Jia-Chi Wang

Quantitative measures of functional outcomes and quality of life in patients with C5 palsy

Background: It is generally understood that postoperative C5 palsy can occur with anterior or posterior decompression surgery, but functional measures of the palsy have not been well documented. This study aimed to investigate the incidence of C5 palsy in different surgical procedures, examine the correlations between muscle strength, upper extremity functional measures, and health‐related quality of life, and to observe potential risk factors contributing to C5 palsy. Methods: Our investigation involved a retrospective study design. A total of 364 patients who underwent decompression surgery were indicated within the selected exclusion criteria. Additionally, 12 C5 palsy patients were recruited. The relationships between the manual muscle test (MMT), the action research arm test (ARAT), the Jebsen test of hand function (JTHF), and the European quality of life‐5 dimensions (EQ‐5D) were studied, and univariate analyses were performed to search possible risk factors and recovery investigation. Results: The data analyzed in the 12 cases and C5 palsy incidences (3.3%) were: 0.7% in anterior procedures (n = 2), 8.8% in posterior procedures (n = 6), and 36.4% in combined procedures (n = 4). Moderate‐to‐high correlations were observed between the ARAT, JTHF, EQ‐5D visual analog scale scores, and MMT (r = 0.636–0.899). There were significant differences in patient age, etiology of cervical lesion, variable decompression procedures, and the number of decompression levels between the C5 palsy and non‐C5 palsy groups. For female patients (p = 0.018) and number of decompression levels (p = 0.028), there were significant differences between the complete recovery and the incomplete recovery groups. Conclusion: Patients undergoing combined anterior–posterior decompression surgery had the highest incidence of C5 palsy, and correlations between the ARAT, JTHF, EQ‐5D visual analog scale clinical tools, and MMT scores supported these findings. Female status and lower decompression levels could also be predictive factors for complete recovery, although additional research is needed to substantiate these findings.

The influence of shoulder pain on functional limitation, perceived health, and depressive mood in patients with traumatic paraplegia

Abstract Objective To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain. Design Cross sectional and comparative investigation using the unified questionnaire. Setting Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan. Participants Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously). Outcome measures Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale. Results Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r = 0.278, P = 0.017) and lower self-perceived health scores (r = −0.433, P < 0.001) but not SCIM scores (P = 0.342). Conclusion Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels.

Sonographic diagnosis of a glomus tumor of the thigh.

Extradigital glomus tumors are a very rare entity. Here, we report a rare case of a glomus tumor in an atypical anatomic site: the thigh. The clinical features together with the results of MRI, and sonography and Doppler sonographic imaging helped to distinguish glomus tumor of the thigh from other soft tissue neoplasms. The tumor arising from the thigh was excised, and following surgery, the patient was symptom free without evidence of complications or recurrence. There have only been a few previously reported cases describing the use of Doppler sonography in the evaluation of extradigital glomus tumors.

Effect of pillow size preference on extensor digitorum communis muscle strength and electromyographic activity during maximal contraction in healthy individuals: A pilot study

Background Cervical pillow height is an important factor that affects the perception of pillow comfort. However, few studies have addressed methods for predicting a patients preferred cervical pillow size. We studied the effect of pillow size preference on the strength and electromyographic (EMG) signals of the upper extremity muscle. If the response of the upper extremity muscle is affected by pillow size preference, this would aid in devising an alternate strategy for selecting the optimal pillow size. Methods Twenty‐nine healthy individuals (mean age: 28.6 years, range: 24–55 years) participated in this study. The participants performed isometric maximal finger extension in the supine position with their heads supported on four different size preferences of cervical pillow (the most comfortable, next most comfortable, worst, and next worst). Maximal contraction force and peak‐to‐peak EMG amplitude of the extensor digitorum communis (EDC) during contraction were measured. One‐way repeated‐measures analysis of variance was used to evaluate the effect of pillow size preference. We also explored the relationship between anthropometric parameters and the individuals cervical pillow height preference. Results The two most comfortable pillows were associated with significantly larger maximal EDC force than the two worst pillows. However, no significant differences in EMG were observed between pillows. No statistically significant correlation was found between anthropometric parameters and pillow height preference. Conclusion The results suggest that anatomical body measurements are not good predictors of optimal pillow height. As EDC muscle strength is affected by pillow height preference, maximal EDC muscle strength may be a useful complement for selecting the optimal pillow size.

The effect of statins on the occurrence of peptic ulcer

BACKGROUND This study was to determine the association between the use of statins and the occurrence of peptic ulcer diseases (PUD). METHODS Using the National Health Insurance Research Database to conduct a population-based cohort study. We identified 48,562 patients who were newly diagnosed with hyperlipidemia during the period of 1998 to 2011 and who were divided into two groups based on their use of statins. The non-statin cohort (without statin treatment, 24,139 patients) were 1:1 frequency matched with sex, age, year of diagnosis of hyperlipidemia and index-year to the statin cohort (24,423 patients). The relative risk of patients with and without statins treatment on the occurrence of PUD and concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin were analyzed using the univariable and multivariable Cox proportional hazards regression model. RESULTS The incidence of PUD increased with age in both cohorts and female had a higher occurrence rate than male in both cohorts. Compared with the non-statin cohort, the statin cohort was associated with a significant lower risk of PUD for all age group. The concomitant use of aspirin and/or NSAIDs had higher incidence of PUD than those without in both cohorts. Analyzing the cumulative defined daily dose (DDD) of statins indicated that high-dose groups (≧ 575 DDD) exhibited significantly decreased risk compared with non-statin users. CONCLUSION The results of the present study indicated that statins might be associated with the protection of peptic ulcer in a dose-respondent manner.

Delayed Onset of Peroneal Neuropathy After Minor Ankle Torsion in a 9-Year-Old Boy

Ankle sprain is only rarely reported as the cause of peroneal nerve palsy and occurs predominantly in adults. Peroneal nerve palsy following an ankle sprain is extremely rare in children. Furthermore, peroneal nerve palsy most commonly results from a severe ankle sprain with considerable pain and edema. Peroneal nerve palsy after minor ankle torsion without major clinical symptoms of ankle sprain is uncommon. Here, we report the case of a 9-year-old boy who developed right peroneal neuropathy, leading to foot drop, following minor ankle plantar flexion/inversion torsion. Electrophysiological findings confirmed a focal neuropathy around the fibular head. The neurologic symptoms resolved completely 4 months after the injury. This case emphasizes that peroneal neuropathy can occur after minor ankle torsion without evident ankle sprain symptoms. Moreover, electrophysiological evaluation is very helpful to confirm the diagnosis and is important for prognostic evaluation.

The therapeutic effect of collateral meridian therapy is comparable to acupoint pressure therapy in treating myofascial pain syndrome

PURPOSE This study compared the therapeutic effects of collateral meridian therapy (CMT) with traditional acupoint pressure therapy (APT) in patients with unilateral upper back pain. MATERIAL AND METHODS Forty-nine patients with active myofascial trigger points in upper trapezius muscle were randomly allocated to the control (CTL), APT, or CMT group. Each subject in the CMT and APT groups received 2 sessions of treatment per week over 1 month. RESULTS Patients in the APT and CMT groups showed significant improvements 1 month after treatment in visual analogue scale, range of motion, pain pressure threshold, regional superficial blood flow, and physical health, as compared to the CTL group. No significant differences in outcome measures were found between APT and CMT groups 1 month after treatment. CONCLUSION Both APT and CMT have comparable therapeutic efficacy in the treatment of unilateral upper back pain with active myofascial trigger points in the upper trapezius muscle.

Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial

OBJECTIVE To compare the effectiveness of local steroid injection plus splinting with that of local steroid injection alone using clinical and electrophysiological parameters in patients with carpal tunnel syndrome (CTS). DESIGN Randomized controlled study with 12 weeks of follow-up. SETTING Tertiary care center. PARTICIPANTS Volunteer sample of patients (N=52) diagnosed with CTS. INTERVENTIONS Participants were randomly assigned to the steroid injection group (n=26) or the steroid injection-plus-splinting group (n=26). Patients of both groups received ultrasound-guided steroid injection with 1mL of 10mg (10mg/mL) triamcinolone acetonide (Shincort) and 1mL of 2% lidocaine hydrochloride (Xylocaine). Participants in the second group also wore a volar splint in the neutral position while sleeping and also during daytime whenever possible for the 12-week intervention period. MAIN OUTCOME MEASURES Participants were evaluated before the treatment and at 6 and 12 weeks after the onset of treatment. The primary outcome measure was Boston Carpal Tunnel Questionnaire scores. The secondary outcome measures were as follows: scores on the visual analog scale for pain; electrophysiological parameters, including median nerve distal motor latency, sensory nerve conduction velocity (SNCV), and compound muscle action potential and sensory nerve action potential (SNAP) amplitudes; and patients subjective impression of improvement. RESULTS At 12-week follow-up, improvements in symptom severity and functional status scores on the Boston Carpal Tunnel Questionnaire as well as SNCV and SNAP amplitudes were greater in the group that received steroid injection combined with splinting than in the group that received steroid injection alone. The between-group difference was .48 points (95% confidence interval [CI], .09-.88 points; P=.032) in the Symptom Severity Scale score, .37 points (95% CI, .06-.67 points; P=.019) in the Functional Status Scale score, 3.38m/s (95% CI, 0.54-6.22m/s; P=.015) in the SNCV amplitude, and 3.21μV (95% CI, 0.00-6.46μV; P=.025) in the SNAP amplitude. CONCLUSIONS In people with CTS, steroid injection combined with splinting resulted in modestly greater reduction of symptoms, superior functional recovery, and greater improvement in nerve function at 12-week follow-up as compared with steroid injection alone. However, these small differences are of unclear clinical significance.

Sonographic median nerve change after steroid injection for carpal tunnel syndrome: Change After Steroid Injection

Introduction: The sonographic changes of the median nerve after steroid injection for carpal tunnel syndrome (CTS) still require investigation. Methods: Sixty‐two patients with CTS were included. The Boston Carpal Tunnel Questionnaire was administered, and ultrasonographic examinations were performed before and at 2, 6, and 12 weeks after steroid injection. At 12 weeks, general improvement was scored on a 6‐point Likert scale. Results: After treatment, the cross‐sectional area (CSA) of the median nerve was significantly reduced at 2‐, 6‐, and 12‐week follow‐ups (for each, P < 0.001, analysis of variance). The “significant improvement” group (n = 39) had a significantly greater reduction in the CSA at the carpal tunnel inlet (P = 0.014) and CSA in the proximal carpal tunnel (P = 0.003) compared with the “little/no improvement” group (n = 23). Discussion: Sonographic measurement of CSA may be considered complementary to the standard clinical evaluation in monitoring of treatment response in patients with CTS. Muscle Nerve 58: 402–406, 2018

Acute Radial Neuropathy at the Spiral Groove Following Massage: A Case Presentation

Massage‐related nerve injury is an uncommon, rarely reported complication. We report an unusual case of radial nerve neuropathy at the spiral groove in a 58‐year‐old woman that resulted from a single episode of deep tissue massage. Although the spiral groove is known as the most common site implicated in radial nerve neuropathy, to our knowledge, there have not previously been any reports of massage‐related spiral groove radial nerve neuropathy. Electrodiagnostic and ultrasound examinations were used to localize the nerve lesion at the spiral groove and also to provide prognostic evaluation. Serial follow‐ups demonstrated concomitant improvement in clinical symptoms and electrodiagnostic parameters. A near‐total recovery was achieved after 6 months. This case presentation aims to increase awareness and early recognition of massage‐related nerve injuries.