Accuracy of a portable electroneurometer for measuring distal motor latency.

BACKGROUND: A facile electromyographic test in the outpatient clinic is needed to evaluate the outcome of screening for carpal tunnel syndrome. The purpose of the current prospective study was to compare the accuracy of Nervepace digital electroneurometer (Nervepace) and Dantec Neuromatic 2000M (Dantec) measurements of a wide range of distal motor latency (DML) of the median nerve. METHODS: The DML values for 112 of 126 median nerves examined with Nervepace and conventional electromyography, Dantec were statistically analyzed in this prospective study. The 30 hands of 15 clinically healthy adults 20-24 years old served as the reference group. Sixty consecutive patients (96 hands) with idiopathic carpal tunnel syndrome provided a wider range of DML values. All of the patients had standard clinical tests and standard motor (Dantec and Nervepace) and sensory (Dantec) electrodiagostic tests before endoscopic carpal tunnel release. RESULTS: The DML was measurable in all 30 hands of the reference group, in all 96 hands of the patients by Dantec, but in only 82 hands (52 patients) by Nervepace. Nervepace and Dantec DML values of 6.0 ms or less had high correlation and agreement. CONCLUSIONS: Correlation and agreement decreased significantly among values greater than 6.0 ms.

Three-dimensional gait analysis of adults with hip dysplasia after rotational acetabular osteotomy.

Dysplasia of the hip, the most common cause of secondary coxarthrosis, has a relatively high prevalence in Japan. Rotational acetabular osteotomy (RAO) is an interventional strategy that seeks to reduce the abnormal amount of high stress concentration in the acetabulum and thereby to prevent the development of coxarthrosis. Long-term clinical results have been reported, but functional evaluations of the gait before and after RAO are underreported. The aim of our recently initiated long-term prospective study is to assess the effect of RAO on the gait characteristics of patients using quantitative gait analysis. Thus far 22 patients (1 male, 21 females; mean age 30 years, range 15-43 years) have been enrolled, treated, and completed the preoperative and postoperative gait analyses. Hip pain during walking decreased in all patients after the RAO. The postoperative hip extension motion angle on the treated side increased significantly and correlated positively with the improvement in the Japanese Orthopaedic Association (JOA) pain score. The current study shows that coxalgia and gait function improved after RAO.

Effect of NOS2 gene deficiency on the development of autoantibody mediated arthritis and subsequent articular cartilage degeneration.

OBJECTIVE: To determine the effect of NOS2 gene deletion on articular cartilage degradation in autoantibody mediated arthritis (AMA). METHODS: Female C57BL/6Ai-[ko] NOS2 N5 (NOS2-/-) mice (7-8 weeks old) and the counterpart C57/Bl6 Crj mice (wild-type, WT) were studied. Arthritis was induced by intraperitoneal injection of 4 mg of an arthritogenic cocktail of 4 monoclonal antibodies raised against type II collagen twice on Day 0 and Day 1 followed by intraperitoneal injection of 50 micro g of lipopolysaccharide on Day 2. Individual limbs were scored for arthritis in 4 grades; the total maximum score per mouse was 16. Femoral condyles and tibial plateaus of both knee joints were collected on Day 15 for immunohistological studies on nitrotyrosine and matrix metalloproteinase (MMP)-3 and -9. DNA fragmentation in chondrocytes was detected by the nick-end labeling (TUNEL) method. Blood was also collected on Day 15 to determine serum levels of nitrite/nitrate and interleukin 1 beta (IL-1 beta). RESULTS: Both NOS2-/- and WT mice with AMA developed clinically apparent arthritis. In WT mice, the arthritis progressed rapidly and reached the peak score 11.4 +/- 2.9 on Day 12, whereas the arthritis in NOS2-/- mice was milder and the peak score was 7.7 +/- 2.8 on Day 13 (p < 0.05). The serum nitrite/nitrate levels, histological grades of articular cartilage degradation, and numbers of apoptotic chondrocytes and nitrotyrosine positive chondrocytes were significantly lower in NOS2-/- mice with AMA than in WT mice with AMA. Conversely, significant differences were not observed in MMP-3 or -9 expression in chondrocytes, or in serum IL-1 beta levels between these 2 groups of mice. CONCLUSION: NOS2 gene deletion did not affect the inflammatory responses, but reduced the cartilage degradation.

Carpal tunnel syndrome grading system in rheumatoid arthritis.

The grading system of Hashizume and Hirooka for carpal tunnel syndrome (CTS) was modified to refine the system for surgical treatment selection for specific subsets of CTS in patients with rheumatoid arthritis (RA). The grading system uses clinical signs and symptoms of CTS, including pain indications, to identify surgical subsets of patients to facilitate treatment selection. Retrospective analysis of the system included radiographic and electromyographic findings. Twenty-nine hands of 21 adult patients with CTS in RA were graded in the current study. Eight hands with mild synovitis received conservative treatment only. Endoscopic carpal tunnel release (ECTR), using Okutsu's universal subcutaneous endoscopic system with a clear cannula, was performed in 11 hands with moderate synovitis. Open carpal tunnel release (OCTR) combined with flexor tenosynovectomy was performed in 9 hands with severe synovitis. One more hand required OCTR after ECTR when malignant RA was diagnosed. Clinical results, evaluated using Kelly's criteria, were: excellent in 19 hands, good in 5, fair in 4, and poor in the 1 patient with malignant RA. Clinical symptoms of CTS improved in all but the latter patient. Although the sample size in the current study is small, the results appear to warrant further study to determine the clinical utility of the grading system.