1/18. Adhesive capsulitis of the glenohumeral joint with an unusual neuropathic presentation: a case report.A 37-yr-old woman presented with a 7-mo history of unilateral shoulder girdle stiffness, pain, and weakness and had already been diagnosed with frozen shoulder. physical examination revealed scapular winging and suspicious focal paralysis of shoulder girdle muscles. Subsequently, electrodiagnostic studies reported denervation of deltoid, infraspinatus, serratus anterior, and lower cervical paraspinal muscles, in addition to a prolonged long thoracic nerve latency. The history, physical examination, and cervical magnetic resonance imaging scan seemed most consistent with neuralgic amyotrophy, although the electrodiagnostic examination could be interpreted as cervical radiculopathy. Some of the difficulties in identifying neuralgic amyotrophy and distinguishing it from cervical radiculopathy are discussed herein. Historically, frozen shoulder has seemed to develop as a complication of the neuropathic process. Both neuralgic amyotrophy and frozen shoulder have a poorly understood pathogenesis, and their combined presence is presumed to be rare. Because of difficulties inherent in the physical examination of frozen shoulder, a coexistent neuropathic process may go undetected.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/18. Acute brachial plexus neuritis: an uncommon cause of shoulder pain.patients with acute brachial plexus neuritis are often misdiagnosed as having cervical radiculopathy. Acute brachial plexus neuritis is an uncommon disorder characterized by severe shoulder and upper arm pain followed by marked upper arm weakness. The temporal profile of pain preceding weakness is important in establishing a prompt diagnosis and differentiating acute brachial plexus neuritis from cervical radiculopathy. magnetic resonance imaging of the shoulder and upper arm musculature may reveal denervation within days, allowing prompt diagnosis. electromyography, conducted three to four weeks after the onset of symptoms, can localize the lesion and help confirm the diagnosis. Treatment includes analgesics and physical therapy, with resolution of symptoms usually occurring in three to four months. patients with cervical radiculopathy present with simultaneous pain and neurologic deficits that fit a nerve root pattern. This differentiation is important to avoid unnecessary surgery for cervical spondylotic changes in a patient with a plexitis.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
3/18. Management of a patient with post-polio syndrome.PURPOSE: To describe the current understanding of the management of patients with post-polio syndrome (PPS) and relate the research to a case study. DATA SOURCES: Standard neurology textbooks, current review and research articles, and a case study. CONCLUSIONS: More than 15 years following a diagnosis of poliomyelitis, a new onset of weakness, fatigue, joint pain, decreased endurance, muscle atrophy, gait disturbance, respiratory and swallowing problems, cold intolerance, and difficulties with activities of daily living might indicate a neurologic disorder called PPS. IMPLICATIONS FOR PRACTICE: Non-post-polio causes of weakness, fatigue or pain must be excluded before making a diagnosis of PPS. Approaches to management vary depending on the symptoms and level of disability. Reducing physical and emotional stress, energy conservation, adequate rest, modification of work and home environments, joint protection, and the use of orthoses, adaptive equipment, or mobility aids can reduce fatigue and preserve function.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
4/18. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome.Droopy shoulder has been proposed as a cause of thoracic outlet syndrome. Two patients developed manifestations of neurovascular compression upon arm abduction, associated with unilateral droopy shoulder and trapezius muscle weakness caused by iatrogenic spinal accessory neuropathies following cervical lymph node biopsies. The first patient developed a cold, numb hand with complete axillary artery occlusion when his arm was abducted to 90 degrees. The second patient complained of paresthesias in digits 4 and 5 of the right hand, worsened by elevation of the arm, with nerve conduction findings of right lower trunk plexopathy (low ulnar and medial antebrachial cutaneous sensory nerve action potentials). Spinal accessory nerve grafting (in the first patient) coupled with shoulder strengthening physical exercises in both patients resulted in gradual improvement of symptoms in 2 years. These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
5/18. Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis.In rehabilitation for hemiparesis, one of the goals of an occupational therapist is to practice upper extremity tasks with the recovering individual. The practice is intended to strengthen muscles and refine movements. It also provides examples for the recovering body and brain as they attempt to reestablish the now delicate cognitive and neural connections mediating voluntary behavior. However, the paresis significantly limits the movement sequence possibilities that may be physically practiced. We outline a method for using simulation of movement, which is intended to provide a means for experiencing a range of smooth and controlled movements completed by a paretic limb. The simulation provides a compelling perceptual experience of bilateral motion beyond the current capabilities of the affected limb. The benefits of this technique after a 3-week course of the simulation practice are exemplified by the presented case study that reveals improved function as demonstrated by increases in Fugl-Meyer scores and faster movement speeds as demonstrated by decreased movement times for the Jebsen test of hand function.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
6/18. Bilateral suprascapular nerve entrapment.Bilateral suprascapular nerve entrapment syndrome is very rare. It presents with shoulder pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. We present a twenty-year old man having a history of bilateral shoulder pain associated with weakness. Electromyographic studies revealed signs of a lesion that caused a neupraxic state of the left suprascapular nerve, moderate axonal loss of the right suprascapular nerve and denervation of the right suprascapular muscle. The patient was treated with physical and medical therapy. Due to worsening of the symptoms, a surgical operation was performed by the excision of the transverse scapular ligaments bilaterally. His pain, weakness and atrophy had diminished on examination six weeks later. Suprascapular nerve entrapment should be considered in patients with shoulder pain, particularly those with weakness and atrophy of the supraspinatus and infraspinatus muscles.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
7/18. Episodic ataxia type 1 with distal weakness: a novel manifestation of a potassium channelopathy.Episodic ataxia type1 (EA1) is an autosomal dominant disorder characterised by episodes of ataxia, dysarthria, tremor and visual disturbances lasting for seconds or minutes, precipitated by physical and emotional stress, startle or sudden movements. In addition there is continuous myokymia. Phenotypic variants such as the combination with epilepsy, shortening of the achilles tendon in children, transient postural abnormalities in infancy, and a very few patients with longer lasting episodes have been reported. We describe a 10-year-old girl with EA1 who has distal weakness with paresis of the extensors of the feet and prolonged spells of limb stiffness (neuromyotonia) lasting up to 12 hours. A novel single nucleotide change at position 785 T > C that alters a highly conserved residue in the third transmembrane segment of the voltage-gated potassium channel Kv1.1 was found.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
8/18. rehabilitation for postpolio sequelae.BACKGROUND: Postpolio sequelae (PPS) are new, late manifestations that occur many years after the initial poliomyelitis infection. recurrence of symptoms and fear of reactivation of the polio virus is particularly distressing to polio survivors. OBJECTIVE: This article outlines the diagnosis, pathophysiology, and management of PPS disabilities using a case vignette. DISCUSSION: Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. diagnosis can be complicated particularly in nonparalytic cases of poliomyelitis. Disabilities in PPS may not be obvious to the observer but significantly affect the quality of life of the PPS patient. Previous rehabilitation intervention focussed on physical effort and determination to overcome disability at all costs. The treatment in PPS is now modified, and aggressive physical measures that may exacerbate muscle weakness are avoided. Most disabilities in PPS can be well managed with rehabilitation interventions that address limitations in patient activities of daily living, mobility and cardiopulmonary fitness.- - - - - - - - - - ranking = 0.24085509856486keywords = physical (Clic here for more details about this article) |
9/18. Pediatric physical functioning reference curves.We developed normative profiles of physical functioning (mobility and self-care) in infancy up through 14 years of age with an expanded version of the Pediatric Evaluation of Disability Inventory. Mobility and self-care reference curves were based on the original Pediatric Evaluation of Disability Inventory standardization data (n = 412) and data from an additional cross-sectional, convenience sample (n = 373) via web-based survey, telephone or in-person interviews of parents. This new sample, which included children up through 14 years-of-age, was stratified for race, age, and sex, but was primarily limited geographically to the Northeast region of the united states. Goodness of fit of male, female, and combined sex (male and female) reference curves was examined. The mobility and self-care reference curves produced efficient and well-fitting estimates of conventional percentiles (3rd, 10th, 25th, 50th, 75th, 97th). Differences between males' and females' reference curves were negligible. This study highlights the use of these reference curves for determining the functional impact of Pompe disease, a lysosomal storage disorder that affects skeletal and cardiac muscle, restricting normal expression of mobility and self-care activities. This physical functioning instrument could also be used to evaluate the impact of muscle weakness in other neuromuscular disorders.- - - - - - - - - - ranking = 0.72256529569457keywords = physical (Clic here for more details about this article) |
10/18. Eosinophilic perimyositis as the presenting feature of a monoclonal T-cell expansion.A 51-year-old physically active man was investigated for exertional myalgias and muscle stiffness. On examination he had mild proximal muscle weakness of the upper extremities and retraction of the digit flexors. blood eosinophilia was present, but serum creatine kinase (CK) levels and an electromyographic study were normal. A skin-fascia-muscle biopsy of the calf revealed a macrophagic and CD4 T-cell infiltration of the perimysium, and a T-cell expansion was observed in blood, bone marrow, and muscle. A diagnosis of eosinophilic perimyositis was made, and prednisone and azathioprine were administrated with a good clinical response. This case highlights the differential diagnosis of blood eosinophilia with muscle disorders, and underscores that eosinophilic perimyositis may be the expression of a T-cell monoclonal expansion. Although the pathogenesis behind the T-cell expansion is unclear but probably inflammatory, we suggest regular follow-up to allow early treatment of any T-cell lymphoproliferative malignancy that may develop.- - - - - - - - - - ranking = 0.12042754928243keywords = physical (Clic here for more details about this article) |
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