-
The Journal of Hand Surgery Mar 2019The dorsoradial ligament (DRL) is essential for stability of the first carpometacarpal joint (CMC1) and is innervated with nerve endings and mechanoreceptors known to...
PURPOSE
The dorsoradial ligament (DRL) is essential for stability of the first carpometacarpal joint (CMC1) and is innervated with nerve endings and mechanoreceptors known to contribute to joint proprioception. The influence of these nerve endings on the neuromuscular stability of CMC1 is not yet known. This study investigated whether a ligamento-muscular reflex pathway is present between the DRL and CMC1 muscles.
METHODS
Ten healthy subjects (5 women and 5 men, mean age 28 years; range, 24-37 years) were included. Four primary CMC1 stabilizing muscles were investigated: the extensor pollicis longus, abductor pollicis longus (APL), abductor pollicis brevis, and first dorsal interosseous. Needle electrodes were inserted into each muscle and a fine-wire electrode was inserted into the DRL. The DRL was stimulated at 200 MHz while EMG activities in the muscles were recorded during isometric tip, key, and palmar pinch. Average EMG values were analyzed to compare prestimulus (t) with post-stimulus (t) activity.
RESULTS
Poststimulus changes were observed in all 4 muscles and 3 positions tested. During tip pinch we observed mass inhibition with a decrease in all muscle amplitudes. In key pinch we observed a rapid co-contraction response. Rapid inhibitory response of antagonistic musculature was observed during palmar pinch. The APL was the only muscle to react within 20 ms after stimulation.
CONCLUSIONS
We identified CMC1 ligamento-muscular reflexes. The mass inhibition of activity observed during tip pinch indicated a protective ligamento-muscular relation that affects all 4 muscles. The co-contractions observed promote joint stability. The fast response in the APL, coupled with its neuroanatomical proximity to the DRL, indicate a particular role in CMC1 proprioception.
CLINICAL RELEVANCE
Proper ligamentous support and retained innervation is likely important for adequate joint function; their innate functions ought to be considered when planning surgical or orthotic treatments.
Topics: Adult; Carpometacarpal Joints; Electric Stimulation; Electromyography; Female; Healthy Volunteers; Humans; Ligaments, Articular; Male; Muscle, Skeletal; Proprioception; Reflex; Thumb; Young Adult
PubMed: 30158062
DOI: 10.1016/j.jhsa.2018.06.011 -
Acta Dermatovenerologica Alpina,... Jun 2011Reflex sympathetic dystrophy syndrome (RSDS) is a painful condition that usually follows regional trauma. We report the case of a 13-year-old girl that was seen for a...
Reflex sympathetic dystrophy syndrome (RSDS) is a painful condition that usually follows regional trauma. We report the case of a 13-year-old girl that was seen for a painful swelling of the right hand associated with palmar hyperhidrosis, which occurred after a trauma to the hand. Bone scan images showed early tissue abnormality, which was more significant on the right hand and wrist, as well as moderate bone uptake on the right side. Nonsteroidal anti-inflammatory drugs and alternating hot and cold baths led to a marked improvement. RSDS occurs following trauma or subsequent to various diseases or drug intake. This syndrome is related to impaired tissue microvasculature under the influence of abnormal sympathetic reflex hyperactivity. Bone scan is the diagnostic procedure of choice in RSDS, but it may be normal. Physiotherapy should be preferred in pediatric cases.
Topics: Adolescent; Female; Humans; Reflex Sympathetic Dystrophy
PubMed: 21993705
DOI: No ID Found -
International Journal of Environmental... Jan 2023The aim of the pilot project was to research relationships between the occurrence and level of intensity of primitive reflexes in primary school children, the ability to...
The aim of the pilot project was to research relationships between the occurrence and level of intensity of primitive reflexes in primary school children, the ability to read an analogue clock and to tell the time. A group of 28 children (14 girls and 14 boys) who attended Montessori Primary School was examined. In the first stage, participants were assessed for the presence of five primitive reflexes (PR): the asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR), spinal Galant reflex, tonic labyrinthine reflex (TLR) and Palmar grasp reflex. Romberg's test was employed to identify signs of difficulties with control of balance and/or proprioception. In the second stage, pupils underwent tests that challenged their ability to read a clock and calculate passing time. After summing up points obtained for all tests, a correlation coefficient was made from which the results were derived. There is a negative correlation between the ability to read an analogue clock and the continued presence of some primitive reflexes. Lower neuromotor maturity (higher points of PR) correlates with lower ability to read a clock. The highest correlations between difficulty with telling the time were found with persistence of the STNR, ATNR and Romberg's test.
Topics: Male; Female; Humans; Child; Pilot Projects; Reflex, Abnormal; Reflex; Dyslexia
PubMed: 36767689
DOI: 10.3390/ijerph20032322 -
Clinical Rheumatology Jan 2019It has been claimed that hyperestrogenism occurs in hypertrophic osteoarthropathy (HOA), but not in simple clubbing. However, one of our patients had simple clubbing and...
It has been claimed that hyperestrogenism occurs in hypertrophic osteoarthropathy (HOA), but not in simple clubbing. However, one of our patients had simple clubbing and hyperestrogenism. We therefore measured estrogens, androgens, sex hormone-binding globulin (SHBG), and gonadotropins in five patients with HOA and in 18 patients with simple clubbing. Of the patients with HOA, 80% had a high urinary estriol concentration. In their serum, 80% had high estrone, 0% high estradiol, and 40% high SHBG. Of the patients with simple clubbing, 89% had a high urinary estriol concentration. In their serum, 76% had high estrone, 6% high estradiol, and 31% high SHBG. In all patients, urinary estriol concentration correlated positively with the degree of clubbing. Serum concentration of androstenedione, testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) was mostly normal, but androstenedione concentration correlated positively with the degree of clubbing. Spider angiomas were present in 74%, palmar erythema in 39%, and gynecomastia in 9%. Urinary creatinine concentration was low in 48% and correlated positively with the degree of clubbing. We reject the claim that hyperestrogenism occurs in HOA, but not in simple clubbing. Hyperestrogenism occurs both in HOA and in simple clubbing. Our results also support earlier reports that clubbing and HOA are associated with spider angiomas, palmar erythema, gynecomastia, adrenal cortical hyperfunction, muscle atrophy, and water retention. These results led to a new hypothesis on the pathogenesis of HOA, involving estrogens, prostaglandin E, prostaglandin A, and the inflammatory reflex.
Topics: Adult; Aged; Creatinine; Estriol; Estrogens; Estrone; Female; Fingers; Humans; Male; Middle Aged; Osteoarthropathy, Primary Hypertrophic; Osteoarthropathy, Secondary Hypertrophic; Prostaglandins; Sex Hormone-Binding Globulin
PubMed: 29480386
DOI: 10.1007/s10067-018-4044-z -
Journal of the Autonomic Nervous System May 1983The autonomic (including sudomotor, baroreceptor, and vasomotor) functions were assessed in 3 groups of individuals, comprising normal, hyperhidrotic, and denervated...
The autonomic (including sudomotor, baroreceptor, and vasomotor) functions were assessed in 3 groups of individuals, comprising normal, hyperhidrotic, and denervated subjects. The normal group had no palmar hyperhidrosis, with intact T2-3 ganglia, the hyperhidrotic group had palmar hyperhidrosis with intact T2-3 ganglia, and the denervated group had palmar hyperhidrosis treated with T2-3 ganglionectomy. Compared with both the normal and hyperhidrotic subjects, the denervated subjects had a much smaller sweating response of both the forehead, the upper chest region and the upper extremities, and a much greater sweating response of both the lateral lumbar and ventral thigh regions in response to body exercise. In addition, cardiovascular responses to either the Valsalva manoeuver, face immersion, or finger immersion were evaluated in these groups of subjects. When compared with those of either the normal or the denervated subjects, the hyperhidrotic subjects had less reflex bradycardia in response to either Valsalva manoeuver or face immersion. In contrast, when compared with those of either the normal or the denervated subjects, the hyperhidrotic subjects had a higher degree of cutaneous vasoconstriction in response to finger (or cold) immersion. The data indicate that the sympathetic fibers passing through the T2-3 ganglia play an important role in the elaboration or modulation of autonomic function elsewhere. Probably, the hyperhidrotic subjects have an over-functioning of the sympathetic nervous fibers which pass through the T2-3 ganglia, which leads to autonomic dysfunction. The autonomic dysfunctions observed in the hyperhidrotic subjects could be eliminated after the interruption of the excessive sympathetic activities passing through the T2-3 ganglia level. A preliminary report of this work was delivered at the 15th Congress of the Pan-Pacific Surgical Association, January 12-18, 1980 and the 12th World Congress of Neurology, September 20-25, 1981.
Topics: Adult; Autonomic Nervous System; Ganglia, Sympathetic; Hand; Heart Rate; Humans; Hyperhidrosis; Male; Reflex; Sweat Glands; Sweating; Sympathectomy; Vasoconstriction
PubMed: 6875200
DOI: 10.1016/0165-1838(83)90021-8 -
Frontiers in Neuroscience 2017George Marinesco is the founder of Romanian School of Neurology and one of the most remarkable neuroscientists of the last century. He was the pupil of Jean-Martin...
George Marinesco is the founder of Romanian School of Neurology and one of the most remarkable neuroscientists of the last century. He was the pupil of Jean-Martin Charcot in Salpêtrière Hospital in Paris, France, but visited many other neurological centers where he met the entire constellation of neurologists of his time, including Camillo Golgi and Santiago Ramón y Cajal. The last made the preface of Nervous Cell, written in French by Marinesco. The original title was "La Cellule Nerveuse" and is considered even now a basic reference book for specialists in the field. He was a refined clinical observer with an integrative approach, as could be seen from the multitude of his discoveries. The descriptions of the succulent hand in syringomyelia, senile plaque in old subjects, palmar jaw reflex known as Marinesco-Radovici sign, or the application of cinematography in medicine are some of his important contributions. He was the first who described changes of locus niger in a patient affected by tuberculosis, as a possible cause in Parkinson disease. Before modern genetics, Marinesco and Sjögren described a rare and complex syndrome bearing their names. He was a hardworking man, focused on his scientific research, did not accepted flattering of others and was a great fighter against the injustice of the time.
PubMed: 29317856
DOI: 10.3389/fnins.2017.00726 -
Techniques in Hand & Upper Extremity... Mar 2023Various surgical techniques exist to treat de Quervain's stenosing tendovaginitis. Specific surgical techniques for de Quervain's are designed to avoid complications...
Various surgical techniques exist to treat de Quervain's stenosing tendovaginitis. Specific surgical techniques for de Quervain's are designed to avoid complications including injury to branches of the superficial branch of the radial nerve, inadequate decompression, reflex sympathetic dystrophy, and palmar subluxation of the released tendons. A simple dorsal incision through the extensor retinaculum is advocated by many as a means to release the compartment while preventing postoperative subluxation. A single incision through the retinaculum limits exposure of the compartment and could lead to reannealing of the retinaculum and recurrent symptoms. Partial resection of the extensor retinaculum provides a more complete release and has not been found to lead to palmar tendon subluxation.
Topics: Humans; Tenosynovitis; Tendons; Tendon Entrapment; Forearm; Tenotomy; Joint Dislocations; De Quervain Disease
PubMed: 35686888
DOI: 10.1097/BTH.0000000000000402 -
Clinical Neurophysiology : Official... Jul 2007The nervous system structures involved in the control of the lower urinary tract (LUT) are usually divided using a neuroanatomical classification system into... (Review)
Review
The nervous system structures involved in the control of the lower urinary tract (LUT) are usually divided using a neuroanatomical classification system into suprapontine, pontine, spinal and sacral. In all patients with LUT symptoms, after exclusion of local causes, a nervous system disorder needs to be considered. For the diagnosis of neurogenic LUT disorders, in addition to clinical assessment, neurophysiologic testing might be useful. Imaging and other laboratory studies (e.g., cystometry) often provide relevant additional information. Neurophysiologic tests are more useful in patients with sacral compared with suprasacral disorders. Although in patients with LUT disorders external urethral sphincter (EUS) electromyography (EMG) would seem the most appropriate, anal sphincter EMG is the single most useful diagnostic test, particularly for focal sacral lesions, and atypical parkinsonism. Another clinically useful method that tests the sacral segments, and complements EMG, is the sacral (penilo/clitoro-cavernosus) reflex. Kinesiologic EMG is useful to demonstrate detrusor sphincter dyssynergia (i.e., increased EUS activity during bladder contraction), which is particularly common in spinal cord disease. Somatosensory evoked potential (SEP) and motor evoked potential (MEP) studies (cortical and lumbar) may be useful to diagnose clinically silent central lesions. MEP, in addition, seems to be very promising in research into cortical excitability. Theoretically, cortical SEP on bladder/urethra stimulation would be much more useful than pudendal SEP because it tests thin nerve afferents from the pelvic viscera. However, the utility of this technique is limited by technical difficulties, which can be partially overcome by the concomitant recording of a palmar sympathetic skin response (SSR). SSR recorded from the saddle region is also useful for testing the lumbosacral sympathetic system. Although the technique of detrusor EMG has been recently described in humans, a clinically useful test for evaluating the sacral parasympathetic system, which is crucial for LUT functioning, is still lacking.
Topics: Animals; Electrodiagnosis; Electromyography; Electrophysiology; Humans; Pelvic Floor; Peripheral Nervous System; Urinary Bladder, Neurogenic
PubMed: 17466586
DOI: 10.1016/j.clinph.2007.01.022 -
Journal of Neurosurgery Aug 1993Sympathetic nerve disorders of the upper extremities can be treated by neurosurgeons using upper thoracic sympathectomy via a posterior approach. Descriptions have been...
Sympathetic nerve disorders of the upper extremities can be treated by neurosurgeons using upper thoracic sympathectomy via a posterior approach. Descriptions have been published of alternative endoscopic procedures involving thermocoagulation, laser coagulation, or nonvideo-assisted ganglionectomy using equipment not widely available, with low morbidity and excellent results. The authors describe the use of an endoscopic approach to the thoracic sympathetic ganglia with systems designed for laparoscopic cholecystectomy. Thoracic ganglionectomy is reported in 22 patients with primary palmar hyperhidrosis and eight patients with reflex sympathetic dystrophy. The patients underwent double-lumen endotracheal intubation, after which 11- and 5.5-mm trocars were introduced into the chest cavity. Pneumothorax was produced with CO2 insufflation. Fiberoptic closed-circuit television was used to visualize the structures to be dissected. The parietal pleura over the heads of the first and second ribs was excised using 5-mm blunt and sharp insulated coagulating microscissors. The stellate and upper thoracic ganglia were clearly identified and dissected. The T-2 and T-3 ganglia were grasped with forceps and excised. A No. 16 French chest tube was introduced through a trocar, placed under water seal after the lungs were reinflated, and removed in the recovery room. The average hospital stay was 15.4 hours. There were no intraoperative complications. The average operating time was 30 minutes per side. Five patients had mild pleuritic pain which resolved within 2 weeks after surgery. Six (75%) of the eight patients with reflex sympathetic dystrophy had complete or partial relief of their symptoms (average follow-up period 5 months), and all patients had complete relief of hyperhidrosis (average follow-up period 8 months). Endoscopic ganglionectomy requires readily available and easily used instrumentation and provides a well-tolerated, cost-effective alternative to posterior thoracic sympathectomy for primary palmar hyperhidrosis and reflex sympathetic dystrophy.
Topics: Ganglionectomy; Humans; Hyperhidrosis; Reflex Sympathetic Dystrophy; Television; Thoracoscopy; Treatment Outcome
PubMed: 8331407
DOI: 10.3171/jns.1993.79.2.0238 -
L'Encephale 1983Psychophysiology is the study of physiological measures in the human for information about behavioral concomitants. Measures used include heart-rate, blood-pressure,...
Psychophysiology is the study of physiological measures in the human for information about behavioral concomitants. Measures used include heart-rate, blood-pressure, palmar sweating (skin conductance), salivation, pupil size, electromyogram, respiration, electroencephalogram and averaged evoked response. States of anxiety are accompanied by physiological changes which can be regarded as high "arousal". Such measures are useful as monitors of emotional change, both during the induction and alleviation of anxiety. Finally, psychophysiology provides some insights into the complex nature of anxiety and its relationship to brain mechanisms.
Topics: Anti-Anxiety Agents; Anxiety; Arousal; Behavior Therapy; Electroencephalography; Electromyography; Galvanic Skin Response; Humans; Monitoring, Physiologic; Psychophysiology
PubMed: 6144515
DOI: No ID Found