Annals of Rehabilitation Medicine

The Effects of the Local Steroid Injection in the Patients with Medial Superior Cluneal Nerve Entrapment.: Jeong, Yong Seol , Ahn, Kyung Hoi , Kim, Hee Sang , Lee, Jong Ha , Kim, Dong Hwan , Kim, Hak Jun , Kim, Jin Sung; J Korean Acad Rehabil Med 2005;29(3):276-280.

Abstract
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Objective
The aim of this study was to evaluate the efficacy of the local steroid injection in the patients with medial superior cluneal nerve entrapment. Method: The participants were 20 (13 men, 7 women) patients with medial superior cluneal nerve entrapment diagnosed by Maigne's criteria (unilateral buttock pain, tender point at iliac crest, and relieved pain by nerve block). All patients were injected with 1% lidocaine 1.75 ml and triamcinolone 10 mg at maximal tender point which was 7∼8 cm away from spinous process horizontally on the iliac crest. The visual analogue scale (VAS) and the modified Oswestry questionnaire (MOQ) were checked at before, 2 weeks and 4 weeks after injection. And the VAS waschecked 10 min after injection to determine the accuracy of injections. Results: The mean VAS scores of before injection, 10 min, 2 weeks, and 4 weeks after injection were 7.7, 2.8, 4.0, and 4.0 respectively. The mean MOQ of before injection, 2 weeks, 4 weeks after injection were 35.7, 23.8, and 23.8 respectively. Both VAS and MOQ were significantly different in before injection, 2 weeks and 4 weeks after injection (p＜0.05). Conclusion: The local steroid injection is an effective treatment of medial superior cluneal nerve entrapment. (J Korean Acad Rehab Med 2005; 29: 276-280)

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Nerve Conduction Study of Medial Calcaneal Nerve in Healthy Koreans.: Park, Joo Hyun , Park, Geun Young , Ko, Young Jin , Kang, Eugene; J Korean Acad Rehabil Med 2003;27(4):535-538.

Abstract

OBJECTIVE
To determine the normal values of medial calcaneal nerve (MCN) conduction study for the diagnostic reference value. METHOD: The subjects were healthy 54 adults (30 males, 24 females). Antidromic sensory nerve conduction study of medial calcaneal nerve was performed in 108 feet of the subjects. The active surface electrode (G1) was placed to the point of one third of the distance from the apex of the heel to a point midway between the navicular tuberosity and prominence of the medial malleolus. The reference surface electrode (G2) was placed to the apex of the heel. The stimulation was done at the site of 10 cm proximal to the proposed G1 site. RESULTS: Reference values (mean+/-2 SD) were determined for MCN onset latency (1.62+/-0.16 msec), peak latency (2.41+/-0.19 msec), baseline-to-peak amplitude (12.46+/-4.87 microV), onset conduction velocity (62.28 +/-6.30 m/sec), and peak conduction velocity (41.70+/-3.19 m/sec). The maximum intrasubject side-to-side differences of above values were 0.17 msec, 0.17 msec, 2.90 micro V, 6.63 m/sec, and 2.87 m/sec respectively. The MCN response was elicitable in 92.6% of the subjects.
CONCLUSION
The results of this study would be used for the electrophysiologic evaluation of the MCN.

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The Usefulness of Ultrasonographic Evaluation in the Musculoskeletal Disease.: Park, Gi Young , Kim, Hyun Ree , Lee, Sung Moon; J Korean Acad Rehabil Med 2000;24(6):1142-1147.

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Objective: The aim of this study is to know the usefulness of ultrasonographic evaluation in the musculoskeletal disease.

Method: Thirty-nine cases with musculoskeletal pain were evaluated by physical examination, Cyriax selective tension technique, simple X-ray, electromyography, arthrography, Computed tomography, Magnetic resonance image and the high-resolution realtime ultrasonography to define the location of pain. The ultasonographic results were compared to other diagnostic methods.

Results: The ultrasonographic findings are as follow; 22 tendinitis, 7 entrapment neuropathies, 6 bursitis, 2 ligament injuries, and 2 rotator cuff injuries. Clinical diagnosis were matched with ultrasonographic findings in 30 cases out of 39. The most common ultrasonographic findings in 22 tendinitis cases were hypoechogenicity in affected tendon. Ultrasonographic findings in 7 entrapment neuropathies were 6 nerve swellings and 1 nerve flattening.

Conclusion: The ultrasonography can provide detailed images of musculoskeletal system, including tendons, nerves and subcutaneous tissue. Therefore the ultrasonography is very useful in diagnosis and treatment of some musculoskeletal diseases such as tendinitis and entrapment neuropathy.

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Electrodiagnostic Study on Neuropathies in String Players.: Kwon, Yong Wook , Kim, Jong Min; J Korean Acad Rehabil Med 1999;23(2):316-324.

Abstract
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Objective: To determine the frequency, involved nerves and sites of entrapment neuropathy in string players.

Method: The subjects were 24 string playing musicians and age matched 24 normal controls. Questionnaire, physical examination were taken in the musicians and the electrodiagnostic study was performed in both the musician and the control groups. Electrodiagnostic study included nerve conduction study of median and ulnar nerves. The distal motor latency, segmental motor conduction velocity, distal sensory latency, and amplitude of sensory nerve action potentials were measured. Each parameter of nerve conduction study was compared in two groups and was correlated to the string playing duration.

Results: Three musicians (12.5%) were diagnosed as entrapment neuropathy: One, left ulnar neuropathy at the elbow and the wrist and left median neuropathy at the wrist; Two, left ulnar neuropathy at the elbow. Ulnar motor conduction velocity of right forearm segment and left elbow segment were significantly reduced in the musicians compared to those of the controls (P＜0.05). The distal sensory latency of left ulnar nerve was significantly prolonged in musicians compared to that of the controls (P＜0.05). The string playing duration significantly correlated with the distal motor latency of right median nerve (R=0.632, P＜0.05) and the distal sensory latency of left median nerve (R=0.518, P＜0.05).

Conclusions: These results suggest that some entrapment neuropathies could be developed due to cumulative trauma in string players. Elbow and wrist segment of left ulnar nerve, forearm segment of right ulnar nerve are possible sites of entrapment neuropathy in string players.

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Distal Motor Nerve Conduction Studies of Medial Plantar Nerve, Lateral Plantar Nerve and Inferior Calcaneal Nerve.: Lee, Jong Min , Choi, Jong Chul; J Korean Acad Rehabil Med 1999;23(1):82-89.

Abstract
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Objective: To determine the reference values for the diagnosis of isolated entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel.

Method: The subjects were neurologically healthy 30 adults (15 males, 15 females). Distal motor nerve conduction study of medial and lateral plantar nerves and inferior calcaneal nerve was performed. The recording muscles for medial and lateral plantar nerves and inferior calcaneal nerve were flexor hallucis brevis, flexor digiti minimi brevis, and abductor digiti minimi pedis, respectively. The stimulation was done at distal and proximal to the tarsal tunnel to differentiate the tarsal tunnel syndrome and the entrapment neuropathy of distal to the tarsal tunnel. The distance of recording and distal stimulation site was fixed to 10 cm for medial and lateral plantar nerves. The skin temperature was maintained 33^oC or above. The proximal latency, distal latency, peak to peak amplitude, conduction velocity and residual latency were measured. The reference values were obtained by 95 percentile values.

Results: The reference values for the diagnosis of isolated entrapment neuropathies of medial plantar nerve, lateral plantar nerve and inferior calcaneal nerve distal to tarsal tunnel are as follows.

1) Medial plantar nerve: distal latency, ＞ 4.3 msec; side to side difference, ＞ 0.7 msec

2) Lateral plantar nerve: distal latency, ＞ 4.1 msec; side to side difference, ＞ 0.6 msec

3) Latency difference of medial and lateral plantar nerve: ＞ 0.7 msec

4) Inferior calcaneal nerve: distal latency, ＞ 4.3 msec; distal peak latency, ＞ 7.2 msec; side to side difference of distal onset latency, ＞ 1.5 msec; side to side difference of distal peak latency, ＞ 0.8 msec; residual latency, ＞ 3.0 msec

Conclusion: The distal motor nerve conduction method used in this study and the reference values could be used to differentiate entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel from tarsal tunnel syndrome.