Objective To determine whether the presence of posterior ponticles markedly increases by 30% or more, the incidence of major rotational stenosis of vertebral arteries. Methods Doppler ultrasound studies were performed in 3 private chiropractic clinics and in the radiology department of a public hospital, and magnetic resonance angiography (MRA) studies were made in the latter location. Thirty-two chiropractic patients had Doppler velocimetery, and 16 of these patients had MRA scanning. The outcome measures included changes in Doppler velocimetry signals and MRA images indicative of marked rotational stenosis of vertebral arteries. Results All vertebral arteries from the 32 patients displayed no signs indicative of marked rotational stenosis. Conclusion The findings of this study show that the incidence of major rotational stenosis of vertebral arteries is not markedly increased by the presence of posterior ponticles.

Objective: To determine whether lumen narrowing in vertebral arteries during atlanto-axial rotation is due to stretch or localized compression.Design and Setting: Experiments with models were made in a private chiropractic clinic, whereas studies of cadaveric specimens were performed in an anatomy laboratory. Doppler ultrasound and magnetic resonance angiography (MRA) studies were carried out in the radiology department of a public hospital.Patients: Eight patients had their vertebral arteries examined by use of a Doppler velocimeter and MRA.Main Outcome Measure: Stenosis of the vertebral arteries caused by stretch, localized compression, or kinking.Results: All 16 vertebral arteries from the 8 patients displayed no changes in their lumen dimensions with full cervical rotation, although curves in each of the arteries did change. The model and cadaveric vertebral arteries demonstrated localized compression or kinking of the vessel wall with atlanto-axial rotation contralaterally but revealed no evidence of major contribution of stretching to stenosis.Conclusion: The lumen of vertebral arteries is usually unaffected by atlanto-axial rotation. In cases where there is stenosis, this is mainly due to localized compression or kinking. These findings are relevant to premanipulative screening of vertebral arteries with Doppler ultrasound scanning.

The differential patterns of muscle involvement in the upper and lower limbs in sporadic inclusion body myositis (sIBM) were examined in 18 patients using both quantitative and manual muscle testing as well as magnetic resonance imaging (MRI) in 9 patients. Weakness of the quadriceps femoris and the forearm flexors was present in most patients, but there was considerable variability in the patterns and severity of muscle involvement. MRI disclosed preferential patterns of muscle involvement within functional groups such as the quadriceps femoris, in which there was severe involvement of the vasti with relative sparing of the rectus femoris, and the triceps surae, in which selective involvement of the medial gastrocnemius was common. Involvement of flexor digitorum profundus on MRI was found in only one third of patients. The results emphasize the variability in the clinical phenotype and differential susceptibility of muscles to the disease process in sIBM. © 2001 John Wiley & Sons, Inc. Muscle Nerve 24: 1526–1534, 2001