the typical anterior interosseous nerve syndrome following supracondylar lesions of the median nerve and the literature is reviewed. In most cases this syndrome is a complication of supracondylar fractures of the humerus in children. A simple clinical test for the diagnosis, the pinch test, and the typical electromyographic findings are described. Whereas electroneurography has been considered to provide little help in diagnosis, a significantly lower nerve conduction velocity was found in the median nerve between the medial intermuscular spatium and the cubital fossa compared to the normal arm, and a prolonged response latency of the pronator quadratus of the injured arm following stimulation of the median nerve in the intermuscular medial spatium and the cubital fossa.  相似文献   

2.
A 49-year-old woman acutely developed severe bilateral shoulder pain followed by weakness of the right shoulder girdle muscles. Within a few days, an inability to flex the terminal phalanges of the bilateral thumbs and index fingers emerged. Neurologic examination 1 month after the onset of symptoms showed atrophy of the right shoulder girdle muscles and mild decreased cutaneous sensation in the distribution of the right axillary nerve. Needle electromyography examination at this time showed fibrillation potentials in the right deltoid and bilateral flexor pollicus longus muscles. Recruitment of the right deltoid, supra- and infraspinatus muscles was reduced. Motor unit potentials in these muscles were of normal configuration. Nerve conduction studies in the upper limb were normal. She was diagnosed as neuralgic amyotrophy with bilateral anterior interosseous nerve syndrome. 4 months later, the muscles innervated by the bilateral anterior interosseous nerve improved in the muscle strength. Clinical features of this case were compatible with a mononeuropathy multiplex form of neuralgic amyotrophy associated with an autoimmune etiology. We think this case is important for speculating the pathogenesis of neuralgic amyotrophy. This case reminds us that patients with neuralgic amyotrophy sometimes demonstrate anterior interosseous nerve syndrome and most patients manifesting anterior interosseous nerve syndrome are patients with neuralgic amyotrophy.  相似文献   

3.
The anterior interosseous nerve syndrome (AINS) is well known. A case is presented that had electromyographic findings limited to the distri-bution of the anterior interosseous nerve. A small area of sensory loss and slight asymmetry of amplitudes noted on median nerve conduction studies were inconsistent with an AIN syndrome. An antecubital level partial median nerve compromise primarily involving the bundles that form the anterior interosseous nerve was surgically noted. This case illustrates that localization of a peripheral nerve lesion must include consideration of the internal topography of peripheral nerves.  相似文献   

4.
In anterior interosseous nerve syndrome and ulnar neuropathy, paralysis or weakness of the flexor digitorum profundus (FDP) muscles has been shown to vary according to the degree of involvement of the median and ulnar nerves, respectively. We traced these nerves in 50 cadaveric specimens in which each FDP was completely separated. The specimens were classified into six anatomic and another six presumptive electromyography (EMG) types according to the innervation patterns of the entire and the proximal one‐third of the FDP muscles, respectively. The diverse anatomic and presumptive EMG types in this study suggest that the FDP muscles of the 2nd to the 5th digits should be examined by functional tests and EMG in lesions of the median or ulnar nerve. Muscle Nerve, 2009  相似文献   

5.
Carfi J  Ma DM 《Muscle & nerve》1985,8(6):499-502
The question of how the supinator syndrome and the posterior interosseous syndrome are (or are not) related has not been well discussed in the literature. The anatomy of the radial nerve and its innervations is quite variable, as are the etiology, presentation, and clinical findings in the lesions of the posterior interosseous nerve. The present study was based on a retrospective review of the electrodiagnostic records of 12 patients with involvement of the deep radial nerve (posterior interosseous nerve) diagnosed at the EMG lab of New York University Medical Center from 1975 to 1983. Two-thirds of these patients had electrophysiologic abnormalities of the supinator muscle, and in the remainder, the supinator was not involved. All superficial radial nerves had normal evoked mode action potential amplitudes and latencies. We propose that the supinator syndrome is a special case of the posterior interosseous syndrome.  相似文献   

6.
We report the case of a 47-year-old woman with a left anterior interosseous nerve palsy. Surgical release of the anterior interosseous nerve was initially proposed, but electrodiagnostic evaluation demonstrated that the neuropathy was due not to compression or to neuralgic amyotrophy but to a proximal conduction block. At that time, the conduction block could be defined only by indirect electrodiagnostic criteria. A multifocal motor neuropathy with persistent conduction block was subsequently diagnosed, and the patient was treated with intravenous immunoglobulins. The efficacy of this treatment and the subsequent disclosure of conduction block in the right posterior interosseous and peroneal nerves definitively confirmed the multifocal motor neuropathy.  相似文献   

7.
Supramaximal electrical stimulation of a motor nerve produces a full contraction of a muscle and the corresponding compound action potential can be recorded. Recent studies appear to support the view that all the motor units are activated during voluntary maximal contraction, at least in the tibialis anterior muscle. The compound action potential and the EMG interference pattern in the tibialis anterior are regarded as two different manifestations of the activation of all the motor units. A method has been developed which compares these EMG activities, by automatic analysis, in order to obtain useful parameters for clinical applications.  相似文献   

8.
According to Henneman's size principle, small motor units are recruited before large ones. We used the electromyographic (EMG) signal decomposition technique to determine the quantitative relationships between five motor unit action potential (MUAP) parameters (amplitude, duration, area, thickness, and size index) and the recruitment threshold of the motor units recruited up to 50% of the maximum voluntary contraction in the first dorsal interosseous, biceps brachii, rectus femoris, and tibialis anterior muscles of 5 healthy young men. In each muscle, the amplitude, duration, area, and size index had significant, positive high correlations with the motor unit recruitment thresholds. We conclude that the size principle applies to recordings made with concentric needle EMG electrodes under special recording conditions, and therefore that more importance should be attached to the patient's contraction force during EMG examinations in order to evaluate MUAPs for electrodiagnostic purposes.  相似文献   

9.
This is a prospective cohort study on neurologically asymptomatic patients with primary hypothyroidism. It was conducted to evaluate the frequency and pattern of neurophysiological changes in this group of patients. Twenty-three subjects were included over a period of 2(1/2) years. Neurophysiological evaluation included nerve conduction studies (NCS) of median, ulnar, and peroneal motor nerves as well as median palmar and ulnar and sural sensory responses. Electromyography of deltoid, first dorsal interosseous, vastus lateralis, and tibialis anterior muscles was performed with concentric needle electrodes in which duration, amplitude, and stability of motor unit action potentials, recruitment, and interference pattern were evaluated. NCS showed that 52% of the patients had some abnormality, predominantly of the motor demyelinating pattern, as evidenced by prolonged F-wave and distal latencies with normal amplitudes in most affected nerves. Thirty percent of patients had median mononeuropathy consistent with carpal tunnel syndrome. Nondisfigurative myopathic changes in the form of myopathic motor unit action potentials without spontaneous activity were seen in 74% of the patients, most commonly in deltoid (70%). Frequencies of involvement of other muscles were 39% in the vastus lateralis muscle, 26% in tibialis anterior muscle, and 9% in the first dorsal interosseous muscle. We conclude that electromyographic/NCS changes commonly exist in treated, neurologically asymptomatic patients with hypothyroidism and are most frequently myopathic. Median neuropathy is the most common nerve abnormality. Other nerves are involved, with a higher tendency for motor nerve demyelination. We speculate that some neuromuscular changes secondary to hypothyroidism persist after treatment and that motor nerve abnormalities are less likely to be symptomatic than sensory nerve changes in these patients.  相似文献   

10.
目的增进对多发性肌炎患者肌电图特点的认识,提高其检查的阳性率。方法对91例多发性肌炎患者进行肌电图(EMG)、神经传导速度测定。结果肌电图异常率为87.9%,肌源性损害者占79.1%,神经源性损害者占8.8%。其中插入电位延长、自发电位的阳性率分别为6%和52%,肱二头肌出现率较高,外展拇短肌出现率最低(p<0.05);运动单位电位(MUP)时限缩短的阳性率为71%,胫前肌出现率最高,外展拇短肌最低(p<0.05);MUP波幅降低的阳性率较低,仅为7%;多相波增多的阳性率为29%,胫前肌出现率最高,股四头肌最低(p<0.05);重收缩时波形异常的阳性率为26%,以股四头肌出现率最高;重收缩时峰值电压降低的阳性率为31%,胫前肌出现率最高,外展拇短肌最低(均p<0.05)。5例患者EMG呈神经源性损害,1例感觉神经传导速度减慢,2例运动神经传导速度减慢。肌电图正常组、肌源性损害组及神经源性损害组患者的病程、年龄无明显差异。结论 EMG对多发性肌炎诊断的阳性率为87.9%,其中以MUP时限缩短出现率最高为71%,其次为自发电位为52%。EMG异常最多见于肱二头肌、股四头肌和胫前肌。  相似文献   

11.
Reports show wide variability of electromyography (EMG) in detecting pediatric neuromuscular disorders. The study's aim was to determine EMG/nerve conduction study accuracy compared to muscle biopsy and final clinical diagnosis, and sensitivity for myopathic motor unit potential detection in childhood. Of 550 EMG/nerve conduction studies performed by the same examiner from a pediatric neuromuscular service, 27 children (ages 6 days to 16 years [10 boys; M:F, 1:1.7]) with muscle biopsies and final clinical diagnoses were compared retrospectively. Final clinical diagnoses were congenital myopathies (5 of 27,18%), nonspecific myopathies (biopsy myopathic, final diagnosis uncertain; 6 of 27, 22%), congenital myasthenic syndrome (3 of 27, 11%), juvenile myasthenia gravis (1 of 27, 4%), arthrogryposis multiplex congenita (2 of 27, 7%), hereditary motor and sensory neuropathy (1 of 27, 4%), bilateral peroneal neuropathies (1 of 27, 4%), and normal (8 of 27, 30%). There were no muscular dystrophy or spinal muscular atrophy patients. EMG/nerve conduction studies had a 74% agreement with final clinical diagnoses and 100% agreement in neurogenic, neuromuscular junction, and normal categories. Muscle biopsies concurred with final diagnoses in 87%, and 100% in myopathic and normal categories. In congenital myasthenic syndrome, muscle biopsies showed mild variation in fiber size in 2 of 3 children and were normal in 1 of 3. EMG sensitivity for detecting myopathic motor unit potentials in myopathies was 4 of 11 (36%), greater over 2 years of age (3 of 4, 75%), compared to infants less than 2 years (1 of 7, 14%), not statistically significant (P = .0879). EMGs false-negative for myopathy in infants < 2 years of age were frequently neurogenic (3 of 6, 50%). In congenital myopathies EMG detected myopathic motor unit potentials in 40%, with false-negative results neurogenic (20%) or normal (40%). Because our study has no additional tests for active myopathies, for example Duchenne muscular dystrophy genetic testing, our sensitivity for myopathies is lower than if we used a more global view. In conclusion, EMG detection rate of myopathic motor unit potentials at a young age was low, improving in children over 2 years of age. In neurogenic and neuromuscular junction disorders, the EMG has a very high detection rate. In children with mild to moderate neurogenic EMG findings and normal nerve conduction, a myopathy should always be considered.  相似文献   

12.
OBJECTIVE: To compare motor unit action potential (MUAP) metrics recorded by standard and pediatric size concentric EMG electrodes. METHODS: Commercial electrodes were used to record MUAPs from biceps brachii, first dorsal interosseous and tibialis anterior muscles in normal subjects and those with amyotrophic lateral sclerosis (ALS). RESULTS: In normal subjects, peak amplitude and area were significantly higher when recorded by the pediatric size electrode in tibialis anterior muscles and peak amplitude recorded in first dorsal interosseous muscles. In ALS subjects, peak amplitude was higher recorded by the pediatric size electrode in tibialis muscle but lower when recorded in first dorsal interosseous muscles. CONCLUSIONS: Differences of MUAP metrics when recording with standard and pediatric size electrodes do not seem to have a clinical relevance. SIGNIFICANCE: Pediatric and standard concentric electrodes record similar MUAP metrics.  相似文献   

13.
R Rosenbaum 《Muscle & nerve》1999,22(7):960-967
True neurogenic radial tunnel syndrome is an uncommon condition caused by entrapment of the radial or posterior interosseous nerve in the radial tunnel and is usually easily identifiable by focal motor weakness in the distribution of the posterior interosseous nerve. Roles and Maudsley, analogizing to carpal tunnel syndrome, believed "radial tunnel syndrome" had a different presentation: proximal forearm pain and tenderness in the region of the supinator muscle. However, their patients lacked weakness or other neurologic deficit. They and subsequent surgeons have decompressed the radial nerve to treat forearm pain and tenderness, even though it is debatable whether radial nerve entrapment causes the forearm discomfort. The term "radial tunnel syndrome" is best reserved for the truly neurogenic cases. Surgical approaches to "persistent tennis elbow" should be assessed in a controlled fashion, rather than adopted on the basis of a flawed analogy to carpal tunnel syndrome.  相似文献   

14.
Median--ulnar nerve communications and carpal tunnel syndrome.   总被引:1,自引:0,他引:1       下载免费PDF全文
Carpal tunnel syndrome in the presence of anomalous median to ulnar nerve communications in the forearm produces a characteristic change in motor conduction studies. Median nerve stimulation at the elbow evokes a thenar muscle action potential (MAP) with an initial positive deflection not seen on stimulation at the wrist. In 63 patients this change occurred in 16 (25%) and is a useful additional criterion in the diagnosis of carpal tunnel syndrome. The initial positive deflection is due to the volume-conducted MAP from the first dorsal interosseous and some thenar muscles whose motor point lies some distance from the recording electrode over abductor pollicis brevis. The first dorsal interosseous and thenar MAPs resulting from elbow stimulation of those median nerve axons crossing to ulnar nerve in forearm, are generated before that from thenar muscles supplied by the axons going through the carpal tunnel.  相似文献   

15.
Entrapment of the posterior interosseous nerve has been distinguished as one cause of 'lateral elbow' pain. However, this diagnosis has been confirmed by routine neurophysiological techniques in rather few cases. In order to investigate if a more elaborate neurophysiological technique would lend further support to the entrapment diagnosis, a study was undertaken including determination of the nerve conduction during active contraction of the supinator muscle and a quantified analysis of EMG. Motor conduction velocity of the deep radial nerve at rest did not differ from normal contol subjects. On active resisted supination patients showed a higher frequency of conduction time prolongation at low and moderate contraction strengths. Motor unit analysis showed a significant increase of amplitude, duration, and number of phases among EDC motor units in patients as compared with controls. The study supports the possibility of an entrapment aetiology in cases with lateral elbow pain in combination with local tenderness of the posterior interosseous nerve where it passes through the supinator muscle.  相似文献   

16.
BackgroundAbnormalities of the spinal cord were considered uncommon in progressive supranuclear palsy (PSP), and therefore spinal symptoms were not included among PSP characteristic features. However there have been some neuropathological reports of spinal cord lesions in patients with PSP. The aim of our study was to find out if the possible lower motor neuron involvement in PSP is reflected by electromyographic (EMG) and/or electroneurographic (ENG) abnormalities.Material24 patients with clinically probable PSP (mean age 67.5 yrs; 66% males) were included in the study. The control group for ENG studies consisted 25 age matched healthy volunteers.MethodsNerve conduction studies in the ulnar, peroneal and sural nerves and EMG of the first interosseus dorsal and tibial anterior muscles were performed.ResultsThe only ENG abnormality observed was decreased compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes in the ulnar nerve. Such decrease was registered in 8.3% and 20% of PSP patients respectively. There was no significant difference between the values of ENG parameters between PSP patients and the control group. In EMG abnormalities suggesting chronic reinnervation were recorded in the first interosseous dorsal (FID) muscle in 45.8%, and in the tibialis anterior (TA) muscle in 37.5% of PSP patients. A significant correlation was found between the age of PSP patients and their mean motor unit potential (MUP) amplitude in TA muscle (p = 0.04) and also between the age of onset and MUP amplitude in both, the TA and FID muscles (p = 0.026 and p = 0.03 respectively).ConclusionsIn PSP, neurogenic EMG abnormalities in skeletal muscles are present in nearly half the patients suggesting a loss of motor neurons in the anterior horns of the spinal cord which is in line with our histopathological findings. In contrast, electrophysiological signs of neuropathy in peripheral nerves in PSP are very rare. Concluding, although PSP is characterized by the pathological process in specific basal ganglia and brainstem areas, our electromyographic study suggests the need for broadening the spectrum of PSP for lower motor neurons degeneration.  相似文献   

17.
The occurrence of bilateral brachial mononeuropathies presenting as anterior interosseous nerve syndromes in association with cytomegalovirus mononucleosis in an otherwise healthy adult is reported, a relationship not previously described.  相似文献   

18.
Anterior interosseous nerve syndrome (AINS) has been well described. A key muscle to examine clinically and on electromyography is the pronator teres, as this can differentiate between forearm and more proximal entrapment sites. We present a case of AINS with marked weakness and denervation of pronator teres. At operation the anterior interosseous nerve gave rise to the nerve to pronator teres and was entrapped by a fibrous band from the deep head of pronator teres. © 1997 John Wiley & Sons, Inc. Muscle Nerve 20: 1591–1594, 1997  相似文献   

19.
Weakness of the flexor pollicis longus, flexor digitorum profundus and pronator quadratus is usually related to an isolated paralysis of the anterior interosseous nerve in the volar aspect of the forearm. The same syndrome may be caused by lesions of the median nerve in the supracondylar region and by involvement of the fibers assigned to the abovementioned nerve in the medial and lateral cords of the brachial plexus. We report 4 cases of the anterior interosseous nerve syndrome (3 spontaneous and one traumatic), review and discuss etiological factors, clinical features and electromyographic findings in the syndrome.
Sommario La paralisi dei muscoli flessore lungo del pollice, flessore profondo delle dita e pronatore quadrato è generalmente attribuita a lesionidel nervo interosseo anteriore all’avambraccio. La stessa sindrome può essere determinata da lesioni del mediano a livello del gomito e da lesioni delle fibre destinate all’interosseo anteriore a livello delle corde del plesso brachiale. Gli Autori presentano 4 casi di sindrome dell’interosseo anteriore, tre dei quali spontanei e uno traumatico. Essi passano in rassegna i fattori etiopatogenetici, il quadro clinico ed i reperti elettromiografici relativi alla sindrome.
  相似文献   

20.
This paper analysed the FMGs of 78 cases with the motor neuron disease(MND). The EMG of all patients showed following characteristics that the average duration of wave prolonged, the average voltage increased and it was found that fibrillation and fasciculatton potentials appeared spontaneously. The fibrillation potential of ENG waa related to course of disease. In the patients whose course of disease was short, the fibri llation potential increased obviously, while in the cases of chronic MND, It usually decreased. The motor nerve conduction velocity of most pa tients (41%) reduced, however, the sensory nerve conduction velocity was normal but two. We reviewed some references about EMG of the motor neuron disease and discussed their characteristics and mechanism  相似文献   

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