Optimal Placement of Needle Electromyography in Extensor Indicis: A Cadaveric Study

OBJECTIVE: To identify the center of extensor indicis (EI) muscle through cadaver dissection and compare the accuracy of different techniques for needle electromyography (EMG) electrode insertion. METHODS: Eighteen upper limbs of 10 adult cadavers were dissected. The center of trigonal EI muscle was defined as the point where the three medians of the triangle intersect. Three different needle electrode insertion techniques were introduced: M1, 2.5 cm above the lower border of ulnar styloid process (USP), lateral aspect of the ulna; M2, 2 finger breadths (FB) proximal to USP, lateral aspect of the ulna; and M3, distal fourth of the forearm, lateral aspect of the ulna. The distance from USP to the center (X) parallel to the line between radial head to USP, and from medial border of ulna to the center (Y) were measured. The distances between 3 different points (M1– M3) and the center were measured (marked as D1, D2, and D3, respectively). RESULTS: The median value of X was 48.3 mm and that of Y was 7.2 mm. The median values of D1, D2 and D3 were 23.3 mm, 13.3 mm and 9.0 mm, respectively. CONCLUSION: The center of EI muscle is located approximately 4.8 cm proximal to USP level and 7.2 mm lateral to the medial border of the ulna. Among the three methods, the technique placing the needle electrode at distal fourth of the forearm and lateral to the radial side of the ulna bone (M3) is the most accurate and closest to the center of the EI muscle.

Diagnosis of Pure Ulnar Sensory Neuropathy Around the Hypothenar Area Using Orthodromic Inching Sensory Nerve Conduction Study: A Case Report

Ulnar neuropathy at the wrist is an uncommon disease and pure ulnar sensory neuropathy at the wrist is even rarer. It is difficult to diagnose pure ulnar sensory neuropathy at the wrist by conventional methods. We report a case of pure ulnar sensory neuropathy at the hypothenar area. The lesion was localized between 3 cm and 5 cm distal to pisiform using orthodromic inching test of ulnar sensory nerve to stimulate at three points around the hypothenar area. Ultrasonographic examination confirmed compression of superficial sensory branch of the ulnar nerve. Further, surgical exploration reconfirmed compression of the ulnar nerve. This case report demonstrates the utility of orthodromic ulnar sensory inching test.

Reliability of Hip Migration Index in Children with Cerebral Palsy: The Classic and Modified Methods

OBJECTIVE: To determine reliability and clinical use of two methods of migration index (MI) in CP patients with or without hip dysplasia. METHOD: The materials included radiographs of 200 hips of children with cerebral palsy. Conventional anteroposterior radiographs of the pelvis were taken with the child in the supine position with standardized methods. Two rehabilitation doctors measured the migration index using two methods. In the classic method, the lateral margin of the acetabular roof was used as a landmark and in the modified method the lateral margin of the sourcil was used as a landmark. Each rater measured the migration index at three separate times with a time interval of at least one week. Intraclass correlation (ICC) was used to test the inter- and intra-rater reliability. RESULTS: MI shows excellent intra-rater reliability in both the classic and modified methods, but the inter-rater reliability was higher in the classic method than in the modified method. When categorized according to the sourcil classification, inter-rater reliability was higher in the normal sourcil type and lower in the dysplastic sourcil types. CONCLUSION: Generally, the classic method showed higher reliability than the modified method, even though the reliability of the MI measurement was relatively high with both methods.

Effect of Treatment With Excision of Papillae and Supratarsal Triamcinolone Injection on Refractory Vernal Keratoconjunctivitis

PURPOSE: To evaluate the therapeutic effect of the combined treatment of excision of the papillae and a supratarsal injection of triamcinolone on refractory vernal keratoconjunctivitis (VKC). METHODS: Twenty-three eyes of 14 patients with refractory vernal keratoconjunctivitis were included. Patients were treated with the combined excision of papillae and supratarsal injection of triamcinolone. Best corrected visual acuity (BCVA), intraocular pressure, symptoms of itching, tearing, discomfort, secretion and epiphora, and signs including limbal hypertrophy, hyperemia, papilla size, keratitis, corneal neovascularization and blepharitis were evaluated before and two weeks, four weeks, and eight weeks after treatment. The CCL11 level in the tears of each eye were analyzed before and two weeks after treatment. RESULTS: The mean scores of subjective symptoms and objective signs as well as BCVA were significantly improved two weeks after treatment. CCL11 levels in the tears were 389.5+/-474.9 pg/ml before treatment and were undetectable two weeks after treatment. Improvement of symptom and sign parameters was maintained up to eight weeks after treatment. However, seven eyes (30.4%) recurred within two weeks after treatment. CONCLUSIONS: Combined excision of the papillae and a supratarsal injection of triamcinolone may be effective in the treatment of refractory VKC.