Axillary nerve conduction changes in hemiplegia
Tóm tắt
To prove the possibility of axillary nerve conduction changes following shoulder subluxation due to hemiplegia, in order to investigate the usefulness of screening nerve conduction studies in patients with hemiplegia for finding peripheral neuropathy. Forty-four shoulders of twenty-two patients with a first-time stroke having flaccid hemiplegia were tested, 43 ± 12 days after stroke onset. Wasting and weakness of the deltoid were present in the involved side. Motor nerve conduction latency and compound muscle action potential (CMAP) amplitude were measured along the axillary nerve, comparing the paralyzed to the sound shoulder. The stimulation was done at the Erb's point whilst the recording needle electrode was inserted into the deltoid muscle 4 cm directly beneath the lateral border of the acromion. Wilcoxon signed rank test was used to compare the motor conduction between the sound and the paralytic shoulder. Mann-Whitney test was used to compare between plegic and sound shoulder in each side. Mean motor nerve conduction latency time to the deltoid muscle was 8.49, SD 4.36 ms in the paralyzed shoulder and 5.17, SD 1.35 ms in the sound shoulder (p < 0.001). Mean compound muscle action potential (CMAP) amplitude was 2.83, SD 2.50 mV in the paralyzed shoulder and was 7.44, SD 5.47 mV in the sound shoulder (p < 0.001). Patients with right paralyzed shoulder compared to patients with right sound shoulder (p < 0.001, 1-sided for latency; p = 0.003, 1-sided for amplitude), and patients with left paralyzed shoulder compared to patients with left sound shoulder (p = 0.011, 1-sided for latency, p = 0.001, 1-sided for amplitude), support the same outcomes. The electro-physiological changes in the axillary nerve may appear during the first six weeks after stroke breakout. Continuous traction of the axillary nerve, as in hypotonic shoulder, may affect the electro-physiological properties of the nerve. It most probably results from subluxation of the head of the humerus, causing demyelinization and even axonopathy. Slowing of the conduction velocities of the axillary nerve in the paralyzed shoulders may be related also to the lowering of the skin temperature and muscular atrophy in the same limb. The usefulness of routine screening nerve conduction studies in the shoulder of hemiplegic patients seems to be advocated.
Tài liệu tham khảo
Kaplan PE, Meredith J, Taft G, Betts HB: Stroke and brachial plexus injury: a difficult problem. Arch Phys Med Rehabil 1977, 58:415–418.
Moskowitz E, Porter JI: Peripheral nerve lesions in the upper extremity in hemiplegic patients. N Engl J Med 1963, 269:776–778.
Nepomuceno CS, Miller JM: Shoulder arthrography in hemiplegic patients. Arch Phys Med Rehabil 1974, 55:49–51.
Chaco J, Wolf E: Subluxation of the glenohumeral joint in hemiplegia. Am J Phys Med 1971,50(3):139–143.
Griffin JW: Hemiplegic shoulder pain. Phys Ther 1986, 66:1884–93.
Ourwenaller C, Laplace PM, Chantraine A: Painful shoulder in hemiplegia. Arch Phys Med Rehabil 1986,67(1):23–26.
Meredith J, Taft G, Kaplan P: Diagnosis and treatment of the hemiplegic patient with brachial plexus injury. Am J Occup Ther 1981, 35:656–660.
Turner-Stokes L, Jackson D: Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil 2002, 16:276–298.
Ring H, Tsur A, Vashdi Y: long-term clinical and electromyographical (EMG) follow-up of hemiplegic's shoulder. Eur J Phys Med Rehabil 1993, 3:137–140.
De Lisa JA, Lee HJ, Baran EM, Lai K, Spielholz N, MacKenzie K: Manual of nerve conduction velocity and clinical neurophysiology. 3rd edition. Lippincott Williams & Wilkins; 1994.
Lee HJ, Bach JR, DeLisa J: Peroneal nerve motor conduction to the proximal muscles: an alternative approach to conventional methods. Am Phys Med Rehab 1997, 76:197–199.
Tsur a, Glass I, Solzi P: Exhausting fatigue influences F-wave and peripheral conduction velocity, following lumbar radiculopathy. Disability and Rehabilitation 2002, 24:647–653.
Chino N: Electrophysiological investigation on shoulder subluxation in hemiplegics. Scand J Rehabil Med 1981,13(1):17–21.
Ring H, Feder M, Berchadsky R, Samuels G: Prevalence of pain and malalignment in the hemiplegic's shoulder at admission for rehabilitation: a preventive approach. Eur J Phys Med Rehabil 1993, 3:199–203.
Milanov I: Neurographic studies in hemiplegic patients. Functional Neurology 1995, 10:77–82.
Culham EG, Noce RR, Bagg SD: Shoulder complex position and glenohumeral subluxation in hemiplegia. Arch Phys Med Rehabil 1995, 76:857–864.
Prevost R, Arsenault AB, Dutil E, Drouin G: Rotation of the scapula and shoulder subluxation in hemiplegia. Arch Phys Med Rehabil 1987, 68:786–790.
Prevost R, Arsenault AB, Dutil E, Drouin G: Shoulder subluxation in hemiplegia: a radiologic correlational study. Arch Phys Med Rehabil 1987, 68:782–785.
Walsh MT: Upper limb neural tension testing and mobilization. Fact, fiction, and a practical approach. J Hand Ther 2005,18(2):241–258.
Ring H, Leillen B, Server S, Luz Y, Solzi P: Temporal changes in electrophysiological, clinical and radiological parameters in the hemiplegic's shoulder. Scand J Rehabil Med Suppl 1985, 12:124–127.
Lee KH, Khunadorn F: Painful shoulder in hemiplegic patients: a study of the suprascapular nerve. Arch Phys Med Rehabil 1986, 67:818–820.
Steinmann SP, Moran EA: Axillary nerve injury: diagnosis and treatment. J Am Acad Orthop Surg 2001,9(5):328–335.
Bucy PC: Vasomotor changes associated with paralysis of cerebral origin. Arch Neurol Psychiatry 1935, 33:30–52.
Takebe K, Narayan MG, Kukulka C, Basmajian JV: Slowing of nerve conduction velocity in hemiplegia: possible factors. Arch Phys Med Rehabil 1975, 56:285–289.
McComas AJ, Sica REP, Upton ARM, Aguilera N, Currie S: Motoneuron dysfunction in patients with hemiplegic atrophy. Nat New Biol 1971, 233:21–23.
Seneviratne C, Then KL, Reimer M: Post-stroke shoulder subluxation: a concern for neuroscience nurse. Axone 2005,27(1):26–31.