Diagnosis Accuracy of Carpal Tunnel Syndrome in Diabetic Neuropathy.

Background and objectives: Carpal tunnel syndrome (CTS) is a common pathology, but sometimes the diagnosis is delayed in patients with diabetic neuropathy (DN). The aim of the study is twofold: first, to compare the accuracy of ultrasound (US) with that of electroneurography (ENG) in the diagnosis of CTS associated with DN, using the clinical diagnosis as a reference standard, and second, to investigate the correlation between morphological US parameters and electrodiagnosis (EDX) measurements in patients with CTS and DN. Materials and Methods: This study included patients with DN. They were divided into two groups: Control (patients without CTS) and Cases (patients with CTS). We performed US and ENG in both hands, totaling 56 wrists, with 28 wrists in each group. Results: We found that the difference in the sensory distal latencies between the median and the ulnar nerves (ring finger) exhibited the highest diagnostic accuracy of all the US and ENG parameters, areas under the receiver operating characteristic (AUC) = 0.99 (95% CI 0.97-1), and it was significantly different from the best US diagnostic method. The wrist cross-sectional area (CSA) had the most accurate US diagnosis, while the wrist-to-forearm ratio had the worst AUC. Moreover, in the group of CTS and DN patients, the wrist CSA enlargement was statistically directly proportional to the median compound muscle action potential (CMAP) distal latency and inversely proportional to the antidromic median nerve conduction study (NCS) and the orthodromic median palm-wrist NCS. Conclusions: Both examinations can be used with confidence in the diagnosis of CTS overlapping with DN, but the EDX examination seems to be more accurate. Furthermore, we found a positive correlation between the US and EDX parameters.

A comparison of a prototype electromyograph vs. a mechanomyograph and an acceleromyograph for assessment of neuromuscular blockade.

The extent of neuromuscular blockade during anaesthesia is frequently measured using a train-of-four stimulus. Various monitors have been used to quantify the train-of-four, including mechanomyography, acceleromyography and electromyography. Mechanomyography is often considered to be the laboratory gold standard of measurement, but is not commercially available and has rarely been used in clinical practice. Acceleromyography is currently the most commonly used monitor in the clinical setting, whereas electromyography is not widely available. We compared a prototype electromyograph with a newly constructed mechanomyograph and a commercially available acceleromyograph monitor in 43 anesthetised patients. The mean difference (bias; 95% limits of agreement) in train-of-four ratios was 4.7 (-25.2 to 34.6) for mechanomyography vs. electromyography; 14.9 (-13.0 to 42.8) for acceleromyography vs. electromyography; and 9.8 (-31.8 to 51.3) for acceleromyography vs. mechanomyography. The mean difference (95% limits of agreement) in train-of-four ratios between opposite arms when using electromyography was -0.7 (-20.7 to 19.3). There were significantly more acceleromyography train-of-four values > 1.0 (23%) compared with electromyography or mechanomography (2-4%; p < 0.0001). Electromyography most closely resembled mechanomyographic assessment of neuromuscular blockade, whereas acceleromyography frequently produced train-of-four ratio values > 1.0, complicating the interpretation of acceleromyography results in the clinical setting.

Characterization of the mechanomyographic signal of three different muscles and at different levels of isometric contractions.

PURPOSE: Lateral (X) and longitudinal (Y) mechanical oscillations of muscle fibers that take place during muscular contraction seem to contain information additionally to the myoelectric activity, which can contribute to the interpretation of some muscle gradation force mechanisms. However, no previous study was found that had investigated the relationship between the muscle force and features associated to the mechanomyographic (MMG) signal obtained by means of a biaxial accelerometer in three different muscles. Therefore, the aim of this study was to evaluate the relationship between the force output at different load levels (20% to 100%) of the maximum voluntary isometric contraction (%MVIC) and the two signals supplied by a biaxial accelerometer and, in addition, the so-called resultant (R) acceleration signal derived from the two signals mentioned previously. Twenty seven male volunteers participated in this study. METHODS: The force output related to the right biceps brachii, soleus and gastrocnemius medialis muscles was studied by means of linear regression models fit to log-transformed of the root mean square (RMS) values of the MMG signals in X, Y, and R axes versus each %MVIC. The phase angle of R acceleration (PhaseR) and anthropometric data were also considered. RESULTS: The angular coefficient a and the antilog of y-intercept b from the log-transformed of MMG data values versus force output were able to distinguish partially motor unit strategies during isometric contractions in the three muscles studied. CONCLUSION: The findings suggest that biaxial accelerometer seems to be an interesting approach in the assessment of muscle contraction properties.

The effect of accelerometer location on the classification of single-site forearm mechanomyograms.

BACKGROUND: Recently, pattern recognition methods have been deployed in the classification of multiple activation states from mechanomyogram (MMG) signals for the purpose of controlling switching interfaces. Given the propagative properties of MMG signals, it has been suggested that MMG classification should be robust to changes in sensor placement. Nonetheless, this purported robustness remains speculative to date. This study sought to quantify the change in classification accuracy, if any, when a classifier trained with MMG signals from the muscle belly, is subsequently tested with MMG signals from a nearby location. METHODS: An arrangement of 5 accelerometers was attached to the flexor carpi radialis muscle of 12 able-bodied participants; a reference accelerometer was located over the muscle belly, two peripheral accelerometers were positioned along the muscle's transverse axis and two more were aligned to the muscle's longitudinal axis. Participants performed three classes of muscle activity: wrist flexion, wrist extension and semi-pronation. A collection of time, frequency and time-frequency features were considered and reduced by genetic feature selection. The classifier, trained using features from the reference accelerometer, was tested with signals from the longitudinally and transversally displaced accelerometers. RESULTS: Classification degradation due to accelerometer displacement was significant for all participants, and showed no consistent trend with the direction of displacement. Further, the displaced accelerometer signals showed task-dependent de-correlations with respect to the reference accelerometer. CONCLUSIONS: These results indicate that MMG signal features vary with spatial location and that accelerometer displacements of only 1-2 cm cause sufficient feature drift to significantly diminish classification accuracy. This finding emphasizes the importance of consistent sensor placement between MMG classifier training and deployment for accurate control of switching interfaces.

Uncovering chaotic structure in mechanomyography signals of fatigue biceps brachii muscle.

The mechanomyography (MMG) signal reflects mechanical properties of limb muscles that undergo complex phenomena in different functional states. We undertook the study of the chaotic nature of MMG signals by referring to recent developments in the field of nonlinear dynamics. MMG signals were measured from the biceps brachii muscle of 5 subjects during fatigue of isometric contraction at 80% maximal voluntary contraction (MVC) level. Deterministic chaotic character was detected in all data by using the Volterra-Wiener-Korenberg model and noise titration approach. The noise limit, a power indicator of the chaos of fatigue MMG signals, was 22.20+/-8.73. Furthermore, we studied the nonlinear dynamic features of MMG signals by computing their correlation dimension D(2), which was 3.35+/-0.36 across subjects. These results indicate that MMG is a high-dimensional chaotic signal and support the use of the theory of nonlinear dynamics for analysis and modeling of fatigue MMG signals.

Time and frequency domain responses of the mechanomyogram and electromyogram during isometric ramp contractions: a comparison of the short-time Fourier and continuous wavelet transforms.

The purposes of this study were to examine the mechanomyographic (MMG) and electromyographic (EMG) time and frequency domain responses of the vastus lateralis (VL) and rectus femoris (RF) muscles during isometric ramp contractions and compare the time-frequency of the MMG and EMG signals generated by the short-time Fourier transform (STFT) and continuous wavelet transform (CWT). Nineteen healthy subjects (mean+/-SD age=24+/-4 years) performed two isometric maximal voluntary contractions (MVCs) before and after completing 2-3, 6-s isometric ramp contractions from 5% to 100% MVC with the right leg extensors. MMG and surface EMG signals were recorded from the VL and RF muscles. Time domains were represented as root mean squared amplitude values, and time-frequency representations were generated using the STFT and CWT. Polynomial regression analyses indicated cubic increases in MMG amplitude, MMG frequency, and EMG frequency, whereas EMG amplitude increased quadratically. From 5% to 24-28% MVC, MMG amplitude remained stable while MMG frequency increased. From 24-28% to 76-78% MVC, MMG amplitude increased rapidly while MMG frequency plateaued. From 76-78% to 100% MVC, MMG amplitude plateaued (VL) or decreased (RF) while MMG frequency increased. EMG amplitude increased while EMG frequency changed only marginally across the force spectrum with no clear deflection points. Overall, these findings suggested that MMG may offer more unique information regarding the interactions between motor unit recruitment and firing rate that control muscle force production during ramp contractions than traditional surface EMG. In addition, although the STFT frequency patterns were more pronounced than the CWT, both algorithms produced similar time-frequency representations for tracking changes in MMG or EMG frequency.

Stationarity distributions of mechanomyogram signals from isometric contractions of extrinsic hand muscles during functional grasping.

This study investigates the stationarity of steady state mechanomyogram signals for the purpose of determining appropriate features for signal classification. Mechanomyography is the superficial recording of low frequency vibrations detected over contracting muscles. Steady state mechanomyogram signals, recorded at the belly of the extensor digitorum, flexor digitorum superficialis and flexor pollicis longus muscles during functional grasps were tested for weak stationarity. Twenty percent of the contractions were found to be non-stationary, indicating that time frequency methods may be appropriate for automatic pattern recognition of functional grasp from the mechanomyogram. The distribution of the stationary test statistic was dependent on the type of muscle contractions, suggesting that the test statistic itself might be a discriminating feature for mechanomyogram pattern recognition in applications such as multifunction prosthetic control. Since the major known source of non-stationarity was decreasing variance, it is suggested that shifts in the distribution of the test statistic may indicate the time course of relative muscle contributions to functional grasp.

Comparison of Fourier and wavelet transform procedures for examining the mechanomyographic and electromyographic frequency domain responses during fatiguing isokinetic muscle actions of the biceps brachii.

The primary purpose of the present study was to compare the fast Fourier transform (FFT) with the discrete wavelet transform (DWT) for determining the mechanomyographic (MMG) and electromyographic (EMG) center frequency [mean power frequency (mpf), median frequency (mdf), or wavelet center frequency (cf)] patterns during fatiguing isokinetic muscle actions of the biceps brachii. Seven men (mean+/-SD age=23+/-3 years) volunteered to perform 50 consecutive maximal, concentric isokinetic muscle actions of the dominant forearm flexors at a velocity of 180 degrees s(-1). Non-parametric "run" tests indicated significant (p<0.05) trends in the MMG and EMG signals for the 5th, 25th, and 45th muscle actions for all subjects, thereby confirming non-stationarity of the MMG and EMG signals. There were significant (p<0.05) correlations among the average normalized mpf, mdf, and cf values for contractions 1-50 for both MMG (r=0.671-0.935) and EMG (r=0.956-0.987). Polynomial regression analyses demonstrated quadratic decreases in normalized MMG mpf (R2=0.439), MMG mdf (R2=0.258), MMG cf (R2=0.359), EMG mpf (R2=0.952), EMG mdf (R2=0.914) and EMG cf (R2=0.888) across repetitions. The primary finding of this study was the similarity in the mpf, mdf, and cf patterns for both MMG and EMG, which suggested that, despite the concerns over non-stationarity, Fourier based methods are acceptable for determining the patterns for normalized MMG and EMG center frequency during fatiguing dynamic muscle actions at moderate velocities.

Mechanomyographic responses in human biceps brachii and soleus during sustained isometric contraction.

The purpose of this study was to elucidate the responses of the mechanomyogram (MMG) from two apparently different muscles (biceps brachii and soleus) during a sustained voluntary contraction at 50% maximum voluntary contraction. The MMG and surface electromyogram (EMG) were recorded from human biceps brachii and soleus during sustained elbow flexion and plantar flexion, respectively. Results indicated that the slope coefficient of rise in EMG amplitude as a function of time for the biceps was significantly greater than that for the soleus ( P<0.001). On the contrary, the MMG amplitude of the biceps showed a significant increase during the initial phase of sustained contraction ( P<0.05); however, when exhaustion was approached the amplitude declined significantly ( P<0.05). In the soleus muscle the decrease in MMG amplitude toward exhaustion occurred to a much lesser extent than that observed in the biceps. This difference could be attributed to the nature of the fusion state of the underlying muscle fibers. That is, the great extent of fusion observed in the biceps may be as a result of a greater quantity of fatigable motor units. In addition, the absence of MMG reduction in the soleus would indicate the absence of fatigue-induced slowing of contractile machinery and/or the lack of full activation (tetanus) of muscle fibers even at the exhaustion phase of plantar flexion.

Differential responses in human subcutaneous and skeletal muscle vascular beds to critical limb ischaemia.

OBJECTIVES: To investigate the effects of chronic ischaemia on the subcutaneous and the skeletal muscle resistance vasculature. To understand the redistribution of available blood in the ischaemic limb. METHODS: Human subcutaneous and skeletal muscle resistance arteries were obtained from limbs amputated for critical limb ischaemia and studied under isobaric conditions using pressure myography. Morphological measurements of wall and lumen were analysed using light microscopy and image analysis. Vasoconstrictor responses to potassium and adrenoceptor agonists were used to measure functional status. Noradrenaline re-uptake mechanisms and alpha(1)-selectivity were investigated. RESULTS: Both human skeletal muscle and subcutaneous resistance arteries undergo a severe atrophy of the arterial wall in ischaemic conditions. However, whereas subcutaneous resistance arteries become less able to vasoconstrict to adrenoceptor stimulation, the response of skeletal muscle resistance arteries becomes exaggerated and significantly augmented. This is true in response to both the endogenous vasoconstrictor noradrenaline and the alpha(1)-selective adrenoceptor agonist phenylephrine. CONCLUSIONS: Hypersensitivity to circulating catecholamines in the skeletal muscle vascular resistance bed may contribute to the progression of ischaemic disease by differentially diverting available blood to the subcutaneous tissue to the detriment of skeletal muscle perfusion.

Electro and acoustic myography for noninvasive assessment of lumbar paraspinal muscle function.

In 31 normal subjects (17 male), aged 19-48 years, and 8 patients with chronic low back pain (4 male), aged 37-55 years, the repeatability of surface recordings of acoustic myography (AMG) and electromyography (EMG) were examined in the lumbar paraspinal muscles. Five isometric test positions were examined. In 21 of the normal subjects, four positions tested were: quiet standing, half extension from prone lying, full extension from prone with and without resistance. In 10 of the normal subjects and the 8 back pain patients, a standardised, unsupported horizontal position with the upper body over the end of a couch was tested. The AMG and EMG signals were full-wave rectified and integrated (iAMG and iEMG). The variability of recordings during repeated 5-s isometric contractions was assessed by analysis of variance (ANOVA) and the coefficient of variation (CV) was calculated from the ANOVA. Both recording techniques produced the most repeatable results during the unsupported, horizontal hold position. In the normal subjects, CV were, iAMG 5.6%, iEMG 4.9%; and in the patients, iAMG 4.4%, iEMG 2.6%. The CV for the other four isometric test positions ranged from 15.3% to 29.4% for iAMG, and 8% to 15.7% for iEMG. These results demonstrated that a controlled test manoeuvre for examining AMG and EMG of the paraspinal muscles was vital for repeatable recordings. The CV for the standardised, horizontal position were lower than for previously published results.(ABSTRACT TRUNCATED AT 250 WORDS)