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KMID : 0361619730080020113
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Journal of the Korean Orthopaedic Association
1973 Volume.8 No. 2 p.113 ~ p.121
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Electrodiagnostic Studies of Peripheral nerve Injuries in the Extremities
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鄭淳萬/Chung, Soon Mhan
文亨南/申廷淳/Moon, Hyung Nam/Shin, Jung Soon
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Abstract
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Thirty cases of peripheral nerve injury were selected and analysed by means of electromyographic studies at Severance Hospital, Yonsei University, from January 1972 to August 1972.
1. The sex ratio was 17:13 (male: female). The peak incidence occurred in the twenty to thirty year age group. Involved side: right side 18 cases: left side 12 cases.
2. Nervc involved: peroneal nerve (15 cases), tibial nerve (2 cases), median nerve (7 cases), ulnar nerve (4 cases) and radial nerve (2 case).
3. Mode of nerve injuries
1) Peroneal nerve:
Nerve compression, variable (10 cases)
Tibia &fibular fracture complication (4 cases)
Stab wound, fibular neck region (1 case)
2) Tibial nerve
Injection neuritis, buttock (2 cases)
3) Median nerve:
Cut glass laceration, wrist region (3 cases)
Carpal tunnel syndrome (3 cases)
Undetermined mode (1 case)
4) Ulnar nerve:
Cut glass laceration, wrst region (2 cases)
Forearm bones fracture complication (1 case)
Supracondylar fracture (cubitus valgus) (1 case)
5) Radial nerve:
Cut glass laceration, wrist region (1 case)
Crushing injury, elbow region (1 .case)
4 Among the 15 cases of peroneal nerve injury, there were 10 cases of partial denervation and 5 cases of complete denervation.
5. The mode of injury in 10 cases of partial denervation was nerve compression from the following . causes: lithotomy posture during forceps delivery (1 case), external rotation of legs during recovery state after surgery (3 cases), abnormal posture during coma state after CO intoxication (2 cases), tight long leg cast t3 cam), and direct trauma while descending stairs (1 case).
6. In all 10 cases of partial denervation of the peroneal nerve, decreased motor nerve conduction velocities, diminished amplitude and prolonged latencies were observed.
7. In partial denervation of the peroneal nerve, the earliest that reinnervation was observed was within 3 weeks in 3 out of 10 cases.
8. Spontaneous fibrillation was observed 3 weeks after injury in all cases except one in which it was observed only 7 days after peroneal nerve injury.
9. The earliest appearance of positive sharp waves among all peroneal nerve injuries was observed 2 weeks after injury.
10. The initial appearance of nascent potentials (polyphasic potentials) in peroneal nerve injuries was observed 3 weeks after injury (1 case), 5 weeks after injury (1 case), and 5 months after injury C1 casej. They are all partial denervation cases due to nerve compression.
11. Ten cases of partial denervation of the peroneal nerve were treated with electrical stimulation and drop foot board with good recovery. Five cases of complete denervation of the peroneal nerve were treated with neurorrhaphy (1 case) and short leg bracing (4 cases).
12. The initial appearance, of polyphasic potentials was observed 5 months after injury in one case out of 3 cases of median nerve injury.
13. Three cases of median nerve injury were classified as carpal tunnel syndrome and occurred in women only. Observations included absence of sensory nerve action potentials below the lesion, delayed distal latency at wrist and normal motor nerve conduction velocity. They were treated by division of the deep transverse carpal ligament with good result.
14. The initial appearance of nascent potentials was observed 7 months after injury in one case among 3 cases of ulnar nerve injury.
15. In two cases each of radial and tibial nerve injury, no reinnervation pattern was observed until the six month follow-up study after injury. At that time no muscle contraction could be seen or palpated clinically.
16. We observed normal motor unit potentials in the muscles in the follow-up studies even though muscle contraction could not be seen or palpated clinically.
17. Electromyographic examination at selected intervals made accurate diagnosis and prognosis possible and aided in evaluating the course of nerve regeneration, which permictted the choice of appropriate treatment.
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