edx evaluation of the brachial plexus and upper limb nerves...nerve conduction and electromyography...
TRANSCRIPT
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2018
EDX Evaluation of the Brachial Plexus and Upper Limb Nerves
Jun Kimura, MDDepartment of NeurologyUniversity of Iowa Health Care
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Financial Disclosure
Nothing to Disclose.
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Principles and Practice1) Hx & Px before EDx
2) Watch twitch, then measure
3) Distal vs Proximal Shocks
4) Linear or Nonlinear Changes
5) Short and Long of NCS
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From Kimura, 2013.
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Principles and Practice1) Hx & Px before EDx
2) Watch twitch, then measure
3) Distal vs Proximal Shocks
4) Linear or Nonlinear Changes
5) Short and Long of NCS
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From Kimura, 2013.
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Palm
Wrist
Elbow
0.5 mV5 ms
71 year old Chinese woman with multiple myeloma
5/27/09
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Principles and Practice1) Hx & Px before EDx
2) Watch twitch, then measure
3) Distal vs Proximal Shocks
4) Linear or Nonlinear Changes
5) Short and Long of NCS
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Patient History
• 63 y.o. right handed male with a history of left biceps tendon rupture
• Currently experiencing left forearm and thumb pain and feeling of “tightness” in radial forearm
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From Kimura, 2013.
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Diagnostic Nerve Ultrasound Video
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Final Diagnosis: Ultrasound
• Study is somewhat limited due to excess scar tissue and post-operative status.
• There has been complete transection of the lateral antebrachial cutaneous nerve with subsequent neuroma formation at the proximal biceps repair site.
• There also is most likely repair failure approximately 1 cm proximal to radial insertion based primarily on dynamic evaluation.
• Excessive scar tissue is present.
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Nerve Conduction and Electromyography
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Principles and Practice1) Hx & Px before EDx
2) Watch twitch, then measure
3) Distal vs Proximal Shocks
4) Linear or Nonlinear Changes
5) Short and Long of NCS
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fFrom Kimura, 2013.
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From Kimura, 2013.
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Principles and Practice1) Hx & Px before EDx
2) Watch twitch, then measure
3) Distal vs Proximal Shocks
4) Linear or Nonlinear Changes
5) Short and Long of NCS
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Medical History
• 8 y.o. African boy with left elbow injury in 2015 while in Uganda.
• Closed reduction and casting at a local hospital.
• Dislocation but no apparent fracture by X-ray study.
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Musculoskeletal Exam
• Clinically 30° varus deformity of the left elbow with arm extended
• Range from 15° hyperextension to 130° flexion on affected side.
• Range from 20° hyperextension to 150° flexion on unaffected side.
• No intrinsic muscle wasting noted
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From Kimura, 2013.
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Left Ulnar Inching
1.1 ms shift above ulnar groove
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Ulnar Inching Superimposed
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NCS: Long and Short of It1) Short distances magnify focal
abnormality despite increased measurement error.
2) Long distances, though insensitive to focal lesions, yield better for diffuse process
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From Kimura, 2013.