Flexor Carpi Radialis Muscle: Anatomic Features and Electromyography Technique Under Ultrasound Control.

The electromyographic assessment of the flexor carpi radialis muscle (FCRM) in the context of an upper limb extensors' deficiency helps physicians in differentiating radial nerve damage from C7 radicular impairment. Ultrasound (US)-guided electromyography (EMG) is mandatory to locate this muscle, particularly in the case of muscle atrophy, denervation, and neuromuscular disorders. The aim of this manuscript is to illustrate the anatomical specific features of the FCRM and the technical procedure of FCRM EMG with US guidance.

Clinical Significance of Anatomic Peculiarities and Ultrasound-Guided Electromyography of the Posterior Tibial Muscle.

The posterior tibial muscle (PTM) is a key muscle in diagnosing the level of the neurologic lesion that causes steppage gate that is a paralysis of nervous origin of the muscles ensuring the foot dorsiflexion. The aim of this manuscript is to illustrate the anatomical peculiarities of the PTM, the ultrasound (US) anatomy of the infero-posterior part of the leg, and the technique of US-guided electro-neuro-myography (ENMG) of the PTM, which is considered a key muscle in the diagnosis of the neurological lesion causing steppage gate. The US-guided ENMG of the PTM is technically easy and safe for young practitioners provided there is a good knowledge of US anatomy of the infero-posterior part of the leg.

Importance of Anatomic Peculiarities and Ultrasound-Guided Electromyography of the Extensor Indicis Proprius Muscle.

The extensor indicis proprius muscle (EIPM) is considered a key muscle in the assessment of the level of the neurologic lesion causing any motor or sensory medio-cubital impairment of the hand. The aim of this study is to illustrate the anatomical peculiarities of the EIPM, the ultrasound (US) anatomy of the inferoposterior part of the forearm, and the technique of US-guided electromyography (EMG) of the EIPM. The US-guided EMG of the EIPM is technically easy and safe for young practitioners, provided there is a good knowledge of US anatomy of the inferoposterior part of the forearm.

Efficacy of botulinum toxin A for the treatment of hemiparesis in adults with chronic upper limb spasticity.

INTRODUCTION: this study aimed to evaluate the effectiveness of botulinum toxin A (BoNT-A) injection in hemiparetic patients with chronic spasticity in the upper limb resulting from stroke or traumatic brain injury. METHODS: we conducted a retrospective study including 45 patients seen, in our department of Physical Medicine and Rehabilitation, between January 2014 and December 2016. All patients received an injection of BoNT-A (Dysport, 100 U/ml). Affected upper-extremity muscles could be injected as per the investigator's discretion to a maximum total dose of 1000 U. We evaluated muscle tone using Modified Ashworth Scale (MAS). Functional disability was assessed using Modified Frenchay Scale (MFS), Nine Hole Peg Test (NHPT) and Barthel Index (BI). Quality of life (QoL) was assessed using the 36-Item Short Form Health Survey (SF-36). The achievement of treatment goal was assessed by the Goal Attainment Scaling (GAS). RESULTS: patients decreased their MAS score over the first and the third months (p<0.05). MFS showed improvement at 1 month after injection with a median change from baseline of 8 (range: 1-16; p<0.001). The change from baseline ranged from 0 to 5 points for NHPT at 1 month after injection (p< 0.001). This functional improvement was maintained to 3 months. Improvements in Barthel Index was observed at 3 months with a median change from baseline of 5 points (range 0-15; p<0.001). The mean change from baseline of SF-36 score was 4.77 ± 3.39 (p<0.001). The mean GAS T-score was 47.04 ±7.78 (median 50, IQR 7.7), giving a mean (SD) change from baseline of 25.36 ± 8.46 (95% CI 22.82 to 27.90; p <0.001). Binary logistic regression was used to identify the independent factors predicting a favorable functional outcome of Bon-T treatment. It showed that neglect was independent predictive factor treatment failure (p=0.009, OR=3.2) while previous injection of BoNT-A was an independent predictive factors of treatment success (p=0.009, OR=0.3). CONCLUSION: our study showed a good response to BoNT-A injection delivered in the management of chronic upper limb spasticity resulting from stroke or traumatic brain injury. It demonstrated its outcome in improving muscle tone, function and QoL. It also showed that the majority of patients achieved their goal as defined at the start of the treatment, mainly for patients who received previous injection of BoNT-A.

Contribution of isokinetic muscle strengthening in the rehabilitation of obese subjects.

AIMS: Our objective was to evaluate the specific effect of isokinetic muscle strength enhancement in the rehabilitation of obese subjects by comparing two groups (isokinetic muscle exercising associated with aerobic exercising or only aerobic exercising). PATIENTS AND METHODS: This was a randomized, prospective study from January 2008 to December 2009 involving 40 obese patients randomized into two groups. The first group G1 (n=20) followed a program of aerobic training and isokinetic exercising of the extensor and flexor muscles of lower limbs and spine. The second group G2 (n=20) followed only a program of aerobic exercising. All patients completed their rehabilitation protocols comprising 3 sessions per week for two months. The parameters evaluated before and after the program were anthropometric parameters (weight, stature, body mass index, body fat and lean body mass percentages), cardiovascular parameters by stress test on electromagnetic ergo-cycle, an assessment of muscle strength by isokinetic dynamometer and an assessment of psychological status and quality of life. RESULTS: We recruited 36 women and 4 men. Initially, the 2 groups were comparable. After training, in both groups we noted an improvement in anthropometric parameters, with an average weight loss of 1.83 kg/week (P<0.001), an improvement in cardiovascular parameters with a decrease in heart rate at rest and under effort, and in systolic and diastolic arterial blood pressure values at rest and under effort (P<0.01 in both group), an improvement in parameters of muscle strength with increase in moment of maximum strength of extensor and flexor knee and spine muscles for all three test speeds, and an improvement in psychological status and in quality of life. The improvement of all these parameters was statistically greater in G1 (P<0.05). CONCLUSION: Isokinetic muscle strengthening increases the effects of aerobic exercising in the obese by improving muscle strength, increasing lean body mass and reducing body fat.