Accuracy of Point-of-Care-Ultrasonography in Confirming Shoulder Reduction in Emergency Departments.

Aims Accurate identification of the successful reduction of a dislocated shoulder could avoid additional episodes of procedural sedation and repeated performance of X-rays. The objective of this study was to assess the diagnostic accuracy of point-of-care-ultrasound (POCUS) in the confirmation of a successful joint reduction in patients with shoulder dislocation. Methods This was a single-centre, prospective observational study set in an urban academic ED in Ireland, with a convenience sample of adult patients with shoulder dislocation on X-ray. Ultrasound was performed on participants before and after joint reduction using a posterior approach technique. The operator's confidence levels were recorded after image acquisition. Results Thirty-three subjects were recruited. All dislocations were correctly identified on pre-reduction US, indicating a sensitivity of 100% (CI 89.42 - 100). Post-reduction US confirmed successful reduction in 30 subjects that were subsequently reported as such on X-Ray, giving it a specificity of 100% (CI 88.43 - 100). Failure to achieve reduction was correctly identified on US in three cases, resulting in post-reduction US Sensitivity of 100% (CI 29.24 - 100) and 100% accuracy (CI 89.42 - 100). Conclusion This study has shown that POCUS, with a posterior approach technique, has 100% sensitivity and specificity in confirming successful shoulder reduction in the ED.

Changes in the spike activity of neurons in the ventrolateral nucleus of the thalamus in humans during performance of a voluntary movement.

The responses of neurons in the ventrolateral nucleus (VL) of the thalamus were studied in humans during performance of voluntary motor tests; recordings were made with microelectrodes during stereotaxic operations in patients with Parkinson's disease. Two previously classified types of polyvalent neurons (A, B) were found to show different patterns of responses during the functional stages of carrying out a voluntary movement (preparation, initiation, performance). A and B neurons showed concordant changes in the dynamics of ongoing network activity in the form of linked (activation-inhibition) and synergic (activation) response patterns, correlating with the preparation-trigger and performance phases of movements. It is suggested that the simultaneous activity of both types of neuron, with their common functional nature, reflects integrative processes occurring in the ventrolateral nucleus and associated with programming and processing of general signal parameters but not with the performance of any particular movement. The anterior (Voa nucleus) and posterior (Vop) parts of the ventrolateral nucleus were found to have different roles in organizing voluntary movements, associated with differences in their cellular organization and mechanisms of transmitting motor signals. It is suggested that the concordant changes in the activities of the two types of neurons in these areas seen during the performance of voluntary movements gives the ventrolateral nucleus a key role in the motor control system in humans.

Analysis of spontaneous activity patterns of human thalamic ventrolateral neurons and their modifications due to functional brain changes.

In the human thalamic ventralis lateralis nucleus the spontaneous activity of 235 single units during 38 stereotactic operations in locally anaesthetized parkinsonian patients was analysed. Two basic cell types (A and B) were shown to exist in this nucleus: (i) with unitary irregular (2-40/s) discharges characterized by a tendency to spike grouping in the range of 4-6 Hz and 10-30 Hz (A-type, 74%), (ii) with bursting discharges firing in short trains (5-30 ms) characterized by an unstable rhythmic 3-6 Hz pattern similar to a low-threshold Ca2+ intrinsic burst structure of discharges (B-type, 26%). The functional brain changes after a motor tests performance were accompanied by the appearance of two different transient modifications of activity of A-cells pattern into rhythmic burst discharges: (i) in the range of 3-6 Hz, similar to the bursts found for B-cells and recorded mainly in the anterior ventrolateral region in rigid patients, (ii) in the range of 5 +/- 1 Hz, characterized by other interspike interval and recorded in the posterior ventrolateral region in patients with tremor. Modifications during short-term anaesthesia resulted in 10-15 Hz burst discharges that were associated with gradual disappearance of A-cells activity. In contrast to what happens for A-cells, the activity of bursting B-units was characterized by an invariant intrinsic structure of discharges irrespective of the functional brain changes or the forms of parkinsonian pathology. The nature of A- and B-units as well as the mechanisms of transient modifications of their spontaneous activity patterns due to the functional brain changes are discussed.

Analysis of evoked activity patterns of human thalamic ventrolateral neurons during verbally ordered voluntary movements.

In the human thalamic ventralis lateralis nucleus the responses of 184 single units to verbally ordered voluntary movements and some somatosensory stimulations were studied by microelectrode recording technique during 38 stereotactic operations on parkinsonian patients. The tests were carried out on the same previously examined population of neurons classified into two groups, named A- and B-types according to the functional criteria of their intrinsic structure of spontaneous activity patterns. The evaluation of the responses of these units during functionally different phases of a voluntary movement (preparation, initiation, execution, after-effect) by means of the principal component analysis and correlation techniques confirmed the functional differences between A- and B-types of neurons and their polyvalent convergent nature. Four main conclusions emerge from the studies. (1) The differences of the patterns of A- and B-unit responses during the triggering and the execution phases of a voluntary movement indicate the functionally different role of these two cell types in the mechanisms of motor signal transmission. (2) The universal non-specific form of anticipatory A- and B-unit responses during the movement preparation and initiation of various kinds of voluntary movements reflect the integrative "triggering" processes connected with the processing and programming of some generalized parameters of a motor signal and not with the performance of a certain forthcoming motor act. (3) The expressed intensity of these "triggered" non-specific processes in the anterior parts of the ventralis lateralis nucleus indicates their relation not only to the motor but to the cognitive attentional functions forming a verbally ordered voluntary movement. (4) The appearance of the transient cross-correlations between the activities of adjacent A- and B-cells and also the synchronization of their 5 +/- 1 Hz frequency during and/or after motor test performances point to the contribution of these two populations to central mechanisms of the voluntary movement and the parkinsonian tremor. The functional role of two A- and B-cell types is discussed with references to the central mechanisms of verbally ordered voluntary movements and the parkinsonian tremor.

Spontaneous activity of individual neurons in the human ventrolateral thalamus during changes in the functional state of the brain.

Background spike activity of 235 cells of the integrative subcortical motor center, i.e., the ventrolateral nucleus of the thalamus, were analyzed in nonanesthetized human brains during stereotaxic surgery in patients with various forms of Parkinson's disease. Previous data on the existence of two major types of neurons with convergent properties in the ventrolateral nucleus were confirmed. These cell types are: 1) cells with irregular occasional activity, with a tendency for spikes to group into the frequency ranges 5 +/- 1 and 10-30 Hz (type A cells, 74%), and 2) cells with constant rhythmic (3-6 Hz) generation of short volleys of discharges, with an interval structure similar to that of low-threshold Ca(2+)-dependent volley activity (type B, 26%). This is the first report demonstrating that changes in the functional state of the brain (after repeated movement trials, in transient anesthesia) are accompanied by transiently occurring transformations of the initial irregular activity of A cells into a rhythmic, volley-like pattern whose interval structure was in some cases similar to the spike activity of B cells. Differences in the localizations of A and B neurons in the ventrolateral nucleus are described, along with differences in the correlation characteristics of their background spike activity with the pathological features of Parkinson's disease (tremor, rigidity). The nature of the two types of convergent neurons in the ventrolateral nucleus is discussed, and a basis is laid for the importance of the functional factor in understanding the transformation of their background spike activity, due to the properties of cell membranes and intercellular and interstructure interactions in conditions of the living nonanesthetized human brain.

[Changes in the impulse activity of neurons of the human thalamic ventrolateral nucleus during voluntary movement]. / Izmeneniia impul'snoi aktivnosti neironov ventrolateral'nogo iadra talamusa mozga cheloveka pri realizatsii proizvol'nogo dvizheniia.

Functional differences were revealed in evoked activity of two types (A and B) of units of the human thalamic ventro-lateral nucleus (VL). Collective activities of these polyfunctional neurons were selectively related to triggering and execution phases of movement. Common character of dynamics of the responses seems to be due to similar polyfunctional nature as well as to the functional role of these two complementary elements in the motor signal transmission. The collective activities reflect in the VL the integrative processes related to processing and programming of generalised parameters of motor signals, but unrelated to performance of a concrete motor act.

[The characteristics of the spontaneous activity of single neurons in the human ventrolateral thalamus during changes in the functional state of the brain]. / Osobennosti spontannoi aktivnosti odinochnykh neironov ventrolateral'nogo talamusa cheloveka pri izmenenii funktsional'nogo sostoianiia mozga.

In the thalamic ventro-lateral nucleus of parkinsonian patients, two main types of convergent cells were shown to exist: 1) units with irregular discharges (A-cells, 74%) and 2) units with bursts of unstable rhythmic discharges (B-cells, 26%). The functional brain changes were accompanied by modifications of A-cells activity into the transient rhythmic burst-like pattern, characterized by two different types of intrinsic structure burst discharges being in some cases similar to the structure of B-cells. A correlation between activities of these units and the type of parkinsonian pathology was revealed.

[Electromyography in patients with spastic torticollis]. / Elektromiografiia u bol'nykh so spasticheskoi krivosheei.

The article describes the results of electromyographic examination of the muscles of the neck in 26 patients with spasmodic torticollis. Electromyography was performed before and after stereotaxic operative interventions on the nucleus of Cajal or in combination with the diencephalic structures. It is shown that electromyographic examination of patients, especially with the use of functional motor and oculomotor tests, widens essentially the possibilities of the diagnosis by facilitating the identification or specification of the predominantly involved group of muscles. The discovery of concurrent oculographic and electromyographic changes in the dominant muscles of the neck during oculomotor tests is evidence of the connection of the system of concurrent movements of the eyes and head with the motor systems participating in the pathology of torticollis. Analysis of the dynamics of electromyographic changes in patients with predominance of the tonic component in the early and late postoperative periods is indicative of gradual increase of positive changes in the motor sphere, which, evidently, is due to the dynamic reorganizations in the previously formed stable pathological system.