Bone age in children with obstetrical brachial plexus palsy: effect of peripheral nerve injury on skeletal maturation.

The purpose of this retrospective study was to analyze the effect of peripheral nerve injury on the skeletal maturation process. The bone ages of the affected and unaffected hand-wrists of 42 children with obstetrical brachial palsy were determined according to the Greulich and Pyle atlas. In 23 patients, the bone ages of the both sides were identical (bone-age-symmetrical group), in 19 patients the bone age of the affected side was delayed (bone-age-delayed group). The mean bone age of the affected side was delayed 0.48 ± 0.25 years that of the unaffected side (P = .000), and the delay of bone age was inversely correlated with chronological age (R (2) = .45, P < .02) in the bone-age-delayed group. Skeletal retardation can be recognized after appearance of ossification centers by plain radiography, dating from the third month of life, in early infancy. Thus, bone age determination method might be helpful for predicting potential future limb shortness.

Critical illness polyneuropathy: a case report.

Critical illness polyneuropathy (CIP) is defined as a common complication of critically ilness patients who were admitted to the intensive care unit due to sepsis, multiple trauma and/or multi-organ failure. We aimed to present a patient who was diagnosed as CIP. He was admitted to our outpatient clinic due to weakness and pain in his lower extremities. He had been followed in an intensive care unit due to suicid five months ago. There were symmetrically and predominantly muscle weakness, sensory impairment, absence of deep tendon reflexes in his lower extremities. Electrophysiological evaluation demonstrated motor and sensory axonal distal polyneuropathy predominantly in lower extremities. At follow up, he had high fever, and elevated acute phase responses. Therefore source of infection was investigated and was suspected to a diagnosis of infective endocarditis. He was discharged to be hospitalized in cardiology clinic. With this case, we think that physiatrists should take into consideration a diagnosis of critical illness polyneuropathy in patients with symmetric motor weakness. In CIP, muscle weakness, sensory loss, neuropathic pain, and autonomic problems lengthened the rehabilitation period. Due to a diagnosis of infective endocarditis in our case, we point out that source of infection should be carefully investigated if there is acute phase responses in CIP patients even if during rehabilitation period.

Ankle clonus and its relationship with the medium-latency reflex response of the soleus by peroneal nerve stimulation.

Ankle clonus and soleus medium-latency reflex are stretch-induced responses. Clonus is traditionally considered to be the result of oscillation in the group Ia mediated spinal stretch reflex but the soleus medium-latency reflex response originates mainly from the activation of group II afferents. The medium latency reflex response (MLR) was recorded in soleus muscle by peroneal nerve stimulation and clonus beats were recorded in soleus muscle using EMG in 19 spastic patients. The dorsiflexion (DF) and plantarflexion (PF) times of clonus and the half-period were calculated based on accelerometric measurements in 11 patients. The MLR of the soleus was 73.63 ± 8.9 ms. The half-period of the clonus was 79.34 ± 12.31 ms. The difference between the MLR and half-period was significant. The PF was 71.75 ± 6.73 ms, and the DF was 88.63 ± 10.83 ms. The difference between the soleus MLR and PF part of the clonus beat was not significant. The PF part of the clonus beat is due to soleus muscle contraction and controlled by the neural part of the oscillation. There may be relationship between the soleus MLR and the PF part of the clonus. Clonus is considered to be the result of oscillations in the group Ia spinal stretch reflex, but there is sufficient time for group II afferents to be involved.

Paraplegia associated with spinal hydatid cyst: a case report.

STUDY DESIGN: Case report. OBJECTIVES: To report a case with paraplegia caused by spinal hydatid cyst. SUMMARY OF BACKGROUND DATA: Hydatid cyst is a disease caused by larval Echinococcus granulosus tapeworm. Spinal hydatid cyst rarely leads to severe neurologic problems. METHODS: A 34-year-old male patient was referred to our outpatient clinic due to back and low back pain, progressive weakness and numbness in both lower extremities, and a prediagnosis of lumbar disc hernia. He had spastic paraplegia, and thorax magnetic resonance imaging revealed a lobulated cystic lesion with extradural intraspinal localization. RESULTS: After surgery and following 2 months of rehabilitation program, the patient showed a dramatic clinical improvement. CONCLUSION: By this case, it is emphasized that spinal hydatid cyst should come to mind in the differential diagnosis of spinal cord compression, and the importance of prevention, early diagnosis, and treatment is highlighted because of high mortality and morbidity.

Effect of cold application and tizanidine on clonus: clinical and electrophysiological assessment.

BACKGROUND/OBJECTIVES: Clonus is an involuntary rhythmic muscle contraction after sudden muscle stretch that occurs as a result of a lesion in the upper motor neurons. The real mechanism behind clonus remains obscure. The objective of this study was to investigate the effects of central-acting tizanidine treatment and peripheral extremity cooling on clonus. PARTICIPANTS: Thirty-eight patients with upper motor neuron involvement and sustained clonus. METHODS: The 38 patients were divided into 3 groups: cold group (n=19), tizanidine group (n=13), and patient control group (n=6). A separate group of 21 able-bodied volunteers served as controls for the cold group. The physiologic effects of cold application were measured in the able-bodied group and compared with the effects in the patients in the cold group. All participants were evaluated by clinical and electrophysiologic measurements. RESULTS: Changes in clinical and electrophysiologic measurements in the cold group were statistically significant compared with those of the tizanidine and patient control groups. CONCLUSIONS: Subsequent and long-term cold application induced prolonged inhibitory effects on clonus. Tizanidine had no significant effect on clonus. Suppression of clonus by cold highlights the importance of peripheral input in relation to central mechanisms.

Complex regional pain syndrome (CPRS type I) after a burn injury of the hand.

Complex regional pain syndrome (CRPS) type I is a clinical condition characterized by persistent pain in one part or the entire extremity after a minor trauma, fracture, or after an operation which does not involve nerve damage and/or sympathetic hyperactivity. Despite large-scale studies on the complications that arise after burns, literature reveals few reports on neurological problems and CRPS developing after burns. It is a rare complication of a burn injury to an extremity. Its early signs and symptoms are similar to those of burn wound itself. This study describes an unusual cause of complex regional pain syndrome in burn patients. The report highlights physical examination findings, the new diagnostic criteria of complex regional pain syndrome, and difficulties in diagnosis.

Extremity shortness in obstetric brachial plexus lesion and its relationship to root avulsion.

A total of 73 patients with obstetric brachial plexus palsy and extremity shortness were evaluated clinically, electrophysiologically, and with cervical magnetic resonance imaging. Patients were separated into groups according to age and the level of lesion. The differences of the length of the humerus, ulna, radius, and the second and fifth metacarpal bones were significant between the involved and uninvolved extremities. The difference in shortness increased in relation to the age of the groups and stabilized to approximately 10% in the groups aged 4 to 8 years and 8+ years. A significant relationship was observed between bone length differences and lesion levels. Differences in bone lengths were statistically significant in patients with avulsion in the group aged 8+ years. Extremity shortness appears to be related to avulsion and the level of lesion. The effect of avulsion on extremity shortness gradually increases with age. Finally, root avulsion can be an important factor in extremity shortness of obstetric brachial plexus palsy patients.

Upper extremity shortness in children with hemiplegic cerebral palsy.

OBJECTIVE: To evaluate upper extremity shortness in patients with hemiplegic cerebral palsy (HCP) and to investigate the association between extremity shortness, motor level, and muscle tone. DESIGN: Prospective, controlled study. SUBJECTS: Forty-two children with HCP and 29 healthy children. METHODS: Radiographs of the involved and the uninvolved humerus, forearm, and hands were obtained with a radiographic ruler placed adjacent to the extremity. The lengths and the diameters of both the diaphyses and metaphyses of the humerus, ulna, radius, and the second and the fifth metacarpal bones were measured in patients and the control group. The discrepancy was calculated as a percentage compared with the normal side. The Ashworth Scale was used in the evaluation of spasticity, and the Brunnstrom recovery staging was used in the motor evaluation. RESULTS: Children with HCP had significant differences in bone lengths and diameters compared with control children. There was no significant correlation between the upper extremity Brunnstrom stagings and the differences of bone length and diameter. A significant correlation was observed between the hand Brunnstrom staging and percentage difference of the bone length and diameter. The spasticity level showed no relation to the differences in bone length and diameter. CONCLUSIONS: Children with HCP have significant side-to-side limb-length discrepancy when compared with control children. The discrepancy increases with age. The extent of shortening did not appear to be related to upper extremity function and spasticity. The extremity shortness showed a relation to hand function.