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Biomedical subjects

G Rushworth

Publications and source records attributed to G Rushworth.

At least 19 recordsLinked to original sources
PubMed1993

Thoracic outlet syndromes and magnetic resonance imaging.

The thoracic outlet syndromes encompass the diverse clinical entities affecting the branchial plexus or subclavian artery including cervical ribs or bands. Thoracic outlet syndrome are often difficult to diagnose on existing clinical and electrophysiological criteria and new diagnostic methods are necessary. This study reports our experience with magnetic resonance imaging (MRI) of the brachial plexus in 20 patients with suspected thoracic outlet syndrome. The distribution of pain and sensory disturbance varied widely, weakness and wasting usually affected C8/T1 innervated muscles, and electrophysiology showed combinations of reduced sensory nerve action potentials from the fourth and fifth digits, and prolonged F-responses or tendon reflex latencies. The MRI study was interpreted blind. Deviation of the brachial plexus was recorded in 19 out of the 24 symptomatic sides (sensitivity 79%). Absence of distortion was correctly identified in 14 out of 16 asymptomatic sides (specificity 87.5%). The false positive rate was 9.5%. Magnetic resonance imaging demonstrated all seven cervical ribs visible on plain cervical spine radiographs. Magnetic resonance imaging also showed a band-like structure extending from the C7 transverse process in 25 out of 33 sides; similar structures were detected in three out of 18 sides in control subjects. These MRI bands often underlay the brachial plexus distortion observed in our patients. We also observed instances of plexus distortion by post-traumatic callus of the first rib, and by a hypertrophied serratus anterior muscle. If they did not demonstrate a cervical rib, plain cervical spine radiographs had no value in predicting brachial plexus distortion. We believe MRI to be of potential value in the diagnosis of thoracic outlet syndrome by: (i) demonstrating deviation or distortion of nerves or blood vessels; (ii) suggesting the presence of radiographically invisible bands; (iii) disclosing other causes of thoracic outlet syndrome apart from ribs or bands.

Adult↗
PubMed1992

Carpal canal stenosis in men with idiopathic carpal tunnel syndrome.

The carpal canal and carpal bones of 14 male patients with idiopathic carpal tunnel syndrome and 26 normal male controls were examined by computed tomography. When compared with the controls, there was significant stenosis of the proximal part but not of the distal part of the carpal canal. Carpal canal stenosis is an important etiologic factor in the development of idiopathic carpal tunnel syndrome in males.

Adult↗
PubMed1991

Reanimation for facial palsy using gracilis muscle grafts.

Twelve patients have been reviewed at least 2 years after gracilis muscle transfer, preceded by crossface nerve grafting, for complete unilateral facial palsy. Levels of satisfaction among the patients were good. Examination showed all had voluntary movement of the graft which could produce reasonable mouth symmetry in most patients. However, the involuntary spontaneity and expressive movements were not so satisfactory, though still worthwhile. The technique and some lessons learned from this experience are discussed. It appears from electromyographic studies that continuing innervation and activity can occur in these grafts for many years postoperatively.

Adolescent↗
PubMed1991

Generalized peripheral neuropathy in a dental technician exposed to methyl methacrylate monomer.

A 58-year-old dental prosthetic technician developed generalized sensorimotor peripheral neuropathy. Neurophysiologic studies showed a generalized sensorimotor neuropathy of axonal degeneration type. Examination of a sural nerve biopsy showed a moderately severe axonal neuropathy with loss of large myelinated fibers and unmyelinated axons. There was evidence of slow ongoing degeneration and considerable fiber regeneration. Electron microscopy showed increased numbers of filaments in a few fibers. These findings show resemblances to the nerve changes caused by another acrylic resin, acrylamide. We suggest that the neuropathy may have been caused by 30 years of occupational cutaneous and inhalational exposure to methyl methacrylate monomer since we excluded other recognized causes of neuropathy.

Dental Technicians↗
PubMed1989

Diagnostic specificity of sensory and motor nerve conduction variables in early detection of carpal tunnel syndrome.

In the carpal tunnel syndrome (CTS) sensory nerve conduction is more sensitive than motor conduction. However, 8%-25% of the sensory distal latencies in symptomatic hands may still be normal. A systematic study was made of the median, ulnar and radial orthodromic nerve conduction velocities (SNCV) stimulating each of the fingers separately. Four SNCVs from the median nerve, two SNCVs from the ulnar nerve and one from the radial nerve were obtained, and the ratio of the median to radial SNCV and the ratios of the median and ulnar SNCVs were estimated. The significance of these parameters in the diagnosis of the CTS was studied, and a rapid technique for the screening of nerve entrapment in the initial stages of the disease is proposed. Three hundred and seventy-five symptomatic hands were examined. Seventy-five hands showed normal distal latency, in which cases, however, the SNCV of the ring finger was always outside the normal range, while the SNCVs of the thumb, index and middle fingers were abnormal in 64%, 80% and 92% of cases respectively. The amplitudes of the sensory responses were the least sensitive of the parameters studied. Our results suggest that a study of the median nerve digital branch to the ring finger may be of value in providing an easily performed and rapid technique for screening an early median nerve entrapment at the wrist.

Adolescent↗
PubMed1987

Cross-facial nerve transplants: why are spontaneous smiles not restored?

The technique of cross-facial nerve transplantation (CFNT), with or without the addition of vascularised muscle, has made it possible to achieve some voluntary movement of the paralysed side of the face in patients with unrecovered facial palsy. If normal faces are studied during conversation, it can be seen that there are two types of movement of the lips--those of emotional expression and those involved in the formation of vowel sounds and labial consonants. Smiles themselves can be classified roughly according to their length of muscle contraction--the longer "definitive" smile, and the shorter "flash" smile. It is the synergistic facial movement of the unpremeditated "flash" smile and the small movements in the formation of the vowel sounds and labial consonants which fail to occur in patients reanimated by revascularised, reinnervated muscle, despite the return of voluntary contraction and resting facial tone. This study was undertaken to try to determine why these synergistic facial movements of short duration are so difficult to achieve.

Adult↗
PubMed1985

Patterns of injury to the terminal branches of the brachial plexus. The place for early exploration.

Non-operative management has frequently been adopted for closed injuries of the infraclavicular brachial plexus and its branches in the belief that spontaneous recovery is likely to occur, and surgical exploration is performed only if recovery has not occurred in the expected time. This paper correlates the clinical and electrophysiological features with the operative findings in six patients with such injuries. The axillary nerve was ruptured in all six patients, the musculocutaneous nerve in two and the radial nerve in two. When the muscles supplied by a branch of the plexus were denervated, the differentiation between rupture of that branch and a lesion in continuity could only be made by surgical exploration, which should be performed as soon as other injuries permit.

Adolescent↗
PubMed1981

Ponto-bulbar palsy with deafness (Brown-Vialetto-Van Laere syndrome).

The authors describe the clinical and electrophysiological features in 2 cases of ponto-bulbar palsy with deafness, and the clinical course and post-mortem findings in a sibling of one of these, who died in infancy, and who appears to have suffered from the same disease. The cases are compared with 17 previously published cases, and the disease is discussed in relation to other progressive neurological diseases of childhood.

Adolescent↗
PubMed1980

Idiopathic carpal tunnel syndrome caused by carpal stenosis.

Computed tomography was used to measure the cross-sectional area of the carpal canals in normal controls of both sexes and in women with idiopathic carpal tunnel syndrome. The women controls had significantly smaller carpal canals than the men controls both proximally and distally. In the patients both the proximal and distal cross-sectional areas were significantly reduced compared with the women controls. The measurements showed that carpal canal stenosis is associated with idiopathic carpal tunnel syndrome, narrowing of the canal is bilateral in patients who have unilateral symptoms, and narrowing is greater in the proximal carpal canal. There was no correlation between age and the size of the canal. The difference in the size of the carpal canal between normal men and women might explain the tendency of women to develop carpal tunnel syndrome. The lack of correlation between age and the size of the canal suggests that stenosis of the carpal canal is inherited rather than acquired. Symptoms arise only later in life, when degenerated changes in the content or the walls of the carpal canal compete with the median nerve for space and its function becomes impaired by compression.

Adult↗
PubMed1980

Some pathophysiological aspects of spasticity and the search for rational and successful therapy.

In spite of the different uses of the term "spasticity", hyperactivity of skeletal muscle stretch reflexes is the one common factor and we therefore need to know how this is produced by lesions within the central nervous system and what are its consequences to the initiation and execution of voluntary movement, not only initially but also chronically. The alpha motoneurone is directly responsible for the initiation of skeletal muscle contraction and final integration of excitatory and inhibitory nervous input normally takes place on its surface. In spasticity there is not only loss of descending direct excitatory and inhibitory control of motoneurones, but also loss of the control of spinal interneurones which would normally regulate (principally by inhibition) segmental spinal reflexes, including the stretch reflexes, especially those concerned with antigravity muscles. Gamma motoneurones may also have a reduction inhibitory control with consequent increase of muscle spindle sensitivity to stretch, and this may be further exaggerated by changes in the physical properties of affected muscles. The peripheral disorders of function are more accessible to study and to pharmacological and physical treatment, but with the increasing knowledge of inhibitory mechanisms and their pharmacology there is hope that some degree of influence may be possible within the central nervous system, by therapy with drugs that mimic or prolong the action of inhibitory transmitters.

Animals↗
PubMed1977

Delayed (degenerate) interfascicular nerve grafting: a new concept in peripheral nerve repair.

Interfascicular nerve grafts allowed to undergo endoneurial tube emptying in situ before transfer have been compared with grafts transferred fresh in terms of structure and function. The sciatic nerve of the rat was the model and its structure and ultrastructure were superior following degenerate grafting. More importantly, electrophysiological studies showed that function in nerves repaired with degenerate grafts was significantly better than in those repaired with fresh grafts.

Animals↗
PubMed1972

Electrophysiological studies in alcoholism.

Using a range of electrophysiological techniques, it has been possible to demonstrate impaired function in smaller calibre motor fibres and in distal large cutaneous sensory nerve fibres in both alcoholic patients without neuropathy and in those alcoholics with clinical manifestations of peripheral nerve disease. Evidence of more proximal involvement of Ia sensory fibres was obtained, but in the majority of our patients, large motor fibres functioned normally. The nature of the underlying pathological process is discussed.

Action Potentials↗
PubMed1971

Facial reflexes.

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Brain Diseases↗