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Limbu R, Limbu N, Khadka R, Subedi P, Limbu D. Mean Motor Nerve Conduction Velocity of Right Ulnar Nerve among Physically Trained Adult Males in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:521-524. [PMID: 35690989 PMCID: PMC9275464 DOI: 10.31729/jnma.7217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/30/2022] [Indexed: 11/01/2022] Open
Abstract
Introduction Neural adaptation to physical training allows a person to better coordinate the activation of all relevant muscles producing maximum force. Nerve conduction velocity measures the speed of impulse along the motor neuron and is strongly associated with muscle contraction time. This study aimed to find out the mean motor nerve conduction velocity of the right ulnar nerve among physically trained adult males in a tertiary care centre. Methods This descriptive cross-sectional study was conducted in the Neurophysiology Laboratory of a tertiary care centre from 3rd November, 2019 to 2nd November, 2020. Thirty young adult males who were engaged in the physical training at a training centre for more than 3 months were studied after receiving ethical approval from the Institutional Review Committee (Reference number: 1578/019). Motor nerve conduction parameters of the right ulnar nerve were measured and data were entered in Microsoft Excel. Statistical analysis was done using the Statistical Packages for the Social Sciences version 25.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentages for binary data, and mean and standard deviation for continuous data. Results Among 30 males studied, the mean motor nerve conduction velocity of the ulnar nerve was found to be 61.02±5.86 m/sec (58.92-63.11 at 95% Confidence Interval). The mean distal latency and amplitude of the muscle action potential were 2.33±0.53 ms and 8.08±1.17 mv respectively. Conclusions Our study found that the mean nerve conduction velocity of the ulnar nerve was similar when compared to studies conducted in similar settings. Keywords Nepal; nerve conduction; ulnar nerve.
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Affiliation(s)
- Rekha Limbu
- Department of Basic and Clinical Physiology, B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan, Nepal,Correspondence: Dr Rekha Limbu, Department of Basic and Clinical Physiology, B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan, Nepal. , Phone: +977-9804319520
| | - Nirmala Limbu
- Department of Basic and Clinical Physiology, B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan, Nepal
| | - Rita Khadka
- Department of Basic and Clinical Physiology, B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan, Nepal
| | - Priza Subedi
- Department of Basic and Clinical Physiology, B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan, Nepal
| | - Dilmaya Limbu
- Department of Basic and Clinical Physiology, B.P. Koirala Institute of Health Sciences, Buddha Road, Dharan, Nepal
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Bowers RL, Cherian C, Zaremski JL. A Review of Upper Extremity Peripheral Nerve Injuries in Throwing Athletes. PM R 2022; 14:652-668. [PMID: 35038233 DOI: 10.1002/pmrj.12762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/07/2022]
Abstract
Peripheral nerve injuries in the upper extremities may be common in throwing athletes as the throwing motion places extreme stress on the dominant arm. The combination of extreme stress along with repetitive microtrauma from throwing uniquely places the throwing athlete at elevated risk of upper extremity peripheral nerve injury. However, because symptoms can be non-specific and frequent co-exist with pathology in the upper extremity, the diagnosis of peripheral nerve injury is often delayed. Diagnosis of peripheral nerve injuries may require a combination of history and physical exam, diagnostic imaging, electrodiagnostic testing, and diagnostic ultrasound guided injections. The primary management should include physical therapy focusing on throwing mechanics and kinetic chain evaluation. However, some athletes require surgical intervention if symptoms do not improve with conservative management. The purpose of this focused narrative review is to highlight upper extremity peripheral neuropathies reported in throwing athletes and to provide an overview of the appropriate clinical diagnosis and management of the throwing athlete with a peripheral nerve injury. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Robert L Bowers
- Assistant Professor of Rehabilitation Medicine, Emory University School of Medicine, Emory Sports Medicine Center, Atlanta, Georgia, USA
| | - Chris Cherian
- Department of Sports Medicine, Rothman Orthopaedics, Paramus, New Jersey, USA
| | - Jason L Zaremski
- Department of Physical Medicine & Rehabilitation, Department of Orthopaedic Surgery & Sports Medicine, University of Florida Health Orthopaedics and Sports Medicine Institute, Gainesville, Florida, USA
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De Giacomo AF, Keller RA, Banffy M, ElAttrache NS. Ulnar Neuritis and Its Affect on Outcomes of Elbow Ulnar Collateral Ligament Reconstruction. Am J Sports Med 2022; 50:224-228. [PMID: 34797176 DOI: 10.1177/03635465211053866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No study has specifically evaluated how ulnar neuritis and ulnar nerve transposition affect outcomes in baseball players undergoing ulnar collateral ligament (UCL) reconstruction (UCLR). PURPOSE To evaluate the effects of ulnar neuritis and ulnar nerve transposition in baseball pitchers undergoing UCLR in regard to return to sport, time to return to sport, and need for revision or additional surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS At a single institution, all consecutive baseball pitchers undergoing UCLR between 2002 and 2015 were identified. Ulnar neuritis was diagnosed preoperatively by the following criteria: ulnar nerve symptoms, Tinel sign at the elbow, symptomatic subluxation, and numbness/paresthesia in an ulnar nerve distribution of the hand. The primary outcome of the study was return to sport. The secondary outcomes of the study were time to return to sport, length of playing career, and revision or additional surgery. RESULTS A total of 578 UCLRs were performed in baseball players; of these, 500 UCLRs were performed in pitchers. Ulnar neuritis was diagnosed in 97 (19.4%) baseball pitchers presenting with UCL injury. There were no significant differences in patient characteristics or surgical techniques performed for reconstruction between baseball pitchers with and without ulnar neuritis. In review of injury characteristics, ulnar neuritis was significantly more likely to be diagnosed in pitchers with an acute onset of UCL injury (P = .03). Transposition of the ulnar nerve was more commonly performed in players with ulnar neuritis (47%) versus those without ulnar neuritis (10%; P = .0001). The players who had ulnar neuritis and underwent UCLR had a significantly lower odds of returning to sport (odds ratio, 0.45; P = .04); however, no significant difference was found for time to return to sport and length of playing career for those with and without ulnar neuritis (P = .38 and .51, respectively). CONCLUSION The study suggests that ulnar neuritis, when present preoperatively in baseball pitchers undergoing UCLR, may adversely affect their ability to return to sport, whereas ulnar nerve transposition at the time of UCLR does not alter the ability to return to sport.
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Affiliation(s)
| | - Robert A Keller
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Michael Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
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Abstract
PURPOSE OF REVIEW During overhead throwing, there are tremendous forces placed on the medial elbow that can result in injury to the ulnar nerve. The purpose of this article is to review the anatomy, biomechanics, and appropriate clinical care of an overhead throwing athlete suffering from injury to their ulnar nerve. The authors preferred clinical work-up; non-operative and operative care are included in this review. RECENT FINDINGS More recent findings support the use of subcutaneous transposition instead of the submuscular transpositions and only to perform a transposition in the setting of specific pre-operative findings. Subcutaneous transpositions have led to decreased rates of post-operative symptoms and complications. Understanding the complexity of the medial elbow is essential to making an accurate diagnosis of ulnar neuritis/neuropathy in the overhead throwing athlete. In general, non-operative management has shown to be successful; however, in those refractory or recurrent cases of ulnar neuritis, ulnar nerve decompression with or without transposition provides these athletes with a surgical procedure that has shown to provide patients with excellent outcomes. Continued refinement surgical indications and surgical technique will allow for a high percentage of athletes who return to competitive sports following surgery for ulnar neuropathy.
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Affiliation(s)
- S Blake Dowdle
- Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT, 84108, USA
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Yadav PK, Yadav RL, Sharma D, Shah DK, Thakur D, Limbu N, Islam MN. Nerve Conduction Study on Sural Nerve among Nepalese Tailors Using Mechanical Sewing Machine. J Clin Diagn Res 2017; 11:CC05-CC09. [PMID: 28511376 DOI: 10.7860/jcdr/2017/22814.9399] [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: 07/17/2016] [Accepted: 09/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The use of new technologies and innovations are out of access for people living in a developing country like Nepal. The mechanical sewing machine is still in existence at a large scale and dominant all over the country. Tailoring is one of the major occupations adopted by skilled people with lower socioeconomic status and education level. Sural nerves of both right and left legs are exposed to strenuous and chronic stress exerted by chronic paddling of mechanical sewing machine with legs. AIM To evaluate the influence of chronic and strenuous paddling on right and left sural nerves. MATERIALS AND METHODS The study recruited 30 healthy male tailors with median age {34(31-37.25)} years (study group), and, 30 healthy male volunteers with age {34(32-36.25)} years (control group). Anthropometric measurements (age, height, weight, BMI and length of both right and left legs) as well as cardio respiratory measurements [Systolic Blood Pressure (SBP), Dystolic Blood Pressure (DBP), Pules Rate (PR) and Respiratory Rate (RR)] were recorded for each subject. Standard nerve conduction techniques using constant measured distances were applied to evaluate sural nerve (sensory) in both legs of each individual. The differences in variables between the study and control groups were tested using Student's t-test for parametric variables and Mann-Whitney U test for nonparametric variables. A p-value of ≤ 0.05 was considered significant. RESULTS Age, height, weight, body mass index and leg length were not significantly different between tailors and control groups. Cardio respiratory measurements (SBP, DBP, PR and RR) were also not significantly altered between both the groups. The sensory nerve conduction velocities (m/s) of the right {44.23(42.72-47.83) vs 50(46- 54)} and left sural nerves {45.97±5.86 vs 50.67±6.59} m/s were found significantly reduced in tailors in comparison to control group. Similarly amplitudes (μv) of right sural (20.75±5.42 vs 24.10±5.45) and left sural nerves {18.2(12.43-21.8) vs 32.0(26.5-35.25)} were significantly less in tailors in comparison to control group whereas, latencies (ms) of right sural {2.6(2.2-2.7) vs 2.0(2.0-2.250} and left sural nerve {2.4(2.07-2.72) vs 2.0(2.0-2.0)} were found significantly high in tailors as compared with control group. CONCLUSION Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left sural nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.
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Affiliation(s)
- Prakash Kumar Yadav
- Assistant Professor, Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Ram Lochan Yadav
- Assistant Professor, Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Deepak Sharma
- Assistant Professor, Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Dev Kumar Shah
- Assistant Professor, Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
| | - Dilip Thakur
- Additional Professor, Department of Physiology, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Nirmala Limbu
- Additional Professor, Department of Physiology, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
| | - Md Nazrul Islam
- Professor, Department of Physiology, Chitwan Medical College, Bharatpur, Chitwan, Nepal
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Yadav PK, Yadav RL, Sharma D, Shah DK, Sapkota NK, Thakur D, Limbu N, Islam MN. Vibration upshot of operating mechanical sewing machine: an insight into common peroneal nerve conduction study. Ann Occup Environ Med 2017; 29:8. [PMID: 28344816 PMCID: PMC5364598 DOI: 10.1186/s40557-017-0164-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background Most of the people associated with tailoring occupation in Nepal are still using mechanical sewing machine as an alternative of new technology for tailoring. Common peroneal nerves of both right and left legs are exposed to strenuous and chronic stress exerted by vibration and paddling of mechanical sewing machine. Methods The study included 30 healthy male tailors and 30 healthy male individuals. Anthropometric variables as well as cardio respiratory variables were determined for each subject. Standard Nerve Conduction Techniques using constant measured distances were applied to evaluate common peroneal nerve (motor) in both legs of each individual. Data were analyzed and compared between study and control groups using Man Whitney U test setting the significance level p ≤ 0.05. Results Anthropometric and cardio respiratory variables were not significantly altered between the study and control groups. The Compound muscle action potential (CMAP) latency of common peroneal nerves of both right [(11.29 ± 1.25 vs. 10.03 ± 1.37), P < 0.001] and left [(11.28 ± 1.38 vs. 10.05 ± 1.37), P < 0.01] legs was found to be significantly prolonged in study group as compared to control group. The Amp-CMAP of common peroneal nerves of both right [(4.57 ± 1.21 vs. 6.22 ± 1.72), P < 0.001] and left [(4.31 ± 1.55 vs. 6.25 ± 1.70), P < 0.001] legs was found significantly reduced in study group as compared to control group. Similarly, the motor nerve conduction velocity (MNCV) of common peroneal nerves of both right [(43.72 ± 3.25 vs. 47.49 ± 4.17), P < 0.001] and left [(42.51 ± 3.82 vs. 46.76 ± 4.51), P < 0.001] legs was also found to be significantly reduced in study group in comparison to control group. Conclusion Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left common peroneal nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.
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Affiliation(s)
| | - Ram Lochan Yadav
- Department of Physiology, Chitwan Medical College, Bharatpur, Nepal
| | - Deepak Sharma
- Department of Physiology, Chitwan Medical College, Bharatpur, Nepal
| | - Dev Kumar Shah
- Department of Physiology, Chitwan Medical College, Bharatpur, Nepal
| | | | - Dilip Thakur
- Department of Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nirmala Limbu
- Department of Physiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Md Nazrul Islam
- Department of Physiology, Chitwan Medical College, Bharatpur, Nepal
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Abstract
Overhead throwing activities expose the elbow to tremendous valgus stress, making athletes vulnerable to a specific constellation of injuries. Although baseball players, in particular pitchers, are the athletes affected most commonly, overhead throwing athletes in football, volleyball, tennis, and javelin tossing also are affected. The purpose of this review is to review the anatomy, biomechanics, pathophysiology, and treatment of elbow disorders related to overhead throwing athletes. Although focus is on management of ulnar collateral ligament injuries, all common pathologies are discussed.
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Affiliation(s)
- Ronak M Patel
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - T Sean Lynch
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - Nirav H Amin
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - Gary Calabrese
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA
| | - Stephen M Gryzlo
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, #1350, Chicago, IL, USA
| | - Mark S Schickendantz
- Sports Health, Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125, USA.
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Aluko A, DeSouza L, Peacock J. The Effect of Core Stability Exercises on Variations in Acceleration of Trunk Movement, Pain, and Disability During an Episode of Acute Nonspecific Low Back Pain: A Pilot Clinical Trial. J Manipulative Physiol Ther 2013; 36:497-504.e1-3. [DOI: 10.1016/j.jmpt.2012.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/11/2012] [Accepted: 12/27/2012] [Indexed: 12/20/2022]
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Borges LPNC, Leitão WCDV, Ferreira JO, Carvalho LC. Medida da velocidade de condução nervosa motora em praticantes de três diferentes modalidades esportivas. REV BRAS MED ESPORTE 2013. [DOI: 10.1590/s1517-86922013000500005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: Estudos da condução nervosa têm sido focados para o público em geral, porém não para atletas, havendo carência de informações sobre medidas da velocidade de condução nervosa motora (VCNM) em indivíduos treinados, especialmente quando diferentes esportes são comparados. OBJETIVO: Medir a VCNM do nervo mediano e fibular comum, em três grupos de modalidades esportivas. Métodos: Foram analisados: um grupo de meio-fundistas (Gmf, n = 6), um grupo de velocistas (Gvel, n = 4) e um grupo de jogadores de handebol (Ghan, n = 5) e comparados com um grupo controle (Gcon, n = 9). Cada voluntário foi submetido a um único exame, no qual foram obtidos os dados para calcular a VCNM dos membros inferiores do Gmf e do Gvel, dos membros superiores do Ghan, e membros superiores e inferiores do Gcon. Os dados da pesquisa apresentaram distribuição normal e variâncias homogêneas, assim, utilizamos o teste t de Student para amostras independentes na comparação das médias da VCNM dos grupos de atletas com as do Gcon e as do Gvel com as do Gmf (comparações intergrupo). O teste t pareado foi usado para comparar as médias da VCNM entre membro dominante (Md) e membro não dominante (Mnd) (comparações intragrupo). RESULTADOS: Na análise intergrupo foram encontradas diferenças significativas nas comparações entre o Gvel e o Gcon e entre o Gmf e o Gcon (diferença apenas nas comparações entre os Md's). Por outro lado, a análise intragrupo, exibiu diferença significativa apenas nas comparações entre Md e Mnd do Ghan. CONCLUSÃO: O estudo sugere que a VCNM é beneficiada pelo esforço físico, principalmente em esportes com uso predominante dos membros inferiores, e que a maior utilização de um membro superior sobre outro pode levar a diferença significativa nos valores da VCNM do Md e Mnd.
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