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[Surgical correction of malunited fractures of the forearm in children].

AIM: In our goal-oriented society the demands for a forearm with full function are increasing. Functional deficits are not acceptable even if they persist only for a limited period of time. Therefore a rising number of surgical corrections of malunited forearm fractures in the pediatric patient has been performed during the last years. However literature about indication, technique and outcome in these patients is rare. For that reason we report our experience about surgical correction of malunited fractures of the forearm in 14 children. METHODS: Fourteen patients with an average age of 13 years at the time of surgical correction of a malunited fracture of the forearm were included. Seven had a deformity of the shaft, five at the distal forearm without and two with growth disturbance. Malunions without growth disturbance were corrected with an osteotomy and plate fixation. Those with growth disturbance were first treated with callus distraction. Previous to and 24 (3 to 100) months after surgical correction the patients were examined clinically and radiologically. Range of motion was noted. Additionally to the range of motion, grip strength and pain (VAS) were documented. Patients with correction of the distal forearm were asked to fill out the DASH questionnaire. RESULTS: In all groups a significant increase of the range of motion was noted in pro-/supination of 61 per cent to 85-0-80 degrees. In patients with distal correction additionally the range of motion in extension/flexion of the wrist improved 30 per cent to 70-0-65 degrees and in ulnar/radialduction 22 per cent to 30-0-35 degrees. At follow-up the grip strength following distal corrections was 98 per cent of the opposite side. The patients had no pain (VAS < 3 points). The median subjective functional result was excellent with a median DASH score of 3.5 points. CONCLUSIONS: Our results show that potent techniques for surgical correction of malunited forearm fractures in the growing skeleton are available. These techniques allow excellent functional outcome.

Adolescent↗

[Clinical long-term outcome after Kapandji-Sauvé procedure].

PURPOSE: The present study was designed to evaluate long-term outcome of upper extremities and subjective self-assessment of patient disability after a Kapandji-Sauvé procedure by means of the DASH score. PATIENTS AND METHOD: Between 1986 and 1996, a modified Kapandji-Sauvé procedure was performed in 117 patients with painfully limited forearm rotation and arthrosis of the distal radioulnar joint (DRUJ). Of the 117 patients, 73 women and 32 men, whose ages at operation ranged from 22 to 74 years (average, 58 years) were retrospectively reviewed clinically and radiologically eight years (range, five to twelve years) after the operation. The DASH questionnaire was used in 43 patients. RESULTS: The mean DASH score was 28 points (range, 0 to 53 points). The mean score in part A was 1.9 points, in part B 1.8 points. Worst outcomes were noted for activities requiring the exertion of force. Pain was reduced in 97 % of the patients. Forearm rotation and grip strength improved in all patients. CONCLUSION: Our clinical findings suggest that the Kapandji-Sauvé procedure is indicated in symptomatic, non-reconstructable disorders of the DRU-joint with or without ulnocarpal impaction syndrome. The DASH questionnaire provides a general view of functional outcome after the Kapandji-Sauvé procedure, though rotation is absolutely necessary to evaluate the success of the operation.

Adult↗

Effects of body composition and fat distribution on ventilatory function in adults.

Clinically, gross obesity is associated with disturbances of ventilatory function, but less severe obesity is not generally thought to have a significant effect on ventilatory function. The purpose of this report was to examine cross-sectional data to determine the effects of body composition and fat distribution on ventilatory function in 1235 adults (621 men and 614 women). Forced vital capacity (FVC) was used as a measure of ventilatory function and was adjusted for age, height, smoking, and bronchial symptoms in separate models for men and women. Body fat and fat-free mass were estimated from skinfold-thickness measurements. Adjusted FVC was not significantly associated with body mass or body mass index, but was negatively associated with percentage body fat in men (P = 0.0003) and women (P = 0.043) and positively associated with fat-free mass in men (P = 0.018) and women (P = 0.0001). Handgrip strength was positively associated with adjusted FVC in both sexes (P < 0.02), suggesting that the effect of fat-free mass may be mediated by muscular strength. Adjusted FVC was negatively associated with subscapular-skinfold thickness in both sexes (P < 0.0003) and with waist circumference (P = 0.01) and waist-to-hip ratio (P = 0.03) in men. Previous reports that considered only body mass index or body mass failed to distinguish the opposing effects of fat-free mass and fat mass on FVC.

Adipose Tissue↗

Grasping power by means of functional electrical stimulation in a case of C6 complete tetraplegia.

Grasping power (GP) by means of functional electrical stimulation (FES) was measured in a case of C6 complete tetraplegia. This was compared with GP by means of the dynamic tenodesis effect, the flexor hinge splint and the GP of normal female. Palmar grasp strength by means of FES was approximately 16% of the control group and 2.4 times greater than the flexor hinge splint. Lateral grasp strength by FES was approximately 13% of the control group. Our results suggest that FES is more effective than the flexor hinge splint in increasing the GP of tetraplegic patients, and that a stronger and stable GP, which is not affected by wrist position, makes FES practical for improving activities of daily living (ADL).

Adult↗

Disability and functional assessment in former polio patients with and without postpolio syndrome.

OBJECTIVES: To compare perceived health problems and disability in former polio subjects with postpolio syndrome (PPS) and those without postpolio syndrome (non-PPS), and to evaluate perceived health problems, disability, physical performance, and muscle strength. DESIGN: Cross-sectional survey; partially blinded data collection. SUBJECTS: One hundred three former polio subjects, aged 32 to 60yrs. This volunteer sample came from referrals and patient contacts. Criterion for PPS: new muscle weakness among symptoms. MAIN OUTCOME MEASURES: Nottingham Health Profile (NHP), adapted D-code of the International Classification of Impairments, Disabilities and Handicaps, performance test, and muscle strength assessment. RESULTS: PPS subjects (n = 76) showed higher scores (p < .001) than non-PPS subjects (n = 27) within the NHP categories of physical mobility, energy, and pain. On a 16-item Polio Problems List, 78% of PPS subjects selected fatigue as their major problem, followed by walking outdoors (46%) and climbing stairs (41%). The disabilities of PPS subjects were mainly seen in physical and social functioning. No differences in manually tested strength were found between patient groups. PPS subjects needed significantly more time for the performance test than non-PPS subjects and their perceived exertion was higher. Perceived health problems (NHP-PhysMobility) correlated significantly with physical disability (r = .66), performance-time (r = .54), and muscle strength (r = .38). With linear regression analysis, 54% of the NHP-PhysMobility score could be explained by the performance test (time and exertion), presence of PPS, and muscle strength, whereas strength itself explained only 14% of the NHP-PhysMobility score. CONCLUSIONS: PPS subjects are more prone to fatigue and have more physical mobility problems than non-PPS subjects. In former polio patients, measurements of perceived health problems and performance tests are the most appropriate instruments for functional evaluation.

Activities of Daily Living↗

Creatine monohydrate supplementation enhances high-intensity exercise performance in males and females.

Creatine monohydrate supplementation has been shown to enhance high-intensity exercise performance in some but not all studies. Part of the controversy surrounding the ergogenic effect(s) of creatine monohydrate supplementation may relate to design issues that result in low statistical power. A further question that remains unresolved in the creatine literature is whether or not males and females respond in a similar manner to supplementation. We studied the effect of creatine supplementation upon high intensity exercise performance in 24 subjects (n = 12 males, n = 12 females). Creatine monohydrate (Cr; 5g, 4x/d 3 4d) and placebo (Pl; glucose polymer 3 4d) were provided using a randomized, double-blind crossover design (7 week washout). Outcome measures included: 2 3 30-s anaerobic cycle test, with plasma lactate pre- and post-test; dorsi-flexor: maximal voluntary contraction (MVC), 2-min fatigue test, and electrically stimulated peak and tetanic torque; isokinetic knee extension torque and 1-min ischemic handgrip strength. Significant main effects of Cr treatment included: increased peak and relative peak anaerobic cycling power ( 3.7%; p <. 05), dorsi-flexion MVC torque ( 6.6%; p <.05), and increased lactate ( 20.8%; p <.05) with no gender specific responses. We concluded that short-term Cr supplementation can increase indices of high-intensity exercise performance for both males and females.

Adult↗

Do grip and pinch strength predict neurologic complications in children with spina bifida and hydrocephalus?

BACKGROUND: Neurological complications occur commonly in children with meningomyelocele and can cause significant morbidity and mortality. An earlier study suggested that acute changes in grip and pinch strength could be used to identify individuals at increased risk for developing a neurological complication. OBJECTIVE: To evaluate the use of grip and pinch measurements to screen for neurological problems in children with spina bifida and hydrocephalus. DESIGN: A prospective evaluation of screening tests. PATIENTS: 92 children, born since 1976, who had meningomyelocele and hydrocephalus and were treated at the University of Rochester Medical Center. METHODS: Grip and pinch strength were measured between July, 1991, and June, 2003. RESULTS: Mean grip and pinch strengths were similar to those found in previous studies of children with meningomyelocele; 58 neurological events occurred in 39 (40%) individuals. These included 31 episodes of ventricular shunt failure and 22 symptomatic tethered cord occurrences. Specificity, sensitivity and likelihood ratios were calculated in multiple ways using different criteria for loss of grip or pinch strength and for interval to neurological event. Sensitivities were low (<0.35) and the highest positive likelihood ratio found, using fall in either lateral pinch with 6 months to neurological event, was 2.3. CONCLUSIONS: Despite previous recommendations, grip and pinch measurements were not helpful when used as a routine screening test for neurological dysfunction for children with meningomyelocele and hydrocephalus.

Adolescent↗

Symptomatic, partial union of the hook of the hamate fracture in athletes.

BACKGROUND: Many clinicians believe that after fracture of the hook of the hamate, nonunions are the rule rather than the exception. PURPOSE: To describe a previously unreported condition in which the fractured hook of the hamate unites only along its ulnar column and causes pain similar to that in cases of nonunion. STUDY DESIGN: Retrospective review. METHODS: Eight patients who had sustained a hook of the hamate fracture were identified, on the basis of their persistent pain, as having achieved only partial union. This diagnosis was made despite evidence on computed tomography of healed bone across a significant portion of the fracture. All eight patients underwent subperiosteal excision of the hamulus because of persistent pain. At an average of 4 years after excision, each patient was evaluated by dynamometer grip strength testing and a subjective outcome assessment. RESULTS: All patients were able to return to their preinjury level of sports participation at an average 8 weeks after excision of the hook of the hamate. Grip strength was not adversely affected in any patient. Subjective evaluation of each patient revealed no residual pain. CONCLUSIONS: Chronic or unresolved pain on the ulnar side of the wrist after hook of the hamate fracture can be due to partial union. This condition should be managed no differently from a symptomatic nonunion, with excision of the hook of the hamate and repair of the ligament attachments.

Adult↗

Performance decrement after combined exposure to ionizing radiation and Shigella sonnei.

Ionizing radiation could increase morbidity from common bacterial infections in military personnel on the modern battlefield. The combined effects of a sublethal dose of ionizing radiation and the bacterial diarrheal agent Shigella sonnei on body weight and forelimb grip strength in mice were assessed over a 30-day period. Individually housed B6D2F1 female mice were divided into four groups: control, sham irradiation + gavage with saline vehicle; 3 Gy 60Co gamma radiation at 0.4 Gy/min radiation + saline gavage; sham irradiation + 1.3 x 10(8) colony-forming units (CFUs) S. sonnei via gavage, administered 4 days postirradiation; and the combination of 3 Gy 60Co gamma radiation + 1.3 x 10(8) CFUs S. sonnei. Behavioral tests were conducted 3 days preirradiation and on days 9, 14, and 22 postirradiation. Body weight was significantly reduced in the radiation + Shigella group on days 5 to 10 postirradiation. Forelimb grip strength was reduced for mice in the radiation + Shigella group on days 9 and 14 postirradiation. These data demonstrate that an exposure to gamma radiation in combination with the bacterial agent S. sonnei can lead to a synergistic loss of body weight and degradation in performance.

Animals↗

Dorsal capsulodesis using suture anchors.

Scapholunate instability can be treated by stabilizing the scaphoid with the dorsal wrist capsule, which acts as a tether to control palmar rotation. We began using suture anchors instead of pull-out wires to secure the dorsal capsule to the scaphoid. Thirty-eight patients were treated with this method, and 35 were followed an average of 24 months. Sixteen were pain free, 12 had pain with activity, and 7 required additional surgical treatment. Patients regained 85% of expected grip strength, with 25 of the 35 returning to their preinjury job. The scapholunate gap, reduced at the time of surgery, recurred in 31 of the 35 patients, but this alone did not correlate with symptoms. This procedure improves symptoms in a majority of patients, but like other procedures described for scapholunate instability, it does not completely cure the problem.

Adult↗

Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group.

OBJECTIVE: To evaluate the efficacy of an oral nonsteroidal anti-inflammatory drug in the treatment of lateral epicondylitis. DESIGN: Multicenter double-blind randomized controlled trial in which the following hypothesis was tested: whether diclofenac sodium provided a 20% or greater improvement over rest and cast immobilization in the response rate to treatment of lateral epicondylitis beyond and over rest in an experimental group compared with a control group after 4 weeks of treatment. SETTING: Recruitment from urban general practices and referrals to 4 university hospitals. SUBJECTS AND METHODS: During a 1-year period, 206 subjects aged 18 to 60 years with lateral epicondylitis were recruited from the clientele treated by family physicians. Thirty subjects refused to participate and 47 presented with exclusion criteria, leaving 129 subjects who entered the study. One subject withdrew after 21 days. INTERVENTIONS: The experimental group was treated with a daily dose of diclofenac sodium (150 mg) for 28 days, while the control group received a placebo during the same period. In addition, both groups were immobilized in a cast for 14 days and were told not to perform repetitive movements of the involved limb for 21 days. MAIN OUTCOME MEASURES: Measuring instruments consisted of grip strength measurements with a squeeze dynamometer, a visual analog pain scale, a visual analog function scale, and an 8-item pain-free function index. RESULTS: A statistically and clinically significant reduction of pain was associated with treatment with diclofenac, but no clinically significant difference in grip strength or functional improvement could be detected between the 2 groups. Secondary effects (diarrhea and abdominal pain) were significantly more frequent in the diclofenac-treated group. CONCLUSION: Taking into account the limited improvement noted over rest and cast immobilization and the number of associated adverse events, it is difficult to recommend the use of diclofenac in the treatment of lateral epicondylitis at the dosage used in this study.

Adult↗

Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY study.

INTRODUCTION: Vitamin D status is considered as an important determinant of bone health but supplementation trials with vitamin D(3) have yielded conflicting results. The aim of this study was to investigate the associations between serum 25-hydroxyvitamin D (25-OH D), bone turnover markers, bone mineral density (BMD), radius bone loss and incidence of fracture in postmenopausal women. METHODS: 669 postmenopausal women (mean age: 62.2 years) belonging to a population-based cohort were followed prospectively for a median of 11.2 years. At baseline, 25-OH D levels, BMD, bone turnover markers and clinical risk factors of osteoporosis were assessed. BMD loss at the radius was estimated by annual measurements of BMD and all incident fractures which occurred in 134 women were confirmed by radiographs. RESULTS: 73% and 35% of women had serum 25-OH D levels below 75 and 50 nmol/l which correspond respectively to the median and lowest optimal values recently proposed for fracture prevention. 11% of women had levels below 30 nmol/l. Serum 25-OH D correlated modestly with intact PTH (r(2)=0.023, p<0.0001), but not with bone turnover markers or BMD at the hip and radius after adjustment for age. When levels of 25-OH D were considered as a continuous variable, there was no significant association between 25-OH D levels and radius BMD loss or fracture risk. After adjustment for age, there was no significant difference in incidence of fracture, BMD, radius BMD loss, bone turnover markers, grip strength and the percentage of fallers in the previous year between women with 25-OH D levels below or above 75, 50 or 30 nmol/l. CONCLUSIONS: In a population of home-dwelling healthy postmenopausal women with few of them with severe vitamin D deficiency, vitamin D status may not be an important determinant of bone health.

Absorptiometry, Photon↗

Restoration of metacarpophalangeal extension of the thumb in inflammatory arthritis.

Nine patients (11 cases) with inflammatory arthritis who had an early boutonnière deformity of the thumb treated by rerouting of the extensor pollicis longus tendon were reviewed. Preoperatively, all patients complained of pain, disability in activities of daily living and extensor lag of the MP joint ranging from 10 to 60 degrees. At a mean follow-up of 38 months, nine thumbs had equal active and passive MP joint extension. Two thumbs had a moderate extensor lag. Functional strength assessment demonstrated no deleterious effect of the procedure in the operated compared to the non-operated thumb. Subjectively, all patients but one were satisfied. This procedure appeared to correct or to limit the progression of the deformity. A deficit of interphalangeal extension in five patients may require a modification of the procedure to tighten the extensor pollicis longus distal to the MP joint.

Adult↗

Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients.

BACKGROUND: About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff. OBJECTIVE: The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ). DESIGN: The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay. RESULTS: The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 euros (91 US dollars) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength. CONCLUSIONS: Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.

Body Mass Index↗

The effects of a twenty-four-week aquatic training program on muscular strength performance in healthy elderly women.

The purpose of the present study was to determine the effectiveness of a 24-week aquatic training (AT) program, which included both aerobic and resistance components, on muscle strength (isometric and dynamic), flexibility, and functional mobility in healthy women over 60 years of age. Twenty-two subjects were assigned randomly to either an AT (n = 12) or a control (C, n = 10) group. Volunteers participated in a supervised shallow-water exercise program for 60 minutes a day, 3 days a week; the exercise program consisted of a 10-minute warm-up and stretching, 25 minutes of endurance-type exercise (dancing) at 80% of heart rate (HR)(max), 20 minutes of upper- and lower-body resistance exercises with specialized water-resistance equipment, and a 5-minute cool down. Maximal isometric torque of knee extensors (KEXT) and knee flexors (KFLEX) were evaluated by a Cybex Norm dynamometer, grip strength (HGR) was evaluated using a Jamar hydraulic dynamometer, and dynamic strength was evaluated via the 3 repetition maximum (3RM) test for chest press, knee extension, lat pull down, and leg press. Jumping performance was evaluated using the squat jump (SJ), functional mobility with the timed up-and-go (TUG) test, and trunk flexion with the sit-and-reach test. Body composition was measured using the bioelectrical impedance method. The AT induced significant improvements in KEXT (10.5%) and KFLEX (13.4%) peak torque, HGR strength (13%), 3RM (25.7-29.4%), SJ (24.6%), sit-and-reach (11.6%), and TUG (19.8%) performance. The AT group demonstrated a significant increase in lean body mass (3.4%). No significant changes in these variables were observed in the C group. The results indicate that AT, with both aerobic and resistance components, is an alternative training method for improving neuromuscular and functional fitness performance in healthy elderly women.

Aged↗

A probabilistic model of glenohumeral external rotation strength for healthy normals and rotator cuff tear cases.

The reigning paradigm of musculoskeletal modeling is to construct deterministic models from parameters of an "average" subject and make predictions for muscle forces and joint torques with this model. This approach is limited because it does not perform well for outliers, and it does not model the effects of population parameter variability. The purpose of this study was to simulate variability in musculoskeletal parameters on glenohumeral external rotation strength in healthy normals, and in rotator cuff tear case using a Monte Carlo model. The goal was to determine if variability in musculoskeletal parameters could quantifiably explain variability in glenohumeral external rotation strength. Multivariate Gamma distributions for musculoskeletal architecture and moment arm were constructed from empirical data. Gamma distributions of measured joint strength were constructed. Parameters were sampled from the distributions and input to the model to predict muscle forces and joint torques. The model predicted measured joint torques for healthy normals, subjects with supraspinatus tears, and subjects with infraspinatus-supraspinatus tears with small error. Muscle forces for the three conditions were predicted and compared. Variability in measured torques can be explained by differences in parameter variability.

Computer Simulation↗

Naloxone fails to antagonize initial hypoalgesic effect of a manual therapy treatment for lateral epicondylalgia.

BACKGROUND: Recent research has shown that Mulligan's Mobilization With Movement treatment technique for the elbow (MWM), a peripheral joint mobilization technique, produces a substantial and immediate pain relief in chronic lateral epicondylalgia (48% increase in pain-free grip strength).([1]) This hypoalgesic effect is far greater than that previously reported with spinal manual therapy treatments, prompting speculation that peripheral manual therapy treatments may differ in mechanism of action to spinal manual therapy techniques. Naloxone antagonism and tolerance studies, which employ widely accepted tests for the identification of endogenous opioid-mediated pain control mechanisms, have shown that spinal manual therapy-induced hypoalgesia does not involve an opioid mechanism. OBJECTIVE: The aim of this study was to evaluate the effect of naloxone administration on the hypoalgesic effect of MWM. METHODS: A randomized, controlled trial evaluated the effect of administering naloxone, saline, or no-substance control injection on the MWM-induced hypoalgesia in 18 participants with lateral epicondylalgia. Pain-free grip strength, pressure pain threshold, thermal pain threshold, and upper limb neural tissue provocation test 2b were the outcome measures. RESULTS: The results demonstrated that the initial hypoalgesic effect of the MWM was not antagonized by naloxone, suggesting a nonopioid mechanism of action. CONCLUSIONS: The studied peripheral mobilization treatment technique appears to have a similar effect profile to previously studied spinal manual therapy techniques, suggesting a nonopioid-mediated hypoalgesia following manual therapy.

Adult↗

Neuronal nitric oxide synthase inhibitor, 7-nitroindazole, delays motor dysfunction and spinal motoneuron degeneration in the wobbler mouse.

Gene mutations of superoxide dismutase (SOD) have been discovered in familial amyotrophic lateral sclerosis (ALS). Neuronal nitric oxide synthase (NOS), endothelial NOS and 3-nitrotyrosine immunoreactivities are selectively increased in the spinal motoneurons of sporadic ALS. Other study suggests that 3-nitrotyrosine immunoreactivity is enhanced in the spinal motoneurons of sporadic and familial ALS patients. The hypothesis is postulated that increased production of radical species, such as superoxide and peroxynitrite, may cause motoneuron degeneration in ALS. There are increased amounts of nitric oxide and SOD hypoactivities in the brain and spinal cord of wobbler mice. NOS is also induced in the vacuolated spinal motoneurons or axons in this animal. Free radicals might contribute to the pathogenesis of wobbler mouse motoneuron disease. Lecithinized SOD treatment has retarded the progression of this disease. This evidence allowed us to determine whether NOS inhibitors delay progression of wobbler mouse motoneuron disease. After clinical diagnosis at age 3-4 weeks, wobbler mice were injected with intraperitoneal non-selective NOS inhibitor, N(G)-nitro-L-arginine methyl ester (L-NAME, 50 mg/kg), two doses of neuronal NOS inhibitor, 7-nitroindazole (5 or 50 mg/kg) or a vehicle solution, daily for 4 weeks in a blind fashion. In comparison with vehicle, 7-nitroindazole-treated mice potentiated grip strength and attenuated deformities in the forelimbs. 7-Nitroindazole treatment increased the biceps muscle weight, reduced denervation muscle atrophy, and suppressed degeneration of spinal motoneurons. To a lesser degree, L-NAME-treated mice displayed slowed progression of disease. The present studies indicate that neuronal NOS inhibitor may be a candidate for promising therapy in lower motoneuron disease or motor neuropathy.

Amyotrophic Lateral Sclerosis↗