Functional Electromyography (eBook)

Provocative Maneuvers in Electrodiagnosis

Loren M. Fishman, Allen N Wilkins (Autoren)

eBook Download: PDF

2010 | 2011
XVI, 171 Seiten
Springer US (Verlag)
978-1-60761-020-5 (ISBN)

Infos

Functional Electromyography: Provocative Maneuvers in Electrodiagnosis integrates electrophysiology further into the physical examination than ever before. It introduces the use of electrodiagnostic studies to quantify the neurological changes brought about by three provocative maneuvers commonly used in contemporary medicine. This widens the scope of electromyography while sharpening physicians' diagnostic acuity. The book presents nerve conduction velocity (NCV) and H-reflex techniques to identify common conditions that are difficult to diagnose by any other means, often using the needle exam (EMG), MRI or musculoskeletal ultrasound to verify their clinical utility. Functional electromyography successfully diagnoses some cases of thoracic outlet syndrome, nearly all cases of piriformis syndrome, and offers a method for determining whether spinal stenosis or radiculopathy is the main pain generator when both are present in a single patient, even at the same level. This is particularly valuable because the standard conservative and surgical treatments for these two conditions are opposite, in spite of the identical symptom-set they produce. The book carefully describes each technique and persuasively documents their validity in statistical series and individual case presentations. It further guides the attentive electromyographer to adapt these methods to cases beyond those presented in its pages, suggesting a safe and scientific approach to other functional maneuvers of value to the electromyographer, and methods for validating one-time measures that may aid the electromyographer in clinical situations that are neither common nor easily analyzed. Hand drawn illustrations are included alongside text developed by experts in the field. An invaluable resource for physiatrists, neurologists, orthopedic surgeons, specialists in pain management and other providers, Functional Electromyography: Provocative Maneuvers in Electrodiagnosis represents a major contribution to the field of electrodiagnosis.

Inhalt

Acknowledgment 7
Preface 8
Contents 9
1 Electricity in Medicine: Philosophy Meets Physiology 13
Electricity and Medicine Grew Up Together 14
Electricity Through History: Minerals 14
Neanderthals 14
The Bible 14
Electrophysiology Through History: Animals 15
The Electric Fish 15
Evidence of Electricity Through History: Beginning to Understand 16
Animal Electricity Controversy 18
Technological Advances in Medicine 22
EMG Specific Advances 31
References 33
2 Electrodiagnosis and the Physical Examination: Casting a Fine Net Widely 34
Summary of the First Chapter and Perspective on the Next 34
Relevance to Our Subject 35
The Physical Examination Is Not Just Physical 37
You Can Observe a Lot Just by Looking. Yogi Berra 37
It Takes Two 37
Proposed Provocative Maneuvers in Electrodiagnosis 41
Philosophical Reflection of the Yet Unseen 41
References 43
3 Dynamic Electrodiagnosis: Provocative/Evocative Maneuvers Define Diagnoses of Exclusion and Refine Dual Diagnoses 44
The Fallacy Inherent in a Diagnosis of Exclusion 44
Thoracic Outlet Syndrome 48
Piriformis Syndrome 50
Lumbar Spinal Stenosis Versus Herniated Disc 54
References 55
4 Neurological Thoracic Outlet Syndrome: Approaching a Pathognomonic Sign 57
Functional Identification of Thoracic Outlet Syndrome 57
Symptoms 58
Signs 58
Standard Test 63
Treatment 64
A New Test 64
In the Clinical Context: Solving the Patients Problem 65
Grown Girl with Guitar 66
References 72
5 Treating Neurological Thoracic Outlet Syndrome Identified by a Provoked Electromyographic Sign: Analysis of the Data 74
Treatment of Thoracic Outlet Syndrome Based on Dynamic Changes in Nerve Conduction 74
What Is Botulinum Neurotoxin Type B 75
Injection 76
Physical Therapy 77
Scheduled Follow-Up Visits 78
Analysis of the Data 78
Results 78
Results of Scalenus Injections and Physical Therapy 79
References 84
6 Piriformis Syndrome: Electrophysiology vs. Anatomical Assumption 85
Can Piriformis Syndrome Be Operationally Defined 85
Gardenpathogenesis 90
Some Cadaveric Studies of Anomalous Sciatic-Piriformis Intersection 91
The Anatomy Close-Up 91
Symptoms 92
Signs 93
Electrophysiological Suggestion of Piriformis Syndrome 93
Mix of Clinical and Electrophysiological Findings 94
Functional Confirmation: Electrophysiological Evidence of Piriformis Syndrome 94
Technique 95
Technical Metrics 96
Measurement of Delay: The H Loop 97
Discrepancy Between Motor and Sensory Nerve Conduction Velocity 97
Results 99
References 101
7 Treating Piriformis Syndrome Identified by a Provoked Electromyographic Sign: Analysis of the Data 102
Treatment of Piriformis Syndrome Patients Identified by Functional EMG 102
Outcome Statistics of the 1,014 Leg Study 104
Treatment 104
Physical Therapy for Piriformis Syndrome 105
How Does Dual Diagnosis Affect Treatment 107
Tabulation of Results 107
Characteristics of Patients with Positive FAIR Tests 107
Results 108
Surgical Corroboration of the FAIR Test 110
Locating the Piriformis Muscle 114
Summary 115
References 116
8 Radiculopathy vs. Spinal Stenosis: Evocative Electrodiagnosis Identifies the Main Pain Generator 117
Intraspinal Stenosis vs. Foraminal Stenosis 117
Strategies and Methods 118
Spondylolisthesis 123
Is This Information Useful 125
Discussion of the Procedure 126
References 133
9 Treating Spinal Stenosis Identified by an Evoked Electromyographic Sign: Analysis of the Data 134
Illustrative Examples 134
The Tale of the Horses Tail 134
Stenosis or Thrombosis 135
Fusion and Confusion 136
Evocative Maneuver 136
Aye, Wheres the Rub 137
Recreational Therapy 138
If It Walks Like a Duck 139
Small Change 140
When Therapy Is Not Enough 141
Less Was Probably More 141
A Long Shot 142
Embarrassment of Riches 143
Less There Than Met the MRI 144
Now You See It, Now You Dont, Oh, There It Is Again 145
Ex Pluribus Unum 146
Simple Solutions When There Were Too Many Diagnoses 146
Asymmetrical on Both Sides 146
A Long-Standing Problem with Sitting 146
Less There Than Meets the MRI 147
The Woman with Everything 147
He Who Hesitates Was Right 148
Reference 149
10 Extending Dynamic Electrodiagnosis: Application to Common and Uncommon Conditions 150
Other Uses of Functional Electromyography 150
Resources 151
Memoirs of a Snapping Scapula 152
Triple Trouble 155
Acting on a Hunch 156
Right to Bare Arms 156
Ironing with a Wrinkle 157
Taking Matters to Extremes 157
Its Not All in the Wrist 158
Driving for a Stretch 159
Exclusive Considerations 159
A Turn for the Worse 160
Who If Not We 160
Surgery 163
The Tools of the Trade 164
This Book As a Provocative/Evocative Maneuver 167
References 167
Index 168

Produkt-Details

• Erscheint lt. Verlag: 4.11.2010
• Zusatzinfo: XVI, 171 p.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Anästhesie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Orthopädie
• Themenwelt: Medizinische Fachgebiete ► Radiologie / Bildgebende Verfahren ► Radiologie
• ISBN-10: 1-60761-020-5 / 1607610205
• ISBN-13: 978-1-60761-020-5 / 9781607610205