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Posa A, Kornhuber M. [EMG phenomena of myogenic hyperexcitability]. DER NERVENARZT 2024; 95:553-559. [PMID: 38193935 PMCID: PMC11178624 DOI: 10.1007/s00115-023-01597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
The type, distribution pattern and time course of spontaneous muscular activity are important for the diagnostics of neuromuscular diseases in the clinical practice. In neurogenic lesions with motor axonal involvement, pathologic spontaneous activity (PSA) is usually reliably detectable by needle electromyography (EMG) 2-4 weeks after occurrence of the lesion. The distribution pattern correlates with the lesion location. The focus of the present work is the description of the different forms of PSA in myogenic diseases.
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Affiliation(s)
- Andreas Posa
- Universitätsklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Malte Kornhuber
- Universitätsklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
- Klinik für Neurologie, Helios Klinik Sangerhausen, Sangerhausen, Deutschland
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Fereshtehnejad SM, Ruel M, Bourque PR, Warman-Chardon J, Kontolemos M, Zwicker J. Brachial Plexopathy Following Minimally Invasive Coronary Artery Bypass Grafting. Can J Neurol Sci 2024; 51:463-465. [PMID: 37272520 DOI: 10.1017/cjn.2023.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pierre Raymond Bourque
- Department of Medicine (Neurology), The Ottawa Hospital, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), The Ottawa Hospital, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mario Kontolemos
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Jocelyn Zwicker
- Department of Medicine (Neurology), The Ottawa Hospital, Ottawa, ON, Canada
- The University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Rayegani SM, Bahrami MH, Aalipour K, Malek Mahmoudi R, Maleki Kahaki S. Optimization of Muscle Selection for Needle Electromyography in Isolated C6 Root Lesion: A Prospective Chart Review Study. Am J Phys Med Rehabil 2024; 103:439-443. [PMID: 38063323 DOI: 10.1097/phm.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES The aim of the study is to evaluate muscles with more prominent needle electromyographic findings to optimize needle electromyography screening of isolated C6 radiculopathy in patients with C6 root lesions. DESIGN This prospective clinical study was performed on 39 patients with isolated and unilateral cervical radiculopathy selected from all referrals of 1733 patients to the electrodiagnosis unit of the physical medicine and rehabilitation department of a tertiary medical center (from April 2021 to December 2021). The presence of fibrillation potentials, positive sharp waves, and/or neurogenic motor action potentials that occurred in isolation or combination with selected muscles was considered an abnormal finding. RESULTS Of 1733 referrals, 39 patients (18 males [46.1%] and 21 females [53.8%]), with a mean age of 49.7 ± 9.6 yrs, were found eligible. According to needle electromyography findings, the most involved muscles in C6 root lesion were pronator teres (100%), followed by extensor carpi radialis longus (94.8%), flexor carpi radialis (89.7%), brachioradialis (82%), infraspinatus (82%), supraspinatus (79.4%), deltoid (74.3%), biceps brachii (64.1%), extensor digitorum communis (33.3%), and triceps brachii (15.3%) muscles. CONCLUSIONS The pronator teres is the most involved muscle of patients diagnosed with C6 radiculopathy. It might be considered the key muscle for screening and accurate diagnosis of C6 root involvement.
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Affiliation(s)
- Seyed Mansoor Rayegani
- From the Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Levaro F, Hill EJR, Bertelli JA. A cut throat: a case of C5-C8 brachial plexus root transection providing evidence of T1 innervation of thumb and finger extensors. Br J Neurosurg 2024; 38:128-130. [PMID: 36062588 DOI: 10.1080/02688697.2022.2118233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
The T1 nerve root is not routinely thought of as innervating the extensors of the thumb and fingers. Work by Bertelli and Ghizoni proposed that the pattern of brachial plexus paralysis with intact hand function and thumb and finger extensors traditionally attributed to C5/6/7 root injury is in fact a C5/6/7/8 injury, with only T1 remaining intact - a 'T1 hand'. This case presents a 19-year-old male who was stabbed in the neck; exploratory surgery determined complete transection of the brachial plexus, with only the T1 nerve root remaining intact. Clinical examination demonstrated grade M4 pronation (with pronator quadratus), wrist extension (with extensor carpi ulnaris), thumb and finger extension (with extensor policis longus and brevis, extensor digitorum communis and extensor index proprius), wrist flexion (with palmaris longus), finger flexion (with flexor digitorum superficialis and profundus), thumb flexion (with flexor policis longus), and thenar and hypothenar muscles. Extensor carpi radialis longus and brevis, flexor carpi radialis and flexor carpi ulnaris were paralyzed. Triceps scored M2. This case provides unequivocal evidence that the T1 root provides significant innervation to the extrinsic thumb and finger extensors.
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Affiliation(s)
- Fernando Levaro
- Department of Orthopaedic Surgery, The University of Texas, Houston, TX, USA
| | - Elspeth Jane Rose Hill
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
- Department of Medicine and Surgery, Harris Manchester College, Oxford University, Oxford, England
| | - Jayme Augusto Bertelli
- Department of Orthopaedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil
- Department of Plastic Surgery, Joana de Gusmão Children's Hospital, Florianópolis, Brazil
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Sonoo M. Recent advances in neuroanatomy: the myotome update. J Neurol Neurosurg Psychiatry 2023; 94:643-648. [PMID: 36653172 DOI: 10.1136/jnnp-2022-329696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
The myotome of a muscle is the basis for diagnosing spinal and peripheral nerve disorders. Despite its critical importance in clinical neurology, myotome charts presented in many textbooks, surprisingly, show non-negligible discordances with each other. Many authors do not even clearly state the bases of their charts. Studies that have presented with raw data regarding myotome identification are rather rare. A classic study in the 19th century that pursued the nerve course in cadavers still has a substantial influence on existing charts, despite its definite limitations. Other scarce studies in humans include identification by root stimulation during surgery, clinical observations in root avulsion or spinal cord injury and clinical and electromyographical investigations in patients with single radiculopathies or certain plexopathies. A few recent studies have proposed new theories regarding the myotomes of some muscles. T1 innervation of the median intrinsic hand muscles is a typical example. We have added a number of new findings, such as T1 innervation of the forearm flexor muscles innervated by the median nerve except the pronator teres and flexor carpi radialis, C5 innervation of the brachioradialis, and two C6 indicator muscles, pronator teres and extensor carpi radialis brevis. Increased accuracy of the myotome charts will improve the localisation in neurology.
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Affiliation(s)
- Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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Hong CG, Nam WD. Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy. Neurospine 2022; 19:1006-1012. [PMID: 36597659 PMCID: PMC9816603 DOI: 10.14245/ns.2244194.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/17/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the reliability and diagnostic accuracy of typical dermatomes and myotomes for determining the pathologic level in surgically verified patients with cervical radiculopathy. METHODS Patients who underwent single-level surgery due to cervical radiculopathy with at least a 60% reduction in preoperative symptoms or recovery of muscle power after surgery were included. The observed clinical symptoms (pain, paresthesia, motor weakness) were compared to those of typical cervical dermatomes and myotomes. RESULTS Among the 227 patients reviewed, 142 (62.6%) had a standard dermatomal pattern, and 74 of 110 (67.3%) had a standard myotomal pattern. The myotome of C5/6 radiculopathy showed much more variance than those of other cervical segments. Among the patients with severe motor weakness (muscle strength ≤ grade 3 or obvious muscle atrophy), all those with involvement of root C5, C7, and C8 showed a typical pattern (C4/5: 13 of 13 patients, C6/7: 5 of 5 patients, C7/T1: 3 of 3 patients), while only 2 of the 6 patients (33.3%) with severe motor weakness caused by C5/6 radiculopathy fit the typical pattern. CONCLUSION Among various symptoms, cervical myotome is of great value in determining the pathological level. However, it should be noted that there is high variability in human dermatomes and myotomes, especially for motor weakness due to C6 root compression, which is more variable than others.
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Affiliation(s)
- Chul Gie Hong
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Woo Dong Nam
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea,Corresponding Author Woo Dong Nam Department of Orthopedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon 24289, Korea
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Rodríguez-Huguet M, Vinolo-Gil MJ, Góngora-Rodríguez J. Dry Needling in Physical Therapy Treatment of Chronic Neck Pain: Systematic Review. J Clin Med 2022; 11:jcm11092370. [PMID: 35566496 PMCID: PMC9105967 DOI: 10.3390/jcm11092370] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 12/10/2022] Open
Abstract
Chronic Neck Pain (CNP) is one of the main causes of disability worldwide, and it is necessary to promote new strategies of therapeutic approach in the treatment of chronic pain. Dry needling (DN) is defined as an invasive physiotherapy technique used in the treatment of neuromusculoskeletal disorders. The purpose of this review was to assess the effectiveness of invasive techniques in treatment of CNP. The search focused on randomized clinical trials, and according to the selection criteria, eight studies were obtained. In conclusion, DN can be an effective treatment option for CNP, positive outcomes were achieved in the short-term and in the follow-up performed between three and six months, and this technique may offer better outcomes than a placebo intervention based on the application of simulated DN.
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Affiliation(s)
- Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain;
- Clinical Management Unit Rehabilitation, University Hospital of Puerta del Mar, 11009 Cádiz, Spain
- Correspondence:
| | | | - Jorge Góngora-Rodríguez
- Department of Physiotherapy, Osuna School University, University of Sevilla, 41640 Sevilla, Spain;
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Thimjon C, Olewnik Ł, Iwanaga J, Loukas M, Dumont AS, Hanna A, Tubbs RS. C6 and not C5 nerve fibers more commonly contribute most to deltoid muscle innervation: anatomical study with application to better diagnosing cervical nerve injuries. Neurosurg Rev 2022; 45:2401-2406. [PMID: 35246783 DOI: 10.1007/s10143-022-01761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/06/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
Most anatomical textbooks list both the C5 and C6 spinal nerves as contributing to the deltoid muscle's innervation via the axillary nerve. To our knowledge, no previous study has detailed the exact spinal nerve components of the axillary nerve terminating in the deltoid via cadaveric dissection. Twenty formalin-fixed cadavers (40 sides) underwent dissection of the brachial plexus. The fascicles making up the axillary nerve branch that specifically terminated in the deltoid muscle were traced proximally. The axillary nerve branch to the deltoid muscle was most commonly (70%) made up of three spinal nerve segments and less commonly (30%) by two spinal nerve segments. For all axillary nerve branches to the deltoid muscle, C4 spinal nerves contributed 0-5%, C5 spinal nerves contributed 1-80%, C6 spinal nerve contributed 15-99%, C7 spinal nerves contributed 0-30%, and C8 and T1 spinal nerves were not found to contribute any fibers to any deltoid muscle branches. The nerve to the deltoid muscle was contributed to equally by C5 and C6 nerve fibers on 10% of sides. On 16% of sides, C5 contributed the most nerve fibers to this muscle. On 35% of sides, C6 contributed the majority fibers found in the axillary nerve branches to the deltoid. Based on our anatomical study, C6 is more often than not the main level of innervation. C5 was never the sole component of the axillary nerve branches to the deltoid muscle. Such anatomical data will now need to be reconciled with clinical studies.
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Affiliation(s)
- Connor Thimjon
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Łódź, Łódź, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA. .,Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Amgad Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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