By Y. Garik. University of Medicine and Dentistry of New Jersey. 2018.
Muscle Nerve 24: 1388–1390 180 Dorsal scapular nerve Genetic testing NCV/EMG Laboratory Imaging Biopsy +– Fig 850mg glucophage with visa. This nerve is purely motor cheap glucophage 500mg amex, and innervates the levator scapulae and rhomboid muscles (Fig buy generic glucophage 850mg online. Function: To elevate and adduct the medial border of the shoulder blade (together with the rhomboid muscles) cheap 500mg glucophage free shipping. Almost no symptoms are reported, and usually only with powerful arm move- Symptoms ments. The scapula becomes slightly abducted Signs from the thorax wall, with outward rotation of the inferior angle. Neuralgic shoulder amyotrophy Pathogenesis Iatrogenic: operations Nerve is sometimes used as a graft for nerve transplantations. EMG Diagnosis None Therapy Mumenthaler M, Schliack M, Stöhr M (1998) Läsionen einzelner Nerven im Schulter-Arm- Reference Bereich. In: Mumenthaler M (ed) Läsionen peripherer Nerven und radikuläre Syndrome. Thieme, Stuttgart, pp 296–311 182 Suprascapular nerve Genetic testing NCV/EMG Laboratory Imaging Biopsy + MRI, US Fig. The nerve has no cutaneous sensory distribution (Fig. Symptoms Dull, aching pain in the posterior aspect of shoulder, which is aggravated by arm use. The patient is unable to lie on his shoulder due to pain. Signs Lesion at the suprascapular notch: involvement of both muscles. Lesion at the spinoglenoid notch: only infraspinatus muscle impairment. Abnormal transverse scapular ligaments (occasionally bilateral) Causes Arthroscopic shoulder surgery Closed trauma: the most common cause Entrapment by the transverse superior or inferior ligaments Neuralgic amyotrophy Open trauma Overuse: athletic activities (basketball, volleyball, boxing) or construction trades (e. Therapy Conservative: rest the limb, analgesics, activity modification, nerve block. Replacement surgery: if the lesion appears to be permanent, a transfer from the horizontal part of the trapezoid muscle can be considered. Depends on the etiology Prognosis McCluskey L, Feinberg D, Dolinskas C (1999) Suprascapular neuropathy related to a References glenohumeral joint cyst. Muscle Nerve 22: 772–777 Mumenthaler M, Schliack H, Stöhr M (1998) Läsionen einzelner Nerven im Schulter-Arm- Bereich. In: Mumenthaler M, Schliack H, Stöhr M (eds) Läsionen peripherer Nerven und radikuläre Syndrome. Thieme, Stuttgart, pp 261–368 Staal A, van Gijn J, Spaans F (1999) The suprascapular nerve. In: Staal A, van Gijn J, Spaans F (eds) Mononeuropathies. Saunders, London, pp 23–25 Stewart J (2000) Nerves arising from the brachial plexus. Lippincott, Williams & Wilkins, Philadelphia, pp 157–181 184 Subscapular nerve Genetic testing NCV/EMG Laboratory Imaging Biopsy + Fig. The nerve innervates the subscapularis and teres major muscle, to secure the shoulder joint and provide inward rotation of the shoulder (Fig. Compensation for the function of both muscles is provided by the pectoralis Symptoms major, latissimus dorsi, and anterior deltoid muscle. Upon securing shoulder joint, an outward rotation of the upper arm. Signs Atrophy is not visible, and there are no sensory findings.
In: Campell WW (ed) Essentials of electrodiagnostic References medicine order glucophage 500 mg mastercard. Williams & Wilkins cheap 500 mg glucophage with mastercard, Baltimore cheap glucophage 500 mg otc, pp 207–224 Dyck PJB cheap glucophage 500mg, Windebank AJ (2002) Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve 25: 477–491 Feasby TE, Burton SR, Hahn AF (1992) Obstetrical lumbosacral plexus injury. Muscle Nerve 15: 937–940 Jaeckle KA (1991) Nerve plexus metastases. Neurol Clin 9: 857–829 Kutsy RL, Robinson LR, Routt ML (2000) Lumbosacral plexopathy in pelvic trauma. Muscle Nerve 23: 1757–1760 Mumenthaler M (1998) Pseudoradikuläre Syndrome und andere, nicht radikuläre Schmerzsyndrome. In: Mumenthaler M, Schliack H, Stöhr M (eds) Läsionen peripherer Nerven und radikuläre Syndrome. Thieme, Stuttgart, pp 197–201 Said G, Elgrably F, Lacroix C, et al (1997) Painful proximal diabetic neuropathy: inflamma- tory nerve lesions and spontaneous favorable outcome. Ann Neurol 41: 762–770 Stewart JD (2000) Lumbosacral plexus. Lippincott, Philadelphia, pp 355–374 Thomas JE, Cascino TL, Earle JD, et al (1985) Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology 35: 1–7 Wohlgemuth WA, Stöhr M (2002) Percutaneous arterial interventional treatment of exer- cise induced neurogenic intermittent claudication due to ischemia of the lumbosacral plexus. M1 + M2: represent the mobile parts 119 Cervical radiculopathy Genetic testing NCV/EMG Laboratory Imaging Biopsy + Fig. Left hand: C8 radicul- opathy with atrophy in a pa- tient with leukemic infiltration Fig. Meningeal carcinoma- tosis with neoplastic deposits in C6 and C7. Extensor deficits of fingers 3, 4, 5 mimicks partial radial paralysis 120 Anatomy With exception of the upper two, the cervical vertebrae articulate with each other by an intervertrebral disc, plus a pair of smaller joints between articular facets and pedicles. The intervertebral foramina are formed by the pedicles (above and below), anteriorly by intervertebral discs and joints of Luschka, and posteriorly by the facets and facet joints. The transverse processes are (except in the case of C7) foramina for the vertebral arteries. A deep horizontal groove lies on the upper surface of each transverse process. The scalene muscles are attached to the transverse processes. Two important structures are the longitudinal ligaments and the intervertebral discs. The laminae of the vertebral arches are connected by the ligamentum flavum. Rootlets of ventral and dorsal origin form roots (fusing in the intervertebral foramen). The dorsal root ganglia (DRG) lie just dorsal to the fusion. Dura and arachnoid extend around nerve roots into the intervertebral foramina as root pouches or sleeves. In the cervical spine, the nerve roots exit over the vertebral body and are numbered by the vertebral body beneath the root (e. C6 exits between C5–C6, the C8 root exits between C7 and T1). While the cervical roots exit horizontally, there is about a one segment difference (see Fig.
S: I’d just let it go by itself and the energy just seemed to zoom around along the route cheap 500mg glucophage amex. S: Maybe three quarters of an hour each time cheap glucophage 850mg mastercard, twice each day glucophage 850mg free shipping. I’ve been told that I don’t have to cycle the route as many times as I had glucophage 500mg on line. Originally, I’d been asked to do it 100 times which I never could because I’d lose count. It varied but it was not measured in seconds be- cause I had to visualize stations as it were along the way. Even- tually, though, he had me just touch on four points at the navel, perineum, lumbar region and at the top of my head. Interviews Three Practitioners S: It was relaxing and felt warm. I could sit in half lotus comfortably for a fairly long time. And Master Chia didn’t suggest to you or have you autosuggest that you are healing your back? S: No, though he did say that the practice would heal it. An Interview with Dan Dan is a young photographer who, for eight years, had been put- ting much effort into practicing esoterics on his own, and had tried many other methods with many different masters. After studying with Master Chia for only two months, through simply concentrating on his navel, the Chi energy started to circulate in the Microcosmic Orbit automatically without concentrating on the other energy cen- ters. Young: I know that you have been studying with Master Chia for about two months. I would like to know why you came here in the first place and what you have found since. Dan: I found out about Master Chia through the “Free Spirit”, a magazine I picked up in a health food store. I called him up and he mailed me one of the booklets, which explains everything about the Microcosmic Orbit. After reading and practicing with forty to fifty teachers, his system sounded very good to me but I couldn’t be sure and so I went to see him. After he explained the way the energy works, it seemed pretty logical to me, so I tried it out. Young: Did he say that you should make yourself feel warm, to create the warmth or just concentratre and to feel whatever you could feel? Dan: First he taught me a breathing exercise to relax me and to get the energy in the navel going. Young: So did the warmth come up by itself or you created it in your mind? Dan: Actually I didn’t feel much warmth in my navel. The other points felt warm, and my navel may have been slightly warm. I felt a lot of activity in the tip of my spine, in my back where my kidneys are, around my shoulder blades and especially in my head. My head felt, as though it had expanded and felt full of that same activ- ity. When I stuck my tongue up against my palate, I felt something like a charge of elec- tricity on contact. Young: You don’t suppose that suggestion was somehow involved when he had you concentrate on your navel, do you? Before I came here I had already seen yellow between my eyebrows, and had used it to concentrate on for hours at a time. When Master Chia asked me to concentrate on my navel, I saw light there too, but he told me not to pay any attention to it and insisted that I con- centrate on my navel. In two days it had broken down to a yellow color sitting here and there and moving around but I didn’t pay at- tention to it, I just continued to concentrate on my navel and kept my tongue sticking up toward my palate. I don’t know exactly when, but I started to feel energy.