Volume 110, Issue 2

Context: In the 1940s, osteopathic researchers suggested that paraspinal tissue abnormality was associated with spontaneous muscle activity, but few studies have since re-examined these reports. Objective: To determine whether abnormal motor activity plays a role in deep paraspinal tissues that appear abnormal to palpation. Methods: Using an observational study design, the PVG of participants with thoracic pain were palpated by two examiners for consensus on the most marked level of tissue abnormality. Dual fine-wire, intramuscular electrodes were inserted into the deep transversospinalis (multifidus, rotatores) muscles at the abnormal level and at two normal sites (above and below the abnormal level). Surface electrodes were placed over the erector spinae muscles adjacent to each intramuscular electrode site. Electromyography signals were recorded during initial prone resting, three maximal voluntary isometric contractions (MVIC), and a second prone resting. The area under the curve for a 2-second period was analyzed for each condition, and values were normalized and reported as a percentage of MVIC. Data were analyzed using a 2-factor repeated-measures analysis of variance. Results: Twenty-five participants with mean (SD) thoracic pain of 3.3 (1.9) on a 0 to 10 visual analog pain scale completed the study protocol. There were no statistically significant differences in normalized resting activity between the three intramuscular sites ( P =.25) or between the three surface sites ( P =.33). Substantial variability in normalized resting activity at each of the three intramuscular sites was evident (mean [SD] percent of MVIC: abnormal 7.83 [8.76]; normal 9.47 [8.45], 6.65 [7.39]). No statistically significant differences existed in the intramuscular EMG values between the two resting baseline periods ( P =.10). Conclusion: The lack of statistically significant differences between EMG activity at the abnormal and normal paraspinal sites suggests that factors other than muscle activity are responsible for the apparent abnormality of these tissues to palpation. Investigation of these regions for increased tissue fluid and inflammatory mediators is recommended.

Glycemic control is suboptimal in many patients with type 2 diabetes mellitus (T2DM). Despite documented benefits of insulin therapy, initiation of insulin is delayed in many cases because of the reluctance of patients and physicians to use this important treatment. A review of the literature revealed that educating patients about the role of insulin in managing T2DM and the advantages of using insulin analogs and insulin delivery devices may help alleviate some patients' concerns regarding insulin therapy. Compared with standard clinic-directed approaches, patient-driven algorithms that empower patients to initiate and titrate basal insulin therapy have been shown to improve glycemic control. Additional research is needed to confirm the importance of patient empowerment programs in T2DM management.

Gait dysfunctions are commonly encountered in the primary care setting. Compensated Trendelenburg gait is a gait dysfunction that was originally described in patients with weakness of ipsilateral hip abduction. This condition is thought to result from neuronal injury or myopathy. No treatment modalities currently exist for compensated Trendelenburg gait. The authors present a case in which osteopathic manipulative treatment may have improved a Trendelenburg gait dysfunction in a man aged 65 years with multiple sclerosis. Evidence of this improvement was obtained with the GaitMat II system for measuring numerous gait parameters. Based on the results reported in the present case, the authors propose that compensated Trendelenburg gait may arise from somatic dysfunction and may be corrected by osteopathic manipulative treatment.

Peripartum cardiomyopathy (PPCM) is a rare but serious cause of heart failure occurring in the last month of pregnancy or the first 5 months postpartum. The current definition of PPCM only includes patients with left ventricular systolic dysfunction. The authors present a case of peripartum heart failure with normal ejection fraction and raise the possibility that the definition of PPCM be expanded to include left ventricular diastolic dysfunction. Because the mortality and morbidity of patients with PPCM are higher in women who experience a subsequent pregnancy after a prior episode of pregnancy-related heart failure, a revised definition of PPCM has important potential implications.

Pneumaturia has long been known to be the characteristic pathognomonic finding in emphysematous cystitis. However, its history is often difficult to elicit. Imaging studies are diagnostic in the majority of emphysematous cystitis cases described in the literature. The authors present a unique case in which the patient did not admit having pneumaturia until detailed questioning about her medical history was completed after diagnostic imaging. Had an earlier and more thorough medical history been conducted, the patient's diagnosis would have been achieved several months earlier, before presentation to the emergency department, as described in the present case. Early diagnosis is vital to decrease the morbidity and mortality associated with emphysematous cystitis.