Reliability of Ultrasonography in Evaluating Hyoid Bone Movement.

BACKGROUND: Timely and adequate laryngeal elevation along with hyoid bone movement is an essential component of the swallowing movement under normal physiological conditions. The purpose of this study was to verify the reproducibility of using ultrasonography to evaluate hyoid bone displacement during swallowing through the assessment of inter- and intrarater reliability and examine its accuracy by comparing the results with videofluoroscopic swallowing study (VFSS). METHODS: A self-designed water balloon was fixed to the transducer, which provided good contact between the transducer and the submental skin. Ten participants with dysphagia were recruited. The measurements of hyoid bone displacement using ultrasonography were performed by two of the authors. All the participants underwent ultrasonographic examinations and VFSS within 24 hours. RESULTS: The intrarater intraclass correlation coefficient (ICC) of the two examiners was 0.996 and 0.959, respectively (p < 0.01); the interrater ICC between the two examiners was 0.892 (p < 0.05). ICCs between VFSS and ultrasonography for two researchers were 0.815 and 0.916 (p < 0.01). CONCLUSION: Submental ultrasonography is a reliable and accurate method for assessing the hyoid bone movement.

Ultrasound-guided injection of botulinum toxin in a patient with omohyoid muscle syndrome: a case report.

Omohyoid muscle syndrome has a characteristic feature of a protruding lateral neck mass during swallowing. We present a case of omohyoid muscle syndrome diagnosed based on the clinical presentation and a dynamic imaging study. Botulinum toxin was injected into the inferior belly of one omohyoid muscle, and the neck mass resolved.

Detrimental correlation between air pollution with skin aging in Taiwan population.

Dissecting the complex relationships between skin aging and air pollution has been an ongoing effort. The increased exposure to air pollution over time imposed a negative effect on skin. This study explores the correlation between skin aging in the Asian population and levels of air pollutants to show different relationship between the two. This study was retrospective and included 389 patients, age between 30 and 74, who planned to receive a session of laser treatment for skin disorders in Kaohsiung Medical University Hospital (KMUH) from 2006 to 2019. Preoperative skin condition quantified by VISIA Complexion Analysis System (Canfield Imaging Systems, Fierfield, NJ, US). Eight air pollutants such as carbon monoxide (CO), non-methane hydrocarbon (NMHC), nitrogen oxides (NO, NO2, and NOx), particulate matters (PM2.5 and PM10), ozone (O3), sulfur dioxide (SO2) and 8 skin condition such as spots, wrinkles, textures, pores, ultraviolet spots (UV spots), brown spots, red area, and porphyrin were analyzed to explore correlation between air pollution and skin aging. Strong correlation was found between NMHC exposure and texture, pores and brown spots formation. A positive correlation between O3 and better VISIA texture and pores scores was found. Brown spots was found to negatively associate with CO, NMHC, NO2, NOx, PM10, PM2.5, and SO2. The skin condition of population over age 45 affected by CO, NMHC, NO2, NOx, PM2.5, PM10, and SO2. Skin condition of the bottom 10% strongly correlates with exposure to PM10 and SO2, whereas skin condition of the top 10% was affected by PM10. Air pollutants such as CO, NO2, NOx, PM2.5, PM10, SO2, and NMHC were found to correlate with negative skin quality strongly. In contrast, O3 exposure is associated with less texture and pores. Future studies are warranted to further appreciate the relationships between air pollutants and skin condition.

Ultrasonography-guided botulinum toxin injection to the cricopharyngeus muscle: a case report and technical notes.

Dysphagia associated with the cricopharyngeus muscle (CPm) dysfunction negatively influences the quality of life. This high-pressure region must relax and the lumen must open for smooth food passage. The CP muscle is therefore a common target of chemodenervation with botulinum toxin (BTX). Here we presented a patient with severe left lateral medullary syndrome and non-relaxation of the CPm. We described how to localize the CPm in the transverse and longitudinal views under ultrasonography and offered a video demonstrating ultrasonography-guided BTX injection. Ultrasonography-guided CPm injection with BTX may serve as a reliable, rapid, and effective choice for treatment of cricopharyngeal dysphagia.

Increased carrying angle is a risk factor for nontraumatic ulnar neuropathy at the elbow.

UNLABELLED: The literature suggests a possible relationship between carrying angle and nontrauma-related ulnar neuropathy. To confirm that relationship, we asked whether carrying angle is a risk factor in patients with nontrauma-related ulnar neuropathy. We measured the carrying angles of the elbow in 36 patients with a clinically and electrophysiologically confirmed diagnosis of nontraumatic ulnar neuropathy at the elbow and in 50 healthy control subjects. Correlation analysis was performed between carrying angles and parameters of nerve conduction studies, including nerve conduction velocities and amplitudes of muscle and nerve action potentials. The mean carrying angle was greater in the patients than in the control subjects. Females had a greater carrying angle than males. We observed an inverse relationship between carrying angles and motor nerve conduction velocities at cross-elbow segments of the ulnar nerves and with sensory nerve conduction velocities of the distal ulnar nerves. An increased carrying angle of the elbow appears to be an independent risk factor of nontrauma-related ulnar neuropathy. LEVEL OF EVIDENCE: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Medial calcaneal neuropathy is associated with plantar fasciitis.

OBJECTIVE: To demonstrate a method of sensory nerve conduction study (NCS) for the medial calcaneal nerve (MCN) and confirm the medial calcaneal neuropathy in patients with plantar fasciitis (PF). METHODS: Twenty-six patients with clinical and ultrasonographic diagnosis of PF participated in the present study. An antidromic method for sensory NCS of MCN was performed in each patient and in 30 controls. The conduction latency, sensory nerve conduction velocity (SNCV) and amplitude of the sensory nerve action potential (SNAP) were measured and the correlation of the SNCV of MCN with both body weight and body mass index (BMI) was studied. RESULTS: The mean conduction latency obtained in the MCN was greater in the PF patients than in the normal controls. Mean SNCV and SNAP amplitude of the MCN were significantly less in the PF patients than in the normal controls. Body weight and BMI were greater in PF patients than in controls. Six patients were identified as having a medial calcaneal neuropathy by using the criteria of the lowest normal values of the NCS of MCN from the normal controls. CONCLUSIONS: Medial calcaneal neuropathy is associated with PF. The present method of sensory NCS is useful and objective in the diagnosis of the medial calcaneal neuropathy. SIGNIFICANCE: Medial calcaneal neuropathy was confirmed by the sensory NCS of MCN and shown to be associated with PF.

Neck muscle stiffness quantified by sonoelastography is correlated with body mass index and chronic neck pain symptoms.

This study aimed to quantify neck muscle stiffness in the normal population with ultrasound elastography. We applied the acoustic radiation force impulse technique and measured shear wave velocities (SWVs) as representative values. The mean ± standard deviation values of SWV in 20 healthy volunteers were 2.09 ± 0.45, 1.21 ± 0.30, 1.12 ± 0.17 and 0.97 ± 0.10 m/s for the trapezius, levator scapulae, scalene anterior and sternocleidomastoid muscles, respectively. The SWV values of the four muscles significantly differed (Kruskal-Wallis test, p < 0.001). The SWV values for the trapezius muscle correlated with body mass indexes (Pearson's correlation, p = 0.034). Subjects with chronic neck pain symptoms had significantly stiffer trapezius muscle (Mann-Whitney U test, p = 0.008). This study demonstrated the technique and feasibility of quantifying neck muscle stiffness using acoustic radiation force impulse elastography and shear wave velocity detection. Further study is necessary to evaluate its diagnostic power in assessing various neck muscle diseases.

Sublesional spinal vertebral bone mineral density correlates with neurological level and body mass index in individuals with chronic complete spinal cord injuries.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: Our aim was to find out the factors influencing the bone mineral density (BMD) change of sublesional spinal vertebrae in spinal cord injury (SCI) individuals. SUMMARY OF BACKGROUND DATA: In individuals with SCI, the BMD of sublesional extremities dramatically decreases to fracture threshold because of unloading. In contrast, the BMD of sublesional spinal vertebrae is reported to be preserved. The etiology of the discrepancy is unknown. METHODS: This study was performed in a university tertiary referral medical center. A total of 62 men with traumatic and neurologically complete SCI attending a special SCI clinic attached to the medical center from 2000 to 2003. Participants were prescreened using lumbosacral roentgenography to rule out heterotopic ossification and early-onset spinal degeneration. The BMD was then evaluated with dual energy radiograph absorptiometry at the thoracic spine and lumbar spine, using anteroposterior and lateral scout images. RESULTS: The mean age was 27.3 +/- 8.3 years and mean injury duration was 11.7 +/- 6.8 years. Lumbar spine BMD did not increase or decrease significantly after SCI. Lumbar spine BMD correlated significantly with body mass index. Thoracic and lumbar spine BMDs were significantly higher if the injury level was below T6. There were no correlations with postinjury duration, age of the subject, or level of physical activity. CONCLUSION: In men with chronic complete SCI, the long-term sublesional spinal vertebrae BMDs are significantly lower if injury levels are at T6 or above, suggesting the role of neurologic control on bone metabolism.

Dynamic visualization of the coracoacromial ligament by ultrasound.

Subacromial impingement syndrome (SIS) is prevalent in athletes who make throwing motions over their heads, as well as in the normal population, but it is difficult to diagnose precisely using physical examination and traditional imaging modalities. Furthermore, the diagnostic testing protocols have not been strictly standardized. We used ultrasound to dynamically visualize coracoacromial ligament (CAL) morphology during shoulder impingement tests: the CAL is the key impinging structure in SIS. Fifty normal shoulders were examined. With the transducer placed on the CAL, the shoulders were examined with seven different testing protocols described in the literature. The degree of CAL bulge from the resting position was measured, and the degree of bulge in different testing protocols was compared. We found that the Hawkins-Kennedy impingement test caused more CAL bulge than the Neer's impingement test, and the most prominent morphological change in the CAL occurred with an internally rotated and horizontally abducted shoulder. We conclude that high-resolution ultrasound is an excellent tool for dynamically inspecting the impinging structures, is applicable in clinical settings, and allows more accurate diagnosis of SIS.