Relationship Between Functional Level and Muscle Thickness in Young Children With Cerebral Palsy

OBJECTIVE: To investigate the relationship between functional level and muscle thickness (MT) of the rectus femoris (RF) and the gastrocnemius (GCM) in young children with cerebral palsy (CP). METHODS: The study participants were comprised of 26 children (50 legs) with spastic CP, aged 3–6 years, and 25 age-matched children with typical development (TD, 50 legs). The MT of the RF, medial GCM, and lateral GCM was measured with ultrasound imaging. The functional level was evaluated using the Gross Motor Function Measurement-88 (GMFM-88), Gross Motor Function Classification System (GMFCS), and based on the mobility area of the Korean version of the Modified Barthel Index (K-MBI). The measurement of spasticity was evaluated with the Modified Ashworth Scale (MAS). RESULTS: We note that the height, weight, body mass index, and MT of the RF, and the medial and lateral GCM were significantly higher in the TD group (p < 0.05). There was a direct relationship between MT of the RF and medial GCM and the GMFM-88, GMFCS, and mobility scores of the K-MBI in individuals with early CP. In addition, we have noted that there was a direct relationship between MT of the lateral GCM and the GMFM-88 and GMFCS. Although there was a tendency toward lower MT with increasing MAS ratings in the knee and ankle, the correlation was not statistically significant. CONCLUSION: In young children with CP, MT of the RF and GCM was lower than in age-matched children with TD. Furthermore, it is noted with confidence that a significant positive correlation existed between MT and functional level as evaluated using the GMFM-88, GMFCS, and mobility area of K-MBI.

Upper Limb Pain and Paresthesia in a Post-Stroke Patient Treated with Ultrasound-Guided Electrical Twitch-Obtaining Intramuscular Stimulation (ETOIMS) of Scalene Muscles

In post-stroke patients, the pain or paresthesia of the affected limb is common. These symptoms may be caused by a variety of pathologic conditions. Considering the debilitating effects of the pain, it is important to determine the exact cause and manage appropriately. A 41-year-old woman who had experienced a hemorrhagic lesion in the right basal ganglia and corona radiata 4 months previously presented with an irritating tingling sensation in her left upper extremity. She failed to respond to a number of treatment options including medications and physical agent modalities. Following a diagnosis of disputed thoracic outlet syndrome (TOS) caused by scalene muscle dysfunctions, she received ultrasound-guided electrical twitch-obtaining intramuscular stimulation (ETOIMS) which significantly alleviated the pain. This case suggests that the disputed TOS should be considered as one of the possible causes of post-stroke pain, and that detailed history-taking and physical examination, as well as imaging or electrophysiological studies, might be required for accurate diagnosis. Furthermore, ultrasound-guided ETOIMS can be used as a safe and minimally invasive technique for the treatment of the disputed TOS with fewer systemic and local side effects.

Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report

Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort.