Rotator cuff rupture: management with suprascapular neuropathy.

In patients with shoulder pain, weakness, and limitation of motion from rupture of the rotator cuff, there may be concomitant suprascapular neuropathy. In five patients with partial tears and one postsurgical patient with a complete tear of the rotator cuff, confirmed by arthrography, shoulder pain and weakness persisted 6 to 10 weeks after trauma. Electrodiagnosis in all six patients demonstrated prolonged suprascapular distal nerve latencies to the involved infraspinatus muscles. During the first 5 months after trauma, clinical recovery was much more rapid than later. Eight months after injury, despite conservative therapy, some discomfort remained and electrodiagnostic values had not completely returned to normal. The combination of a torn rotator cuff and a suprascapular neuropathy can present a complex diagnostic and management challenge, suggesting the importance of alertness to the possibility of such a combination in patients with tears of the rotator cuff.

Tarsal tunnel syndrome: an electrodiagnostic and surgical correlation.

The tarsal tunnel syndrome is not as commonly diagnosed as is its counterpart in the hand, the carpal tunnel syndrome. Electrodiagnostic evaluation has shown that reduced amplitude and increased duration of motor evoked potentials are more sensitive indicators of the presence of tarsal tunnel syndrome than is the distal motor latency. The lateral plantar branch of the posterior tibial nerve is probably affected earlier than is the nerve's medial plantar branch. Surgical release usually results in complete relief of the compression neuropathy. Electrodiagnostic evaluation also may help to separate patients with a tarsal tunnel syndrome from those with compression of the first sacral-nerve root.

Early confirmation of stress fractures in joggers.

Four joggers had early confirmation of clinically suspected stress fractures by radionuclide bone scans. The radioactive bone scan was abnormal as early as six weeks prior to the appearance of conventional roentgenographic changes. The stress fractures involved the bones of the lower extremities and included the femur, tibia, and calcaneus. Radioactive bone scanning also correctly identified stress fractures with bilateral involvement and referred pain. In joggers, when a stress fracture is clinically suspected and the conventional radiographs are negative, a radioactive bone scan is indicated for early confirmation and institution of appropriate treatment.