Establishing Normal Values for F-Wave Latencies in Diagnosing Peripheral Neuropathies for the Pediatric Population.

PURPOSE: We present a unique technique applying F-wave latencies to assist in the diagnosis of peripheral neuropathy within the pediatric age group. METHODS: We calculated an F-wave estimated deviance adjusted for limb length measurements, distal motor conduction velocity, and distal motor latencies. We compared the F-wave estimated deviance from the normal subjects with those with peripheral neuropathy (both axonal and demyelinating) to establish diagnostic accuracy in pediatric patients. RESULTS: The normal range for the F-wave estimated deviance in the upper limb was -1 to +6 ms and in the lower limb was -8 to +5 ms. When compared with 82 subjects with peripheral neuropathy, there was a significant difference between the normal subjects and those with neuropathy (P values between 0.002 and 0.0005 for each of the individual nerves tested). CONCLUSIONS: The F-wave estimated deviance is independent of age and can be accurately applied to the electrodiagnostic testing of pediatric patients with suspected neuropathy.

Nerve conduction normal values for electrodiagnosis in pediatric patients.

INTRODUCTION: Existing normal value references for pediatric nerve conduction studies (NCS) are based on limited sample sizes with uncertain reliability, suggesting a need for better normative data. METHODS: Electronic medical records were reviewed for pediatric patients (0 to <18 years) with normal findings on electromyography and NCS during the period from January 1, 1997 through September 20, 2017. Electrodiagnostic and demographic data were collected. Gaussian and descriptive statistics were used to establish normal values by age group. RESULTS: In this study we analyzed 1,918 normal NCS on 1,849 unique pediatric patients. Patients were stratified by age: 0 to <1 month; 1 to <6 months; 6 to <12 months; 12 to <24 months; 2 to <3 years; 3 to <4 years; 4 to <5 years; 5 to <10 years; 10 to <15 years; and 15 to <18 years. Normal reference ranges for amplitude, conduction velocity, and distal latency were established for each age group for 4 motor and 4 sensory nerves. DISCUSSION: The large sample size of this study provides reliable reference values for interpreting pediatric NCS. Muscle Nerve 60: 155-160, 2019.

Posterior Vertebral Endplate Fractures: A Retrospective Study on a Rare Etiology of Back Pain in Youth and Young Adults.

BACKGROUND: Posterior lumbar vertebral endplate fracture occurs with avulsion of the ring apophysis from the posterior vertebral body. Although this has been described in adolescents and young adults, proper diagnosis is often delayed or missed entirely. Surgery may be curative. OBJECTIVE: To determine the common clinical features and treatment outcomes in youth and young adults with posterior lumbar vertebral endplate fractures. DESIGN: Retrospective case series. SETTING: Academic medical institution. PATIENTS: Patients 10 to 25 years old from 2000 through 2012 with posterior vertebral endplate fracture diagnosis. MAIN OUTCOME MEASUREMENTS: Demographic characteristics, diagnostic studies, interventions, and change in symptoms postoperatively. RESULTS: A total of 16 patients had posterior vertebral endplate fractures (8 male patients; mean age, 15.2 years)-8.3% of 192 patients with inclusion age range undergoing spinal surgery for causes unrelated to trauma, scoliosis, or malignancy. The most common signs and symptoms were low back and radiating leg pain, positive straight leg raise, hamstring contracture, and abnormal gait. Cause was sports related for 12 patients (75%). Mean (range) time to diagnosis was 13.0 (3.0-63.0) months. Diagnosis was most commonly made with lumbar magnetic resonance imaging (n = 6). Most fractures occurred at L5 (n = 8, 50%) and L4 (n = 5, 31.3%). Conservative measures were trialed before surgery. Nine patients had "complete relief" following surgery and seven "improved." CONCLUSIONS: Posterior vertebral endplate fracture should be considered in differential diagnosis of a youth or young adult with back pain, radiating leg pain, and limited knee extension, regardless of symptom onset. For patients in whom conservative management fails, consultation with an experienced physician whose practice specializes in spine medicine is recommended. LEVEL OF EVIDENCE: IV.

Three decades of citation classics: the most cited articles in the field of physical medicine and rehabilitation.

With the American Academy of Physical Medicine and Rehabilitation recently celebrating its 75th anniversary, it is an opportune time to assess the impact and influence that physiatric articles and research have had on the field, as well as the greater scientific community. One useful metric of scientific impact is citation count, which is the most common method for analyzing the magnitude of scientific recognition of an individual article. This study presents 2 reading lists of influential physiatric academic journal articles drawn from the Web of Science index based on citation count. The first list contains the top 25 most-cited articles during the last 3 decades from the American Journal of Physical Medicine and Rehabilitation, the Archives of Physical Medicine and Rehabilitation, and PM&R. The second list contains the top 10 articles in 20 different physiatric topical areas. This topical list was generated via an expanded search without limitation of time span or journal. This allowed for the identification of influential physiatric articles not found in the field's 3 major publications from the United States. Although citation index is not a direct measure of quality or importance, it offers one form of quantitative assessment of scientific impact. This assessment contributes to the identification of trends, which illustrate the evolution of scope and focus of physiatry research. The lists of most-cited articles presented in this review can be used to provide historical context to physiatry's existing body of research, direct future evidence-based research efforts, and help guide educators as they select resident reading lists or journal club materials.