RESUMO
OBJECTIVES: To evaluate, in patients with ulnar neuropathy at the elbow (UNE), if ultrasonographic differences in ulnar nerve size correlate with severity score determined by electrodiagnostic studies. METHODS: We examined prospectively 38 patients (50 elbows) with UNE. Patients were classified into mild, moderate and severe groups according to electrodiagnostic studies. Cross-sectional areas (CSAs) of the ulnar nerve were measured 4 cm proximal to the medial epicondyle (CSA-prox), 4 cm distal to the epicondyle (CSA-dist) and at the maximum CSA (CSA-max) of the ulnar nerve found between these points. We used a control group of 50 normal elbows. RESULTS: The CSA-max in the patient group was highly correlated with the severity score obtained by electrodiagnostic studies: mild: 11.1 +/- 3.4 mm(2), moderate: 15.8 +/- 3.8 mm(2), severe: 18.3 +/- 5.1 mm(2) (P < 0.001). Patients with UNE had larger ulnar nerve CSAs than controls at all three levels (P = 0.012 for CSA-prox, P < 0.001 for CSA-max, P = 0.003 for CSA-dist). A cut-off point of > or =10 mm(2) for CSA-max yields both sensitivity and specificity of 88%. CONCLUSIONS: Ultrasonography can have a role not only in the diagnosis, but also in the severity stratification of patients with UNE.
Assuntos
Cotovelo/inervação , Neuropatias Ulnares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cotovelo/diagnóstico por imagem , Eletrodiagnóstico/métodos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/patologia , Nervo Ulnar/fisiopatologia , Neuropatias Ulnares/diagnóstico , UltrassonografiaAssuntos
Torcicolo/complicações , Vaginismo/complicações , Adulto , Toxinas Botulínicas Tipo A/uso terapêutico , Estimulação Elétrica , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Miografia , Fármacos Neuromusculares/uso terapêutico , Torcicolo/fisiopatologia , Vaginismo/fisiopatologiaAssuntos
Baclofeno/uso terapêutico , Estatura , Bombas de Infusão Implantáveis , Relaxantes Musculares Centrais/uso terapêutico , Quadriplegia/tratamento farmacológico , Aumento de Peso , Antropometria , Baclofeno/administração & dosagem , Criança , Feminino , Humanos , Masculino , Relaxantes Musculares Centrais/administração & dosagem , Estudos RetrospectivosRESUMO
Our purpose was to test the effect of botulinum toxin injections on hypertonic pelvic floor muscles of patients suffering from genital pain syndromes. We report two cases of women complaining of a genital pain syndrome resistant to pharmacological therapies and rehabilitation exercises associated with a documented involuntary tonic contraction of the levator ani muscle as a defense reaction triggered by vulvar pain. We performed botulinum toxin injections into the levator ani with the intent to relieve pelvic muscular spasms. Within a few days after the injections both the patients reported a complete resolution of the painful symptomatology, lasting for several months. Our experience suggests that botulinum injections are indicated in patients with genital pain syndrome with documented pelvic muscle hyperactivity, whose symptoms arise not only from genital inflammation and lesions, but also, and sometimes chiefly, from levator ani myalgia.
