OBJECTIVE: To analyze the relationship between painful hemiplegic shoulder (PHS) and ultrasonographic (US) findings according to the motor recovery stage of the stroke. METHOD: The medical records were reviewed retrospectively in 82 stroke patients from January 2005 to November 2009 who undertook US examination on hemiplegic shoulder. The clinical data collected were age, gender, stroke type, affected side, duration from stroke onset, manual function test (MFT) and the Brunnstrom stage of arm. The presence of spasticity, glenohumeral subluxation and sensory impairment were also investigated. The patients were classified into three groups according to the Brunnstrom recovery stage: the first, second and third recovery stages (RS1, RS2 and RS3). Furthermore, the correlations between US findings and the clinical characteristics according to the Brunnstrom recovery stage were analyzed. RESULTS: The presence of spasticity, glenohumeral subluxation, sensory impairment (proprioception) and MFT scores had statistically significant differences in each group. Among the 82 stroke patients, 62 patients (75.6%) had abnormal findings in US examination. The common abnormal structures were supraspinatus tendon (SST), biceps long head tendon (BLH), subacromial-subdeltoid bursa (SA-SD bursa). The frequencies of total US abnormality in each group were not significantly different (p=0.07). However, the SST abnormality was more frequent in the RS1, and the BLH and SA-SD bursa abnormality were more frequent in the RS3 (p<0.05). CONCLUSION: In this study, abnormal findings in US examination are frequent in PHS. The abnormal SST is related to the flaccidity, and the abnormal BLH and SA-SD bursa are related to the overuse.
Arm ; Head ; Humans ; Hydrogen-Ion Concentration ; Medical Records ; Muscle Spasticity ; Retrospective Studies ; Shoulder ; Shoulder Dislocation ; Stroke ; Tendons

OBJECTIVE: The purpose of this study is to evaluate the types of aphasia and the clinicoanatomic correlation in aphasic patients with subcortical lesions, and to investigate the change in the types of aphasia during the recovery stage. METHOD: Twenty-three stroke patients (16 men and 7 women) with left subcortical lesion was investigated. On the basis of the brain CT or MRI findings, the patients were divided into the 4 groups. Language dysfuntion was evaluated using the modified Western Aphasia Battery (WAB) and the type of aphasia and aphasia quotient were determined. Initial examination was performed within 2 months post-onset in all of the patients and the follow-up examination was done after 6 months post-onset in 9 patients. RESULTS: The most common type was anomic aphasia (39%). The type of subcortical aphasia was variable regardless of the sites of left subcortical lesion. Aphasia quotient was significantly related with the lesion size (gamma = 0.05, p<0.05) and the initial Barthel index (gamma = 0.65, p<0.05). The scores of all the subtests of the modified WAB and aphasia quotient were significantly decreased in the group with the cortical involvement or the history of operation. On the follow-up examination, the scores of fluency, information and naming subtests were significantly increased. CONCLUSION: The most common type of aphasia was anomic aphasia and the type of subcortical aphasia was not correlated to the anatomic lesion. Severity of subcortical aphasia would be related with the lesion size, the history of operation or the cortical involvement. The prognosis of subcortical aphasia was generally good.
Anomia ; Aphasia* ; Brain ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Prognosis ; Stroke

OBJECTIVE: To evaluate each digital branch of the median sensory nerve and motor nerves to abductor pollicis brevis (APB) and 2nd lumbrical (2L) according to the severity of carpal tunnel syndrome (CTS). METHODS: A prospective study was performed in 67 hands of 41 patients with CTS consisting of mild, 23; moderate, 27; and severe cases, 17. Compound muscle action potentials (CMAPs) were obtained from APB and 2L, and median sensory nerve action potentials (SNAPs) were recorded from the thumb to the 4th digit. Parameters analyzed were latency of the median CMAP, latency difference of 2L and first palmar interosseous (PI), as well as latency and baseline to peak amplitude of the median SNAPs. RESULTS: The onset and peak latencies of the median SNAPs revealed significant differences only in the 2nd digit, according to the severity of CTS, and abnormal rates of the latencies were significantly lower in the 2nd digit to a mild degree. The amplitude of SNAP and sensory nerve conduction velocities were more preserved in the 2nd digit in mild CTS and more affected in the 4th digit in severe CTS. CMAPs were not evoked with APB recording in 4 patients with severe CTS, but obtained in all patients with 2L recording. 2L-PI showed statistical significance according to the severity of CTS. CONCLUSION: The branch to the 4th digit was mostly involved and the branch to the 2nd digit and 2L were less affected in the progress of CTS. The second digit recorded SNAPs and 2L recorded CMAPs would be valuable in the evaluation of severe CTS.
Action Potentials ; Carpal Tunnel Syndrome ; Hand ; Humans ; Median Nerve ; Muscles ; Neural Conduction ; Prospective Studies ; Thumb

OBJECTIVE: To evaluate the usefulness of the sural/superficial radial sensory nerve action potential amplitude ratio (SRAR) in the electrodiagnosis of diabetic polyneuropathy. METHOD: Nerve conduction study was performed in 80 diabetic patients and 31 normal adults. Standard nerve conduction studies were performed. Sural nerve response was recorded with the active electrode on the posterosuperior margin of the lateral malleolus and stimulation 14 cm proximally. Superficial radial nerve response was recorded with the active on the snuffbox and stimulation 10 cm proximally. Baseline-to-peak sensory nerve action potential(SNAP) amplitudes were measured, and SRAR were obtained. The diabetic group was subdivided into an electro physiologically normal group (DMNL, n=32) and neuro pathy group (DMPN, n=48). SRAR was compared among the control (NORM, n=31), DMNL and DMPN groups. RESULTS: SRAR was 0.344 in NORM, 0.314 in DMNL and 0.145 in DMPN, respectively. SRAR showed 77.1% sensitivity and 93.8% specificity. Sural SNAP amplitude sensitivity was 85.4% and specificity, 88.7%. CONCLUSION: The relatively high specificity of SRAR indicates its usefulness in the diagnosis of diabetic polyneu ropathy. However, as the superficial radial sensory SNAP amplitude decreased significantly in the diabetic groups compared to control, the SRAR is not superior to the sural SNAP amplitude in the diagnosis of diabetic polyneuropathy.
Action Potentials ; Adult ; Diabetic Neuropathies* ; Diagnosis ; Electrodes ; Electrodiagnosis* ; Humans ; Neural Conduction ; Radial Nerve ; Sensitivity and Specificity ; Sural Nerve*

OBJECTIVE: To assess the frequency of traumatic basal ganglia hemorrhage (TBGH) and its functional recovery in traumatic brain injury (TBI). METHOD: Three hundred two patients with TBI were retrospectively analyzed via the medical records and radiologic findings. The subjects were divided into 4 groups according to the brain lesions: extraaxial lesion (subdural hemorrhage, epidural hemorrhage, subarachnoid hemorrhage), intraaxial lesion (diffuse axonal injury, white matter hemorrhage, gray matter hemorrhage), mixed lesion, and TBGH. Statistical comparison of cause, severity and prognosis between groups. RESULTS: Mean age was 41.6 years old. The most common lesion of TBI was extraaxial lesion. The most common cause was falls (47.5%). The incidence of TBGH group was 4.7%. Although TBGH group was of longer duration of hospital stay and lower GCS than the other brain lesions, there was no significant difference in GOS score. TBGH with extraaxial or mixed lesion was of lower GCS and GOS score compared with TBGH itself or TBGH with intraaxial lesion. CONCLUSION: The associated cerebral lesion, but not TBGH itself, could be considered to be an important factor in determining severity and recovery of TBI.
Axons ; Basal Ganglia Hemorrhage* ; Basal Ganglia* ; Brain ; Brain Injuries* ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Medical Records ; Prognosis* ; Retrospective Studies ; Subarachnoid Hemorrhage

OBJECTIVE: To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. METHOD: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. RESULTS: BT_L and L12 were 1.4+/-3.7 mm and 4.4+/-3.7 mm respectively. ME_M, M8 and M10 were 28.6+/-6.9 mm, 18.9+/-8.9 mm and 18.3+/-8.2 mm respectively. The thickness of LABCN and MABCN was 19.1+/-4.9 mm and 13.2+/-4.2 mm respectively. CONCLUSION: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm.
Cadaver ; Elbow ; Forearm ; Radial Artery ; Tendons ; Upper Extremity ; Wrist