Masuo Senda

Anatomic relation between the medial collateral ligament of the elbow and the humero-ulnar joint axis.

The anatomic relation between the proximal attachment of the medial collateral ligament of the elbow joint and the humero-ulnar joint axis has not been clearly shown in a published study. We examined cadaveric specimens to find the exact relation between them. The medial collateral ligament was microscopically dissected to isolate specific fiber bundles. The length of each bundle was measured with a charge-coupled device camera system that faced the medial side of the elbow joint. The measurements indicated that the projected length of the deep middle bundle of the anterior oblique ligament, which is the strong cord-like part of the medial collateral ligament, is isometric during elbow flexion. The proximal end of the deep middle bundle was thus considered to be located almost on the humero-ulnar joint axis.

Chronic Compartment Syndrome of the Lower Leg: A New Diagnostic Method Using Near-Infrared Spectroscopy and a New Technique of Endoscopic Fasciotomy

A 19-year-old female basketball player had chronic compartment syndrome. During basketball playing, she complained of bilateral lower leg pain that disappeared after several minutes of rest. The intracompartmental pressure in the anterior compartment was 41 mm Hg on the right side and 29 mm Hg on the left side immediately after playing. Prolonged ischemia of the anterior compartment was observed in comparison with four normal controls using near-infrared spectroscopy. Magnetic resonance imaging also revealed that the anterior compartment was mainly affected. Endoscopic fasciotomy was performed using an arthroscope, a transparent outer tube, and a retrograde blade. After the operation, her symptoms disappeared. Three months postoperatively, the anterior compartment pressure decreased and prolonged tissue ischemia improved. Endoscopic fasciotomy allowed us to cut the fascia safely and less invasively. We concluded that this technique is useful in treating chronic compartment syndrome in the anterior compartment of the lower leg.

The Effect of Service Dogs on the Improvement of Health-Related Quality of Life

To assess the effects of service dogs on health-related quality of life (HRQOL), we conducted a survey of 10 service dog owners using SF-36v2 (Medical Outcomes Study 36 Item Short-Form Health Survey Version 2.0) and compared it with a matched control group of people with physical disabilities who did not have service dogs but were eligible for one. The scores for mental health and role emotional of service dog owners were relatively high, and their mental component summary was higher than the general population norm. These results indicate that service dogs affect the mentality of their owners. The comparison with the control group indicated that service dogs alleviate the mental burden of daily activities, and subjectively improved the physical functioning of their owners. This study showed that service dogs have positive functional and mental effects on their disabled owners.

Recovery from exercise-induced desaturation in the paraspinal muscles in idiopathic scoliosis.

STUDY DESIGN A study using near-infrared light spectroscopy to measure recovery from exercise-induced desaturation in the paraspinal muscles of patients with idiopathic scoliosis. OBJECTIVES To measure oxygenation of the paraspinal muscles and obtain differences between the convex and concave sides. SUMMARY OF BACKGROUND DATA Authors of previous studies have reported that some patients experience pain on the convex side of the paraspinal muscles. The muscles on the convex side are more stretched and stressed than those on the concave side. The current authors investigated the degree of stress by measuring oxygenation and blood volume changes. METHODS Paraspinal muscle spectral properties at L3 were investigated using near-infrared light spectroscopy. Thirty-six patients (8 men and 28 women) underwent this procedure. To assess a level of peripheral adaptations to exercise, the half-time of Oxyhemoglobin/Myoglobin recovery was measured, which indicates the recovery from energy deficit after exercise. RESULTS The average half-time recovery on the convex side was 3.38 seconds (range, 1.5-5.5 seconds), whereas that on the concave side was 1.51 seconds (range, 0.7-4.0 seconds). The average difference between the convex side and the concave side was 1.87 seconds (range, 0.9-3.5 seconds). CONCLUSIONS Half-time recovery on the convex side in the patients with idiopathic scoliosis was slower than that in healthy adults (P < 0.05). Half-time recovery on the concave side in such patients was faster than that on the convex side (P < 0.01). The authors consider half-time recovery an indication of back muscle stress.

Gait characteristics after limb-sparing surgery with sciatic nerve resection: A report of two cases

Limb‐sparing surgery may be considered for the treatment of soft-tissue sarcoma even when resection of a major neurovascular bundle is necessary to achieve a satisfactory surgical margin1,2. Function of an upper extremity with loss of one major nerve is often superior to function with use of a prosthesis after amputation3. In the lower extremity, limb‐sparing surgery may be considered even when the sciatic nerve must be resected because of tumor involvement. Resection of the sciatic nerve results in a sensory loss distal to the knee and motor dysfunction of the knee, foot, and ankle. However, an analysis of functional loss after sciatic nerve resection for the treatment of soft-tissue sarcoma has been reported only once to our knowledge4. We treated two patients with a soft-tissue sarcoma with a limb‐sparing procedure that included resection of the sciatic nerve. During rehabilitation, both patients walked very slowly with excessive lateral displacement of the trunk along the line of progression. Very slight improvement in their gait was noted at the two and five-year follow‐up examinations. We assessed walking function and gait characteristics of the two patients with use of a nonparametric objective evaluation system and a subjective gait analysis technique to obtain quantitative measures of functional loss5‐8. The results were compared with those of patients with a hip disarticulation who used a prosthesis and with the findings in healthy individuals. A fifty‐one‐year‐old man (Case 1) and a twenty-six-year‐old woman (Case 2) had a limb‐sparing operation with sciatic nerve resection. Both patients had a malignant peripheral nerve-sheath tumor that developed in the sciatic nerve in the proximal half of the posterior aspect of the thigh. The surgical stage according to the Musculoskeletal Tumor Society Classification9 was IIB in each patient. Wide resection …

Characteristics of Postural Sway during Quiet Standing Before and After the Occurrence of Neurogenic Intermittent Claudication in Female Patients with Degenerative Lumbar Spinal Canal Stenosis

[Purpose] This study investigated the effect of neurological symptoms and/or signs after the occurrence of neurogenic intermittent claudication (NC) on postural sway during quiet standing of patients with lumbar spinal canal stenosis (LSS). [Subjects and Methods] Thirty-two female patients with LSS at the L4/5 level were studied. We measured the path of center of foot pressure (COP) during quiet standing with eyes open for 30 s using a stabilometer before and after the occurrence of NC. [Results] The total path length of COP (LC) and area surrounded by the outline of the path of COP (AC) significantly increased after NC. Body mass index (BMI) correlated with both the NC rate (after NC/before NC) of LC and that of AC. The average lateral COP displacement from the center of the base of support (COPRL) before NC was located on the asymptomatic side from the center of the base of support in 29 of 32 patients. After NC, COPRL moved to the symptomatic side in 31 patients. [Conclusion] These results suggest that patients with LSS are at risk of falling after NC, especially those with high BMI.

Diagnostic value of turns-amplitude analysis in neuromuscular disease

We describe a new method of turns-amplitude analysis of electromyography interference patterns, modified from the original St»lbergs method. Ten samples were obtained from one muscle at maximum voluntary contraction. As indices of amplitude (A), the average of the three highest and three lowest values from the ten samples was calculated. Similar indices were calculated for turns (T) and the T/A ratio. A total of six indices were evaluated. Criteria for abnormalities in these six indices were determined through a control study of healthy volunteers. The test-retest reliability of the six indices was confirmed in the extensor digitorum communis muscle, and the Pearson product-moment correlation coefficients ranged from 0.767 to 0.907 (P<0.01). The clinical usefulness of this method was evaluated in 21 patients with mild or moderate neuromuscular disorders. Abnormalities in the T/A indices were found in 77.8%–100% of the patients, a higher incidence of abnormality than for the other indices. Two of the three criteria were found to be abnormal in 80% of patients with myopathy and in 78.6% of those with neuropathy. The diagnostic sensitivity of our method in these patients was 79.2% (19 of 24 studies [in 3 patients with myopathy, two muscles were examined]). The clinical usefulness of our method of analysis appears to be similar to that in other reports of turns-amplitude analyses.

O-3-14. Treatment of ulnar neuropathy after total elbow arthroplasty (TEA) and nerve conduction test

Ulnar neuropathy is one of complications of TEA (total elbow arthroplasty, incidence; 5 to 10%), yet there are not many evaluations and clinical course reports. Out of 117 patients with rheumatoid arthritis (RA) who underwent TEA, 8 patients showed numbness and muscle weakness of the ulnar nerve region after surgery, and received electromyography (EMG). EMG examinations revealed ulnar neuropathy at the elbow in 6 subjects, 5 of whom performed neurolysis. Two patients were diagnosed with cervical spondylosis. A 50-year-old female developed RA in 1998. She underwent left TEA (JACE) in June 2014. As numbness appeared, we performed EMG to her in October 2014. Delay of sensory nerve conduction velocity (SCV) was observed at cubital tunnel. In April 2015 left ulnar nerve neurolysis was performed. After that, both EMG finding and symptoms were improved. However, EMG in June 2016 again confirmed a delay in SCV and we performed a second ulnar nerve neurolysis in September 2016. Evaluations of ulnar neuropathy are important because RA also causes cervical spinal lesions such as atlantoaxial subluxation. Adhesion and scars are recognized at the elbow joint in the five patients who underwent neurolysis. Thus, it is necessary to follow up with electromyogram examination, for diagnosis of neuropathy and postoperative evaluation.