Upper Extremity Problem-Solving: Challenging Cases

Nathaniel H Mayer

doi:10.1016/j.pmr.2018.04.003

Upper Extremity Problem-Solving: Challenging Cases

Phys Med Rehabil Clin N Am. 2018 Aug;29(3):593-617. doi: 10.1016/j.pmr.2018.04.003. Epub 2018 May 30.

Author

Nathaniel H Mayer¹

Affiliation

¹ Motor Control Analysis Laboratory, Department of PM&R, MossRehab, Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA 19027, USA; Department of Rehabilitation Medicine, Temple University Health Sciences Center, 3500 North Broad Street, Philadelphia, PA 19140, USA. Electronic address: nmayer@einstein.edu.

PMID: 30626517
DOI: 10.1016/j.pmr.2018.04.003

Abstract

Consequences of an upper motor neuron syndrome (UMNS) include voluntary weakness or paresis, superimposed involuntary phenomena such as spastic co-contraction and associated reactions, and superimposed rheologic changes in affected muscles. This article describes the use of dynamic poly-electromyography to assess UMNS muscle overactivity and inform muscle selection for chemodenervation. Cases are presented that involve spastic co-contraction, spastic dystonia, associated reactions, hyperextended wrist and finger flexor tenodesis, differentiating neural versus non-neural (rheologic) hypertonia, upper motor neuron weakness, muscle selection for chemodenervation, and electrical stimulation for muscle specific targeting.

Keywords: Associated reactions; Dynamic EMG; Muscle selection for chemodenervation; Rheologic properties; Spastic cocontraction; UMNS weakness; Upper motor neuron syndrome (UMNS).

Publication types

Case Reports
Review

MeSH terms

Adult
Female
Humans
Male
Middle Aged
Motor Neuron Disease / complications
Motor Neuron Disease / diagnosis*
Motor Neuron Disease / physiopathology
Motor Neuron Disease / therapy*
Muscle Spasticity / complications
Muscle Spasticity / diagnosis*
Muscle Spasticity / physiopathology
Muscle Spasticity / therapy*
Upper Extremity / physiopathology