Informazioni
Non ci sono recensioni
Punto di Riferimento
per Medici e Operatori Sanitari
per Medici e Operatori Sanitari
LIBRERIA STUDIUM
Functional Electromyography
Fishman, Wilkins
Editore
Springer
Anno
2011
Pagine
171
ISBN
9781607610205
140,00 €
- Introduces provocative maneuvers to widen the scope of application and sharpen the diagnostic acuity of electrodiagnostic stuides
- Presents three well-documented examples of functional EMG
- Suggests a safe and scientific method for determining other functional maneuvers of value to the electromyographer
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.
Contents
1 Electricity in Medicine: Philosophy Meets Physiology . . . . . . . . 1
Electricity and Medicine Grew Up Together . . . . . . . . . . . . . . 2
Electricity Through History: Minerals . . . . . . . . . . . . . . . . 2
TheBible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Electrophysiology Through History: Animals . . . . . . . . . . . . 3
Evidence of Electricity Through History: Beginning to Understand . 4
AnimalElectricityControversy . . . . . . . . . . . . . . . . . . . . 6
Technological Advances in Medicine . . . . . . . . . . . . . . . . . . 10
EMG Specific Advances . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2 Electrodiagnosis and the Physical Examination: Casting
a Fine Net Widely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Summary of the First Chapter and Perspective on the Next . . . . . . . 23
Relevance to Our Subject . . . . . . . . . . . . . . . . . . . . . . . . 24
ThePhysicalExamination IsNot JustPhysical . . . . . . . . . . . . . 26
“You Can Observe a Lot Just by Looking.”—Yogi Berra . . . . . . . . 26
ItTakesTwo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Proposed Provocative Maneuvers in Electrodiagnosis . . . . . . . . . 30
Philosophical Reflection of the Yet Unseen . . . . . . . . . . . . . . . 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3 Dynamic Electrodiagnosis: Provocative/Evocative
Maneuvers Define Diagnoses of Exclusion and Refine Dual
Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
The Fallacy Inherent in a “Diagnosis of Exclusion” . . . . . . . . . . . 33
Thoracic Outlet Syndrome . . . . . . . . . . . . . . . . . . . . . . . . 37
Piriformis Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Lumbar Spinal Stenosis Versus Herniated Disc . . . . . . . . . . . . . 43
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4 Neurological Thoracic Outlet Syndrome: Approaching
a Pathognomonic Sign . . . . . . . . . . . . . . . . . . . . . . . . . 47
Functional Identification of Thoracic Outlet Syndrome . . . . . . . . . 47
Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
xiii
xiv Contents
Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Standard Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
ANewTest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
IntheClinicalContext:Solving thePatient’sProblem . . . . . . . . . 55
GrownGirlwithGuitar . . . . . . . . . . . . . . . . . . . . . . . . . 56
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
5 Treating Neurological Thoracic Outlet Syndrome Identified
by a Provoked Electromyographic Sign: Analysis of the Data . . . 65
Treatment of Thoracic Outlet Syndrome Based on Dynamic
Changes in Nerve Conduction . . . . . . . . . . . . . . . . . . . . . . 65
What IsBotulinumNeurotoxinTypeB? . . . . . . . . . . . . . . . . 66
Injection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
PhysicalTherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Scheduled Follow-Up Visits . . . . . . . . . . . . . . . . . . . . . . . 69
Analysis of theData . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Results of Scalenus Injections and Physical Therapy . . . . . . . . . . 70
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
6 Piriformis Syndrome: Electrophysiology vs.
Anatomical Assumption . . . . . . . . . . . . . . . . . . . . . . . . 77
Can Piriformis Syndrome Be Operationally Defined? . . . . . . . . . . 77
Gardenpathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Some Cadaveric Studies of Anomalous Sciatic-Piriformis
Intersection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
TheAnatomyClose-Up . . . . . . . . . . . . . . . . . . . . . . . . . 83
Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Electrophysiological Suggestion of Piriformis Syndrome . . . . . . . . 85
MixofClinical andElectrophysiologicalFindings . . . . . . . . . . . 86
Functional Confirmation: Electrophysiological Evidence
of Piriformis Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . 86
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Technical Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Measurement ofDelay:TheHLoop . . . . . . . . . . . . . . . . . . 89
Discrepancy Between Motor and Sensory Nerve
Conduction Velocity . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
7 Treating Piriformis Syndrome Identified by a Provoked
Electromyographic Sign: Analysis of the Data . . . . . . . . . . . . 95
Treatment of Piriformis Syndrome Patients Identified
by Functional EMG . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Contents xv
OutcomeStatisticsof the 1,014LegStudy . . . . . . . . . . . . . . . 97
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Physical Therapy for Piriformis Syndrome∗ . . . . . . . . . . . . . . . 98
How Does Dual Diagnosis Affect Treatment? . . . . . . . . . . . . . . 100
Tabulation ofResults . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Characteristics ofPatientswithPositiveFAIRTests . . . . . . . . . 100
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Surgical Corroboration of the FAIR Test . . . . . . . . . . . . . . . . 103
Locating thePiriformisMuscle . . . . . . . . . . . . . . . . . . . . . 107
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
8 Radiculopathy vs. Spinal Stenosis: Evocative
Electrodiagnosis Identifies the Main Pain Generator . . . . . . . . 111
Intraspinal Stenosis vs. Foraminal Stenosis . . . . . . . . . . . . . . . 111
Strategies and Methods . . . . . . . . . . . . . . . . . . . . . . . . . 112
Spondylolisthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
IsThis InformationUseful? . . . . . . . . . . . . . . . . . . . . . . . 119
Discussion of the Procedure . . . . . . . . . . . . . . . . . . . . . . . 120
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
9 Treating Spinal Stenosis Identified by an Evoked
Electromyographic Sign: Analysis of the Data . . . . . . . . . . . . 129
IllustrativeExamples . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
TheTale of theHorse’sTail . . . . . . . . . . . . . . . . . . . . . . . 129
Stenosis or Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . 130
Fusion andConfusion . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Evocative Maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Aye,Where’s theRub? . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Recreational Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 133
If It Walks Like a Duck. . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Small Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
When Therapy Is Not Enough . . . . . . . . . . . . . . . . . . . . . . 136
Less Was Probably More . . . . . . . . . . . . . . . . . . . . . . . . 136
A Long Shot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Embarrassment of Riches . . . . . . . . . . . . . . . . . . . . . . . . 138
LessThereThanMet theMRI . . . . . . . . . . . . . . . . . . . . . . 139
NowYouSee It,NowYouDon’t,Oh,There It IsAgain . . . . . . . . 140
ExPluribusUnum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Simple Solutions When There Were Too Many Diagnoses . . . . . . 141
Asymmetrical onBothSides . . . . . . . . . . . . . . . . . . . . . . 141
A Long-Standing Problem with Sitting . . . . . . . . . . . . . . . . . 141
LessThereThanMeets theMRI . . . . . . . . . . . . . . . . . . . . 142
TheWomanwithEverything . . . . . . . . . . . . . . . . . . . . . . 142
HeWhoHesitatesWasRight . . . . . . . . . . . . . . . . . . . . . . 143
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
xvi Contents
10 Extending Dynamic Electrodiagnosis: Application to
Common and Uncommon Conditions . . . . . . . . . . . . . . . . . 145
Other Uses of Functional Electromyography . . . . . . . . . . . . . . 145
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Memoirs of a Snapping Scapula . . . . . . . . . . . . . . . . . . . . . 147
Triple Trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Acting on a Hunch . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Right toBareArms . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
IroningwithaWrinkle . . . . . . . . . . . . . . . . . . . . . . . . . . 152
TakingMatters toExtremes . . . . . . . . . . . . . . . . . . . . . . . 152
It’sNotAll intheWrist! . . . . . . . . . . . . . . . . . . . . . . . . . 153
Driving for aStretch . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
ExclusiveConsiderations . . . . . . . . . . . . . . . . . . . . . . . . 154
ATurn for theWorse . . . . . . . . . . . . . . . . . . . . . . . . . . 155
WhoIfNotWe? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
TheTools of theTrade . . . . . . . . . . . . . . . . . . . . . . . . . . 159
This Book As a Provocative/Evocative Maneuver . . . . . . . . . . . . 162
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
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