Comparison of Electrodignostic Findings in Diabetic Neuropathy according to the Pedal Vascular Pulsation

OBJECTIVE: To evaluate the effect of vascular abnormality on diabetic neuropathy with the use of pedal vascular pulsation and electrodiagnostic study. METHOD: One hundred-eight non-insulin dependent diabetes mellitus patients were studied. All patients underwent nerve conduction studies. Evaluation of vascular status was done using pedal pulse palpation. Four groups were formed. Electrophysiologically normal group was subdivided into non-vascular abnormality group (A1) and vascular abnormality group (A2). Neuropathy group was subdivided into non-vascular abnormality group (B1) and vascular abnormality group (B2). The frequency of diabetic neuropathy among whole groups and the difference of amplitude, conduction velocity, and F-wave latency within A groups and B groups were investigated, respectively. RESULTS: Diabetic neuropathy was significantly correlated with vascular abnormality (p<0.05). There was no definite difference of electrophysiologic parameters between A1 and A2 groups. B1 group showed significantly reduced amplitude of SNAPs in sural and median sensory nerves compared with B2 group (p<0.05). CONCLUSION: The results of the study support the influence of vascular abnormality on diabetic neuropathy and suggest that vascular abnormality in patients with diabetic neuropathy results in axonal injury rather than demyelination injury.

Anatomical Locations of the Motor Points of the Triceps Surae Muscles

OBJECTIVE: To identify the range of the precise locations of the motor points of triceps surae muscles in relation to bony landmarks. METHOD: Eight limbs of four male cadavers were dissected. The number and location of the motor points from the tibial nerve to each head of the triceps surae muscle were identified related to the bony landmarks. Bony landmarks were medial and lateral epicondyles of the femur, and medial and lateral malleolli of the tibia. The length of the lower leg was defined as the distance from the intercondylar line of the femur to the intermalleolar line of the tibia. The locations of the motor points were expressed as the vertical distance from the intercondylar line, which was normalized to the length of the lower leg. RESULTS: The most proximal motor points of the medial gastrocnemius, lateral gastrocnemius, and soleus were located in 9.6+/-3.5%, 12.0+/-3.4% and 20.5+/-3.9% of the lower leg below the intercondylar line of the femur. The most distal points were in 37.5+/-5.5%, 37.9+/-2.3% and 46.7+/-3.6%. CONCLUSION: The identification of the locations of motor points related to the bony landmarks would increase the ease and accuracy of the motor point blocks to the triceps surae muscles.

Anatomical Investigation of Sural Nerve and Its Contributing Nerves

OBJECTIVE: To identify the location and formation of the sural nerve and its contributing nerves. METHOD: Fourteen lower limbs of 7 adult cadavers were anatomically dissected. The location and formation of the sural nerve (SN) in relation to the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN) were investigated. The length and diameter of the SN and contributing nerves were measured and the differences of the results were analyzed. RESULTS: Twelve SNs were formed by the union of the MSCNs and LSCNs, and 2 SNs were direct extensions of the MSCNs. The point of formation of the SN by union of the MSCN and LSCN was found in the middle third of the legs in 66.7% of SNs examined. The union sites of the SNs were located at 40.58+/-13.97% of the length of lower leg from the tip of lateral malleolus and 55.84+/-6.48% of the calf width from the medial border of the calf. There were significant statistical differences of diameter among nerves (p<0.05) and no significant difference of length between MSCN and LSCN. CONCLUSION: The results of this cadaveric study would increase the accuracy of the sural nerve conduction study and provide the locational information for precise surgical approach.