Effects of Zero- and 90-Degree Abduction of Glenohumeral Joint on the Upper Extremity Nerve Conduction Velocity (NCV) in Patients with Diabetes Undergoing Coronary Artery Bypass Graft Surgery

Document Type : مقاله کوتاه

Authors

1 Assistant Professor, Department of Physiotherapy, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

2 MSc student, Department of Physiotherapy, School of Rehabilitation Sciences AND Student Research Committee, Isfahan University of Medical sciences, Isfahan, Iran

3 Associate Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Assistant Professor, Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aim of this study was to evaluate the effect of arm position during coronary artery bypass surgery on neuropathic symptoms and nerve conduction velocity (NCV) of the upper extremity nerves in patients with diabetes.Methods: In this clinical trial, 20 patients with diabetes, who were candidates for open-heart surgery, were divided randomly into control and experimental group. During the operation, patient’s arm was positioned at 90 degree abduction and at the sides of the body in the experimental and control group, respectively. Electrodiagnostic tests including assessing amplitude and conduction velocity of sensory and motor nerves of radial, median and ulnar of left hand was performed. Physical examination was also done for checking the numbness and Paresthesia in both hands.Findings: The Comparison of the changes for mean of amplitude and NCV of radial, median and ulnar nerves showed significant change in the control group after operation (P < 0.050). The Comparison of the changes for mean of amplitude and NCV of radial, median and ulnar nerves showed significant change except in radial motor NCV and sensory amplitude of ulnar nerve in the test group after operation (P < 0.050). The comparison of mean values after operation between groups showed no significant changes except in sensory amplitude of ulnar nerve.Conclusion: Arm abduction at 90 degrees reduces the axonal injury of the ulnar sensory fibers during coronary artery bypass graft surgery.

Keywords

References

  1. Baral N, Koner BC, Karki P, Ramaprasad C, Lamsal M, Koirala S. Evaluation of new WHO diagnostic criteria for diabetes on the prevalence of abnormal glucose tolerance in a heterogeneous Nepali population--the implications of measuring glycated hemoglobin. Singapore Med J 2000; 41(6): 264-7.
  2. Larijani B, Abolhasani F, Mohajeri-Tehrani MR, Tabtabaie O. Prevalence of diabetes mellitus in Iran in 2000. Iran J Diabetes Lipid Disord 2005; 4(3): 75-83. [In Persian].
  3. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011; 94(3): 311-21.
  4. Wong J, Zoungas S, Wright C, Teede H. Evidence-based guidelines for perioperative management of diabetes in cardiac and vascular surgery. World J Surg 2010; 34(3): 500-13.
  5. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289(1): 76-9.
  6. Clausen EG. Postoperative ("Anesthetic") Paralysis of the Brachial Plexus. A Review of the Literature and Report of Nine Cases. Curr Res Anesth Analg 1944; 23(1): 18-24.
  7. Gil HY, Yun MJ, Kim JE, Lee MA, Kim do H. Brachial plexus injury following median sternotomy. Korean J Anesthesiol 2012; 63(3): 286-7.
  8. Hanson MR, Breuer AC, Furlan AJ, Lederman RJ, Wilbourn AJ, Cosgrove DM, et al. Mechanism and frequency of brachial plexus injury in open-heart surgery: A prospective analysis. Ann Thorac Surg 1983; 36(6): 675-9.
  9. Healey S, O'Neill B, Bilal H, Waterworth P. Does retraction of the sternum during median sternotomy result in brachial plexus injuries? Interact Cardiovasc Thorac Surg 2013; 17(1): 151-7.
  10. Hudson DA, Boome R, Sanpera I. Brachial plexus injury after median sternotomy. J Hand Surg Am 1993; 18(2): 282-4.
  11. Jackson L, Keats AS. Mechanism of brachial plexus palsy following anesthesia. Anesthesiology 1965; 26: 190-4.
  12. Jellish WS, Blakeman B, Warf P, Slogoff S. Hands-up positioning during asymmetric sternal retraction for internal mammary artery harvest: A possible method to reduce brachial plexus injury. Anesth Analg 1997; 84(2): 260-5.
  13. Kirsh MM, Magee KR, Gago O, Kahn DR, Sloan H. Brachial plexus injury following median sternotomy incision. Ann Thorac Surg 1971; 11(4): 315-9.
  14. Honet JC, Raikes JA, Kantrowitz A, Pursel SE, Rubenfire M. Neuropathy in the upper extremity after open-heart surgery. Arch Phys Med Rehabil 1976; 57(6): 264-7.
  15. Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: A review of 22 cases. Br J Anaesth 1997; 79(4): 440-5.
  16. Graham JG, Pye IF, McQueen IN. Brachial plexus injury after median sternotomy. J Neurol Neurosurg Psychiatry 1981; 44(7): 621-5.
  17. Jellish WS, Blakeman B, Warf P, Slogoff S. Somatosensory evoked potential monitoring used to compare the effect of three asymmetric sternal retractors on brachial plexus function. Anesth Analg 1999; 88(2): 292-7.
  18. Seyfer AE, Grammer NY, Bogumill GP, Provost JM, Chandry U. Upper extremity neuropathies after cardiac surgery. J Hand Surg Am 1985; 10(1): 16-9.
  19. Sharma AD, Parmley CL, Sreeram G, Grocott HP. Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention. Anesth Analg 2000; 91(6): 1358-69.
  20. Unlu Y, Velioglu Y, Kocak H, Becit N, Ceviz M. Brachial plexus injury following median sternotomy. Interact Cardiovasc Thorac Surg 2007; 6(2): 235-7.
  21. Roy RC, Stafford MA, Charlton JE. Nerve injury and musculoskeletal complaints after cardiac surgery: influence of internal mammary artery dissection and left arm position. Anesth Analg 1988; 67(3): 277-9.
  22. Tomlinson DL, Hirsch IA, Kodali SV, Slogoff S. Protecting the brachial plexus during median sternotomy. J Thorac Cardiovasc Surg 1987; 94(2): 297-301.
  23. Vander Salm TJ, Cereda JM, Cutler BS. Brachial plexus injury following median sternotomy. J Thorac Cardiovasc Surg 1980; 80(3): 447-52.
  24. Jia WP, Shen Q, Bao YQ, Lu JX, Li M, Xiang KS. Evaluation of the four simple methods in the diagnosis of diabetic peripheral neuropathy. Zhonghua Yi Xue Za Zhi 2006; 86(38): 2707-10. [In Chinese].
  25. Vague P, Dufayet D, Coste T, Moriscot C, Jannot MF, Raccah D. Association of diabetic neuropathy with Na/K ATPase gene polymorphism. Diabetologia 1997; 40(5): 506-11.
  26. Yang JL, Chang CW, Chen SY, Lin JJ. Shoulder kinematic features using arm elevation and rotation tests for classifying patients with frozen shoulder syndrome who respond to physical therapy. Man Ther 2008; 13(6): 544-51.
  27. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders: Clinical-electrophysiologic correlations. 2nd ed. Philadelphia, PA: Saunders; 2005. p. 25-45.
  28. Salomon NW, Page US, Okies JE, Stephens J, Krause AH, Bigelow JC. Diabetes mellitus and coronary artery bypass. Short-term risk and long-term prognosis. J Thorac Cardiovasc Surg 1983; 85(2): 264-71.
  29. Ferrante MA. Brachial plexopathies: Classification, causes, and consequences. Muscle Nerve 2004; 30(5): 547-68.
Journal of Isfahan Medical School
Volume 34, Issue 373 - Serial Number 373
January and February 2016
Pages 190-196

Files

History

  • Receive Date: 24 May 2015
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics