The H reflex in the S1 spinal nerve has been used in electrodiagnosis of S1 radiculopathy for several years. Direct stimulation of the S1 spinal nerve has provided more complete information about the H reflex pathway by dividing it into its peripheral and central (or spinal) conduction portions. A previous study compared spinal nerve latency with the H reflex latency, demonstrating an abnormal S1 ratio in subjects with S1 radiculopathy, thereby suggesting slowing within the spinal segment of the nerve. No study, however, has established a normal value for the central (spinal) portion of the H reflex. We electrodiagnostically tested 20 subjects with normal clinical neurologic and musculoskeletal examinations to define a normal sample of the central loop of the H reflex in the S1 spinal nerve. The peak latencies of the M and H reflex responses were measured after a single stimulus to the S1 spinal nerve. The data obtained established 7 +/- 0.3 ms as the normal value for the interpotential latency difference (central loop) of the H reflex in the S1 spinal nerve in healthy subjects. Six patients with clinical and electromyographic evidence of S1 radiculopathy all had central loop latencies of > 8 ms. The normal value of the central loop of the H reflex suggested in this pilot investigation may, therefore, be used to allow for earlier and more accurate diagnosis of an acute S1 radiculopathy.

This is one of the key assessments required for the physician to complete during the evaluation of an injured worker or, for example, an individual applying for disability benefits under a variety of programs_ Options for the examining physician:• Make a guess.This is the most frequently used device; • Look it up.But where?It's not a part of AMA's 4th edition of Impairment Ratings! • Call up a friend who you think might have a clue; • Ask the patient what he thinks he can do; • Forget it and file the form in File 13 (circular container); • Defer filling out the form and sign up for a course purporting to teach this complicated conclusion.Obviously, the latter is the one we all wish for the physician, but it's unrealistic.Most physicians have no understanding of the exertional or postural limitations imposed by impairments.

8470. This is an ICD-9 code? Shorthand for pain in the neck is more realistic. Facet synovitis; occipital nerve neuritis; or myofascial pain uncovered by trauma. In the old days we heard 'whiplash' an unfortunate term implying mode of injury, not result! To accept terminology such as 'whiplash', one would also accept 'fall from a ladder', 'slipped on stairs', 'moving a sofa', 'fell off a house', etc., etc. But cervical sprain/strain is still meaningless and fast becoming a metaphor for continued complaints ... and TREATMENT. I recently reviewed a patient's chart with this diagnosis who was still receiving twice weekly ultrasound, 'myofascial release', and acupuncture. Is this really necessary? To this question, I respond with an emphatic NO! Not even nearly appropriate. But, should I indict the provider or the patient or both?

My appreciation of what is happening in the real world of pain management was enriched by my assumption of a consultant role for a review organization. As a tyro, I was amazed by the machinations of the various attending physicians their reluctance to approach 'benign pain' with a conservative and systematic regimen. As my experience with this organization deepened, my awe changed into disappointment. The usual slippery slope from non-steroidal meds to oral synthetic narcotics to injectables and ending with morphine pumps. Hardly ever did I see an effort for a comprehensive chronic pain management program. Occasionally, a psychologist would be consulted for an opinion in isolation! Another option often encountered was the continuation of acupuncture forever. While I'm. on the subject, passive physical modalities, e.g. acupuncture, diathermy, trigger point injections, myofascial releases, and massage are overused and abused. What's wrong with a short trial of treatment to see what works and then spend more time in instruction of the patient in a home program? Apparently, our colleagues have lost the notion that chronic pain needs attention by the patient every day.

It's personal! I won my varsity letter playing for Akron Central High School. It started innocently enough. My best friend was #1 on the tennis team and to keep him company, I volunteered to be manager ... a single task. Through a series of injuries, I was needed to complete the team schedule and contributed in a small way to the city championship. When I returned from the service, 30 months in the South-West Pacific, I enrolled at Ohio State and participated as a walk on in the tennis program. Only 1 year later, I was in medical school and my tennis career had an intermission. Let's try 20 years. When I returned to the courts, it was 2 X a week in the early morning and soon we had a group of commited 'early birds'. Now 20 years more have past and our summer tennis program includes gold, silver, and platinum ... ages 45, 55, and 65. The platinum team at our club has 20 members, three-quarters of whom are 70 or over (my partner is 76; our captain is 85; I am 70). Our captain is nationally ranked in both singles and doubles in his age group. Because of summer vacations and work schedules, only about half of the team are usually available so we have difficulty fielding the required 3 teams of doubles. My contribution is the quickness and endurance of a 70-year-old who likes to play and accommodates willingly to a variety of partners both in skill level and coordination. We practice once weekly, play one league match each week and participate in regular doubles at least one other time each week. Some of our members appear with 2 rackets, ace bandage knee wraps, tennis elbow straps and ankle sleeves. Others begin with 400 mg of ibuprofen, a proproxyphen capsule, or 2 enteric aspirin. Many finish with ice massage and hot shower. None complain, at least, verbally. Occasionally, I host a brief consultation session after the match ... generally reassuring my colleague with an empathetic 'No problem'. I may even assign a diagnosis 'gray hair of the knee, back, etc.' Few of these 'mature,' aging, seniors with heavy 'wear and tear' bodies miss any sessions. Many, however, complain if they lose. Some agonize with classic excuses ... balls too heavy racket strung too tight sun too hot too much wind, etc., etc. So what's different about weekend athletes over 60? Nothing. There are national tournaments and rankings for 70's, 80's and 90's. Even the King of Sweden played a fair game of tennis in his 90's. Serve 'em up!

Compression of the peroneal nerve is an uncommon complication of labor and delivery. We describe a case of common peroneal nerve injury associated with positioning the knees in hyperflexion during delivery. The pathophysiologic mechanisms, clinical course, and possible prevention of this uncommon complication are discussed.

American Journal of Physical Medicine & Rehabilitation: April 1994 - Volume 73 - Issue 2 - p 75

American Journal of Physical Medicine & Rehabilitation: August 1991 - Volume 70 - Issue 4 - p 171

It has been suggested that the nerve fibers to the first and second lumbrical muscles are relatively spared in patients with carpal tunnel syndrome compared with the fibers to the abductor pollicis brevis. Latencies and amplitudes of the first lumbrical and the abductor pollicis brevis (APB) muscles were compared with both wrist stimulation and midpalmar stimulation. The lumbrical latency at 12 cm and the APB at 8 cm were found to be similar at <4.3 ms. Amplitudes to the lumbrical were 0.6-8 mV compared with 4-13.6 mV for the APB. Three patients who had an abnormal sensory study, yet normal motor values to the APB, were found to have abnormal lumbrical latencies. This is an additional technique that could be useful for individuals suspected of carpal tunnel syndrome who have normal latencies and amplitudes to the APB.

American Journal of Physical Medicine & Rehabilitation: June 1990 - Volume 69 - Issue 3 - p 111

I. STRUGGLE FOR IDENTITY. The controversy about the name of the Academy surfaced again soon after the 3rd International Congress in Washington in 1960. Watkins reemphasized the need to pronounce it "phys-i-a'trist" and suggested that we be called the American Academy of Physiatrics. Krusen responded by suggesting that the name, American Academy of Physical Medicine & Rehabilitation should be retained since the rest of the world wouldn't recognize us. He pointed out that he had just surveyed 40 countries in the developing phase of physical medicine and rehabilitation, and would not want to confuse the issue. Clearly the field of PM&R will be defined by those who practice the specialty. II. LEGISLATION. The legislation initiating Medicare was extraordinarily influential in redefining the specialty. The legislation creating the Office of Vocational Rehabilitation and the subsequent funding of rehabilitation research and training centers engendered an increased awareness in the academic community of the need for rehabilitation medicine. III. CHANGES IN EDUCATION. The Academy gradually increased in number of members, and began to influence the training of residents with the development of a Resident Guide. Many of the senior members of the Academy re-emphasized the need for research to expand new knowledge and all generated a plea for more academic physiatrists. The R&T centers did provide a mechanism to increase the residency training. The role of the physiatrist in the medical school was defined and promoted in colleague with other specialties.(ABSTRACT TRUNCATED AT 250 WORDS)

Carpal tunnel syndrome (CTS) exemplifies a cumulative trauma disorder which may occur in industrial settings. Occasionally, industrial workers develop CTS acutely over the course of a few days to a few weeks. We recently performed electrodiagnostic studies on 22 workers at a midwestern automobile manufacturing plant who developed symptoms compatible with CTS. All tests were within eight weeks of symptom onset; 70% were within four weeks. The acute syndrome was manifested by a conduction block of sensory, motor, or both fiber types beneath the carpal ligament. All patients received sensory studies; nine had motor studies as well. Sensory nerve latencies were not prolonged in proportion to the symptoms, which were short in comparison to the low amplitude sensory nerve action potential evoked proximal to the carpal ligament. Sensory nerve action potential amplitude at midpalm averaged 200% of the value obtained proximally. Because of short distance and residual latency, comparison of motor latencies proximal and distal to the carpal ligament was less helpful than the difference in amplitude of the evoked potentials. Amplitude of the distal response increased an average of 32%. Prompt identification of acute CTS was followed by a recommendation for job change which, along with conservative therapy, led to resolution of symptoms in 77% of patients. The diagnosis of acute CTS leading to avoidance of inciting activities is beneficial in the industrial setting.