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With the object of evaluating the accuracy of electro-myography and of radiculography in the diagnosis of prolapsed intervertebral disc, the writers carried out a critical review of 150 cases operated on with positive findings, in which both the above investigations had been performed preoperatively.
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The frequency of the acoustic myographic (AMG) signal was examined during fresh and fatigued isometric contractions of quadriceps and during dynamic contractions of biceps brachii (BB) in healthy subjects. Recordings were obtained from quadriceps over a range of forces between 10% and 100% maximal voluntary contraction prior to, and 15 minutes after, a fatiguing exercise. Recordings from BB were obtained over a range of submaximal forces (0-8.5 kg) during concentric and eccentric contractions. The mean power frequency (MPF) of the AMG signal was analyzed during each of these contractions by fast-Fourier transform (FFT). The MPF was not significantly different (P > 0.05) during fresh and fatigued contractions of quadriceps and increased quadratically with force in both states (r = 0.81, fresh; r = 0.77, fatigued). During concentric contractions of BB the MPF initially increased with force, but then decreased at the heavier loads (> 5.5 kg). The MPF of eccentric contractions did not significantly (P > 0.05) alter with force. The AMG MPF was within a similar low frequency range for both muscles, during different types of contraction, and was unaltered with fatigue.
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The effect of contact pressure on acoustic myographic (AMG) recordings was examined during voluntary isometric contractions of the human quadriceps muscle in 20 normal males. A piezoelectric disk for recording muscle sounds was placed over rectus femoris at approximately mid-thigh and secured with a rubber electromyography (EMG) strap. Contact pressure was monitored by a load cell placed between the AMG device and the strap. With the subject seated, force at different percentage levels of maximum voluntary contraction (MVC) were held for 5 s each. Both AMG and EMG recordings were full-wave rectified and integrated (IAMG and IEMG) and expressed as a percentage of activity at MVC. Two contraction series were performed with 2 different contact pressures. Pressure 1 (P1), of 180 Pa was applied in all subjects. A higher pressure of either 790 Pa (P2; in 5 subjects) or 1200 Pa (P3; in 15 subjects) was also applied. No significant changes in IAMG activity (P > 0.1) occurred between P1 and P2 but P3 produced increases in IAMG at all force levels (P < 0.05 at 10, 50 and 75% MVC). Both linear and non-linear relationships between force and IAMG were observed in different subjects but the relationship also varied with the 2 contact pressures within some subjects. The force/IEMG relationship was linear in all cases. These results provide quantitative evidence that contact pressure can influence the degree of IAMG activity if the pressure is high enough. The change in the force/IAMG relationship with pressure in some subjects suggests that the different relationships observed are not determined by physiological differences between subjects but rather by technical factors.
In vitro twitch tests were performed on excised muscle bundles from 30 periodic paralysis (PP) patients in an attempt to verify the somatic origin of PP, and to differentiate between the hypokalemic (HypoPP) and the hyperkalemic forms (HyperPP). Seventeen PP patients with a definite diagnosis of familial HypoPP, familial HyperPP (subsequently confirmed by SCN4A mutations), or thyrotoxic PP entered the study, as well as 13 patients with a history of attacks of weakness but with negative clinical provocation tests and therefore ambiguous diagnosis; 15 normal subjects served as controls. In contrast to control, bundles from patients with clear diagnosis went into sustained paralysis on exposure to Cl-free solution. Exposure to K+ channel activators induced a large increase in force. Specifically for HypoPP muscle, low extracellular [K+] decreased twitch force which was further reduced by addition of insulin or adrenaline, whereas HyperPP bundles responded with an irreversible decrease in twitch force when extracellular [K+] was elevated. Out of the 13 patients with unclear diagnosis, the in vitro studies made it possible to classify 10 as HypoPP and one as HypePP (later confirmed by a M1592V mutation). In the remaining two patients who claimed to suffer from paralytic attacks, all in vitro tests were normal, questioning the occurrence of dyskalemic PP. The results demonstrate that in vitro tests can be used to ensure the proper diagnosis to a high percentage when clinical provocative tests have failed.
When isolated muscle synchronous contraction is evoked during in vitro twitches, mechanical vibrations at the surface of the muscle reflect resonant behavior. In contrast, voluntary contraction corresponds to the asynchronous contraction of recruited motor units, therefore, this kind of excitation could lead to different muscle vibrational behavior. We have studied human biceps brachii muscle during voluntary contraction in 10 healthy subjects. Low and high levels of voluntary contraction were explored with simultaneous recording of surface vibration by two sensors located longitudinally or perpendicular to the muscle's main axis. Cross-correlation and coherence functions were computed. Coherence functions revealed a common vibration frequency band between 17 and 28 Hz. Cross correlation functions revealed in-phase vibration for longitudinal sensors and opposite phase vibration for perpendicular sensors thus confirming a lateral bending movement. This behavior suggests that the acoustic myogram is the response of the muscle as a global resonant structure to the local fluctuations of pressure.
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To test the hypothesis that muscle sound amplitudes would remain constant during sustained submaximal isometric contractions, we recorded acoustic myograms from the abductor digiti minimi muscle in 12 subjects at 15, 25, 50, and 75% of a maximum voluntary contraction (MVC). Muscle sounds were detected with an omni-directional electret microphone encased in closed-cell foam and attached to the skin over the muscle. Acoustic amplitudes from the middle and end of the sustained contractions were compared with the amplitudes from the beginning of contractions to determine whether acoustic amplitudes varied in magnitude as force remained constant. Physiological tremor was eliminated from the acoustic signal by use of a Fourier truncation at 14 Hz. The amplitudes of the acoustic signal at a contraction intensity of 75% MVC remained constant, reflecting force production over time. At 50% MVC, the root-mean-square amplitude decreased from the beginning to the end of the contraction (P less than 0.05). Acoustic amplitudes increased over time at 15 and 25% MVC and were significantly higher at the end of the contractions than at the beginning (P less than 0.05). Alterations in the acoustic amplitude, which reflect changes in the lateral vibrations of the muscle, may be indicative of the different recruitment strategies used to maintain force during sustained isometric contractions.
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