OBJECTIVE: Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes.
METHODS: Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up.
RESULTS: Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27).
CONCLUSIONS: The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.

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BACKGROUND: Supraspinatus (SSP) strength tests are an important shoulder examination tool for clinical evaluations of patients with a suspected SSP tear. While the empty can (EC) test is widely used to diagnose SSP dysfunction, the test cannot selectively activate SSP activity. The aim of this study was to access the electromyographic (EMG) activity within SSP, deltoid, and surrounding periscapular muscles after resisted abduction force to determine which shoulder position helps best isolate SSP from deltoid activity.
METHODS: A controlled laboratory EMG study was conducted. Specifically, we conducted an EMG analysis of the seven periscapular muscles (i.e., the middle deltoid, anterior deltoid, SSP, upper trapezius, posterior deltoid, infraspinatus, and pectoralis major) in 21 healthy participants, without any history of shoulder disorder, aged 29 ± 0.9 years old with a dominant-right arm. EMG activities were measured during resisted abduction force according to comprehensive shoulder positions in abduction, horizontal flexion, and humeral rotation. The supraspinatus to middle deltoid (S:D) ratio was calculated using the standardized weighted EMG and the maximum voluntary isometric contraction of the SSP and middle deltoid muscles, for each shoulder position to determine the best isolated SSP muscle strength test position. Results were analyzed with the Kruskal-Wallis test for non-normally distributed data.
RESULTS: Shoulder abduction, horizontal flexion, and humeral rotation significantly affected the activity of the middle deltoid, SSP, and S:D ratio (P < 0.05). The S:D ratio increased significantly in lower degrees of shoulder abduction, lower degrees of horizontal flexion, and external humeral rotation over internal rotation. The greatest S:D ratio (3.4 (0.5-9.1)) occurred at the shoulder position of 30° shoulder abduction combined with 30° horizontal flexion and external humeral rotation. Conversely, the classic EC position manifested nearly the smallest S:D ratio (0.8 (0.2-1.2)).
CONCLUSIONS: Application of the SSP strength test in the shoulder position of 30 degrees abduction, 30 degrees horizontal flexion, and external humeral rotation offers the best position to isolate the abducting activity of the SSP from that of the deltoid, which could help with diagnosis among patients with chronic shoulder pain with a suspected SSP tear condition.

The purpose of this trial was to study the effect on pain and mouth opening of intramuscular injection of botulinum toxin-A into masticatory muscles following surgical intervention in oral submucous fibrosis (OSMF) cases. Injections of either botulinum toxin A (BTX-A) (study group) or normal saline (control group) were given 2 weeks prior to surgical intervention in OSMF patients, into the bilateral masseter and temporalis muscles. All patients were evaluated for pain and ease of active physiotherapy at 1 week and 1, 3, and 6 months after surgery using a numerical rating scale and appropriate questionnaires, with comparisons made between the study and control group patients. Electromyographic studies of the masticator muscles were also carried out in all patients before injection, and at 1 month and 6 months after injection. 20 OSMF patients were equally divided into study and control groups (n = 10 each). At 1, 3, and 6 months after surgery, the study group patients showed significantly greater decreases in pain (p-values of 0.007, 0.001, and 0.005, respectively) and greater ease in physiotherapy compared with the control group. EMG recordings of masticator muscles showed a transient drop in microvolt value in the study group 1 month after injection, unlike the control group recordings. It was concluded that preoperative BTX-A injection was a good addition to surgical therapy in the patient group.

Changes in membrane AChRs in skeletal muscles located near or distant from burn injury similar to denervated muscles may make electrodiagnostic features indistinguishable from true neuropathic changes. The aim of this study was to examine electrodiagnostic changes of muscles at sites local and distant from the burn after thermal injuries due to neuromuscular junction dysfunction. A total of 40 adult male rats were randomly allocated to four groups. Rats in group 1 received thermal burn injury over gastrocnemius muscle of one leg and sham burn on the other leg. A 20-25% and 30-35% surface body area burn and also 30-35% surface body area sham burn were produced at distant site from gastrocnemius muscle in group 2, 3 and 4, respectively. To explore any fibrillation potential, the rats underwent serial electromyographic studies of bilateral gastrocnemius muscles over 5 weeks after burn injury. There were no denervation potentials either in muscles at sites distant from 20-25% and 30-35% of total body surface area burns or in muscles beneath the burn. In the present study on rats, thermal burn injury could not make fibrillation potentials in the electrodiagnostic study of muscles located near and distant from the burn site.

Kabuki make-up syndrome (KMS), also called Niikawa-Kuroki syndrome reported in 1981, is a rare congenital disorder of unknown aetiology. It is know to occur in many other ethnic groups, though initially described in Japan. We report a 24-year-old girl of Asian origin diagnosed with Kabuki syndrome based on characteristic clinical features. It is characterized by distinctive facial features (eversion of the lower lateral eyelid, arched eyebrows with the lateral one-third dispersed or sparse, depressed nasal tip, and prominent ears), skeletal anomalies, Dermatoglyphic abnormalities, short stature. As per our knowledge there is no literature which gives information about the importance of electromyographic study in the diagnosis and treatment of the KMS. Hence, this report emphasizes on the role of the same.