Sensory Thresholds of Normal Human Feet Using Semmes-Weinstein Monofilament

OBJECTIVE: To obtain the sensory thresholds of the feet from healthy adult using Semmes-Weinstein monofilaments. METHOD: Twenty male and twenty female volunteers aging from 24 to 38 years old were selected. There were no known medical conditions associated with decreased foot sensation and history of previous injury to the foot. The subjects were blindfolded with the leg resting on a chair as 14 plantar and 5 dorsal locations were tested on each foot. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. RESULTS: The mean sensitivity for all sites was 3.41+/-0.17. Sensation in the plantar surface of greater toe, 5th toe, arch, and dorsal surface of 1st web space, 3rd toe at the metatarsophalangeal joint level, 5th metatarsal head were the most sensitive. The least sensitive regions were the heel pad, lateral plantar midfoot, and medial and lateral heel. CONCLUSION: Normal data of sensory threshold using Semmes-Weinstein monofilament could be used for the early detection of peripheral neuropathy or loss of protective sensation.

Quantitative Electromyographic Analysis of Scalenus Medius and Upper Trapezius Muscles during Neck Motion

OBJECTIVE: To determine the function of the normal upper trapezius and scalenus medius muscles during neck motion by quantitative eletromyographic analysis. METHOD: Nine subjects were evaluated electromyographically with monopolar fine wire electrodes. The isometric tilting and rotation of neck with manual resistance were performed in the sitting position. The Root Mean Square (RMS) and Mean Rectified Voltage (MRV) were recorded. RESULTS: The RMS and MRV of upper trapezius muscle were significantly higher at each degree of ipsilateral rotation than contralateral rotation. But the RMS and MRV of scalenus medius muscle were significantly higher at each degree of contralateral rotation than ipsilateral rotation. The RMS and MRV of upper trapezius and scalenus medius muscles were significantly higher at ipsilateral tilting than at contralateral tilting. CONCLUSION: Based on these results, we concluded that the upper trapezius muscle acts more in ispilateral rotation, while scalenus medius muscle acts in contralateral rotation, and upper trapezius and scalenus medius muscles act in ipsilateral tilting.

Analysis of Hallux Valgus by Radiologic Foot Mapping

OBJECTIVE: We used the radiologic foot mapping system to evaluate the characteristics of hallux valgus. METHOD: We studied the radiographs of 47 feet of 29 patients who had the hallux valgus. The weight bearing foot AP and lateral views of both sides were taken. The hallux valgus angle, first and second, first and fifth, and second and fifth metatarsal angles were measured with conventional methods. In addition we measured metatarsus primus varus (MPV) and proximal first metatarsal inclination (PFMI) angles. On lateral views, we measured calcaneal pitch, talar pitch and arch depth. By mapping system, we marked T1 through T5, MH1 through MH5, MB1 through MB5, CC, TN and NC, respectively. RESULTS: The first and fifth metatarsal angles were significantly larger in the patients with hallux valgus (p<0.05). The metatarsus primus varus angle was significantly larger in the patients with hallux valgus (p<0.05). The X coordinates at T1 and MH1 were significantly larger in the patients with hallux valgus (p<0.05). The Y coordinates of the MB1, NC and TN were significantly larger negative values in the hallux valgus patients (p<0.05). CONCLUSION: In hallux valgus, the first metatarsocuneiform joint is the site of origin of metatarsus primus varus. The lateral splaying was present from the 5th toe to tarsal bones in hallux valgus groups.

Selective Epidural Steroid Injection in a Patient with Refractory Radicular Leg Pain: A case report

For the management of refractory radicular pain, traditional injection techniques such as transcaudal or translumbar epidural steroid injection may be indicated. This epidural injection, done blindly, may result in improper needle placement. Fluoroscopically guided transforaminal epidural steroid injection and computerized tomography-controlled periganglionic foraminal steroid injection are selective nerve blocks. These procedures are useful for the diagnosis. The advantages of these procedures are precise anatomic location provided by fluoroscope or CT. Intraforaminal or periganglionic steroid injection is useful in the treatment of radicular pain. Thus we introduce a case of selective epidural steroid injection in a patient with refractory radicular pain.

Quadriplegia and Dyspnea Caused by Os Odontoideum in a Down Syndrome Patient: A case report

Os odontoideum is a rare anomaly of the second cervical vertebrae, which is a separated ossicle from the body of the axis. This abnormality of the odontoid process can result in an atlanto-axial instability & subsequent cervical cord compression. In spite of the high prevalence of atlanto-axial instability due to the ligamentous laxity of atlanto-axial joint, the frequency of neurologic symptoms is relatively low in the patient of the Down syndrome. The asymptomatic atlanto-axial instability by trauma may progress to Os odontoideum in Down syndrome population and may cause cervical cord compression. Therefore, early recognition and an appropriate management of patients with atlanto-axial instability can significantly reduce the morbidity and mortality. We report a case of Os odontoideum in a child with Down syndrome, who had an atlanto-axial instability which resulted in the cervical cord compression.