Weak shoulder and arm sparing signs in amyotrophic lateral sclerosis
Weak shoulder and arm sparing signs in amyotrophic lateral sclerosis
复制标题
肌萎缩性脊髓侧索硬化症的肩部和手臂无力症状
作者：
Hamada Y;Kanbayashi T;Takahashi K;Kamiya H;Kobayashi S;Sonoo M
简介/目的肌萎缩性侧索硬化症（ALS）有多种选择性受累的迹象。在这项研究中，我们描述了两种新的迹象，“弱肩”和“手臂保留”迹象。方法回顾性地从我们的电诊断数据库中确定受试者。医学研究委员会对相关肌肉的评分进行了评估。弱肩定义为三角肌（Del）弱于肱二头肌(BB)/肱三头肌（TB）；也就是说，Del比其中一块或两块肌肉都弱，并不比任何一块都强。手臂保留被定义为Del和第一背骨间（FDI）均弱于BB/TB。将这些信号的敏感性与其他选择性受累信号进行比较。研究了肌萎缩颈椎病（CSA）和多灶性运动神经病变（MMN）患者这些体征的特异性。结果我们回顾了130例ALS患者，64例CSA患者和16例MMN患者。73%和55%的ALS患者、44%和2%的CSA患者（近端CSA患者分别为93%和0%）存在弱肩和保臂体征，MMN患者无。弱肩的敏感性高于常规体征，而保留手臂的敏感性没有差异。肩关节弱征在ALS中具有高度敏感性，与MMN相比具有特异性。保留手臂的征象是ALS的高度特异性征象。这两个新的体征有望作为ALS诊断的临床线索。
Introduction/AimsVarious signs of selective involvement have been reported in amyotrophic lateral sclerosis (ALS). In this study, we describe two new signs, “weak shoulder” and “arm sparing” signs.MethodsSubjects were retrospectively identified from our electrodiagnosis database. Medical Research Council scores of relevant muscles were evaluated. Weak shoulder was defined as the deltoid (Del) muscle being weaker than the biceps brachii (BB)/triceps brachii (TB) muscles; that is, Del was weaker than either or both of the muscles and no stronger than either. Arm sparing was defined as both Del and the first dorsal interosseous (FDI) being weaker than BB/TB. Sensitivities of these signs were compared with other signs of selective involvement. The specificities of these signs were investigated in patients with cervical spondylotic amyotrophy (CSA) and multifocal motor neuropathy (MMN).ResultsWe reviewed 130 patients with ALS, 64 patients with CSA, and 16 patients with MMN. The weak shoulder and the arm sparing signs were observed in 73% and 55% of patients with ALS, 44% and 2% of patients with CSA (93% and 0% of patients with proximal CSA), respectively, and no patients with MMN. The sensitivity of the weak shoulder was higher than with conventional signs, whereas that of the arm sparing sign showed no difference.DiscussionThe weak shoulder sign was highly sensitive in ALS, and was specific when compared with MMN. The arm sparing sign was highly specific for ALS. These two new signs are promising as clinical clues in the diagnosis of ALS.