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Zhang HL, Jin RJ, Guan L, Zhong DL, Li YX, Liu XB, Xiao QW, Xiao XL, Li J. Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2022; 101:615-623. [PMID: 35152251 PMCID: PMC9197142 DOI: 10.1097/phm.0000000000001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. DESIGN Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software. RESULTS Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies. CONCLUSIONS Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Hegazy FA, Aboelnasr EA, Salem YT. Effect of lidocaine iontophoresis combined with exercise intervention on gait and spasticity in children with spastic hemiplegic cerebral palsy: A randomized controlled trial. NeuroRehabilitation 2020; 47:133-141. [PMID: 32716326 DOI: 10.3233/nre-203152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gait deviations and spasticity are common impairments seen in children with cerebral palsy (CP) and may interfere with functional performance and effective walking pattern. Lidocaine iontophoresis is effective for reducing muscle spasticity in adults. PURPOSE To investigate the effect of lidocaine epinephrine iontophoresis combined with exercises on gait and spasticity in children with spastic hemiplegic cerebral palsy (HCP). METHODS Thirty children with spastic HCP aged 4-6 (5.20±0.32) years were randomly assigned to the experimental group (n = 15) and control group (n = 15). Children in both groups received one hour of exercises, three times a week for three months. Children in the experimental group received 2% lidocaine iontophoresis immediately before the exercises. The lidocaine iontophoresis was delivered for 20 minutes (1mA/min). Spatio-temporal gait parameters were assessed within one week before and after the intervention using 3D motion analysis. Surface electromyography was used to assess muscle tone using H/M ratio of the soleus muscle. ANOVA was used to investigate the differences between experimental and control groups. Statistical significance was set at P value less than 0.05. RESULTS There was no difference between groups at baseline. Post-intervention, the experimental group showed significant improvements when compared to the control group for gait speed (p = 0.03), stride length (p = 0.04), cadence (p = 0.0001), cycle time (p = 0.0001), and H/M ratio (p = 0.02). CONCLUSION Lidocaine iontophoresis combined with exercises was effective in improving gait spatiotemporal parameters and reducing spasticity in children with CP.
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Affiliation(s)
- Fatma A Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | | | - Yasser T Salem
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt.,Department of Physical Therapy, University of North Texas Health Science Center, Texas, USA
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Karri J, Zhang B, Li S. Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity. PM R 2019; 12:246-250. [PMID: 31278847 DOI: 10.1002/pmrj.12217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND When managing patients with focal spasticity, phenol neurolysis is often avoided largely because of its presumed poor adverse effect profile. It is suggested that dysesthesias may be more common with phenol neurolysis of the mixed sensorimotor nerves (eg, radial, median, and ulnar nerves) compared to neurolysis of pure motor nerves. However, these risks may be mitigated with precise localization of pure motor branches by ultrasound and electrical stimulation (EStim). OBJECTIVE To explore practice patterns of phenol neurolysis to distal upper extremity mixed sensorimotor nerves with ultrasound and EStim guidance. DESIGN A retrospective analysis of all neurolysis procedure records at a single institution from January 2013 to February 2018. Demographic and clinical variables including primary neurological diagnosis, concurrent spasticity treatments, nerves injected, phenol dosage and adverse events were abstracted from the electronic medical records. PARTICIPANTS 57 patients who received phenol neurolysis with ultrasound and EStim guidance for spasticity management to radial, median, or ulnar nerves. MAIN OUTCOME MEASURES Reported adverse effects. RESULTS A total of 57 patients who collectively received neurolysis to 139 nerves across 102 encounters, met inclusion criteria. Most prevalent diagnoses included traumatic brain injury (N = 27, 47.4%) and stroke (N = 18, 31.6%), with a smaller subset having spinal cord injury (N = 10, 17.5%). Most patients received concomitant chemodenervation with botulinum toxin (N = 44, 77.2%). The average phenol dosage per nerve was 1.8 mL, with a range of 0.5-9.0 mL. Reported adverse effects included three cases of prolonged pain, but no dysesthesias were reported during the follow-up period (>40 days). CONCLUSIONS Phenol neurolysis with ultrasound and EStim guidance was successfully and safely used to manage focal spasticity in the distal upper extremity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX.,Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Bei Zhang
- Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.,TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, Texas
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.,TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, Texas
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French clinical guidelines for peripheral motor nerve blocks in a PRM setting. Ann Phys Rehabil Med 2019; 62:252-264. [PMID: 31202956 DOI: 10.1016/j.rehab.2019.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/13/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. METHOD Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society. RESULTS No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine - up to 2mg/kg - "check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician"; for ropivacaine - up to 1.5mg/kg, with a maximum of 100mg - the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician. CONCLUSION These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings.
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Demir Y, Şan AU, Kesikburun S, Yaşar E, Yılmaz B. The short-term effect of ultrasound and peripheral nerve stimulator-guided femoral nerve block with phenol on the outcomes of patients with traumatic spinal cord injury. Spinal Cord 2018; 56:907-912. [DOI: 10.1038/s41393-018-0142-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/16/2018] [Accepted: 03/26/2018] [Indexed: 11/09/2022]
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Sonographic evaluation of peripheral nerve pathology in the emergency setting. Emerg Radiol 2018; 25:521-531. [DOI: 10.1007/s10140-018-1611-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/01/2018] [Indexed: 12/31/2022]
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Matsumoto ME, Berry J, Yung H, Matsumoto M, Munin MC. Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve. PM R 2017; 10:357-364. [PMID: 28919499 DOI: 10.1016/j.pmrj.2017.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ultrasound guidance is increasingly being used for neurolytic procedures that have traditionally been done with electrical stimulation (e-stim) guidance alone. Ultrasound visualization with e-stim-guided neurolysis can potentially allow adjustments in injection protocols that will reduce the volume of neurolytic agent needed to achieve clinical improvement. OBJECTIVE This study compared e-stim only to e-stim with ultrasound guidance in phenol neurolysis of the musculocutaneous nerve (MCN) for elbow flexor spasticity. We also evaluated the ultrasound appearance of the MCN in this population. DESIGN Retrospective review. SETTING University hospital outpatient clinic. PARTICIPANTS Adults (N = 167) receiving phenol neurolysis to the MCN for treatment of elbow flexor spasticity between 1997 and 2014 and adult control subjects. METHODS For each phenol injection of the MCN, the method of guidance, volume of phenol injected, technical success, improved range of motion at the elbow postinjection, adverse effects, reason for termination of injections, and details of concomitant botulinum toxin injection were recorded. The ultrasound appearance of the MCN, including nerve cross-sectional area and shape, were recorded and compared between groups. MAIN OUTCOME MEASURES The volume of phenol injected and MCN cross-sectional area and shape as demonstrated by ultrasound. RESULTS The addition of ultrasound to e-stim-guided phenol neurolysis was associated with lower doses of phenol when compared to e-stim guidance alone (2.31 mL versus 3.69 mL, P < .001). With subsequent injections, the dose of phenol increased with e-stim guidance (P < .001), but not with e-stim and ultrasound guidance (P = .95). Both methods of guidance had high technical success, improved ROM at elbow postinjection, and low rates of adverse events. In comparing the ultrasound appearance of the MCN in patients with spasticity to that of normal controls, there was no difference in the cross-sectional area of the nerve, but there was more variability in shape. CONCLUSIONS Combined e-stim and ultrasound guidance during phenol neurolysis to the MCN allows a smaller volume of phenol to be used for equal effect, both at initial and repeat injection. The MCN shape was more variable in individuals with spasticity; this should be recognized so as to successfully locate the nerve to perform neurolysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mary E Matsumoto
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Jessica Berry
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Herbie Yung
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Martha Matsumoto
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
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Ali ZS, Pisapia JM, Ma TS, Zager EL, Heuer GG, Khoury V. Ultrasonographic Evaluation of Peripheral Nerves. World Neurosurg 2016; 85:333-9. [DOI: 10.1016/j.wneu.2015.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 12/13/2022]
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Abstract
Aside from its prompt use in musculoskeletal injuries (sports lesions, degenerative/inflammatory joint disorders, and peripheral nerve pathologies), ultrasonographic imaging can be used quite conveniently in various types of rehabilitation conditions as well. If used in a rehabilitation setting, ultrasound can significantly contribute to the diagnostic/therapeutic algorithm of rehabilitation patients. Accordingly, in this article, the authors focus on the diagnostic/interventional utility of ultrasound particularly for shoulder problems, overuse injuries of wheelchair users, heterotopic ossification, amputee follow-up, peripheral nerve and botulinum toxin injections, and diaphragm imaging/electromyography.
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Byun SD, Park DH, Choi WD, Hong YH, Lee ZI, Kim CH. Obturator Nerve Block Using Ultrasound-guided Intraneural Alcohol Injection in Patient with Hip Adductor Spasticity. BRAIN & NEUROREHABILITATION 2012. [DOI: 10.12786/bn.2012.5.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Seung Deuk Byun
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Korea
| | - Dong Hwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Korea
| | - Won Duck Choi
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Korea
| | - Yong Ho Hong
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Korea
| | - Zee Ihn Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Korea
| | - Chul Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Korea
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Akkaya T, Unlu E, Umay E. Reply. Acta Anaesthesiol Scand 2011. [DOI: 10.1111/j.1399-6576.2010.02358.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shin DK, Jung YJ, Hong JC, Kim MS, Kim SH. Selective musculocutaneous neurotomy for spastic elbow. J Korean Neurosurg Soc 2010; 48:236-9. [PMID: 21082051 DOI: 10.3340/jkns.2010.48.3.236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/30/2010] [Accepted: 09/15/2010] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness and outcome of selective musculocutaneous neurotomy (SMcN) for spastic elbow. METHODS We retrospectively reviewed the medical records of 14 patients with spasticity of their elbows. The patients were selected using clinical and analytical scales, as well as nerve block tests, for assessment. Their mean age was 37.29 years (range, 19-63 years). SMcN was performed for these patients, and the mean follow-up period was 30.71 months (range, 19-54 months). RESULTS The modified Ashworth scale (MAS) scores recorded before and after the SMcN showed that the patients' mean preoperative MAS score of 3.28 ± 0.12 was improved to 1.71 ± 0.12, 1.78 ± 0.18, 1.92 ± 0.16 and 1.78 ± 0.18 at postoperative 3, 6, 12 months and last follow-up, respectively. On the basis of a visual analogue score ranging from 0-100, the patients' mean degree of satisfaction score was 65.00 ± 16.52 (range, 30-90). CONCLUSION We believe that SMcN can be a good and effective treatment modality with low morbidity in appropriately selected patients who have localized spastic elbow with good antagonist muscles and without joint contracture.
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Affiliation(s)
- Dong-Keun Shin
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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Abstract
OBJECTIVE We present an occurrence of a severe but transient neurologic complication after intraneural injection during an ultrasound-guided interscalene block. CASE REPORT A 36-year-old man underwent ultrasound-guided interscalene nerve blockade before shoulder incision and drainage. On postoperative day 1, he exhibited new-onset arm weakness with dysesthesias. Intraneural injection was recognized based on a retrospective review of the recorded ultrasound imaging. The symptoms persisted for more than 2 weeks and completely resolved by 6 weeks. CONCLUSIONS Our report suggests that intraneural injection during ultrasound-guided interscalene block carries a risk of neurologic complications.
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