Quality of referrals for nerve conduction studies and electromyography to a tertiary care rehabilitation center

To perform an audit of quality of referrals for Electrodiagnosis [EDX]/Nerve conduction studies and Electromyography [NCS/EMG] to a tertiary care rehabilitation center. A detailed referral proforma covering all the prerequisites for EDX studies had already been distributed among the dependent Defense Forces hospitals. The data was taken from that proformas and the patients were asked if the referring physician had explained them about the test and if they had gone through the instructions. Frequencies and percentages were calculated for provision of clinical information, query, reading of instructions by the patients and punctuality of the patients. The reporting time of the patient, if they were late than the appointment time was calculated in minutes. Physician's explanation about the procedure to the patient and provision of information about precautions and contraindications was also included Of the total 130 registered patients, 85 were males and 45 females. 86 [66.2%] referrals were made by consultants, 42 [32.3%] by residents and 2 [1.5%] by General Practitioners. 41 out of total were from consultants and residents in Physical Medicine and rehabilitation followed by 22 from Orthopedics. Regarding institutions, largest number of referrals were from Combined Military Hospital Rawalpindi [43] and Armed Forces Institute of Rehabilitation medicine [40]. By large, the clinicians neither provided clinical notes [62%] nor mentioned the query and provisional diagnosis [53%]. Majority [92%] did not provide information about the test to the patient and did not cue the patient about any precaution to be taken [92%].The patients on the other hand generally read the instructions provided in the request pro forma [54%] and reported well in time for the appointment of procedure [86%]. An inappropriate practice in referring patients uncritically to the EDX studies. Adopting good referral practices seemed crucial for meaningful usefulness of NCS/EMG. Instructions for proper referrals were sent to the concerned hospitals and a repeat audit was planned after one year

Frequency of detrusor hyper-rflexia after stroke: a urodynamic evaluation

To determine the frequency of urinary incontinence due to detrusor hyperreflexia and to check any effect of sex and pathology on detrusor hyperreflexia in stroke. Descriptive This descriptive study carried out at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, over one year from august 2003 to august 2004. Fifty-six [56] adult cases from both sex having urological complaints after cerebrovascular accidents were assessed both clinically and urodynamically for frequency of Detrusor Hyperreflexia leading to urinary incontinence. Detrusor hyperreflexia was present in 62.5% of cases. Increased percentage of Detrusor hyperreflexia was found in thrombotic stroke as compared to haemorrhagic stroke. The female population showed slightly increased percentage of detrusor hyperreflexia i.e. 61.5% as compared to 60.5% in males. However, the effects of sex and pathology on presence of detrusor hyperreflexia were not statistically significant as the P-values were greater than 0.05.. Urodynamic studies were found to be only investigation, which can confirm the presence of detrusor hyperreflexia and provide basis for rationale therapeutics in the management of this condition

Occurrence of deep vein thrombosis in spinal cord injured patients

The aim of this descriptive study was to describe the occurrence of Deep Vein Thrombosis [DVT] in spinal cord injured patients. 50 patients of both sexes [43 men and 7 women] with less then 90 days duration of injury and without other risk factors of DVT were studied over a period of two years. Most of the patients were in 20-39 years age group. They were evaluated for DVT on development of clinical signs or completion of 90 days of injury by Duplex Ultrasound Scan. DVT was found in 6 subjects [12%], all were male. One patient had bilateral, two had right sided and three had left sided involvement. None of the patients with incomplete spinal cord injury developed DVT. DVT is not a rare complication as is considered commonly and therefore requires adequate prophylactic measures in patients with concomitant various risk factors

Electrophysiological evaluation of foot drop

Foot drop can be a presentation of many causes. Most of them initially present with same signs and symptoms, e.g. foot drop, numbness over lateral aspect of the leg and dorsum of the foot especially peroneal nerve lesions, sciatic nerve lesions, L5 radiculopathy. It poses a lot of diagnostic problems .No study has been published in local literature to highlight this very important subject .Aim and objective of this study is to highlight the importance of electrodiagnostic studies in predicting prognosis, localizing lesions, pathophysiological changes and monitoring recovery. Cohort and observational study. This study was carried out at Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi from July 2001 to June 2002. Nerve conduction studies were performed with MS-6 [MEDLEC] using surface electrodes. Concentric needle electromyography was done using Neuropack electromyographic model MEM-7102K. On the basis of electrophysiological studies out of fifty, thirty patients had axonal while 20 patients had demyelinating lesions. Patients were divided into two groups on the basis of axonal and demyelinating lesions. In group A out of 30, [n=30] there were 14 [46.64%] and group B out of 20, [n=20] 7 patients [35%] of foot drop were due to peroneal nerve lesions, rest of the patients had L5 radiculopathy, Sciatic nerve lesions, Polyneuropathy and other abnormalities. Electrodiagnostic studies serves as an important tool in localizing the lesion and assessing its severity in different causes of foot drop

Frequency of carpal tunnel syndrome [CTS] after conservatively managed Colles' fracture

In this study, 56 adult patients of both sexes treated conservatively for Colles' fracture for at least six months, were evaluated both clinically and electrodiagnostically for evidence of CTS. Those found to have CTS electrodiagnostically were divided into 3 categories on the basis of distal motor latency [DML] in median nerve across wrist. A rate of 28.57% of CTS after conservatively managed Colles' fracture was found in this study. This is much higher than that reported in developed countries. Malunion was present in 93.75% of these patients. Main anatomical derangements responsible for malunion were radial shortening more than 2 mm and dorsal angulations more than 10 degrees. Electrodiagnostic studies were not found to be more sensitive than history and physical examination, but they definitely helped in objective confirmation of diagnosis and in assessing the severity of compression thus guiding in devising management strategies