Diabetic Muscle Infarction in Diabetes; Three cases report

Spontaneous muscle infarction in diabetic patients is a rare condition that usually occurs in those with advanced diabetic complications. Increased clinical awareness is important for early recognition, particularly in a diabetic patient presenting with a painful thigh or leg swelling. However, the disorder has received little attention in the rehabilitation medicine literature. Magnetic resonance imaging is the diagnostic choice of study, and in the appropriate clinical setting, may obviate the need for a muscle biopsy. We reported three patients with diabetic muscle infarction, review additional reported cases, and discussed the principles of diagnosis and management.

Musculoskeletal Causes of Anterior Chest Wall Pain

OBJECTIVE: To investigate the musculoskeletal causes of anterior chest pain and know the prevalencies of the diseases. METHOD: During 4-year periods (1997-2001), 37 patients with anterior chest wall pain was analyzed with regard to the causes of pain and the frequencies of the diseases. RESULTS: 17 patients (45.9%) had systemic diseases and 20 patients (54.1%) had focal joint problems. Systemic disease included the undifferentiated spondyloarthropathy (18.9%), ankylosing spondylitis (13.5%), psoriatic arthritis (2.7%), SAPHO (Synovitis, Acne, Psoriasis, Hyperostosis, Osteitis) syndrome (8.1%), and rheumatoid arthritis (2.7%). Focal joint diseases included costochondritis (10.8%), sterno clavicular inflammatory arthropahty (5.4%), sternoclavicular hyperostosis (2.7%) and infective arthritis (2.7%). Other focal joint problems were pain in sternoclavicular joint with the tenderness and swelling (2.7%), pain in costochondral joint (13.6%), sternoclavicular joint (5.4%), xyphoid process (2.7%) with only focal tenderness. 3 (8.1%) patients had pain in chest wall which had no focal tenderness and swellings on the joint. CONCLUSION: Diverse systemic diseases were identified as causes of the anterior chest wall pain. So physiatrist keep in mind this result and make use of them in diagnostic approaching of the anterior chest pain due to chest wall skeletal involvemen.

Estimation of Reference Values of Median Nerve Conduction Study: A Meta-Analysis

OBJECTIVE: The comparison of nerve conduction parameters of each laboratory is difficult because those are influenced by many factors. This study was performed to provide comprehensive normative nerve conduction parameters of median nerve by using a meta-analysis. METHOD: We searched MEDLINE between year 1965 to 2000. Among them we selected 7 articles that provided the mean, standard deviation and sample size of median nerve conduction study and estimated the reference value of median nerve conduction parameters using a meta-analysis. RESULTS: The distal latency of median motor nerve was measured at 8 cm proximal to motor point of abductor pollicis brevis and the distal latency of median sensory nerve was measured at 14 cm proximal to interphalangeal joint of 2nd or 3rd finger. Mean of distal onset latency, amplitude, and conduction velocities of median motor nerve were 3.46 msec, 11.12 mV, and 57.10 m/sec, respectively. Mean of onset distal latency, peak distal latency, and amplitude of median sensory nerve conduction study were 2.72 msec, 3.34 msec, and 37.29 mV, respectively. CONCLUSION: Meta-analysis can summarize large quantity of studies and can maximize subject numbers, it can provide reference value approximate to the normal one. So this value can be used in interpretation of the reference value of each laboratories.

The Long Term Prognosis of Postoperative Femoral Neuropathy

OBJECTIVE: To evaluate long-term prognosis of postoperative femoral neuropathy. METHOD: 15 patients who confirmed as femoral neuropathy by electrodiagnostic study after renal transplantation or abdominal hysterectomy were included in this study. Retrospective chart review and telephone interview of 12 available patients were performed at 36 months on average after operation. Second telephone interview were available in 4 out of 12 patients one year after first telephone interview. After the second telephone interview, we evaluated muscle strength and gait function of them in our labaratory. RESULTS: At immediate postoperative stage (average 16.8 days), knee extensor strength was less than grade III in 8 out of 12 patients. In gait function evaluation, six patients were unable to walk on flat surface. At first interveiw, recovery of muscle strength was excellent in five patients, good in five and fair in two. In gait function, all could walk without walking aids for more than 30 minutes and 9 could run and mount up the stairs. The second follow-up showed functional improvement even after 24 months of onset. The findings of physical examination correlated well with telephone interview. CONCLUSION: Almost all patients who diagnosed as postoperative femoral neuropathy regained near normal motor strength and functional ambulation in the long-term follow-up.

A Quantitative Assessment of Knee Extensor Spasticity Using Isokinetic Dynamometer

OBJECTIVE: To find useful parameters in biomechanical assessment of spasticity. METHOD: Knee extensor muscles of 60 limbs of 47 patients which showed clinical spasticity were stretched by isokinetic dynamometer. Stretch was done with the velocities of 60o/sec, 120o/sec, 180o/sec, 240o/sec. Four parameters [torque onset angle (TOA), peak torque angle (PTA), peak eccentric torque (PET), peak eccentric torque area (PETA)] were measured at each stretch velocity. Then, regression analysis was performed in relationship between each parameter and strech velocity. We analysed the correlation between the slope of each parameter in regression equation and clinical Modified Ashworth Scale (MAS) RESULTS: The slope of TOA and PTA had negative value so that they showed the decreasing trend of their value according to increasing velocity. On the other hand the slope of PET and PETA had positive value which meant that those parameters increased according to increasing velocity. The slope of PET and PETA were correlated statistically. The higher the MAS score was, the larger value of slope of PET, PTEA were noted. CONCLUSION: Peak eccentric torque and Peak eccentric torque area are thought to be useful parameters in biomecha nical assessment of spasticity.

Cervical Radiculopathy: Selective Nerve Root Injection of Steroids

OBJECTIVE: To determine the therapeutic efficacy of fluoroscopic and electrical stimulation guided perineural selective nerve root injection in cervical radiculopathy patients. METHOD: The gold standard of the diagnosis of cervical radiculopathy was based on clinical features, MRI and electrodiagnostic findings. Considering the natural regression of pain in cervical radiculopathy, only patients (n=27, 14 male and 13 female) who had suffered from persisting or aggravating pain for at least 6 weeks or longer duration after the onset of symptoms, were received a selective nerve root injection (SNRI) of steroids to a target nerve root. Patients were followed up at 2 weeks and 2 months, and interviewed via telephone or re-examined at an average of 37.8 weeks 68 weeks after injection by a independent physician. Criteria for a successful outcome were greater than 50% reduction of pain on visual analogue scale and an ability to return to previous level of function. RESULTS: High proportion of patients reported a successful outcome at 2 weeks (88.9%, 24 of 27 patients). Twenty-two of twenty-four patients reported the outcome at 2 months and 20 of 22 patients were followed up for an averrge period of 37.3 weeks. Among these 20 patients 19 patients satisfied with the result of SNRI at an average follow up period of 68 weeks. There was no significant difference of the efficacy according to the duration of the symptoms. There were no complications in any of the patients after injections. CONCLUSION: Fluoroscopic and electrical stimulation guided selective nerve root injections of corticosteroids were an effective and safe treatment modality in cervical radiculopathy. These could be considered as a first line treatment before a surgical intervention in whom another conservative treatments are not effective.