To identify the segmental innervation of L-2-S-1 muscles, we compared the preoperative electrodiagnostic examinations of 45 patients with single-level lumbosacral radiculopathies confirmed radiologically and surgically. The electrodiagnostic findings were classified as abnormal only by the needle examination and only if muscles demonstrated active denervation or a marked neurogenic motor unit potential firing pattern. In comparison to other surgical, intraoperative root stimulation, and clinical studies, we found several differences. Overall, there was little overlap among L-2-4, L-5, and S-1 radiculopathies. The tibialis anterior was predominantly L-5 innervated, the gastrocnemius (medial and lateral head) predominantly S-1 innervated, and the biceps femoris (short and long head) exclusively S-1 innervated. The two heads of biceps femoris were not affected in any patients with L-5 radiculopathy in whom they were examined. These findings help guide both the clinician and surgeon in the diagnosis and treatment of lumbosacral radiculopathies.
We have studied a patient with diabetic muscle infarction (DMI) to add to the 11 other histologically proven cases. '-'
CASE REPORTThe patient was a 46-year-old man with DM for 5 years treated with diet and oral hypoglycemic medication, and known retinopathy, nephropathy, hypertension, and peripheral neuropathy, who had 2 weeks of left calf pain, swelling, and weakness. On examination he was afebrile without a skin rash. Distal arterial pulses were normal. There was a firm nodular mass measuring 2 x 2 cm in the left lateral calf with mild gastrocnemius muscle weakness. There was stocking sensory loss to light touch, pinprick, and vibratory sensation to the ankles. Tendon reflexes were absent at the ankles, but present elsewhere. Babinski signs were not elicited. Laboratory studies showed a fasting glucose of 281 (normal 50-110), with normal serum creatine kinase (CK), complete blood count, erythrocyte sedimentation rate (ESR), serum antinuclear antibody, latex fixation, and arterial and venous doppler studies of the legs. Nerve conduction studies (NCS) were normal in the arms. There were normal velocities with reduced compound muscle action potential amplitudes in the peroneal (2 mV)
A patient developed focal fibrotic myopathy after many years of intramuscular heroin use. While such changes have been associated with chronic intramuscular injections of pentazocine and meperidine, a similar myopathy resulting from chronic intramuscular heroin has not been convincingly described.
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