Neuromuscular

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NEUROMUSCULAR DISORDERS: Sports & Occupations

Sports/Occupation
Backpacking
Baseball
Bicycle
Bodybuilding
Bowling
Cold exposure
Football
Mountain climbing
Musicians
Running
Surfing
Volleyball
Occupations
Batteries: Lead
Cabinet maker: Hexacarbon
Copper smelting: Arsenic
Demolition: Lead
Dentist: Nitrous oxide
Dry cleaner: Trichloroethylene
Epoxy resin: Allyl chloride
Farmers: Organophosphates
Glass & Ceramics: Tellurium
Mining: Arsenic
Painter: Hexacarbon
Plastic industry: Acrylamide
Rayon industry: Carbon disulfide
Rubber industry: Trichloroethylene
Tool use: Vibration syndrome

BASEBALL

Local Nerve Lesions Other Disorders

BODYBUILDERS 1

Local Nerve Lesions Muscle Joint disorders


BOWLING

Neuroma of digital nerve to thumb ("Bowler's thumb")
Acute sensory neuropathy of thumb

SURFING

Saphenous nerve lesion at knee

Myelopathy 9

BICYCLING 6


FOOTBALL


MOUNTAIN CLIMBING & BACKPACKING


TENNIS


RUNNING


SKIING

Ski Boot neuropathies

HOCKEY 7

Neuropathies

MUSICIANS, INSTRUMENTAL 4

Playing-related disorders: General Musculoskeletal disorders: 64% Peripheral nerve disorders: 20% Focal dystonia: 8%



Hand-Arm Vibration syndrome 3


Suprascapular nerve
Spinoglenoid
notch
Suprascapular notch

SUPRASCAPULAR NEUROPATHY



AXILLARY NERVE

  • Anatomy
    • Origin: C5-C6
    • Brachial plexus: Posterior cord
    • Innervation
      • Motor: Deltoid; Teres minor
      • Sensory: Skin over lateral shoulder
  • Lesions: Weak arm abduction & external rotation

Gowers
Deltoid weakness
Shoulder is elevated by trapezius.
Slight abduction by supraspinatus.

Quadrilateral (Quadrangular) Space Syndrome

  • Pathology: Nerve & vessel damaged or occluded in quadrangular space
    • Distal branch of axillary nerve
    • ± Posterior humeral circumflex artery
  • Clinical
    • Age: Young adults; 22 to 35 years
    • Pain
      • Shoulder; Poorly localized
      • Increased by: Abduction & external rotation of arm
    • Tenderness
      • Quadrilateral space
      • Near insertion of teres minor muscle
    • Paresthesias: Lateral shoulder; Upper posterior arm
    • Weakness
      • Muscles: Teres minor ± Deltoid
      • External rotation ± Abduction of arm
      • Dominant extremity
  • Sports
    • Baseball
  • Differential diagnosis
    • Other axillary nerve change
      • Anterior shoulder dislocation
      • Humeral neck fracture
      • Brachial plexus stretch injury
    • Shoulder injury
    • Subclavian artery stenosis
  • Lab
    • EMG: Denervation of teres minor
    • MRI
      • Selective atrophy: Teres minor ± Deltoid muscle
      • Tendon: Normal
    • Subclavian arteriography
      • Posterior humeral circumflex artery
        • Occluded with abduction & external rotation of arm
        • ? Non-specific: Occlusion may also occur in normals



MUSCULOCUTANEOUS NERVE


MEDIAL PECTORAL NERVE 2


HAMSTRING STRAIN 5


NOTALGIA PARESTHETICA 8


ENVIRONMENT: COLD EXPOSURE & PAINFUL SENSORY NEUROPATHY 10


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References
1. Muscle & Nerve 1998;21:809-812
2. Muscle & Nerve 1999;22:1597-1599
3. Clin Neurophysiol 1999;110:1276-1283, Int Arch Occup Environ Health 2006;79:665–671
4. Muscle & Nerve 2003;27:549-561, Neurologist 2002;8:163-174
5. Clinical Experimental Pharmacol Physiol 2004;31:546–550, Med Sci Sports Exerc 2004;36:756-759.
6. Sports Med 2006;36:7-18
7. J Sports Med Phys Fitness 2009;49:224-231
8. SKINmed 2011;9:353-358
9. Neurosurgery 2016;78:602-611
10. Brain 2017; Online August

9/1/2017