Accessory Flexor Digitorum Longus Presenting as Tarsal Tunnel Syndrome: A Case Series.

Tarsal tunnel syndrome (TTS) typically occurs from extrinsic or intrinsic sources of compression on the tibial nerve. We present 3 cases of patients, all of whom have a prolonged time to diagnosis after evaluation with multiple specialties, with foot pain ultimately secondary to an accessory flexor digitorum longus muscle causing TTS. The literature describing the association between TTS and accessory musculature has been limited to single case reports and frequently demonstrate abnormal electrodiagnostic testing.

Can Carpal Tunnel Syndrome be Appropriately Diagnosed in a Cold Hand?

Introduction: The diagnosis of carpal tunnel syndrome (CTS) with nerve conduction studies traditionally involves warming the hand to avoid misleading prolongation of distal latency (DL). Comparing the median nerve DL to the ulnar and radial nerves using the combined sensory index (CSI) has been reported to improve the accuracy of CTS diagnosis. During this study, the authors examined the effect of hand temperature on the CSI and diagnosis of CTS.

Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery.

 The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release.  Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS.

An Additional Electrodiagnostic Tool for Ulnar Neuropathy: Mixed across the Elbow.

 Diagnosing ulnar neuropathy at the elbow (UNE) remains challenging despite guidelines from national organizations. Motor testing of hand intrinsic muscles remains a common diagnostic method fraught with challenges.  The aim of the study is to demonstrate utility of an uncommon nerve conduction study (NCS), mixed across the elbow, when diagnosing UNE.

Frequency of Electrodiagnostically Measurable Berrettini Anastomosis.

Purpose: Ulnar sensory palmar crossover to digit three (D3), the Berrettini anastomosis, is measurable in routine electrodiagnostic nerve conduction studies. The crossover is reported as occurring in 60% of anatomic dissections, but the frequency of measurable ulnar crossover to D3 and its potential as a nerve conduction pitfall is not established. The purpose of this article was to present descriptive statistics regarding the frequency of measurable Berrettini anastomosis in nerve conduction studies.

Incidence of injury and illness during the 2013 world dwarf games.

Background: Dwarfism, or skeletal dysplasia, is a term used to describe short stature. Injuries to athletes with disabilities and medical co-morbidities, such as those present in the dwarf population, can have significant consequences on functionality. The main objectives of this retrospective descriptive study were to 1) evaluate the safety of athletic participation among athletes with skeletal dysplasia, 2) investigate the incidence and characteristics of injuries and illnesses among athletes with skeletal dysplasia during the 2013 World Dwarf Games held on the campus of Michigan State University, 3) describe details and overview of the World Dwarf Games, and 4) identify possible safety and rule issues to improve safety at future World Dwarf Games.

Motor unit number estimation: a technology and literature review.

Introduction: Numerous methods for motor unit number estimation (MUNE) have been developed. The objective of this article is to summarize and compare the major methods and the available data regarding their reproducibility, validity, application, refinement, and utility.

Methods: Using specified search criteria, a systematic review of the literature was performed.

Undershooting of a neutral reference position by asymptomatic subjects after cervical motion in the sagittal plane.

Objective: The objective of this study was to determine if blindfolded, asymptomatic subjects undershoot or overshoot a self-selected neutral reference position (NRP) when performing a full-cycle, head repositioning accuracy test in the sagittal plane.

Methods: An asymptomatic group of subjects, consisting of 7 men and 5 women with no history of head and neck pain, were recruited for the study. Subjects, performing a full-cycle series of head/neck movements in the sagittal plane, attempted to return to a self-selected NRP, defined at the beginning of the movement sequence, without benefit of visual clues.

A standardized protocol for needle placement in suboccipital muscles.

The objective of this study was to assess the safety and accuracy of using common anatomic landmarks to guide the placement of needle electrodes into suboccipital muscles. Atrophic changes in suboccipital muscles have been reported in some patients who have tension-type headaches, and in some patients who have headaches resulting from whiplash-type injuries. These atrophic changes most likely result from disuse or denervation.

Unusual presentation of hereditary neuropathy with liability to pressure palsies.

Background: Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant painless peripheral neuropathy characterized by episodes of repeated focal pressure neuropathies at sites of entrapment/compression, with a considerable variability in the clinical course. Electrodiagnostic and genetic testing are important in the diagnostic evaluation of these patients.

Case Presentation: We report an unusual HNPP phenotype, five compression neuropathies in four nerves in a patient with bilateral hand numbness.

Musculoskeletal disorders in referrals for suspected lumbosacral radiculopathy.

Objective: An electrodiagnostic evaluation is often requested for patients with suspected lumbosacral radiculopathy. Although musculoskeletal disorders can produce lower-limb symptoms, their prevalence in this referral population is unknown. The purpose of this study was to determine the prevalence of common lower-limb musculoskeletal disorders in patients referred for lower-limb electrodiagnosis and determine whether these findings predict study outcome.

Musculoskeletal disorders in referrals for suspected cervical radiculopathy.

Objectives: To determine (1) the prevalence of selected common musculoskeletal disorders in patients referred for electrodiagnosis when cervical radiculopathy is suspected and (2) whether these findings predict electrodiagnostic study outcome.

Design: Prospective study.

Setting: Electrodiagnostic laboratories in departments of physical medicine and rehabilitation at 5 participating institutions.

The prevalence of fibromyalgia in collegiate athletes.

Background: : The prevalence of fibromyalgia in the general population is reported in numbers that range between 0.5% and 10%, with considerable variability in the populations studied and criteria for diagnosis used. The prevalence in competitive young adult athletes is unknown, but we expect it to be less than the general population.

WITHDRAWN: Second AAEM literature review of the usefulness of nerve conduction studies and needle electromyography for the evaluation of patients with carpal tunnel syndrome.

Ahead of Print article withdrawn by publisher.

Thoracic radiculopathy.

Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the evaluation of spinal pain syndromes. Degenerative disc disease and diabetes mellitus may frequently cause radiculopathy at the thoracic level. Electromyography and magnetic resonance imaging are useful in the evaluation of radiculopathy and thoracic spinal pain syndromes.