Neuromuscular adaptations during 30 days of cast-immobilization and head-down bedrest.

Prolonged skeletal muscle disuse, during space flights and on Earth, produces distinct adaptive changes in the neuromuscular system of human subjects. There is a significant decline in muscle mass and strength, exercise capacity, fatigue resistance, integrated EMG (IEMG) output and time-dependent alterations in the behavior of Hoffman (H) and deep tendon reflexes. The objective of this study was to examine the changes in excitability of segmental motoneuronal network and its influence upon gastrocnemius-soleus (G-S) function in healthy male and female subjects, who underwent either 6 degrees head-down bedrest (HDB) or unilateral cast-immobilization (CIM) for a period of 30 days.

Heel pain syndrome: electrodiagnostic support for nerve entrapment.

A local entrapment neuropathy has been proposed as one of the etiologies of heel pain, but it has never been documented by electrodiagnostic studies. Primary symptoms in patients suspected of having a neurologic basis for their heel pain include neuritic medial heel pain and radiation either proximally or distally. On physical examination, all patients in our series had reproduction of their symptomatology with palpation over the proximal aspect of the abductor hallucis and/or the origin of the plantar fascia from the medial tubercle of the calcaneus. Twenty-seven patients (20 women and seven men; average age 49) with these clinical characteristics were examined by electromyography and motor/sensory/mixed nerve conduction studies. Bilateral heel signs and symptoms were present in 11 patients. Ten of the patients had a significant history of back pain with referral to the legs. In 23 of the 38 symptomatic heels, abnormalities were identified in the lateral and/or the medial plantar nerves. The number of abnormal values per heel ranged from one to four, with a mean of 2.1. The most common finding was involvement of the medial nerve (57%). Thirty percent of the heels had isolated findings in the lateral plantar nerve and 13% had abnormalities in both plantar nerves. Two patients had electrophysiologic evidence of active S1 radiculopathy, with ipsilateral evidence of plantar nerve entrapment suggesting a "double crush" syndrome. The results of this study support the presence of abnormalities of plantar nerve function in a selected group of patients with neuritic heel pain.

Isolated injury of the infraspinatus branch of the suprascapular nerve.

A 30-year-old recreational baseball player developed dominant-sided infraspinatus atrophy and shoulder pain after throwing a baseball. Partial denervation of the infraspinatus muscle with delayed motor latency was documented. Isolated lesions of the branch to the infraspinatus may be more common than previously suspected, particularly in throwing athletes with shoulder pain.

Questions asked by patients and their support groups during family conferences on inpatient rehabilitation units.

Although discharge planning from rehabilitation units is discussed in social service and nursing literature, no studies have documented what information the family specifically seeks in preparing for the patient's discharge. In order to gain insight into this issue, the residents assigned to two rehabilitation units were asked to paraphrase and transcribe all questions asked by randomly selected patients and their support groups during family conferences. Forty-six conferences with 45 patients were evaluated, and 213 questions were recorded. Each question was placed into one of ten categories, based on the topic of the question. The most common topic about which information was sought was medical issues not directly related to the primary rehabilitation diagnosis (17% of all questions). Discharge planning was the second most common topic (16%). Thirty-one percent of all questions were related to medical issues. The information derived from this study will help rehabilitation professionals to be better prepared for family conferences and discharge planning.