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Biomedical subjects

R V Kanakamedala

Publications and source records attributed to R V Kanakamedala.

7 recordsLinked to original sources
PubMed1996

Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation.

OBJECTIVE: To compare the effects of splinting alone in the treatment of ulnar nerve lesion at the elbow with the effects of applying a local steroid injection in addition to splinting. DESIGN: Twelve nerves of 10 patients were randomly assigned into two groups: 5 nerves in Group A were treated with elbow splinting only; 7 nerves in Group B were treated with local steroid injection in addition to splinting. Therapeutic effects were assessed 1 and 6 months after treatment. SETTING: Patients were selected from an outpatient clinic of a VA Medical Center. PATIENTS: Ten patients (12 nerves) with ulnar neuropathy at the elbow confirmed by electrodiagnostic tests. INTERVENTIONS: Elbow splint was given to patients of both Groups A and B. A single dose of 40 mg triamcinolone plus 1 mL of 1% lidocaine was injected around the ulnar nerve at the elbow of Group A patients. MAIN OUTCOME MEASURES: Clinical evaluation of symptoms and signs, and ulnar motor and sensory nerve conduction studies were performed before, 1 month after, and 6 months after treatment. RESULTS: There was significant improvement in symptoms in both groups at 1 and 6 months after treatment. Ulnar motor nerve conduction velocity across the elbow improved at 1 month in Group A only, but showed improvement at 6 months in both groups. There was no significant change in the other parameters either at 1 or 6 months in both groups. In comparing the differences between Groups A and B regarding the changes at 1 or 6 months after treatment, there was no significant difference between the two groups in all parameters. CONCLUSIONS: Splint application alone is adequate to improve the symptoms and ulnar nerve conduction across the elbow. The addition of a steroid injection did not provide further benefit in the treatment of cubital tunnel syndrome.

Adult↗
PubMed1991

Conduction of the dorsal digital branches of the radial nerve to the long finger.

Orthodromic conduction of the radial nerve digital branches to the third digit from the anatomic snuffbox has rarely been described. This paper describes a technique for measuring conduction of the lateral and medial digital branches of the radial nerve to the third digit at a distance of 10cm from the base of the digit to the anatomic snuffbox. An evoked response from the lateral digital branch was recorded in each of the 56 nerves tested. Responses had an average latency of 2.10 +/- .18msec. Responses from the medial digital branches of the nerve were obtained in only 55% of the 49 nerves tested. Responses had an average latency of 2.11 +/- .21msec. When no appreciable response was recorded at the anatomic snuffbox from the medial digital branch, a response was recorded from the ulnar nerve at the volar wrist at 14cm.

Action Potentials↗
PubMed1989

Peroneal nerve entrapment at the knee localized by short segment stimulation.

The purpose of this study was to evaluate the usefulness of short segment stimulation (SSS) of the peroneal nerve at the knee in order to localize the site of compression and/or entrapment of the nerve. Eighteen patients with suspected peroneal nerve palsy and 28 controls were studied by SSS of the peroneal nerve across the knee. Compound muscle action potentials (CMAPs) were obtained from the extensor digitorum brevis muscle after successive supramaximal stimuli of the nerve at 2 cm intervals, starting 4 cm distal (D4 and D2) and ending 6 cm proximal (P2, P4, and P6) to the fibular head prominence (P). In patients the average conduction times from D2 to P, P to P2, and P2 to P4 were significantly (P less than 0.05) longer and the average amplitude of CMAPs at P, P2, P4, and P6 significantly (P less than 0.05) lower than those of controls. Fourteen patients showed statistically significant reduction in amplitude and prolongation of conduction time in one or more short segments. Three patients had prolongation of conduction time only and one patient had reduction in amplitude only. When nerve conduction of the entire 10-cm segment across the knee was tested by the conventional method, only nine showed reduction in amplitude from proximal stimulation, or slowing of motor conduction velocity across the 10-cm segment or both. It was concluded that the SSS technique is a sensitive and reliable procedure for the detection of mild compression or entrapment of the peroneal nerve around the knee.

Action Potentials↗
PubMed1988

Ulnar nerve entrapment at the elbow localized by short segment stimulation.

The purpose of the study was to evaluate the differences in the amplitudes of the compound muscle action potentials of the hypothenar muscles and the differences in conduction times. Differences in shoot segment responses were determined by stimulating the ulnar nerve at 2-cm intervals across the elbow in 20 normal adults. Thirteen ulnar nerves on the left side and 12 nerves on the right of 14 men and six women were studied for motor nerve conduction velocity. The amplitudes of the hypothenar compound muscle action potentials and the conduction times after supramaximal stimulation of the ulnar nerve were also determined. The distal-to-proximal reduction in the amplitude of the potentials was 6% on the left and 4.2% on the right. The maximum conduction time in a 2-cm segment on the right side was 0.63msec (mean +2SD = 0.43 + 0.20) and on the left, 0.60msec (mean +2SD = 0.44 + 0.16). Using the same short segment stimulation technique, ulnar nerve motor conduction was also studied in 13 patients with suspected ulnar neuropathy at the elbow in order to localize the nerve lesion. Conduction time only was abnormal in one patient, both conduction time and amplitude in nine, amplitude only in one, and conduction time and mild reduction in amplitude in two. It was concluded that short segment stimulation of the ulnar nerve at the elbow is useful in localizing the exact site of entrapment/compression of the nerve at the elbow.

Adult↗
PubMed1988

Neurogenic true hypertrophy of one calf and atrophy of the other.

Unilateral calf hypertrophy has been described in association with a variety of conditions. Bilateral neurogenic leg weakness with muscle wasting on one side and true hypertrophy on the other, however, has rarely been described. We report a 37-year-old heroin and alcohol abuser with a three-year history of weakness of the left leg and progressive enlargement of the right calf. Computed tomography of the right calf confirmed the presence of true hypertrophy. Electromyography showed denervation in the muscles of both legs. Nerve conduction studies were indicative of peripheral neuropathy. Biopsy of the gastrocnemius muscles revealed the presence of neurogenic atrophy on both sides, with marked hypertrophy and splitting of individual muscle fibers on the right. To our knowledge, this is only the second recorded case showing both muscle atrophy and muscle hypertrophy in response to denervation.

Adult↗
PubMed1988

Electrophysiologic studies of the median nerve and its palmar cutaneous branches after nerve grafting.

Electromyography (EMG) and nerve conduction studies were performed on a patient with an incomplete lesion of the median nerve involving the motor fibers to the thenar muscles, the palmar cutaneous branches, and the sensory fibers to the index finger. The studies were done before, and 13 weeks, 16 weeks, and one year after grafting. The preoperative electrodiagnostic evaluation showed abnormalities involving the median motor fibers and the palmar cutaneous branch. Electromyography of the opponens pollicis and abductor pollicis brevis before surgery showed severe active denervation. Thirteen weeks after nerve grafting, the median motor distal latency was prolonged and the amplitude of the evoked potential of the median motor and index finger digital sensory nerves were decreased. At 16 weeks, both the latency and amplitude showed improvement, as did EMG of the affected muscles. One year later, the electrophysiologic findings were normal except for a slightly prolonged median motor distal latency. Clinical and functional improvement after grafting correlated well with the electrophysiologic findings. We conclude that EMG and nerve conduction studies are useful tools for following the progression of recovery after nerve grafting.

Action Potentials↗