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ABSTRACT: Objective: To determine correlations between ultrasonographic findings of thenar muscle and flexor retinaculum, and nerve conduction studies (NCS) in carpal tunnel syndrome (CTS). Methods: Ultrasound and NCS were performed on 92 wrists with CTS and on 40 wrists from healthy individuals. Ultrasound of thenar and hypothenar muscles, flexor retinaculum, and median nerve were assessed. The ultrasonographic findings were compared between the 2 groups, and correlation analysis between median latency and ultrasonographic findings was performed. Results: Motor latency correlated positively with flexor retinaculum thickness (FRT) and correlated negatively with the ratio of thenar to hypothenar muscle. FRT and motor latency were found to be significantly increased in CTS. The ratio of thenar to hypothenar muscle was found to be significantly decreased in CTS when compared with controls. Conclusions: The ultrasonographic findings of FRT and thenar muscle reflect the severity of disease in patients with CTS and are valuable for the diagnosis of CTS. © 2013 Wiley Periodicals, Inc.
Muscle & Nerve 03/2013; · 2.37 Impact Factor
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ABSTRACT: Introduction: This study was performed to obtain normative ultrasonographic data of the sternocleidomastoid (SCM) muscle in infants and to describe an ultrasound method for evaluating muscular torticollis. Methods: The thickness and cross-sectional area (CSA) of the sternal and clavicular heads of the SCM in 84 subjects were analyzed retrospectively. The diagnostic performance of ultrasonography (US) was estimated using receiver-operating characteristic analysis. Results: Muscle thickness increased with age until 10 months. There were no significant differences in thickness or CSA between the right and left sides (P > 0.05) in normal subjects. A ratio of the thickness of the affected side to the unaffected side for the sternal head of the SCM muscle of >1.19 showed a diagnostic sensitivity of 97.9% and specificity of 96.4%. Conclusions: Distinguishing the heads of the SCM muscle and comparing the thickness of the same head on both sides using US may be helpful for evaluating torticollis in infants. Muscle Nerve 000: 000-000, 2013.
Muscle & Nerve 11/2012; · 2.37 Impact Factor
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ABSTRACT: To perform nerve conduction studies of the four branches of the superficial peroneal nerves to determine normal values and anatomic variations in Koreans.
Antidromic sensory nerve conduction studies of the four distal branches were performed on 70 healthy subjects (100 feet). We applied electrical stimulation at the midpoint of medial and lateral malleoli for the medial dorsal cutaneous nerve (MDCN), and at the lateral 1/4 point between the medial and lateral malleoli for the 2 branches of the intermediate dorsal cutaneous nerve (IDCN).
Reference values (mean±SD) of the onset/ peak latency (ms)/ sensory action potential amplitude (µV) for the two branches of the MDCN and for the first branch of the IDCN were 2.2±0.3/2.9±0.3/9.2±3.1, 2.2±0.3/2.8±0.3/9.1±3.0 and 2.3±0.4/2.9±0.3/8.5±2.8, respectively. For the second IDCN branch, the reference values were 2.3±0.4/3.0±0.4/7.1±2.6 but anomalous sural innervation was also found. Three types of IDCN innervations to the fourth interdigital web space were detected. In type I, the fourth interdigital webspace was innervated solely by the IDCN, whereas in type II, it was innervated by both the IDCN and distal sural nerve. In type III, it was solely innervated by the distal sural nerve.
The results of this study show the reference values of the distal sensory branches of the superficial peroneal nerve, and provide information on the variant innervations to the fourth interdigital web space.
Annals of rehabilitation medicine. 08/2011; 35(4):548-56.
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ABSTRACT: An acute spontaneous spinal epidural hematoma (SSEH) is a rare spinal pathology. A 57-year-old man who had hypertension and had been on dual antiplatelet therapy with aspirin and clopidogrel for primary prevention presented with the sudden onset of mid back pain and monoplegia of the left lower extremity. Magnetic resonance imaging revealed an epidural hematoma, and the patient underwent emergency hemilaminectomy for evacuation. However, the symptoms worsened, and complete paraplegia developed. A second procedure to remove the recurrent hematoma was performed. No vascular malformation or other possible cause for SSEH was found other than the aspirin and clopidogrel medication. This case report describes relapsed SSEH caused by the combination of aspirin and clopidogrel medication and urges caution in prescribing dual antiplatelet agents.
Neurological Sciences 03/2011; 32(4):687-9. · 1.32 Impact Factor
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ABSTRACT: The aim of this study was to identify the detectable threshold of knee effusion by ultrasonography while infusing saline.
Forty knee osteoarthritis patients were allocated randomly to either the midline or the lateral group. Intra-articular injection of 20 ml normal saline was performed under ultrasonographic guidance with the transducer fixated at the midline longitudinal or lateral longitudinal scan in the midline and lateral groups, respectively. We obtained ultrasonography images after infusing each milliliter and measured the maximum depth of effusion.
The smallest amount of infusion detected by ultrasonography was 4.37 ± 2.11 ml in the midline group and 4.13 ± 1.71 ml in the lateral group. An effusion more than 2 mm deep was observed after infusing 7.84 ± 3.85 ml and 7.38 ± 3.01 ml in the midline and lateral groups, respectively. To obtain a 4-mm depth, infusions of 11.58 ± 5.68 ml and 13.13 ± 4.88 ml were needed in the midline and lateral groups, respectively.
To detect knee effusion by ultrasonography, infusion of 4.26 ml (SD, 1.92 ml) of solution is needed. We think that a depth of 2 mm is more appropriate than 4 mm as the definition of knee effusion using ultrasonography.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 02/2011; 90(2):112-8. · 1.56 Impact Factor
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ABSTRACT: In this study, we estimated the reference intervals of the serum homocysteine (Hcy) level using two automated immunoassays, and we demonstrated the effects of various factors on the Hcy level in a Korean population. We calculated the gender- and assay-specific reference intervals using the data from 809 healthy Koreans, and we assessed the effects of physiologic and lifestyle factors on the Hcy level. The upper limit was higher in males (19.21 and 19.76 μmol/l) than that in females (14.99 μmol/l and 15.16 μmol/l, AxSym and ADVIA centaur, respectively); the upper limits were comparable between the two assays. Smokers, vitamin nonusers, and persons without regular exercise showed a lower folate level and a higher Hcy level. The risk of hyperhomocysteinemia was significantly associated with the male gender (adjusted OR: 5.705, P-value: 0.008) and with the low folate level group (adjusted OR: 10.412, P-value: 0.002) on the multivariate analysis. The Hcy level was significantly different according to various factors, especially in the gender and folate level. The reference interval should be determined for each ethnic population and for each assay. The appropriate cutoff for assessing the risk for cardiovascular disease or stroke should also be validated in each population.
Journal of Clinical Laboratory Analysis 01/2011; 25(5):317-23. · 1.38 Impact Factor
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ABSTRACT: Transcranial direct current stimulation (tDCS) is associated with enhancement or weakening of the NMDA receptor activity and change of the cortical blood flow. Therefore, repeated tDCS of the brain with cerebrovascular injury will induce the functional and histologic changes. Sixty-one Sprague-Dawley rats with cerebrovascular injury were used. Twenty rats died during the experimental course. The 41 rats that survived were allocated to the exercise group, the anodal stimulation group, the cathodal stimulation group, or the control group according to the initial motor function. Two-week treatment schedules started from 2 days postoperatively. Garcia, modified foot fault, and rota-rod performance scores were checked at 2, 9, and 16 days postoperatively. After the experiments, rats were sacrificed for the evaluation of histologic changes (changes of the white matter axon and infarct volume). The anodal stimulation and exercise groups showed improvement of Garcia's and modified foot fault scores at 16 days postoperatively. No significant change of the infarct volume happened after exercise and tDCS. Neuronal axons at the internal capsule of infarct hemispheres showed better preserved axons in the anodal stimulation group. From these results, repeated tDCS might have a neuroprotective effect on neuronal axons in rat stroke model.
Journal of Korean medical science 10/2010; 25(10):1499-505. · 0.84 Impact Factor
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ABSTRACT: To assess the effects of joint effusion on proprioceptive status in patients with knee osteoarthritis (OA).
A single-blind, randomized, controlled clinical trial in 40 female subjects aged 50 years and over with painful knee OA. All subjects were randomly assigned to either the control or experimental group. A volume of 20 mL of normal saline was injected into the knee joint cavity of subjects in the experimental group under ultrasonographic guidance. Proprioceptive acuity was assessed by active repositioning of the lower limb using an electrogoniometer to measure knee joint position sense (JPS) under both non-weight-bearing (NWB) and weight-bearing (WB) conditions twice, with a 20-min rest interval. The experimental group performed the task twice (Test 1 and Test 2) before and within 5 min after joint infusion. The control group also performed Test 1 and Test 2 without joint infusion. The outcome of interest was the absolute angular error (AAE), ignoring the direction of the error, between the randomized target angle and the patient's reproduced angle of JPS values.
Compared with the control group, JPS was significantly compromised in the experimental group in the NWB test after joint infusion (P=0.025). However, no significant differences in the angular error were observed between Test 1 and Test 2 in the control group for the NWB or WB test or in the experimental group for the WB test after infusion (P>0.05).
This study showed that joint effusion impairs proprioceptive function in osteoarthritic knee joints.
Osteoarthritis and Cartilage 10/2010; 19(1):22-8. · 3.90 Impact Factor
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ABSTRACT: The purpose of this study was to assess which scan view was sensitive in detecting knee effusion by ultrasonography while infusing normal saline in cadaveric specimens.
Intraarticular injection of normal saline with contrast dye was done in increments (5, 10, 15, and 20 ml) into the knee joint of eight fresh cadavers. After infusion of each amount, sonographic images were obtained with five different scans: medial, midline, and lateral on longitudinal scans, and medial and lateral on transverse scans. When 20 ml had been injected, the knee was flexed at 30 degrees and serial images were taken.
After infusion of 10 ml, effusion of more than 2 mm depth with ultrasonography was most frequently seen in lateral transverse scans (14/14), and the next most frequent view was a lateral longitudinal scan (11/14). After knee flexion, the amount of effusion was increased on medial and middle longitudinal scans and was decreased on transverse scans.
For detecting knee effusion by ultrasonography, lateral transverse and longitudinal scans were the most sensitive in the knee extension posture. With knee flexion at 30 degrees, effusion was more readily detected on the medial and midline longitudinal scans than with knee extension.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 09/2010; 89(9):715-21. · 1.56 Impact Factor
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ABSTRACT: The glenohumeral joint can be accessed by anterior, posterior, or superior approach. Blind shoulder injections using anterior or posterior approach have been often inaccurate and infiltrated untargeted structures. The aim of this study was to investigate the success rate of injections in the glenohumeral joint using the superior approach.
Nineteen shoulders from 12 adult cadavers were anatomically dissected after a dye injection had been performed, with cadavers in the supine position. A clinician rated injection confidence scores. The dissectors rated injection accuracy scores and investigated untargeted structures penetrated.
The clinician's confidence scores were the highest in 18 of 19 shoulders. Superior glenohumeral injections were successful in 18 of 19 (94.7%) shoulders; however, in 3 of these 18 shoulders, the long heads of biceps tendons were penetrated.
The glenohumeral joint injection using the superior approach is accurate and clinically useful, but caution for the likelihood of penetrating the long head of biceps tendon should be considered.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 09/2010; 89(9):755-8. · 1.56 Impact Factor
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ABSTRACT: We evaluated the efficacy of oral alendronate with different dosing regimens for non-nociceptive symptoms and osteoporosis in a sciatic nerve chronic constriction injury (CCI) model. Male Sprague-Dawley rats (n=60) were subdivided into sham control (SC) group and CCI groups, which were divided according to dosage and time of oral alendronate administration: no treatment (NT), low dosage early (LE), high dosage early (HE), low dosage late (LL) and high dosage late (HL). We measured the thickness and temperature of the hind paw, bone mineral density (BMD) of the tibia, along with tibia bone strength. On the 14th day post-CCI, the HE group showed significant reduction in thickness and temperature (P<0.001). On the 42nd day post-CCI, the HE group showed significant reduction in temperature compared to the NT group (P<0.001). Also, both HE and HL groups showed statistically significant increased tibia BMD (P<0.001), along with increase of tibia bone strength compared to the NT group. Based on these findings, early alendronate in high dosages is effective in the non-nociceptive symptoms; early and late alendronate in high dosages, are effective in preventing bone dystrophic changes in a CCI model.
Journal of Korean medical science 06/2010; 25(6):938-44. · 0.84 Impact Factor
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ABSTRACT: Several postpartum neurologic injuries have been described in detail, while obturator nerve injuries are rarely reported. We report a woman who had weakness of the right leg and groin pain after cesarean delivery under general anesthesia. Obturator neuropathy was confirmed by electromyography and no compressive lesion of the nerve was seen on magnetic resonance imaging. The patient was treated conservatively and followed until she recovered fully.
Archives of Gynecology 03/2010; 282(3):349-50. · 0.91 Impact Factor
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ABSTRACT: We evaluated the efficacy of epigallocatechin gallate (EGCG) for improving function in rats with transient middle cerebral artery occlusion (MCAO). Three procedures underwent for each groups; MCAO and EGCG treatment, MCAO without treatment (MCAO control), and sham operation. Function was evaluated on days 1, 5, 10, and 14 after ischemia, using a modified sticky-tape test and the percentage weight borne on the paretic leg. Infarct volume did not differ between the EGCG-treated and MCAO control groups. Compared with the MCAO control group, the EGCG-treated group showed improved forelimb function and had normal function by day 10 (P<0.05). The improvements persisted until day 14 postischemia. In contrast, hind limb function did not differ between the EGCG-treated and MCAO control groups. Thus, EGCG improved certain aspects of function of forelimb until day 14 after MCAO in rats.
Acta neurobiologiae experimentalis 01/2010; 70(1):40-6. · 2.11 Impact Factor
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ABSTRACT: Using nerve conduction studies (NCS) and ultrasonography, we sought to determine the stimulation site that corresponds to the site at which the superficial peroneal nerve (SPN) penetrates the fascia and yields the most accurate NCS results. NCS parameters of the SPN sensory nerve action potential (SNAP) were recorded from 37 legs at 14, 12, 9, 7, and 5 cm (S1, S2, S3, S4, and S5, respectively) proximal to the recording electrode, and analyzed by one-way analysis of variance. SPN penetration sites were visualized by ultrasonography. The mean SNAP amplitude/area (17.2 +/- 6.7 microV/9.6 +/- 4.6 microV/ms) at S3-S5 differed significantly from that at S1-S2 (11.6 +/- 4.7 microV/9.2 +/- 4.4 microV/ms) (F = 10.2, P < 0.001; F = 5.09, P = 0.0007). Ultrasonography showed that the SPN became subcutaneous between S3 and S4. Clinical application of these results should help in obtaining more accurate data during electrodiagnostic studies of conditions that involve the SPN.
Muscle & Nerve 09/2009; 41(2):227-33. · 2.37 Impact Factor
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ABSTRACT: Overt bladder distension can compress the iliac vessels and result in lower extremity swelling mimicking deep venous thrombosis (DVT). This phenomenon has been reported in patients with bladder outlet obstruction due to prostatism but no report has been made in relation to poststroke urinary retention (UR). The authors experienced a rare case of abrupt leg edema with DVT-like symptoms due to iliac vein compression by an overdistended bladder that had developed after cerebrovascular stroke. A 74-year-old woman with left striatocapsular infarction and situs inversus presented with severe right leg swelling. Imaging studies revealed external compression of the right iliac veins by an overdistended bladder and underlying May-Thurner syndrome (MTS). The presence of situs inversus totalis resulted in the rare clinical finding of a right-sided MTS. The patient's symptoms were largely attributable to external compression of right iliac veins by bladder distension and they resolved completely after prompt bladder drainage. Follow-up imaging findings showed complete regression of right external iliac vein stenosis. This case provides the first description of lower extremity swelling manifest as an unusual complication from UR in a stroke patient. Proper and strict bladder screening with appropriate management should be implemented as important therapeutic components during the rehabilitative management of stroke patients.
Archives of physical medicine and rehabilitation 06/2009; 90(5):886-90. · 2.18 Impact Factor
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ABSTRACT: The purpose of this study was to quantitatively assess motor activity and sensory functions and to determine their relationships to infarct severity by measuring infarct volume in rats with transient ischemic stroke. Male Sprague-Dawley rats (11 weeks old, n = 42) were randomly divided into 4 separate groups; a sham operation group, and 1-h, 2-h and 3-h middle cerebral artery occlusion (MCAO) groups. Percent weights borne on paretic hind limbs were measured consecutively for 7 days starting from the day before the induction of ischemia. Fifty percent withdrawal threshold values of forepaws and hindpaws were measured using von-Frey hairs. Infarct volumes in the three ischemic groups, which were significantly different (p < 0.01) from each other, were found to increase in size with ischemic time. The percent weight borne on paretic hind limb in the three MCAO groups were significantly lower than that in the sham group, and this functional deficit remained significant throughout the observational period (p < 0.01). A significant correlation was found between infarct volumes and percent weight borne on paretic hind limbs after ischemia (-0.7 < rho < -0.4, p < 0.05). In contrast the 50% withdrawal threshold values of paretic forepaws and hindpaws in the three ischemic groups were not significantly different from those of the sham controls. Motor test findings, which were used to assess reductions in paretic hind limb weightbearing, were shown to be correlated with infarct volume. The present study shows that this test could be used as a tool to objectively and quantitatively assess functional outcome in MCAO rats.
Brain Research 09/2008; 1230:303-9. · 2.73 Impact Factor
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ABSTRACT: To determine the location of the motor points and intramuscular branches for the muscles involved in thumb-in-palm and the abductor pollicis brevis muscle, the latter of which, because of its anatomic proximity, may be inadvertently blocked.
Hand intrinsic muscles from 20 fresh cadavers were dissected. The point of nerve entry to the muscle belly and the points where the intramuscular endings were located most proximally and distally were defined in relation to a reference line connecting the hook of hamate and the head of the first metacarpal bone.
We were able to define a region, located from 66.08% +/- 8.67% to 70.28% +/- 10.62% of the reference line, with the hook of hamate as starting point, where intramuscular endings for the thumb-in-palm muscles were dense and farther from the intramuscular endings for the abductor pollicis brevis. The region around 40% of the reference line was the point where the intramuscular endings were most dense for the abductor pollicis brevis.
The results may provide guidelines that could help in localizing the appropriate points for the neuromuscular blockade of thumb-in-palm muscles and, at the same time, help in minimizing the inadvertent block of the abductor pollicis brevis.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 08/2008; 87(9):703-9. · 1.56 Impact Factor
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ABSTRACT: After stroke, many factors contribute to the loss of bone mineral density (BMD) and fracture. Pre-stroke low BMD and vertebral fracture may pose a greater risk of fractures and further contribute to additional functional loss. The purposes of this study were to assess pre-stroke BMD and vertebral fracture in patients with first stroke.
Forty-eight patients with first stroke events were included. To reflect pre-stroke BMD, the patients who underwent bone densitometry tests within 30 days from stroke onset were selected. BMD was checked at the lumbar spine and both femurs (total hip and femoral neck). Thoracic and lumbar spine X-rays were performed.
Of the 48 stroke patients, 21 (43.8%) had osteoporosis and 19 (39.6%) had osteopenia. X-ray evaluation showed that 12 (25.0%) had one or more lumbar or thoracic vertebral fractures and 8 (16.7%) had two or more vertebral fractures. Of the 12 patients who had one or more vertebral fractures, 4 (33.3%) were previously aware of the fact that they had a vertebral fracture.
Results showed a high prevalence of pre-stroke low BMD and vertebral fracture in patients experiencing first stroke. Bone loss progresses rapidly in the acute stages of stroke, and such a high prevalence of pre-stroke low BMD and vertebral fracture may pose a greater risk of fractures and further contribute to additional functional loss. Therefore, early screening and active management of osteoporosis from the acute stages of stroke is critical.
Bone 08/2008; 43(1):183-6. · 4.02 Impact Factor
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ABSTRACT: The purpose of this study was to compare the posterior superior iliac spine (PSIS) and the iliac crest as accurate anatomical landmarks for identifying spinal level.
This study was conducted in 2 stages. First, 4 examiners examined 60 patients and blindly identified iliac crest and PSIS levels, and the interexaminer reliability of PSIS and iliac crest palpation were then analyzed. Second, 4 examiners attached a radio opaque marker at presumed PSIS and iliac crest levels in 72 patients, and posteroanterior lumbar radiographs were then taken. Four examiners then confirmed PSIS and iliac crest levels after radiographically identifying the marker levels and checked the spinal level at which the spinous process or interspace was crossed by drawing a horizontal line drawn between radio opaque markers.
The interexaminer reliability of palpation was significantly greater for PSIS level than for the iliac crest (P < .05). Spinal levels of estimated PSISs identified by palpation ranged from the L5-S1 interspace to the S2 spinous process, and the spinal levels of estimated iliac crest ranged from the L2-3 interspace to the L5 spinous process.
Although PSIS palpation showed statistically higher interexaminer reliability than iliac crest level, clinicians should be cautious when applying this method as a measurement tool because estimated spinal level by palpation can be influenced inadvertently by examiner skill and anatomical variations.
Journal of manipulative and physiological therapeutics 07/2007; 30(5):386-9. · 1.06 Impact Factor
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ABSTRACT: The delta4 isoform of phospholipase C (PLC-delta4) is thought to be associated with various cellular functions and disease status. However, little is known about how its function is controlled in cells, particularly in terms of the regulation of its expression. To understand the regulation mechanisms of the PLC-delta4 gene transcription, the 5'-flanking region (-2046 approximately +5) (the nucleotide sequence data reported in this paper have been submitted to the EMBL/GenBank/DDBJ data bank under accession numbers DQ302751) of the human PLC-delta4 gene was isolated from human genomic DNA. It was a TATA-less promoter with very GC-rich sequences near the transcription start site. The activity of the PLC-delta4 promoter was shown in various human and mouse cell lines by luciferase reporter assay. Serial deletion analysis identified the core promoter region as being between -402 and -67, in which an E-box and an AP-1 binding site played important roles in the promoter activity. In addition, we also showed that 12-O-tetradecanoylphorbol-1,3-acetate (TPA), a PKC activator and tumor promoter, induced the activity of the PLC-delta4 promoter via the AP-1 binding site. In summary, this study identified a core promoter region of the hPLC-delta4 gene and the factor binding sites responsible for the promoter activity. These results will provide important new information to further understand the regulatory mechanism of the PLC-delta4 function.
Molecular Biology Reports 06/2007; 34(2):69-77. · 2.93 Impact Factor
