Relationship between EMG-detected and ultrasound-detected fasciculations in amyotrophic lateral sclerosis: A prospective cohort study

ObjectivesFasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas).MethodsThirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort.ResultsThe mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ± 0.25 mV and 3.21 ± 0.88, respectively) than in those with both FP and MUS-fas (1.22 ± 0.92 mV and 3.74 ± 1.39, respectively; p < 0.0001 and p = 0.017, Welch’s t-test).ConclusionSmall FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS.SignificanceClinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.     

Marknagelung bei der Humerusschaftfraktur

Zusammenfassung Die Humerusschaftfraktur ist in 10–18% der Fälle durch primäre Radialisparese kompliziert. Sekundäre Radialisläsionen treten iatrogen bei intramedullären Verfahren in 3%, bei Plattenosteosynthesen in 15,5% auf. In der überwiegenden Mehrzahl der Fälle (80%) ist der Radialisschaden rückläufig. Eine Verletzung der A. radialis ist eher selten; sie erfordert ein offenes Vorgehen mit lokaler Revision des Gefäßes und Frakturversorgung mittels Plattenosteosynthese. Die Marknagelosteosynthese ist bei einfachen, komplexen oder pathologischen Schaftfrakturen primär oder als Verfahrenswechsel nach primärer Fixateuranlage indiziert. Während auch ausgewählte Frakturen im Collum chirurgicum mit einem Nagel versorgt werden können, sind Frakturen im distalen Viertel des Humerus ausgeschlossen. Frakturen bei kleinen Kopffragmenten weisen ein erhöhtes Komplikationsrisiko auf. Zur Vermeidung von Läsionen der Rotatorenmanschette stehen wir der anterograden Nagelung noch zurückhaltend gegenüber. Bei differenzierter Indikationsstellung und Nachbehandlung erwies sich die retrograde Marknagelung als ein schonendes Verfahren mit hohem Patientenkomfort und gutem funktionellem Ergebnis.     

Flexor digitorum profundus tendongrafting (extrasynovial donor tendons)

Although the prevalence of flexor tendon grafting has decreased since the early part of this century, the technique isstill an important part of a hand surgeons armamentarium. Primary and staged flexor tendon grafting are appropriate techniques used to restore digital function after failed or neglected repairs. Appropriate patient selection, meticulous reconstructive techniques, and respect for basic biological principles of healing and repair are essential elements for successful tendon grafting.     

环指屈肌腱损伤吻接术前、后力学性能测试研究

研究正常环指屈肌腱拉伸力学性能和模拟屈肌腱损伤后吻接术后屈肌腱的力学性能,为临床提供生物力学参数。取10个手环指标本,解剖后暴露环指,将标本固定于电子万能试验机底座上,由钢丝绳吊钩沿屈肌腱纵行方向钩住、钢丝绳上端固定于试验机上夹头上,驱动机器,对标本进行拉伸实验,施加拉应力,直至屈肌腱断裂。对断裂后的屈肌腱模拟临床手术进行移位吻接,对10个标本做了腱与腱移位吻接。再对吻接后的标本进行拉伸实验。分别得出了正常组标本和吻接术后标本的拉伸最大载荷、应力、应变等数据。表明:屈肌腱腱与腱吻合组最大载荷、应力、应变均小于正常对照组,但模拟末端编织法吻接术腱与腱吻合组标本,仍具有较好的拉伸力学性能指标。     

指屈肌腱腱纽的显微解剖 Ⅱ、腱纽的动脉和神经

本文解剖观察了30只手共150个手指的腱纽内动脉和神经。进入肌腱的动脉和神经都是手指两侧的指掌侧固有动脉和指掌侧固有神经的分支,它们穿过腱纤维鞘裂孔进入腱纽,然后再分支到屈指肌腱。动脉和神经在进入腱纽的起始处有脂肪团,可作为寻找腱纽内动脉与神经的标志。至拇指腱纽的动脉和神经是在第一指骨底至第一指骨头之间进入腱鞘,其它的指一般一个手指有四组动脉、两组神经分别进入每个手指的四型腱纽,而进入腱鞘的位置分别在:一指底,一指中间1/3与远侧1/3的交接处,二指底,二指头。其中Ⅱ、Ⅳ型的动脉有神经伴行。     

内镜下切断屈肌支持带远侧纤维束治疗腕管综合征

目的探讨内镜下腕管切开减压术（endoscopic carpal tunnel release，ECTR）中切断屈肌支持带远侧纤维束（distal holdfast fibers of the flexor retinaculum，DHFFR）的必要性。方法观察组16例，臂丛神经阻滞麻醉，不使用止血带，皮肤1cm切口，内镜下应用USE系列切断腕管横韧带和DHFFR，与对照组16例单纯切断腕管横韧带进行疗效比较。结果术后6个月功能随访，按照Kelly疗效评定标准，观察组优13例，良3例；对照组优8例，良5例，可3例，2组浜田Ⅱ、Ⅲ级疗效差异有显著性（，=6．278，P=0．043）。2组均无严重并发症及术后复发。结论对浜田Ⅱ、Ⅲ级腕管综合征者术中注意腕横韧带切断不是唯一的目标，同时切断DHFFR才能彻底减压。     

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.     

Nociceptive muscle reflex responses in human forearms

In healthy volunteers, 5-min noxious stimulation with rectangular electrical pulses applied transcutaneously to the phalanges enhanced tonic activity in the palmar and finger flexor muscles resulting in a specific electromyographic pattern consisting of two successive bursts of activity which appeared after a period of inhibition. In patients with chronic pain in the arm, significantly lower thresholds for the first and the second waves of reflex activity have been found. This electromyographic pattern of the forearm muscle reflex responses is supposed to be similar to the nociceptive flexor reflex in the leg. It can be useful for objective assessment of the effectiveness of analgesia and pain syndrome therapy in patients with cervical spinal cord injury. Translated fromByulleten' Eksperimental'noi Biologii I Meditsiny, Vol. 126, No. 9, pp. 278–282, September, 1998     

Contractile properties of single motor units in two multi-tendoned muscles of the cat distal forelimb

Summary The contractile properties of motor units (MUs) in two multi-tendoned forelimb muscles were investigated. In anesthetized cats single MUs of the extensor carpi ulnaris (ECU) and extensor digitorum communis (EDC) muscles were selectively activated by stimulation of cervical ventral root filaments. MUs were characterized by various tests including single twitches, series of tetanic contractions providing a tension-frequency relation and a fatigue test. They were classified by the parameters contraction time (CT, time-to-peak within unpotentiated single twitches) and fatigue-index (R_B, according to Burke). The ECU muscle is composed of 38% type FR MUs (fast, fatigue-sensitive; CT<38 ms; R_B<0.5), 35% type FR MUs (CT<38 ms, R_B>0.5) and 27% type S MUs (slow; CT>38 ms, R_B>0.5). 46% of the EDC MUs were classified as FF (R_B0.25), 29% as FI (fast, intermediately fatiguable; 0.25<R_B<0.75) and 25% as FR/S (fatigue-resistant, fast or slow; R_B>-0.75). The latter group was devised since most MUs appeared as fast and the unequivocal presence of slow MUs could neither be demonstrated nor excluded. Normalized tension-frequency relations of fast ECU and EDC MUs were nearly identical and similar to those reported for fast MUs of other muscles. In contrast to this, the tension-frequency relation of slow ECU MUs has a different shape supporting the use of this function to distinguish fast from slow MUs. The distribution of different types of MUs is discussed with regard to the structure and function of the parent muscles and in relation to hindlimb muscles of comparable architecture. As revealed by comparison to EMG data gained in behaving animals (Fritz et al. 1985; Hoffmann et al. 1986, Botterman et al. 1985), the three muscles of the cat distal forelimb investigated so far seem to be adapted to different tasks: the EDC to rapid movements with a high proportion of type FF MUs, flexor carpi radialis to sustained contractions during the body support with a high proportion of fatigue-resistant MUs; the ECU which changes synergism between both muscles has an intermediate composition.     

桡侧腕屈与腕长伸肌腱部分转位修复手部关节脱位应用解剖

目的 :为桡侧腕屈与腕长伸肌腱部分转位修复桡尺远侧及第 1腕掌关节脱位提供解剖学基础。方法 :3 0侧成人上肢标本 ,分别对桡侧腕屈肌腱、桡侧腕长伸肌腱进行形态学测量。结果 :桡侧腕长伸肌腱性部长 ( 17.8± 2 .6)cm ,肌腱的上、中、下段宽分别为 ( 13 .7± 3 .1)、( 5 .6± 1.1)和 ( 4 .6± 0 .5 7)mm肌腱的上、中、下段厚分别为 ( 1.5± 0 .5 )、( 2 .0± 0 .3 )和 ( 2 .4± 0 .3 )mm。桡侧腕屈肌腱性部长 ( 14 .3± 1.1)cm ,肌腱的上、中、下段宽分别为 ( 9.11.4)、( 5 .5± 0 .9)和 ( 4 .0± 0 .4) ,肌腱的上、中、下段厚分别为 ( 2 .4± 0 .6)、( 2 .2± 0 .4)和 ( 2 .6± 0 .5 )mm。结论 :采用桡侧腕屈肌腱和桡侧腕长伸肌腱部分转位 ,有足够的长度和强度 ,适用于桡尺远侧关节或第 1腕掌关节脱位的修复 ,临床应用获得良好效果