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P32-F Nerve ultrasound in the assessment of posterior interosseous nerve syndrome: a useful tool?
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Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
HRU examination of the median nerve revealed compression of the median nerve at the level of the carpal tunnel in 2 cases. In the other 15 patients no sign of compression was found under the transverse ligament, but permitted to visualise focal or segmental thickening, alteration of the fascicular structure of the median nerve (all 15 cases), neuroma (6 cases) and increased vascularization (3 cases) on the side of the fracture. Conclusion: HRU is a non-invasive and reliable method, that allows diagnostic accuracy in the assessment of median nerve injury following DRF. HRU showed a specificity superior to common EDX on determining the nature of the median nerve involvement in our patients and helped differentiating from the presumed CTS. doi:10.1016/j.clinph.2019.04.482
P31-F Muscle ultrasound improves fasciculation detection in some muscle in patients with amyotrophic lateral sclerosis— Dejan Georgiev *, Nezˇa Kamin, Gregor Omejec, Janez Zidar (Institute of Clinical Neurophysiology, Ljubljana, Slovenia) ⇑
Corresponding author.
Background: Fasciculations represent brief spontaneous or triggered contractions of motor units that can be seen as flickering movements under the skin and represent a valuable sign of lower motor neuron lesion. It is sometimes difficult to detect fasciculations clinically and/or electromyografically (EMG). Muscle ultrasound (MUS) is a promising tool that can aid to the better detection of fasciculations. Materials and methods: 12 patients (4 females, mean age 68.75 ± 12.04, mean disease duration 4.25 ± 2.09) diagnosed with amyotrophic lateral sclerosis were included in this pilot study. EMG needle was inserted under US guidance into right biceps brachii (BB), first dorsal interousseous (FDI) and rectus femoris (RF) muscles. Location of needle tip was marked and remained stationary during 90 s of recording. Two experienced neurophysiologists independently counted the number of fasciculations from the EMG and MUS recordings. Sperman’s q was used to assess interrater reliability. Wilcoxon sign-ranked test was used to compare the number of fasciculations detected by the use of EMG vs. MUS. Results: There interrater reliability was excellent (q = 0.985, p < 0.0001). The number of fasciculations detected by EMG and MUS was not significantly different for BB (p = 0.600) and FDI muscles (p = 0.753). However, the number of MUS detected fasciculations (Mdn = 5, IQR25-75 = 2–23) in the RF muscle was significantly higher compared to the number of EMG detected fasciculations (Mdn = 2, IQR25-75 = 0–10, p = 0.008). Conclusions: MUS seems to be superior to EMG in detecting and quantifying fasciculations in some, but not all muscles. Further studies are needed to standardize the use of MUS in detecting fasciculations in neurological diseases. doi:10.1016/j.clinph.2019.04.483
P32-F Nerve ultrasound in the assessment of posterior interosseous nerve syndrome: a useful tool?—Cid Aurelio Delgado Pugley a, Yiyang Lin-Miao a,*, Alba León Jorba a, Nuria Álvarez López-Herrero a, Jesús Ares Vidal b (a Clinical Neurophysiology Department, Hospital del Mar, Barcelona, Spain, b Diagnostic Imaging Department, Hospital del Mar, Barcelona, Spain) ⇑
Corresponding author.
Background: Nerve ultrasound (NUS) is a technique recently introduced in the routine assessment of neuromuscular diseases. In carpal tunnel syndrome adding a morphological test to the routine electrophysiological assessment does not increase neither cost nor excessive time to the exam. However, there is an ongoing debate if this kind of studies should be introduced in the neurophysiology laboratory and be performed by a neurophysiologist. Material and methods: We present a case in which performing NUS at the same appointment as electromyography (EMG) and neurography implied a change in diagnosis and treatment. A 55-year-old male subject was scheduled for EMG and nerve conduction studies (NCS) due to an acute wrist drop following a 30 min nap. An acute compression of the radial nerve was suspected and EMG and NCS were performed to identify a possible radial mononeuropathy and exclude abnormalities in other nerves, plexus or roots. Results: It was identified a pure motor lesion distal to triceps innervation, indicating a posterior interosseous nerve (PIN) syndrome. Additionally, a NUS exploration of the median, cubital and radial nerves was performed, and a hypo-anechoic mass was identified close to the supinator muscle and in contact with the PIN. A magnetic resonance imaging (MRI) was performed confirming previous findings. Conclusions: This case is interesting because it depicts not only an infrequent entrapment neuropathy, namely posterior interosseous nerve syndrome, but also the added value that an easily available morphological study in a neurophysiology laboratory could have. doi:10.1016/j.clinph.2019.04.484
P33-F Acute ultrasound architectural and sEMG changes in distal biceps brachii muscle with different contraction types—Ovidiu Constantin Banea a,*, Sigurjón Stefansson a, Fernando Bazán b, Eysteinn Ívarsson a, Aron Dalin Jónasson a, Ingvar Hákon Ólafsson c, Paolo Gargiulo d (a Clinical Neurophysiology Unit, Neurology Department, National University Hospital of Iceland, Reykjavik, Iceland , b Radiology Department, National University Hospital of Iceland, Reykjavik, Iceland, c Neurosurgery Department, National University Hospital of Iceland, Reykjavik, Iceland , d School of Science and Engineering, Reykjavik University, Reykjavik, Iceland) ⇑
Corresponding author.
Background: Ultrasound muscle thickness (MT) measurements may offer a valid and reliable method for estimating muscle size (Abe et al., 2014). It was observed that the anterior fascicles of the distal biceps brachii (dBB) inserted to the aponeurosis at an average angle of 17° at 2 cm from the myotendinous junction (MTJ) when the elbow was extended. The angle changed to 21° with flexed elbow (Asakawa et al., 2011). Purpose of this study is to reveal the acute changes and the relationship between architectural parameters and surface EMG (sEMG) of biceps brachii muscle with different contraction types. Material and methods: Five unimpaired participants have been advised to perform 4 different exercises with their right biceps brachii: concentric contraction, eccentric contraction, isometric contraction and isokinetic contraction-extension. With relaxed muscle and the elbow at 110–120° we measured the anterior fascicle angle insertion and MT at 2 and 4 cm from the MTJ in baseline condition and after 30, 60, 90 and 120 s of effective contraction. We used Natus InVisus 12 MHz transducer. Muscle activity was recorded continuously using Kine wireless sEMG Icelandic equipment with a sensor placed on the line between the medial acromion and the cubital fossa at 1/3 from the cubital fossa. Maximal voluntary contractions were performed prior to data
Abstracts / Clinical Neurophysiology 130 (2019) e21–e116
HRU examination of the median nerve revealed compression of the median nerve at the level of the carpal tunnel in 2 cases. In the other 15 patients no sign of compression was found under the transverse ligament, but permitted to visualise focal or segmental thickening, alteration of the fascicular structure of the median nerve (all 15 cases), neuroma (6 cases) and increased vascularization (3 cases) on the side of the fracture. Conclusion: HRU is a non-invasive and reliable method, that allows diagnostic accuracy in the assessment of median nerve injury following DRF. HRU showed a specificity superior to common EDX on determining the nature of the median nerve involvement in our patients and helped differentiating from the presumed CTS. doi:10.1016/j.clinph.2019.04.482
P31-F Muscle ultrasound improves fasciculation detection in some muscle in patients with amyotrophic lateral sclerosis— Dejan Georgiev *, Nezˇa Kamin, Gregor Omejec, Janez Zidar (Institute of Clinical Neurophysiology, Ljubljana, Slovenia) ⇑
Corresponding author.
Background: Fasciculations represent brief spontaneous or triggered contractions of motor units that can be seen as flickering movements under the skin and represent a valuable sign of lower motor neuron lesion. It is sometimes difficult to detect fasciculations clinically and/or electromyografically (EMG). Muscle ultrasound (MUS) is a promising tool that can aid to the better detection of fasciculations. Materials and methods: 12 patients (4 females, mean age 68.75 ± 12.04, mean disease duration 4.25 ± 2.09) diagnosed with amyotrophic lateral sclerosis were included in this pilot study. EMG needle was inserted under US guidance into right biceps brachii (BB), first dorsal interousseous (FDI) and rectus femoris (RF) muscles. Location of needle tip was marked and remained stationary during 90 s of recording. Two experienced neurophysiologists independently counted the number of fasciculations from the EMG and MUS recordings. Sperman’s q was used to assess interrater reliability. Wilcoxon sign-ranked test was used to compare the number of fasciculations detected by the use of EMG vs. MUS. Results: There interrater reliability was excellent (q = 0.985, p < 0.0001). The number of fasciculations detected by EMG and MUS was not significantly different for BB (p = 0.600) and FDI muscles (p = 0.753). However, the number of MUS detected fasciculations (Mdn = 5, IQR25-75 = 2–23) in the RF muscle was significantly higher compared to the number of EMG detected fasciculations (Mdn = 2, IQR25-75 = 0–10, p = 0.008). Conclusions: MUS seems to be superior to EMG in detecting and quantifying fasciculations in some, but not all muscles. Further studies are needed to standardize the use of MUS in detecting fasciculations in neurological diseases. doi:10.1016/j.clinph.2019.04.483
P32-F Nerve ultrasound in the assessment of posterior interosseous nerve syndrome: a useful tool?—Cid Aurelio Delgado Pugley a, Yiyang Lin-Miao a,*, Alba León Jorba a, Nuria Álvarez López-Herrero a, Jesús Ares Vidal b (a Clinical Neurophysiology Department, Hospital del Mar, Barcelona, Spain, b Diagnostic Imaging Department, Hospital del Mar, Barcelona, Spain) ⇑
Corresponding author.
Background: Nerve ultrasound (NUS) is a technique recently introduced in the routine assessment of neuromuscular diseases. In carpal tunnel syndrome adding a morphological test to the routine electrophysiological assessment does not increase neither cost nor excessive time to the exam. However, there is an ongoing debate if this kind of studies should be introduced in the neurophysiology laboratory and be performed by a neurophysiologist. Material and methods: We present a case in which performing NUS at the same appointment as electromyography (EMG) and neurography implied a change in diagnosis and treatment. A 55-year-old male subject was scheduled for EMG and nerve conduction studies (NCS) due to an acute wrist drop following a 30 min nap. An acute compression of the radial nerve was suspected and EMG and NCS were performed to identify a possible radial mononeuropathy and exclude abnormalities in other nerves, plexus or roots. Results: It was identified a pure motor lesion distal to triceps innervation, indicating a posterior interosseous nerve (PIN) syndrome. Additionally, a NUS exploration of the median, cubital and radial nerves was performed, and a hypo-anechoic mass was identified close to the supinator muscle and in contact with the PIN. A magnetic resonance imaging (MRI) was performed confirming previous findings. Conclusions: This case is interesting because it depicts not only an infrequent entrapment neuropathy, namely posterior interosseous nerve syndrome, but also the added value that an easily available morphological study in a neurophysiology laboratory could have. doi:10.1016/j.clinph.2019.04.484
P33-F Acute ultrasound architectural and sEMG changes in distal biceps brachii muscle with different contraction types—Ovidiu Constantin Banea a,*, Sigurjón Stefansson a, Fernando Bazán b, Eysteinn Ívarsson a, Aron Dalin Jónasson a, Ingvar Hákon Ólafsson c, Paolo Gargiulo d (a Clinical Neurophysiology Unit, Neurology Department, National University Hospital of Iceland, Reykjavik, Iceland , b Radiology Department, National University Hospital of Iceland, Reykjavik, Iceland, c Neurosurgery Department, National University Hospital of Iceland, Reykjavik, Iceland , d School of Science and Engineering, Reykjavik University, Reykjavik, Iceland) ⇑
Corresponding author.
Background: Ultrasound muscle thickness (MT) measurements may offer a valid and reliable method for estimating muscle size (Abe et al., 2014). It was observed that the anterior fascicles of the distal biceps brachii (dBB) inserted to the aponeurosis at an average angle of 17° at 2 cm from the myotendinous junction (MTJ) when the elbow was extended. The angle changed to 21° with flexed elbow (Asakawa et al., 2011). Purpose of this study is to reveal the acute changes and the relationship between architectural parameters and surface EMG (sEMG) of biceps brachii muscle with different contraction types. Material and methods: Five unimpaired participants have been advised to perform 4 different exercises with their right biceps brachii: concentric contraction, eccentric contraction, isometric contraction and isokinetic contraction-extension. With relaxed muscle and the elbow at 110–120° we measured the anterior fascicle angle insertion and MT at 2 and 4 cm from the MTJ in baseline condition and after 30, 60, 90 and 120 s of effective contraction. We used Natus InVisus 12 MHz transducer. Muscle activity was recorded continuously using Kine wireless sEMG Icelandic equipment with a sensor placed on the line between the medial acromion and the cubital fossa at 1/3 from the cubital fossa. Maximal voluntary contractions were performed prior to data