Understanding nerve injury classification is essential for prognostic value clinically. Some basic anatomy, along with the two classification systems, and their corresponding EMG findings need to be learned and remembered. Two classification systems exist (and are frequently tested): Seddon's classification (neuropraxia, axonotmesis, neurotmesis) Sunderland's classification (types 1-5) To understand the systems, you must first review some basic nerve anatomy. WikiMedia There are three connective tissue layers in the CNS and PNS. epineurium perineurium endoneurium Individual nerve fibers (single axons) are covered with varying amounts of myelin and then covered by endoneurium. These individually wrapped nerve fibers are then grouped into bundles of fibers...

MedMemoWeb.com Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) caused by an autoimmune antigenic confusion, which causes the attack of the Schwann cells on peripheral nerves. This causes a rapidly progressive (hours to days) symmetric, ascending paralysis, along with complete loss of deep tendon reflexes (areflexia) - with or w/o paresthesias. If not stopped in time, the disease is fatal because of respiratory compromise (diaphragm and intercostal paralysis). Treatment usually consists of immediate administration of intravenous immunoglobulins (IV Ig) for 5 days, or plasmapheresis. Classification: Many variants exists, but I will talk about just two.Acute inflammatory demyelinati...

Radial Nerve Compression Sites The posterior interosseous nerve (PIN) is one of those nerves learned best by knowing the exceptions. In this case, the PIN innervates all the muscles on the dorsal side of the forearm, EXCEPT the brachioradialis, extensor carpi radialis longus (ECRL), and anconeus. It may help to remember these 3 exceptions by remembering they are the only muscles in the dorsal forearm that cross the elbow joint So that means, ALL dorsal forearm muscles that do not cross the elbow joint are innervated by the deep radial nerve/PIN (see below) When does the radial nerve become the PIN? In the distal, lateral arm, the radial nerve splits into a superficial and deep radial nerve The superficial radial nerve helps to provide sensation to the dorsal hand The deep radial nerv...

This article looked at the diagnostic validity of multiple provocative hip maneuvers in predicting true hip pathology (as opposed to pain coming from other sources). An 80% improvement on the visual analog scale between pre- and post- intraarticular (hip) injections of anesthetic (2% lidocaine and 0.75% bupivacaine) was used as the gold standard to confirm "true hip pathology". Four maneuvers were evaluated (see the article for complete descriptions):FABER (Patrick): everyone knows how to do Internal rotation over pressure (IROP): supine; hip and knee flexed to 90o, internal rotation torque put through the femur, while putting down pressure over the opposite side ASIS Scour maneuver: supine; hip and knee flexed to 90o; internal and external rotation torque...

Conclusion of Study: This notes the extremely high prevalence of vitamin D deficiency amongst spinal cord injured patients in our acute inpatient hospitals, and likely points to the necessity to test for, and treat, this common contributor to osteoporosis. Quick Notes about Vitamin D: One of the fat-soluble vitamins Two major forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol) We get this vitamin from sun exposure, food, and supplements - but in an inactive form Calcitriol (1,25-dihydroxycholecalciferol) is the active form of vitamin D in the body Major role is promoting absorption of the calcium and phosphorous from the food/supplements in the intestines, and resorption of calcium from the kidneys ⇨ this increases serum levels of calcium needed for bone mine...

Normal I've made it the "A-OK" sign, instead of just the "OK" sign, because the "A" will help to remind you about its innervation...the Anterior interosseous nerve (AIN) the AIN is a pure motor branch of the median nerve; just like the posterior interosseous nerve is a pure motor continuation of the deep branch of the radial nerve. So which muscles allow you to make this A-OK sign, and what is the clinical significance? First you must think about which actions are being performed to make this sign: the forearm is pronated = pronator quadratus the distal phalanx of the thumb is flexed = flexor pollicis longus the index/middle fingers are flexed at the DIP = lateral half of the flexor digitorum profundus Abnormal Now, what happens if the anterior interosseous muscle is damaged...

Did you know that the median nerve motor fibers (in the hand) comes from the lower part of the brachial plexus (C8/T1; lower trunk; medial cord), while the sensory fibers are from the upper part (C6/7; lateral cord)?? **link to pic of brachial plexus And why is that important clinically? I had a patient with a 2-year history of diabetes that was sent to us from a hand surgeon for evaluation of his right upper extremity. He had an ulnar nerve decompression (no transposition apparently) a few years earlier, and the numbness/tingling is worsening/persisting. He had obvious guttering of that hand (interossei atrophy), virtually no 1st dorsal interosseous, and a combination of the hand of Benediction (when asked to close his hand) and claw hand (these two physical signs can...

backpain-guide.com A 50yo black male was referred to us for evaluation of his right lower extremity. Pt had a gunshot injury to the abdomen about two months ago, with a resultant right-sided retroperitoneal abscess that was subsequently drained. He presented today with significantly weakened right hip flexors (3-/5) and knee extensors (2/5), with numbness over the anterior thigh and medial leg. **note that the knee extension was more affected than the hip flexion The usual nerve conduction testing of the peroneal and sural nerves was normal, but the saphenous nerve had no response. EMG of the vastus medialis and intermedius showed profound (4+) positive sharp waves (PSWs) and fibrillations. The iliopsoas also showed significant PSW & fibs. All oth...

eOrthopod.com A patient presents to your clinic with a very clear presentation of ulnar neuropathy at the elbow: numbness in the medial hand (palmar and dorsal surfaces and medial 1.5 digits), that is worse when talking on the phone and reading a book - basically all activities when his elbows are flexed 90 degrees or more note: if it was only the palmar surface, then the lesion would be more likely at the wrist, b/c the dorsal ulnar cutaneous nerve supplies the dorsal medial hand and branches off before the wrist -- thus not involved in Guyon's canal lesions NO paresthesias in medial forearm (b/c that would be from the medial antebrachial cutaneous nerve, and therefore a lower brachial plexus lesion) When measuring the motor conduction velocity across the elbow, we typically look for...

THE Ohio State University PM&R If the median sensory latency or median motor latencies are prolonged, this index isn't needed. But if they are both normal, then perform the CSI. The CSI is a summation of three latency differences: 1) Split thumb: median and radial antidromic conduction at 10cm; reference = 0.5 or less 2) Split ring: median and ulnar antidromic conduction at 14cm; reference = 0.4 or less 3) P8: median and ulnar orthodromic conduction at 8cm; reference = 0.3 or less The individual reference values for the above are "5, 4, 3" (thumb, ring, P8), with a total combined index above 9ms being considered positive. For example, with the split ring, if the median latency is 3.8ms, and the ulnar latency is 3.2ms, that's a difference of 0.6 = positive. Otherwise, add...

Location:                      300 miles from Seattle Practice Features:         Well-established and respected 3-person physiatry group Reason for need:           One physiatrist will retire in a couple of years Responsibilities:            50% inpatient/50% outpatient; do consults at area hospitals Candidate Qualifications:               Board Certified or Qualified physiatrist with excellent interpersonal and communications skills; If Board Qualified, must be within 2 years [...]

Facility Features:                 Rehab unit in southeastern TX, near Mexico border, city of 49,000 in an area of 500,000+ Affiliation:                               Employee Compensation:                    Competitive salary with a bonus/incentive plan Benefits:                                                Malpractice, vacation, CME, relocation and more Candidate Qualifications:                      Board Certified/Qualified physiatrist with excellent interpersonal and communications skills, will consider J1 and H1 visaholders

Location:                                         Kansas City, KS Responsibilities:                           Inpatient/outpatient position.  Will also teach.  The doctor will see about 9 -10 inpatients (with a resident) and consults on acute floors 2 – 3 days a week (average 5 – 6 consults: again residents see them first.). Benefits:                                    Attractive benefits package to include 4 weeks vacation, 10% pension plan, family health coverage, [...]

Location:                                         Kansas City, KS Responsibilities:                           Inpatient/outpatient position.  Will also teach.  The doctor will see about 9 -10 inpatients (with a resident) and consults on acute floors 2 – 3 days a week (average 5 – 6 consults: again residents see them first.). Benefits:                                    Attractive benefits package to include 4 weeks vacation, 10% pension plan, family health coverage, [...]

Location:                             Kansas City, KS Facility Features:           Recently opened state-of-the-art Marc A. Asher, MD Comprehensive Spine Center.   Under the medical direction of a Physiatrist, the Spine Center’s multidisciplinary team includes Neurosurgery, Neurology, Orthopedic Surgery, Pain Management, Pain Psychiatry.  Also be the Fellowship Director.  Research support and tenure track.  All services are provided in one location.  On-site [...]

Facility Features:           Six-year-old, freestanding, JCAHO-accredited, 50-bed rehab hospital in a medical mall, 9 acute care hospitals in the area, current census is 29; join another physiatrist and an internist; this facility is in good-standing with referral sources growing Responsibilities:            Inpatient services, 15 – 20 inpatients, may also do outpatient if interested as there is plenty [...]

Locum tenens work Location:                 Metro KS Time Frame:          April 1 thru July 31, 2012 Responsibilities:  22 bed inpatient unit, consults and may possibly take call once per month.

EMG OPPORTUNITY Better than average compensation and lifestyle City of 60,000 yet acts like a city of 150,000 with big city amenities Great hours and no call so you can enjoy family or personal time Less stress than most practice opportunities   Location:                     Western TN, about an hour northeast of Memphis and 2 hours from Nashville, [...]

Practice Features:         Join a solo pain management interventional physiatrist with PT in-house and multiple locations in Brooklyn and the other boroughs Responsibilities:            General outpatient musculoskeletal, joint injections and EMG’s Type of Patients:           Mostly Medicare and HMO’s, less than 1-% workers comp no fault Candidate Qualifications:               Board Certified/Qualified physiatrist with excellent interpersonal and communications skills; ultrasound [...]

  Location:                      1 hour from Orlando and Daytona, 2 hours to Tampa, near the University of FL Population:                   250,000(area) Responsibilities:            Procedures and office visits; procedures will be done in the office; will include chronic pain which the practice is sensitive to their issues; also receive auto and workers compensation cases Reason for opening:      21-year-old, well-established [...]