Electrodiagnosis of cervical radiculopathy.

Cervical radiculopathy is a common diagnosis with a peak onset in the fifth decade. The most commonly affected nerve root is C7, C6, and C8. The etiology is often compressive, but may arise from noncompressive sources. Patients commonly complain of pain, weakness, numbness, and/or tingling. Examination may reveal sensory or motor disturbance in a dermatomal/myotomal distribution. Neural compression and tension signs may be positive. Diagnostic tests include imaging and electrodiagnostic study. Electrodiagnostic study serves as an extension of the neurologic examination. Electrodiagnostic findings can be useful for patients with atypical symptoms, potential pain-mediated weakness, and nonfocal imaging findings.

The kinematics and kinetics of turning: limb asymmetries associated with walking a circular path.

The biomechanics of changing direction while walking has been largely neglected despite its obvious relevancy to functional mobility. The world is filled with turns that must be negotiated. These turns carry an increased risk of injury due to a decrease in stability. A VICON 612 system measured joint kinematics and kinetics on 10 normal subjects for straight line walking (ST); turning, inside foot strike (IN); and turning, outside foot strike (OUT). All trials were completed at a self-selected walking speed and across a range of speeds from 0.6 to 1.3 m/s; the turn radius was 1 m. Significant differences between the conditions were detected using a mixed effects repeated measures ANCOVA with walking speed as a covariate. The most pronounced differences were demonstrated in the mediolateral ground reaction force impulse: in straight walking the impulses tended to shift the body toward the contralateral limb. In turning, the IN and OUT impulses shifted the body toward the ipsilateral and contralateral limbs, respectively. Knee flexion during stance was increased on the IN limb, while ankle plantarflexion increased on the OUT limb consistent with body lean during turning; differences in joint kinetics during turning were negligible. Self-selected turning was significantly slower than walking straight ahead (0.96+/-0.12 m/s versus 1.61+/-0.22 m/s) and turning at very slow speeds showed a non-uniform center of mass trajectory. Understanding the mechanisms of turning will provide insights driving design, therapy and intervention to increase functional navigation in amputees, the elderly and individuals with neuromuscular pathologies.

Break-technique handheld dynamometry: relation between angular velocity and strength measurements.

OBJECTIVES: To determine whether the muscle strength, as measured with break-technique handheld dynamometry (HHD), is dependent on the angular velocity achieved during testing and to compare reliability at different angular velocities. DESIGN: Repeated-measures study. Participants underwent HHD by using make-technique (isometric) and break-technique (eccentric) dynamometry at 3 prespecified angular velocities. Elbow movement was recorded with an electrogoniometer. SETTING: Inpatient spinal cord injury unit. PARTICIPANTS: Convenience sample of 20 persons with tetraplegia with weakness of elbow flexors or extensors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Elbow angular velocity and muscle strength recorded during HHD. RESULTS: With the break technique, angular velocities averaging 15 degrees , 33 degrees , and 55 degrees /s produced 16%, 30%, and 51% greater strength measurements, respectively, than velocities recorded by using the make technique (all P < .006 for comparisons between successive techniques). The intraclass correlation coefficient for intrarater reliability was .89 or greater for all testing techniques. CONCLUSIONS: Greater strength is recorded with faster angular velocities during HHD. Differences in angular velocity may explain the wide range previously reported for break- versus make-technique strength measurements. Variation in angular velocity is a potential source of variability in serial HHD strength measurements, and for this reason the make technique may be preferable.

Pigmented villonodular synovitis: an uncommon presentation of anterior hip pain.

Pigmented villonodular synovitis (PVNS) is a rare, benign, idiopathic proliferative disorder of the synovium that results in villous or nodular formation in joints, tendon sheaths, and bursae. The disease can be localized or diffuse. Its estimated prevalence is 1.8 cases per million in the United States. Large joints, such as the knee and hip, are commonly affected. Patients with this condition typically present with symptoms of mild discomfort and associated stiffness of the involved joint; however, the spectrum of presentations is broad. We present a case of an otherwise healthy 40-yr-old man who presented for evaluation of stiffness and pain in the anterior hip. His initial presentation, work-up, and course will be discussed, along with a brief review of the literature.