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Geurkink TH, Marang-van de Mheen PJ, Robbers T, Nagels J, Nelissen RG. Long-term outcomes of pectoralis major transfer for scapular winging due to long thoracic nerve palsy: results after a median follow-up of 17 years. JSES Int 2024; 8:822-827. [PMID: 39035646 PMCID: PMC11258848 DOI: 10.1016/j.jseint.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background A pectoralis major (PM) transfer is a viable treatment option for patients with scapular winging due to long thoracic nerve (LTN) palsy not responding to nonsurgical management. However, the long-term outcomes remain unknown. Therefore, the purpose of this study was to evaluate the long-term outcome of shoulder function (ie, minimum follow-up of 10 years) and quality-of-life (QoL) of patients treated for scapular winging due to LTN palsy with a PM transfer. Methods This observational cohort study included 15 patients (16 shoulders) who underwent PM transfer, using a tendoachilles allograft, between 1995 and 2012. Shoulder forward flexion and abduction were analyzed preoperatively, 1 year after surgery and at the final follow-up. SF-36 component scores (physical component summary (PCS) and mental component summary (MCS)) were used to evaluate the QoL. Results Shoulder forward flexion and abduction measured in degrees improved from 86 (SD 14.5) and 82 (SD 33.8) preoperatively to 140 (SD 27.3) and 138 (31.3) at 1 year postoperatively. After a median follow-up of 17 years, mean shoulder functions were slightly lower than at 1 year postoperatively, but still better than preoperative function, ie, forward flexion 121 (SD 41.9) and abduction 122 (SD 44.5). The mean PCS score at the final follow-up was 41.9 (SD 9.7), and the mean MCS score was 49.9 (SD 12.5). Better shoulder function at the final follow-up was significantly associated with higher QoL in terms of PCS scores (P = .023), but not MCS scores (P = .287). Conclusion The results of the present study indicate that PM transfer augmented with an achilles tendon allograft for scapular winging due to LTN palsy leads to functional improvements that persist in long term. These functional improvements likely translate to better QoL based on their association.
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Affiliation(s)
- Timon H. Geurkink
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Perla J. Marang-van de Mheen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
- Safety & Security Science and Centre for Safety in Healthcare, Delft University of Technology, Delft, The Netherlands
| | - Tim Robbers
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, the Netherlands
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Burton JS, Mackinnon SE, McKee PB, Henderson KM, Goestenkors DM, Thompson RW. Rapid Functional Recovery After Thoracic Outlet Decompression in a Series of Adolescent Athletes With Chronic Atraumatic Shoulder-Girdle Pain, Scapular Winging/Dyskinesis, and Normal Electrodiagnostic Studies. Hand (N Y) 2023:15589447231187088. [PMID: 37522485 DOI: 10.1177/15589447231187088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable by electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed by later development of neurogenic thoracic outlet syndrome (NTOS). METHODS We identified patients referred for evaluation of NTOS that had a history of chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX. Each was refractory to conservative management and underwent supraclavicular decompression and brachial plexus neurolysis for NTOS. Functional disability was quantified by Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. RESULTS There were 5 female patients with a mean age at symptom onset of 14.2 ± 0.4 years, including spontaneous severe pain in the shoulder, scapula, and arm, along with prominent scapular winging/dyskinesis, and normal EDX. Symptoms had persisted for 18.9 ± 4.0 months prior to referral, with pronounced upper extremity disability (mean QuickDASH, 54.6 ± 6.9). By 3 months after surgical treatment for NTOS, all 5 patients experienced near-complete symptom resolution, including scapular winging/dyskinesis, with markedly improved function (mean QuickDASH, 2.2 ± 1.3) and a return to normal activity. CONCLUSIONS A subset of patients with chronic atraumatic shoulder-girdle pain, scapular winging/dyskinesis, and normal EDX may develop dynamic brachial plexus compression characteristic of NTOS, exhibiting an ischemic "Sunderland-zero" nerve conduction block for which surgical decompression can result in rapid and substantial clinical improvement. The presence of surgically treatable NTOS should be considered for selected patients with long-standing scapular winging/dyskinesis who fail conservative management.
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Fidancı H, Buturak Ş, Öztürk İ, Arlıer Z. Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders. Turk J Med Sci 2023; 53:233-242. [PMID: 36945948 PMCID: PMC10387837 DOI: 10.55730/1300-0144.5578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. METHODS The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. RESULTS Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. DISCUSSION There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.
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Affiliation(s)
- Halit Fidancı
- Division of Clinical Neurophysiology, Department of Neurology,University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Şencan Buturak
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - İlker Öztürk
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Zülfikar Arlıer
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Geurkink TH, Gacaferi H, Marang-van de Mheen PJ, Schoones JW, de Groot JH, Nagels J, Nelissen RGHH. Treatment of neurogenic scapular winging: a systematic review on outcomes after nonsurgical management and tendon transfer surgery. J Shoulder Elbow Surg 2023; 32:e35-e47. [PMID: 36252782 DOI: 10.1016/j.jse.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need guidance on what the best treatment decision is for their patients, and such recommendations should be based on the total evidence available. Therefore, the purpose of this review was to systematically review the evidence regarding nonsurgical management and tendon transfer surgery of patients with neurologic scapular winging due to serratus anterior (SA) or trapezius (TP) palsy. METHODS PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier were searched up to April 5, 2022, for studies reporting on clinical outcomes after nonsurgical management and tendon transfer surgery of scapular winging due to weakness of the SA or TP muscle. The Integrated quality Criteria for Review Of Multiple Study (ICROMS) tool was used to classify the quality of the studies. Primary outcomes were the fraction of patients with spontaneous recovery after nonsurgical management and improvement in shoulder function, pain scores, and shoulder scores after tendon transfer surgery. Data were pooled if data on the same outcome were available for at least 3 studies, using random-effects meta-analysis. RESULTS Twenty-three (10 moderate-quality [MQ] and 13 low-quality) studies were included. Six studies (3 MQ; 234 shoulders) reported on outcomes after nonsurgical management of SA palsy, whereas 12 (6 MQ; 221 shoulders) and 6 studies (1 MQ; 80 shoulders) evaluated the outcomes of tendon transfer for SA or TP palsy (1 study addressed both). Spontaneous recovery of scapular winging with nonsurgical management varied between 21% and 78% across studies after a median follow-up of 72 months. For surgical management of SA palsy, pooling data in a meta-analysis showed that patients on average improved by 47° (95% confidence interval [CI]: 34-61, P ≤ .001) in active forward flexion, had lower visual analog scale scores for pain (mean difference [MD]: -3.0, 95% CI: -4.9 to -1.0, P = .003), and had substantial improvements in American Shoulder and Elbow Surgeons (MD: 24, 95% CI: 9-39, P = .002) and Constant scores (MD: 45, 95% CI: 39-51, P ≤ .001). Patients with TP palsy on average improved by 36° (95% CI: 21-51, P ≤ .001) in active forward flexion after tendon transfer. Statistical pooling was not possible for other outcome measures as insufficient data were available. CONCLUSION A substantial part of nonsurgically managed patients with scapular winging seem to have persistent complaints, which should be part of the information provided to patients. Data pooling demonstrated significant improvements in shoulder function, pain scores, and shoulder scores after tendon transfer surgery, but higher quality evidence is needed to allow for more robust recommendations and guide clinical decision-making on when to perform such functional surgery.
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Affiliation(s)
- Timon H Geurkink
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hamez Gacaferi
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Saade F, Bouteille C, Quemener-Tanguy A, Obert L, Rochet S. Parsonage-Turner syndrome and SARS-CoV-2 infection: A case report. HAND SURGERY & REHABILITATION 2023; 42:90-92. [PMID: 36273762 PMCID: PMC9583683 DOI: 10.1016/j.hansur.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 02/07/2023]
Affiliation(s)
- F Saade
- Orthopedics, Traumatology, Plastic & Reconstructive Surgery Unit, Hand Surgery Unit, University, Hospital J. Minjoz, Besançon, France; NanoMedecine Research Unit University of Franche-Comté, 19 Rue Ambroise Paré, 25030 Besançon Cedex, France.
| | - C Bouteille
- Orthopedics, Traumatology, Plastic & Reconstructive Surgery Unit, Hand Surgery Unit, University, Hospital J. Minjoz, Besançon, France; NanoMedecine Research Unit University of Franche-Comté, 19 Rue Ambroise Paré, 25030 Besançon Cedex, France
| | - A Quemener-Tanguy
- Orthopedics, Traumatology, Plastic & Reconstructive Surgery Unit, Hand Surgery Unit, University, Hospital J. Minjoz, Besançon, France; NanoMedecine Research Unit University of Franche-Comté, 19 Rue Ambroise Paré, 25030 Besançon Cedex, France
| | - L Obert
- Orthopedics, Traumatology, Plastic & Reconstructive Surgery Unit, Hand Surgery Unit, University, Hospital J. Minjoz, Besançon, France; NanoMedecine Research Unit University of Franche-Comté, 19 Rue Ambroise Paré, 25030 Besançon Cedex, France
| | - S Rochet
- Orthopedics, Traumatology, Plastic & Reconstructive Surgery Unit, Hand Surgery Unit, University, Hospital J. Minjoz, Besançon, France; NanoMedecine Research Unit University of Franche-Comté, 19 Rue Ambroise Paré, 25030 Besançon Cedex, France
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Coll C, Tessier M, Vandendries C, Seror P. Névralgie amyotrophiante et infection à COVID-19 : deux cas de paralysie du nerf spinal accessoire. REVUE DU RHUMATISME 2022; 89:92-95. [PMID: 34248353 PMCID: PMC8262390 DOI: 10.1016/j.rhum.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
Objectif La névralgie amyotrophiante de Parsonage et Turner (NAPT) apparaît souvent suite à un stress mécanique loco-régional ou à une infection virale. Nous rapportons deux cas d’amyotrophie et déficit de l’épaule liés à une paralysie du nerf spinal accessoire (NSA), causée par une NAPT dans les suites d’une infection à COVID-19. Méthodes Pour les deux patients concernés, l’interrogatoire, l’examen clinique et les examens complémentaires (imageries, examens biologiques et électroneuromyogramme (ENMG)) ont permis de confirmer le diagnostic de NAPT et d’infirmer les diagnostics différentiels. Résultats La NAPT ne concernait que le nerf spinal accessoire dans les deux cas rapportés. L’ENMG a mis en évidence des lésions axonales récentes caractéristiques de la NAPT. Les IRM des deux patients ont révélé un hypersignal T2 de dénervation dans les muscles atteints. Aucun signe de masse, kyste, lésion, bride ou déchirure n’a été retrouvé le long du NSA. Conclusion Comme d’autres viroses, la COVID-19 pourrait être le facteur déclenchant de la NAPT, comme elle semble aussi être un facteur déclenchant possible du syndrome de Guillain Barré.
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Affiliation(s)
- Clemence Coll
- Service de soins de suites et de réadaptation, hôpital Robert-Ballanger, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France
| | - Muriel Tessier
- Service de soins de suites et de réadaptation, hôpital Robert-Ballanger, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France
| | - Christophe Vandendries
- Service de radiologie, fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France
- Centre Medical RMX, 80, avenue Felix Faure, 75015 Paris, France
| | - Paul Seror
- Cabinet d'électroneuromyographie, 146, avenue Ledru Rollin, 75011 Paris, France
- Hopital Privé de l'Est Parisien, 93600 Aulnay-sous-Bois, France
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Silkjær Bak S, Johnsen B, Fuglsang-Frederiksen A, Døssing K, Qerama E. Comparison of ultrasound with electrodiagnosis of scapular winging: A prospective case control study. Clin Neurophysiol 2021; 133:48-57. [PMID: 34801963 DOI: 10.1016/j.clinph.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Compare high-resolution ultrasound (HRUS) and electrodiagnostic examination (EDX) in the diagnostic workup of patients with scapulae alatae. METHODS 27 patients with scapulae alatae and 41 healthy subjects (HS) and underwent a standardized clinical examination (CEX), EDX and HRUS. We measured the thickness of the serratus anterior (SER), rhomboid major and trapezius muscles and the diameter of the long thoracic (LTN), dorsal scapular and spinal accessory nerves (SAN). RESULTS Twenty patients showed medial winging and six patients showed lateral winging on CEX. One patient had both lateral and medial winging. In patients with medial winging, the SER muscle was thinner and the LTN diameter was larger on the symptomatic side compared with the asymptomatic side and with the dominant side in HS. In this group, both EDX and HRUS detected abnormalities of SER muscle/ LTN with sensitivity of 65%, and with specificity of 100% and 57%, respectively. EDX and HRUS detected abnormalities of the trapezius muscle/ SAN with sensitivity of 60% and 40%, and specificity of 91%, and 86 % a, respectively. There was no significant difference between the two methods. CONCLUSION HRUS can contribute to the diagnostic workup of scapulae alatae by demonstrating atrophy of muscles and enlargement in nerve diameter. SIGNIFICANCE HRUS supplements EDX in the diagnostic workup of scapulae alatae.
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Affiliation(s)
- Sara Silkjær Bak
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Kaj Døssing
- Department of Orthopaedics, Viborg Regional Hospital, Heibergs Alle 4F Indgang F, Etage 3, 8800 Viborg, Denmark
| | - Erisela Qerama
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark.
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Change in shoulder external rotation strength and motion after lower trapezius transfer to the infraspinatus in children with obstetric brachial plexus palsy. INTERNATIONAL ORTHOPAEDICS 2021; 45:3163-3170. [PMID: 34664099 DOI: 10.1007/s00264-021-05247-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Quantifying changes in shoulder external rotation range of motion and strength after lower trapezius transfer in children with obstetric brachial plexus palsy (OBPP). METHODS This prospective study included five children with sequelae of OBPP, with a mean age of 6.4 years (range: 4-12 years) who underwent lower trapezius tendon transfer to restore active external rotation (ER) of the shoulder. Pre-operatively and at a 12-month follow-up assessment, we analyzed the passive and active shoulder ER, the modified Mallet score, and the shoulder rotator muscles strength using an isokinetic device. RESULTS Clinical parameters improved significantly after trapezius transfer pre-operative passive ER from -8° (range: -20-0°) to 37° (range: 15-50°) (p = 0.035), the modified Mallet score from 13 (range: 10-15) to 18 (range: 17-19) (p = 0.035). Strength testing revealed improved ER muscle strength in all five cases; the mean Peak Torque increased from 1.95 to 4.46 N·m, albeit non-significantly (p = 0.062). Two patients exhibited a winged scapula post-operatively. CONCLUSION Lower trapezius transfer seems encouraging to restore shoulder external rotation in OBPP children but with non-significant strength improvement. TRIAL REGISTRATION 18/07/31/5783, December 22, 2018.
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Garofoli R, Zauderer J, Seror P, Roren A, Guerini H, Rannou F, Drapé JL, Nguyen C, Lefèvre-Colau MM. Neuralgic amyotrophy and hepatitis E infection: 6 prospective case reports. RMD Open 2021; 6:rmdopen-2020-001401. [PMID: 33219125 PMCID: PMC8011528 DOI: 10.1136/rmdopen-2020-001401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 11/01/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Hepatitis E virus (HEV) represents the main cause of enterically transmitted hepatitis
worldwide. It is known that neuralgic amyotrophy (NA) is one of the most frequent
neurological manifestations of HEV. However, clinical, electrodiagnostic (EDX) and MRI
characteristics, as well as long-term follow-up of HEV-related NA have not been fully
described yet. Case reports We describe longitudinally clinical, EDX, biological and MRI results of six cases of
HEV-associated NA, diagnosed from 2012 to 2017. Patients were between the ages of 33 and
57 years old and had a positive HEV serology. Clinical patterns showed the whole
spectrum of NA, varying from extensive multiple mononeuropathy damage to single
mononeuropathy. EDX results showed that the patients totalised 26 inflammatory
mononeuropathies (1 to 8 per patient). These involved classical nerves such as
suprascapular (6/6 cases), long thoracic (5/6 cases) and accessory spinal nerves (2/6
cases) and, some less frequent more distal nerves like anterior interosseous nerve (3/6
cases), as well as some unusual ones such as the lateral antebrachial cutaneous nerve
(1/6 case), sensory fibres of median nerve (1/6 case) and phrenic nerves (1/6 case).
After 2 to 8 years, all nerves had clinically recovered (muscle examination above
3/5 on MRC scale for all muscles except in one patient). Discussion HEV should be systematically screened when NA is suspected, whatever the severity, if
the onset is less than 4 months (before IgM HEV-antibodies disappear) and appears
to be frequently associated with severe clinical and EDX pattern, without increasing the
usual recovery time.
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Affiliation(s)
- Romain Garofoli
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Jennifer Zauderer
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Paul Seror
- Département De Neurophysiologie, Univ. Paris Pierre Et Marie Curie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandra Roren
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
| | - Henri Guerini
- Service de Radiologie ostéo-articulaire, Hôpital Cochin, Paris, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France.,Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jean-Luc Drapé
- Service de Radiologie ostéo-articulaire, Hôpital Cochin, Paris, France
| | - Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP.Centre-Université de Paris, Paris, France
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Lafosse T, D'Utruy A, El Hassan B, Grandjean A, Bouyer M, Masmejean E. Scapula alata: diagnosis and treatment by nerve surgery and tendon transfers. HAND SURGERY & REHABILITATION 2021; 41S:S44-S53. [PMID: 34246815 DOI: 10.1016/j.hansur.2020.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 04/16/2019] [Accepted: 09/20/2020] [Indexed: 11/17/2022]
Abstract
Scapula alata, also known as winged scapula, can lead to severe upper limb impairment. The shoulders' function is altered because the scapula, which supports the upper limb, is no longer stable. Typical scapula alata is described for serratus anterior palsy; however, any scapulothoracic muscle impairment may lead to scapular winging, particularly trapezius palsy, which is easy to miss, thus needed to be considered as a differential diagnosis. The diagnosis is difficult and based on various clinical tests and a thorough examination as well as electroneuromyography and MRI. The treatment ranges from conservative treatments for spontaneous recovery, nerve surgery including neurolysis, nerve transfers and nerve grafts for acute cases, to tendon transfers for more chronic cases and when nerve procedures are no longer feasible. Tendon transfers in serratus anterior palsy produce excellent results with a high rate of patient satisfaction and are described with the sternal or clavicular head of the pectoralis major; we describe our preferred technique in this article. Tendon transfers in trapezius palsy are performed with the levator scapulae, rhomboid minor and major muscles. Our preferred method is the Elhassan triple transfer. Scapula alata is a frequent and often misdiagnosed condition. Appropriate management can yield excellent results. Patients should be referred right away to specialized centers for surgery if recovery is not spontaneous.
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Affiliation(s)
- T Lafosse
- PBMA, Department of Hand, Upper Limb and Peripheral Nerve Surgery, Clinique Générale d'Annecy, 4, Chemin de la Tour la Reine, 74000 Annecy, France; Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), 20, Rue Leblanc, 75015 Paris, France.
| | - A D'Utruy
- Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), 20, Rue Leblanc, 75015 Paris, France
| | - B El Hassan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - A Grandjean
- Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), 20, Rue Leblanc, 75015 Paris, France; Department of Orthopedics and Traumatology, Polyclinique du Parc Rambot, 2, Avenue du Dr Aurientis, 13100 Aix-en-Provence, France
| | - M Bouyer
- PBMA, Department of Hand, Upper Limb and Peripheral Nerve Surgery, Clinique Générale d'Annecy, 4, Chemin de la Tour la Reine, 74000 Annecy, France
| | - E Masmejean
- Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges Pompidou European Hospital (HEGP), Assistance Publique - Hôpitaux de Paris (APHP), 20, Rue Leblanc, 75015 Paris, France
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11
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Aladawi M, Punsoni M, Piccione E. Clinical Reasoning: A 40-Year-Old Woman With Scapular Winging and Dysphonia. Neurology 2021; 97:503-507. [PMID: 33980702 DOI: 10.1212/wnl.0000000000012179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mohammad Aladawi
- From the Departments of Neurological Sciences (M.A., E.P.) and Pathology and Microbiology (M.P.), University of Nebraska Medical Center, Omaha.
| | - Michael Punsoni
- From the Departments of Neurological Sciences (M.A., E.P.) and Pathology and Microbiology (M.P.), University of Nebraska Medical Center, Omaha
| | - Ezequiel Piccione
- From the Departments of Neurological Sciences (M.A., E.P.) and Pathology and Microbiology (M.P.), University of Nebraska Medical Center, Omaha
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12
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Coll C, Tessier M, Vandendries C, Seror P. Neuralgic amyotrophy and COVID-19 infection: 2 cases of spinal accessory nerve palsy. Joint Bone Spine 2021; 88:105196. [PMID: 33901661 PMCID: PMC8064823 DOI: 10.1016/j.jbspin.2021.105196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome is often triggered by mechanical stress or upper respiratory tract viral infections. We reported 2 cases of shoulder weakness and amyotrophy related to spinal accessory nerve (SAN) palsy due to neuralgic amyotrophy occurring after COVID-19 infection. METHODS For both patients, clinical history, clinical examination, electrodiagnostic (EDX), and imaging examinations invalidated other diagnoses but confirmed NA diagnosis. RESULTS The NA involved only the SAN in both cases. EDX revealed a characteristic axonal lesion found in NA. SAN conduction study revealed normal latencies and low compound motor action potential amplitude for trapezius muscle when needle examination demonstrated a neurogenic pattern and denervation signs in the trapezius muscle. Both patient's MRI revealed denervation T2 hypersignal in impaired muscles, and hypersignal of the involved roots, trunks, or nerves without any mass, cyst, injury, fibrous band, or tearing signs along SAN course. CONCLUSIONS The COVID-19 infection could be the trigger for NA as many other viruses, and as it is a possible trigger for Guillain-Barré syndrome.
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Affiliation(s)
- Clemence Coll
- Locomotor functional rehabilitation department, Robert-Ballanger hospital, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France.
| | - Muriel Tessier
- Locomotor functional rehabilitation department, Robert-Ballanger hospital, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France.
| | - Christophe Vandendries
- Radiology department, fondation ophtalmologique de Rothschild, 29, rue Manin, 75019 Paris, France; RMX-medical center, 80, avenue Felix-Faure, 75015 Paris, France
| | - Paul Seror
- Electroneuromyography laboratory, 146, avenue Ledru-Rollin, 75011 Paris, France; Private hospital of eastern Paris, 93600 Aulnay-sous-Bois, France
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13
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Silkjær Bak S, Johnsen B, Fuglsang-Frederiksen A, Døssing K, Qerama E. Neuromuscular ultrasound of the scapular stabilisers in healthy subjects. Clin Neurophysiol Pract 2021; 6:72-80. [PMID: 33732970 PMCID: PMC7937536 DOI: 10.1016/j.cnp.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/29/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
HRUS can be used to visualise the muscles stabilizing the scapula and their corresponding nerves. We found acceptable intra- and inter-examiner agreements. We present HRUS normative data using regression-based prediction formulas. To our knowledge, we present the first-time normative data of diameter of the dorsal scapular nerve.
Objectives To obtain normative high-resolution ultrasound (HRUS) data for thickness of the serratus anterior, the trapezius and the rhomboid major muscles and diameter of their corresponding nerves, the long thoracic, the spinal accessory and the dorsal scapular nerve. Moreover, we aimed to examine intra- and inter-examiner agreement of the HRUS measurements. Methods We included 41 healthy subjects. Muscle thickness and nerve diameter were measured bilaterally, resulting in 82 ultrasound measurements for each structure. Normative data were calculated using regression equations for the lower limit of muscle thickness and upper limit of nerve diameter, taking into account various variables. For intra- and inter-examiner agreement, ten subjects underwent two extra ultrasound examinations and Bland-Altman plots were calculated. Results This normative data set showed significant correlations between decreasing muscle thickness with increasing age and height and increasing muscle thickness with increasing weight and with male sex. Muscle thickness was larger on the dominant side compared to the non-dominant side for the trapezius and rhomboid muscles, whereas the opposite was found for the serratus anterior muscle. For all nerves, significant correlations were found between decreasing nerve diameter with increasing age and height. Intra-examiner agreement was acceptable in all sites. Inter-examiner agreement was acceptable for all sites but one site for the serratus anterior muscle and long thoracic nerve, and not acceptable for five out of six sites for the trapezius muscle. Conclusion This study provides HRUS normative data and intra- and inter-examiner agreement data for muscle thickness and nerve diameter for the muscles stabilizing the scapulae and their corresponding nerves. Significance The normative HRUS data reported may be useful in future studies investigating neuromuscular disorders.
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Affiliation(s)
- Sara Silkjær Bak
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Kaj Døssing
- Department of Orthopaedics, Viborg Regional Hospital, Heibergs Alle 4F Indgang F, Etage 3, 8800 Viborg, Denmark
| | - Erisela Qerama
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
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14
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Seror P, Roren MA, Garofoli R, Zauderer J, Rannou F, Lefevre-Colau MM. Voluntary winging of the scapula: Proposed diagnostic criteria. Muscle Nerve 2020; 62:611-616. [PMID: 33103253 DOI: 10.1002/mus.27047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
We report a series of 10 patients with unilateral, dynamic, winged scapula (WS), without cause, that was diagnosed as voluntary winging of the scapula (VWS). We compared clinical, electrodiagnostic, and other examination data for 10 patients with VWS and 146 with dynamic WS-related neuromuscular disorders, to establish a detailed pattern of the VWS subtype. In VWS, electrodiagnostic and other examinations did not reveal any neuromuscular or orthopedic cause. Winging was dynamic, obvious, neither medial nor lateral, and mainly involved the inferior angle of the scapula, in young patients. VWS never appeared during floor push-ups. Patients could produce WS at will with the index and healthy shoulder, between 25° and 65° of anterior elevation, or with shoulder internal rotation. VWS is a benign disorder that can be distinguished from neuromuscular WS by normal electrodiagnostic results for muscles and nerves of both shoulders and two specific clinical tests.
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Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie, Paris, France.,Laboratoire d'électroneuromyographie, Hôpital de l'Est parisien, Aulnay-sous-Bois, France
| | - Mk Alexandra Roren
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,ECaMO Team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - Romain Garofoli
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Jennifer Zauderer
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Francois Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,Inserm UMR 1124, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Faculté des Sciences Fondamentales et Biomédicales, UFR Biomédicale des Saints-Pères, Paris, France
| | - Marie Martine Lefevre-Colau
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, APHP, Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.,ECaMO Team, INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France
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15
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Ultrasonographic anatomy of the long thoracic nerve: A reappraisal using high frequency (24-MHz) probe. Diagn Interv Imaging 2020; 102:241-245. [PMID: 33008783 DOI: 10.1016/j.diii.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to analyze the potential of ultrasound with a high frequency probe (24-MHz) in the assessment of the long thoracic nerve (LTN) and describe ultrasonographic landmarks that can be used for standardization. MATERIAL AND METHODS Ultrasonography analysis of the LTN was done on 2 LTNs in a cadaver specimen and then on 30 LTNs in 15 healthy volunteers (12 men, 3 women; mean age, 28.8±3.8 [SD] years; age range: 24-39 years) by two independent radiologists (R1 and R2) using a 24-MHz probe. Interrater agreement was assessed using Kappa test (K) and intraclass correlation coefficient (ICC). RESULTS In the cadaver, dissection confirmed that the India ink was injected near the LTN in the middle scalene muscle. In volunteers, visibility of the LTN above the clavicle was highly reproducible for the branches arising from C5 (R1: 87% [26/30]; R2: 90% [27/30]; K=0.83) and from C6 (R1: 100% [30/30]; R2: 97% [29/30]; K=0.94). Where the nerve emerged from the middle scalene muscle, the mean diameter was 0.85±0.24 (SD) mm (range: 0.4-1.6mm) for R1 and 0.9±0.23 (SD) mm (range: 0.4-1.7mm) for R2 (ICC: 0.96; 95% CI: 0.92-0.98%). Along the thoracic wall, where LTN run along the lateral thoracic artery, the mean diameter was 0.83±0.19 (SD) mm (range: 0.5-1.27mm) for R1 and 0.89±0.21 (SD) mm (range: 0.6-1.2mm) for R2 (ICC: 0.86; 95% CI: 0.72-0.93%). CONCLUSION The LTN can be analyzed with ultrasound using high-frequency probe by using the C5 and C6 roots, the middle scalene muscle above the clavicle and the lateral thoracic artery on the chest wall as landmarks.
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16
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Seror P, Roren A, Lefevre-Colau MM. Infraspinatus muscle palsy involving suprascapular nerve, brachial plexus or cervical roots related to inflammatory or mechanical causes: Experience of 114 cases. Neurophysiol Clin 2020; 50:103-111. [PMID: 32147283 DOI: 10.1016/j.neucli.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To report a large series of neurogenic infraspinatus muscle (ISM) palsy, in order to improve knowledge of diagnosis, diverse etiologies and care management. METHODS Clinical and electrodiagnostic (EDX) data for 114 cases of ISM palsy were collected over a 21-year period. Cases were attributed to 4 clinical conditions: (1) isolated suprascapular nerve mononeuropathy (n=48), (2) multiple mononeuropathies (n=33), (3) plexus lesions (n=17), and (4) cervical radiculopathy (n=16). These were related to 2 mechanisms: inflammatory (dysimmune) and mechanical. RESULTS Group 1 cases were younger, had the most severe ISM palsies, were mostly related to inflammatory lesions (81%) such as neuralgic amyotrophy (NA), and frequently had delayed diagnosis because disability was mild. Group 2 cases were all related to inflammatory lesions and had slightly less severe ISM palsies that were frequently hidden by winged scapula. In groups 3 and 4, ISM palsies were milder and all cases were related to mechanical lesions such as brachial plexus trauma or C4-C5-C6 radiculopathy. In these cases, deltoid and ISM palsies were equal in frequency and severity whereas biceps brachii impairment was less frequent and much milder. Deltoid palsy frequently appeared predominant as compared with ISM palsy, because upper limb elevation palsy was more disabling than external rotation palsy. CONCLUSIONS ISM palsy is a rare condition, often under-diagnosed and misidentified. The 4 main conditions of ISM palsy may be recognized by careful clinical, EDX and other examinations when necessary. Analysis of the present series highlights some clinical and EDX points that should help non-specialist and even specialist clinicians who are faced with this rare condition, to distinguish mechanical and inflammatory causes, and thus adapt patient management accordingly.
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Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie, 146, avenue Ledru Rollin, 75011 Paris, France; Ramsay générale de santé, hôpital privé de l'Est Parisien, Aulnay sous-Bois, France.
| | - Alexandra Roren
- INSERM UMR-S 1153, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, PRES Sorbonne Paris Cité, ECaMO team, Institut Fédératif de Recherche sur le Handicap, Hôpital Cochin, Université Paris Descartes, AP-HP, Paris, France
| | - Marie Martine Lefevre-Colau
- INSERM UMR-S 1153, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, PRES Sorbonne Paris Cité, ECaMO team, Institut Fédératif de Recherche sur le Handicap, Hôpital Cochin, Université Paris Descartes, AP-HP, Paris, France
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