Anatomical Localization of Motor Points of the Abductor Hallucis Muscle: A Cadaveric Study

OBJECTIVE: To identify the anatomical motor points of the abductor hallucis muscle in cadavers. METHODS: Motor nerve branches to the abductor hallucis muscles were examined in eight Korean cadaver feet. The motor point was defined as the site where the intramuscular nerve penetrates the muscle belly. The reference line connects the metatarsal base of the hallux (H) to the medial tubercle of the calcaneus (C). The x coordinate was the horizontal distance from the motor point to the point where the perpendicular line from the navicular tuberosity crossed the reference line. The y coordinate was the perpendicular distance from the motor point to the navicular tuberosity. RESULTS: Most of the medial plantar nerves to the abductor hallucis muscles divide into multiple branches before entering the muscles. One, two, and three motor branches were observed in 37.5%, 37.5%, and 25% of the feet, respectively. The ratios of the main motor point from the H with respect to the H-C line were: main motor point, 68.79%±5.69%; second motor point, 73.45%±3.25%. The mean x coordinate value from the main motor point was 0.65±0.49 cm. The mean value of the y coordinate was 1.43±0.35 cm. All of the motor points of the abductor hallucis were consistently found inferior and posterior to the navicular tuberosity. CONCLUSION: This study identified accurate locations of anatomical motor points of the abductor hallucis muscle by means of cadaveric dissection, which can be helpful for electrophysiological studies in order to correctly diagnose the various neuropathies associated with tibial nerve components.

The Korean Version of the Cognitive Assessment Scale for Stroke Patients (K-CASP): A Reliability and Validity Study

OBJECTIVE: To develop the Korean version of the Cognitive Assessment Scale for Stroke Patients (K-CASP) and to evaluate the test reliability and validity of the K-CASP in stroke patients. METHODS: The original CASP was translated into Korean, back-translated into English, then reviewed and compared with the original version. Thirty-three stroke patients were assessed independently by two examiners using the K-CASP twice, with a one-day interval, for a total of four test results. To evaluate the reliability of the K-CASP, intra-class correlation coefficients were used. Pearson correlations were calculated and simple regression analyses performed with the Korean version of Mini-Mental State Examination (K-MMSE) and the aphasia quotient (AQ) to assess the validity. RESULTS: The mean score was 24.42±9.47 (total score 36) for the K-CASP and 21.50±7.01 (total score 30) for the K-MMSE. The inter-rater correlation coefficients of the K-CASP were 0.992 on the first day and 0.995 on the second day. The intra-rater correlation coefficients of the K-CASP were 0.997 for examiner 1 and 0.996 for examiner 2. In the Pearson correlation analysis, the K-CASP score significantly correlated with the K-MMSE score (r=0.825, p<0.001). The coefficients of determination (r²) of the AQ were 0.586 for the K-MMSE and 0.513 for the K-CASP in the simple regression analysis. CONCLUSION: The K-CASP is a reliable and valid instrument for cognitive dysfunction screening in post-stroke patients. It is more applicable than other cognitive assessment tools in stroke patients with aphasia.

Multiple Lower Extremity Mononeuropathies by Segmental Schwannomatosis: A Case Report

Schwannoma is an encapsulated nerve sheath tumor that is distinct from neurofibromatosis. It is defined as the occurrence of multiple schwannomas without any bilateral vestibular schwannomas. A 46-year-old man with multiple schwannomas involving peripheral nerves of the ipsilateral lower extremity presented with neurologic symptoms. Electrodiagnostic studies revealed multiple mononeuropathies involving the left sciatic, common peroneal, tibial, femoral and superior gluteal nerves. Histologic findings confirmed the diagnosis of schwannoma. We reported this rare case of segmental schwannomatosis that presented with neurologic symptoms including motor weakness, which was confirmed as multiple mononeuropathies by electrodiagnostic studies.

Accuracy of Needle Placement in Cadavers: Non-Guided Versus Ultrasound-Guided

OBJECTIVE: To compare the accuracy rates of non-guided vs. ultrasound-guided needle placement in four lower limb muscles (tibialis posterior, peroneus longus, and short and long heads of the biceps femoris). METHODS: Two electromyographers examined the four muscles in each of eight lower limbs from four fresh frozen cadavers. Each electromyographer injected an assigned dye into each targeted muscle in a lower limb twice (once without guidance, another under ultrasound guidance). Therefore, four injections were done in each muscle of one lower limb. All injections were performed by two electromyographers using 18 gauge 1.5 inch or 24 gauge 2.4 inch needles to place 0.5 mL of colored acryl solution into the target muscles. The third person was blinded to the injection technique and dissected the lower limbs and determined injection accuracy. RESULTS: A 71.9% accuracy rate was achieved by blind needle placement vs. 96.9% accuracy with ultrasound-guided needle placement (p=0.001). Blind needle placement accuracy ranged from 50% to 93.8%. CONCLUSION: Ultrasound guidance produced superior accuracy compared with that of blind needle placement in most muscles. Clinicians should consider ultrasound guidance to optimize needle placement in these muscles, particularly the tibialis posterior.

Rhabdomyolysis in Acute Spinal Cord Injury Presenting With Nausea and Vomiting as Chief Complaints: A Case Report

Dealing with complications is crucial in the management of patients with spinal cord injury (SCI). We describe a case of rhabdomyolysis in SCI without apparent soft tissue injury, presenting with nausea and vomiting as chief complaints. Given that gastrointestinal discomfort is common in SCI, this case highlights the need to consider rhabdomyolysis as a potential cause of unexplained nausea and vomiting in SCI, and indicate the value of regular check-up of creatine kinase level in SCI patients. Early diagnosis and treatment can prevent acute renal failure that can occur with rhabdomyolysis and minimize the potential threat of declined renal function in SCI patients.

The Sitting-Unsupported Balance Score as an Early Predictor of Functional Prognosis in Stroke Patients: A Pilot Study

OBJECTIVE: To evaluate the impact of initial "sitting-unsupported" Berg Balance Scale (SUB), the specific trunk control parameter, on patients' functional outcome, Korean version of Modified Barthel Index (K-MBI) at 6 months. METHODS: The charts of 30 patients retrospectively reviewed reviewed. The initial Korean version of Berg Balance Scale (K-BBS) including SUB along with patients' Korean version of Mini-Mental State Examination (K-MMSE), Glasgow Coma Scale (GCS), and other functional parameters that affect functional outcome were recorded. Cases were divided into low (group I) and high (group II) initial SUB score groups. Correlation and regression analysis were performed to assess the relationship between the initial SUB on the K-MBI at 6 months. RESULTS: The mean+/-standard deviation score of initial SUB/K-MBI at 6 months of groups I and II were 0.056+/-0.236/26.89+/-32.48, 3.58+/-0.515/80.25+/-18.78, respectively, and showed statistical significant differences to each other (p<0.05). K-MBI at 6 months was highly correlated with initial GCS, SUB, K-BBS, K-MMSE, and initial K-MBI (p<0.05). In multiple linear regression analysis, initial SUB and GCS scores remained significantly associated with K-MBI at 6 months. A logistic regression model revealed that initial SUB (p=0.004, odds ratio=16), initial K-MBI, GCS, and K-MMSE were all significant predictors of K-MBI scores at 6 months. CONCLUSION: Initial SUB scores could be helpful in predicting patient's potential functional recovery at 6 months. Further studies with concurrent controls and a larger sample group are required to fully establish this tool.

Korean Version of the ABILOCO Questionnaire in the Assessment of Locomotion in Hemiplegic Stroke Patients

OBJECTIVE: To investigate the intra- and inter-rater reliability of the Korean version of the ABILOCO questionnaire (K-ABILOCO). METHODS: The original ABILOCO questionnaire was translated into Korean and back-translated into English. Stroke patients (n=30) with hemiplegia were evaluated using the K-ABILOCO at one week interval. At each visit, the physiatrist also evaluated patient performance of the activities described in the K-ABILOCO, and the total logit scores were recorded. The total scores were used to evaluate intraclass correlation (ICC). Test-retest scores and each test scores were compared to obtain the intra- and inter-rater reliability. RESULTS: The K-ABILOCO showed good intra-rater correlation at one week interval in both patient and physiatrist evaluations (ICC=0.81, 0.91), respectively. It also showed a high inter-rater correlation between the patient and physiatrist at both the first and second visits (ICC=0.76, 0.84), respectively. CONCLUSION: The K-ABILOCO is a useful tool that may reliably evaluate the locomotion ability in hemiplegic stroke patients.

Real-Time Visualization of Ultrasonography Guided Cubital Tunnel Injection: A Cadaveric Study

OBJECTIVE: To describe an ultrasonography-guided technique for cubital tunnel injection. METHOD: The ulnar nerves from 12 elbows of 6 adult cadavers were scanned, and the cross-sectional areas of the ulnar nerves, cubital tunnel inlets and outlets were measured by using ultrasonography. All elbows were dissected after an ultrasonography-guided dye injection at the inlet of the cubital tunnel. The dissectors evaluated the spread of dye and the coloration of the nerve and remeasured the cross-sectional areas of the cubital tunnel inlets and outlets. RESULTS: After a real-time visualization of an ultrasonography-guided injection, the ulnar nerves were seperated from the medial groove for the ulnar nerve. All the ulnar nerves of the cadavers were successfully colored with the dye, from the inlet to oulet of the cubital tunnel. The post-injection cross-sectional areas were significantly larger than the pre-injection cross-sectional areas. No significant differences were detected in the post-injection cross-sectional areas of the cubital tunnel outlet and the ulnar nerve as compared with the pre-injection areas. CONCLUSION: Clinicians should consider real-time visualization of ultrasonography for guided injection around the ulnar nerve at the inlet of the cubital tunnel.