Ultrasound Diagnostic and Physiotherapy Approach for a Patient with Parsonage-Turner Syndrome-A Case Report.

Parsonage-Turner syndrome (PTS) is a rare neurological disorder that causes major diagnostic problems. This paper presents a case report of a patient with PTS and proposes a new physiotherapy program. CASE DESCRIPTION: a 23-year-old man presents a sudden severe pain of his right arm. The man is consulted by several doctors and physiotherapists. Three magnetic resonance imagings (MRI), a nerve conduction study (NCS), and needle electromyography (EMG) are performed. After 6 months, based on medical history, physical examination and ultrasound imaging (UI), the physiotherapist suggests PTS, which is confirmed by a neurologist. INTERVENTION: due to the lack of physiotherapy treatment standards in PTS, we apply neurodynamic techniques. OUTCOMES: neurodynamic techniques are effective in reducing pain and paraesthesia, improving sensation, and reducing nerve swelling (assessed by UI), as well as improving manual dexterity and overall health status. CONCLUSIONS: the patient with PTS is challenging for making an accurate diagnosis. This study shows an important role for UI, which shows changes in the musculocutaneous nerve, despite the lack of abnormalities in the MRI, NCS, and EMG, and helps in making an accurate diagnosis. This report also confirms that physiotherapy based on neurodynamic techniques may have beneficial effects in PTS.

Changes in Ultrasound Measurements of the Ulnar Nerve at Different Elbow Joint Positions in Patients with Cubital Tunnel Syndrome.

Ultrasound imaging (US) is increasingly being used in the diagnosis of entrapment neuropathies. The aim of the current study was to evaluate changes in stiffness (shear modulus), cross-sectional area (CSA), and trace length (TRACE) of the ulnar nerve in patients with cubital tunnel syndrome (CuTS), with shear wave elastography (SWE). A total of 31 patients with CuTS were included. CSA, shear modulus, and TRACE examinations were performed in the SWE mode in four positions of the elbow: full extension, 45° flexion, 90° flexion, and maximum flexion. There were significant side-to-side differences in the ulnar nerve elasticity value at 45°, 90°, and maximal elbow flexion (all, p < 0.001) but not at elbow extension (p = 0.36). There were significant side-to-side differences in the ulnar nerve CSA value at each elbow position (all, p < 0.001). There were significant side-to-side differences in the ulnar nerve trace value at each elbow position (all, p < 0.001). The symptomatic ulnar nerve in patients with CuTS exhibited greater stiffness (shear modulus), CSA, and TRACE values, compared with the asymptomatic side. US examinations (shear modulus, CSA, and TRACE evaluation) of the ulnar nerve can be helpful in supporting and supplementing the diagnosis in patients with CuTS.

Reliability of Ulnar Nerve Sensation Tests in Patients with Cubital Tunnel Syndrome and Healthy Subjects.

Static two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) tests are commonly used to evaluate sensory disorders in the hand. The aim of this study was to evaluate the reliability of 2PD and SWM tests in the ulnar nerve innervation area in patients with cubital tunnel syndrome (CuTS) and healthy individuals. This was a two-group repeated-measures inter-rater and intra-rater reliability study. Twenty-one patients with CuTS and 30 healthy adults participated. The static 2PD test was performed using a standardized Dellon discriminator, whereas the SWM test was conducted using TOUCH TEST monofilaments. Two examiners performed both tests at the hypothenar eminence and the fourth and fifth digits (ulnar nerve innervation hand territory). First, examiner A conducted three series of 2PD and SWM tests twice with a 15-min rest period (within-day intra-rater reliability). Next, examiner B repeated the same examination 5 min after (inter-rater reliability). Examiner A conducted the same examination 7 days after (between-day intra-rater reliability). For single measurements, the inter-rater reliability and within-day intra-rater reliability in the 2PD was at least 0.81 in patients with CuTS or healthy subjects. The between-days intra-rater reliability for a single measurement varied from 0.56 to 0.95 in CuTS patients and healthy subjects. The between-days intra-rater reliability for mean value from three measurements was above 0.80. The kappa for SWM was above 0.8 and the percentage of agreement was at least 90% for all sessions and trials. In conclusion, the 2PD and SWM tests are reliable for assessing sensation in the ulnar nerve innervation area of the hand in patients with CuTS and healthy subjects.

The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review.

BACKGROUND: To date, various forms of physiotherapy are used in the treatment of cubital tunnel syndrome (CuTS). The effectiveness of physiotherapy for CuTS is inconclusive. The aim of this systematic review was to evaluate the effects of physiotherapy in the conservative treatment of CuTS. METHODS: The six databases were searched from December 2020 to March 2022. The inclusion criteria were randomised controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of adult participants with diagnosis CuTS. A total of 11 studies met the eligibility criteria, capturing a total of 187 participants. RESULTS: In three types of papers, pain, muscle strength, and limitation of upper limb function were the most frequently assessed characteristics. Physiotherapy was most often based on manual therapy, neurodynamic techniques, and electrical modalities. One clinical trial rated the risk of bias "high" and the other two "some concerns". In case-series designs, five studies rated the risk of bias as "serious" and three as "moderate". Most of the studies showed a significant improvement in the clinical condition, also in the follow-up study. Only one clinical trial showed no therapeutic effect. CONCLUSION: There is no possibility of recommending the best method of physiotherapy in clinical practice for people with CuTS based on the results of this systematic review. More high-quality studies are required.

Comparison of results of ACL reconstruction using LARS method and autogenous ST/GR graft.

PURPOSE: The objective of the study was assessment of the function of the knee joint after ACL reconstruction using the LARS method and autogenous graft. The study was of a retrospective character and included 96 patients who had undergone reconstruction of the torn ACL. The study was conducted within 36-48 months after surgery. METHODS: In order to compare the results of the ACL reconstruction performed with 2 types of grafts, the following instruments were used: Lysholm Knee Scoring Scale, SF 36v2 questionnaire for assessment of health-related quality of life, and Biodex System 4 for isokinetic muscle testing. RESULTS: No differences in the evaluation of the quality of life measured using SF 36v2 questionnaire were observed between the LARS and ST GR groups. Using the Lysholm Scale, the distribution of knee function scores was compared according to the type of surgery. There are no grounds to confirm the differences in the distribution of knee function scores considering the type of graft (p = 0.756). Isokinetic test showed a significant weakening of muscle strength in the operated limb, compared to the strength of the healthy limb. CONCLUSIONS: The type of graft used for ACL reconstruction does not exert an effect on the quality of life of patients or the level of their knee joint function. Extensor and flexor muscles strength of the knee joint was lower in the operated limb, irrespective of the type of graft used. Weak relationships were observed between the level of knee joint function and extensor muscle strength of this joint.

Assessment of postural stability in patients after reconstruction of the anterior cruciate ligament with LARS and autogenous graft.

PURPOSE: The aim of the study was to assess static balance after reconstruction of the anterior cruciate ligament (ACL), using gracialis tendons graft (GR) or semi-tendinosus (ST), compared to patients treated with the Ligament Advanced Reinforcement System (LARS). The study was performed within 36 to 48 months after the surgery. METHODS: The study included 96 patients. The LARS group consisted of 44 patients, control group operated with ST/GR tendons included 52 patients. The stabilometric platform Alpha was used to assess the static balance. Two 30-second trials in the double-leg stance position with eyes opened and closed were performed. The distribution of loads in a free standing was also assessed. RESULTS: In the test with open eyes the subjects from the LARS group had a significantly longer center of pressure (COP) path, a higher mean velocity, a greater mean COP sway in foot in the lateral direction and a larger path area occupied by the COP graph. During the tests with eyes closed, a significant difference occurred in the mean displacement of COP in lateral direction - greater in the LARS group. In addition, all parameters deteriorated during the tests with eyes closed in both groups. CONCLUSIONS: In static balance assessed with eyes closed, more proprioceptive deficits may appear in the LARS group.

The Standard Deviation of Differential Index as an innovation diagnostic tool based on kinematic parameters for objective assessment of a upper limb motion pathology.

PURPOSE: Indexing methods are very popular in terms of determining the degree of disability associated with motor dysfunctions. Currently, indexing methods dedicated to the upper limbs are not very popular, probably due to difficulties in their interpretation. This work presents the calculation algorithm of new SDDI index and the attempt is made to determine the level of physical dysfunction along with description of its kind, based on the interpretation of the calculation results of SDDI and PULMI indices. METHODS: 23 healthy people (10 women and 13 men), which constituted a reference group, and a group of 3 people with mobility impairments participated in the tests. In order to examine possibilities of the utilization of the SDDI index the participants had to repetitively perform two selected rehabilitation movements of upper extremities. During the tests the kinematic value was registered using inertial motion analysis system MVN BIOMECH. RESULTS: The results of the test were collected in waveforms of 9 anatomical angles in 4 joints of upper extremities. Then, SDDI and PULMI indices were calculated for each person with mobility impairments. Next, the analysis was performed to check which abnormalities in upper extremity motion can influence the value of both indexes and interpretation of those indexes was shown. CONCLUSION: Joint analysis of the both indices provides information on whether the patient has correctly performed the set sequence of movement and enables the determination of possible irregularities in the performance of movement given.

[Fusogens in the treatment of nervous system injury]. / Fuzogeny w terapii uszkodzen ukladu nerwowego.

In the paper a new method is presented of injured nerve fibres repair by means of the so-called fusogens. This entirely novel approach to the treatment of injuries of the central nervous system and peripheral nerves in humans may be feasible in a near future. Unquestionable advantages of these substances include their easy applicability and no undesirable side effects. What remains to be established is their mode of operation and precise therapeutic indications.

[Doctor Mikolaj Witczak's life and work]. / Zycie i dzialalnosc doktora Mikolaja Witczaka.

On the grounds of conducted research, the life and activities of Dr Mikolaj Witczak (1857-1918) have been reconstructed. The history of Jastrzebie Zdrój Spa has also been presented as one of the most remarkable European health resorts of the turn of the 19th century.

Experimental hyperthyroidism increases the effectiveness of predegenerated peripheral nerve graft implantation into hippocampus of adult rats.

PURPOSE: The aim of the study was to ascertain whether experimental hyperthyroidism changes the neurotrophic activity of 14- and 21-day-predegenerated peripheral nerve grafts towards CNS neurites. METHODS: Hyperthyroidism was induced by subcutaneous injections of T_4. Autologous peripheral nerve grafts were implanted into the hippocampus of both euthyrotic and hyperthyrotic animals 14 or 21 days after sciatic nerve transection (groups ET14, Et21, Ht14 and Ht21, respectively). Non-predegenerated grafts were used as a control group (groups EtN adn HtN). Cells extending their neurites into the grafts were traced with FITC-HRP. RESULTS: The number of traced cells in individual groups was as follows: EtN - 39.4 +/- 9.46, Et14 - 1 +/- 0.94, Et21 - 0.6 +/- 0.69; HtN - 95 +/- 19.46; Ht14 - 95.94 +/- 16.3, Ht21 - 99.94 +/- 7.26. CONCLUSIONS: We found that experimentally induced hyperthyroidism strongly enhanced the regeneration of injured hippocampal neurites after implantation of peripheral nerve grafts that were practically inactive in euthyrotic animals.