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The brachial plexus is the plexus of nerves that supply the upper limb. Anomalies in the formation of lateral cord of brachial plexus and communication between its branches are commonly observed but the variation of the course of lateral cord is very rare. We observed that lateral cord of brachial plexus and its branch had a different configuration in dissecting room in Bandar Abbas medical school. Here, the lateral cord pierced the coracobrachialis muscle and then divided into the musculocutaneus and the lateral root of median nerve. After a distance , the lateral root of median nerve joined the medial root of median nerve, and median nerve formed anterior to brachial artery. The rest of the course of the median nerve and the musculocutaneous was normal in arm region.

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Cervicogenic headache (CEH) is a chronic, hemicranial pain syndrome in which the sensation of pain originates in the cervical spine or soft tissues of the neck and is referred to the head. Cervicogenic headache is a relatively common but often overlooked disorder. There is sufficient evidence to support this category and the existing diagnostic criteria are adequate. The purpose of this case report was to describe an intervention approach consisting of release and muscle energy techniques for an individual with cervicogenic headache. Clinical examination revealed myofacial trigger points in trapezius, sternocliedomastoid and upper cervical spine erectors. Visual analogue scale (VAS) identified severe pain. Range of flexion and rotation was reduced. Complete pain relief was seen following three times treatment sessions. The results indicating definite diagnosis and appropriate treatment of cervicogenic headache.

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Background and Objective: Muscle size is considered to be a good indicator of muscle function. Previous studies demonstrated a major role for longus colli muscle in cervical spine stabilization. This study was designed to compare muscle size and shape of cervical longus colli muscle between patients with bilateral chronic neck pain and healthy subjects. Materials and Methods: In this case – control study, bilateral ultrasound images of longus colli muscle, 2 centimeters below the thyroid cartilage were taken in 20 subjects (10 males and 10 females) with bilateral chronic neck pain and in 20 healthy subjects during 2008. Cross sectional area (cm2) and muscle shape ratio (ratio between lateral and anterior posterior dimensions) were measured. T- test was used for comparison of cross sectional area and shape ratio of right and left sides between the two groups. Results: In healthy subjects the cross sectional area of longus colli muscle in right and left sides were 0.85±0.11 and 0.86±0.12 respectively which was greater than that of neck pain patients: 0.76±0.11 and 0.68±0.07 respectively (P<0.05). In addition, longus colli muscle shape ratio of healthy subjects in right and left sides was 1.18±0.17 and 1.16±0.19 respectively which was smaller than that of neck pain patients: 1.50±0.25 and 1.50±0.27 respectively (P<0.05). Conclusion: This study showd that patients with bilateral chronic neck pain had generally smaller cross sectional area and larger shape ratio of longus colli compared to controls.

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Background and Objective: Several studies have demonstrated the importance of a coordinated, synchronized action of a scapular and glenohumeral muscles. Minimal alteration in performance and coordination of these muscles have the potential to lead to joint dysfunction. The impingement syndrome is the most common diagnosis of shoulder pain. The purpose of this study was to determine whether strength deficits could be detected in patients with shoulder impingement. Materials and Methods: This case – control study was done on 15 patients with impingement syndrome and 15 healthy matched persons by nonprobability sampling in Tehran, Iran during 2008. Strength of glenohumeral and scapulothoracic muscles was tested with a hand held dynamometer. Independent and paired t-test were used to statistically analyze between and within groups differences. Results: Compared to non impaired subjects, those with impingement syndrome demonstrated a significantly lower strength of shoulder muscles (P<0.05). The strength deficit between involved and noninvolved sides of patients was determined (P<0.05). In impingement syndrome patients, the external-to-internal rotator muscles strength ratio was significantly lower than on the control group (P<0.05). Conclusion: The result of this study suggest that strength deficit of shoulder muscles may be an important aspect of the impingement syndrome. Muscular strength assessment should be considered in evaluation and effective treatment of a patient. Physical therapy treatment should be emphasize strengthening of weak muscles.

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Background and Objective: Critical illness diaphragmatic neuromyopathy are significant  causes of weakness, morbidity and prolong mechanical ventilation among critically ill patients under mechanical ventilation. It is important determine the true initial time of neuromyopathic changes associated with critically ventilated patients. Based on new electrodiagnostic studies, electrophysiological studies of diaphragm and phrenic nerve, as an important muscle and nerve in ventilation, compared with other evaluating methods, have specific importance. This study was done to evaluate of the diaphragmatic myopathy onset time among mechanically ventilated patients using electrophysiological method.

Materials and Methods: This descripvtive study was performed on 56 mechanically ventilated patients in intensive care unit without primary neuromuscular disease in Tabriz Imam Khomeini hospital in West of Iran between 2004-06 years. Electromyography (EMG) and nerve conduction velocity test were performed in the 4^th and then in 4 days intervals.

Results: In 56 patients EMG and NCV performed at 4 and 8 days after mechanical ventilation, none of them had any evidence in favor of diaphragmatic myopathy. During the course of study, EMG were done on 24 patients in 12^th days , that in three of them (12.5%), mild myopathy were reported. From 18 patients, considered in 16^th days, only five (31.25%) of them showed mild myopathy. From 10 (100%) reminder patients, in 20^th day, all of them had mild to moderate myopathy.

Conclusion: According to these results, minimum duration of the diaphragmatic weakness onset time in mechanically ventilated patients with diverse causes in general critical care ward were 12 days and increased with prolonged time of mechanical ventilation.

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Background and Objective: Anterior cruciate ligament (ACL) tear is one of the most common injuries at knee joint. This study was done to evalute the effect of reconstruction surgery on hamstring reflex in patients with ACL tear. Materials and Methods: In this Quasi- experimental study, 30 patients (16 males, 14 females) with ACL tear, with mean age of 26.52±8.72 years old were recruited during 2007. Patients were selected in a non probability sampling manner. The Kinsiological Electromyography and trauma mechanism were used for testing the hamstring reflex. Muscle activity were measured as a dependent variable. Data were analyzed with Paired T-Test, ICC, SEM and K-S tests. Results: Hamstring reflex in affected knee and after reconstruction surgery was 73.25±3.22 and 47.35±3.85, respectively. This difference was significant (P<0.05). Conclusion: Reconstruction surgery in patients with ACL tear at acute phase is effective in improvement of hamstring reflex.

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Background and Objective: The reduction of shoe heel height can increase abdominal muscles activity. This study was conducted to evaluate the effect of low shoe heel height on the trunk muscle activity in young healthy females. Materials and Methods: In this quasi- experimental (Pre-post ) study, 48 healthy females were evaluated at University of social welfare and rehabilitation at 2009-2010. Females were selected in a non probability sampling manner and divided randomly into two groups. Subjects in the first group (12 females) were used low heel height shoes(less than 3.4 cm) for six months. The second group (12 female) was used standard heel shoes height (3.5-5 cm) for six months. After the end of the first step of study, females in first group were used standard heel shoes height (3.5-5 cm) for six months. The Kinsiologic Electromyography instrument was used to test the Electromyography magnitude of rectus abdominal and external oblique activity. Data was analyzed with Paired and independent T student and Kolmogorrov-Smirnov tests. Results: Muscle activity in first and second groups at external oblique was 9.72±3.15 μν and 7.87±2.47 μν and at rectus abdominal was 11.60±3.58 μν and 9.81±3.46 μν respectively. Muscle activity before and after using standard shoe heel height was significant (p<0.05). Conclusion: It seems that using lower heel shoes height increase the trunk muscle activity.

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Background and Objective: Malnutrition in hospital increases the mortality of patients. The aim of this study was to investigate the prevalence of malnutrition and related risk factors in hospitalized patients. Materials and Methods: This descriptive study was carried out on 446 patients (217 males, 229 females) during 6 months, admitted to the Taleghani hospital in Tehran, Iran during 2005. Anthropometric measurements and previous admission to hospital in previous 6 months for each patient was recorded. Mild, moderate and severe malnutrition were considered as BMI=18-20 kg/m2 and TSF, or MAMC<10th, or weight loss<5% as BMI=16-18kg/m2 and TSF, or MAMC<5th, or weight loss 5-10% and severe as BMI<16kg/m2 and TSF, or MAMC<5th or weight loss>10% in previous 6 months respectively. Results: The prevalence rate of malnutrition as a general was 52% with following subdivision: 14%, 10% and 28% in mild, moderate and severe, respectively. The highest prevalence of malnutrition observed in gastrointestinal ward, males, those aged 18-29 year and patients with secondary and high school education. In malnourished patients, the prevalence of TSF, MAC and MAMC <5th were significantly more than of well-nourished subjects (P<0.05). Increase BMI per unit decreased the risk of malnutrition by 17% (OR: 0.83 CI: 0.79-0.87). Malnutrition was 64% higher in patients with 1≥ gastrointestinal disturbances, compared with those without it and 2.1 higher in patients with 2≥-hospitalized readmission, compared with subjects without readmission in previous 6 month. Odds ratio of at least one hospitalized admission in previous 6 month was 1.64 in patients with MAC <5th, compared with those with MAC 50-75th (P<0.017). Conclusion: This study showed that Malnutrition upon hospitalization is common in Tehran. BMI, gastrointestinal disturbances, and readmission were associated with malnutrition.

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Background and Objective: Patellofemoral is a pain syndrome, common among athletes and the theraputic regiment based on the improvement of muscle involved in this disorder. This study was done to compare electromyography activity of the vastus medialis obliques and vastus lateralis longus during squat with isometric hip adduction in athletes with patellofemoral pain syndrome and healthy athletes.

Materials and Methods: This case – control study was carried out on 16 national team male athletes (volleyball, handball and taekwondo) aged 30-18 years with patellofemoral pain syndrome and 16 healthy male athletes. Subjects were matched based on weight, height, age, dominant of lower extremity and voluntarily participated. Electromyography activity of vastus medialis obliques and vastus lateralis longus muscles recorded by surface electrodes at 15, 30 and 45 knee flexion degrees. Paired t test was used to compare electromyography activities in each group and One-way ANOVA and Tukey post hoc test was used to compare each muscle in different angles.

Results: There was significant differences in the activity of vastus medialis obliques and vastus lateralis longus muscles in athletes with patellofemoral pain syndrome at 45 knee flexion degree (P<0.05). There were no significant differences between the muscle activities in healthy athletes at none of the knee flexion degrees. There were significant differences in the activity of vastus medialis obliques (P<0.05) and vastus lateralis longus (P<0.05) muscles at 45 degrees in comparison with muscle activities in each group in knee flexion degrees.

Conclusion: Electromyography activity of the vastus medialis obliques in healthy athletes during squat with isometric hip adduction at 45 knee flextion is greater than other degrees and in athletes with patellofemoral pain syndrome is greater than healthy athletes.

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Background and Objective: Myofascial pain syndrome is one of the painful conditions of the musculoskeletal system. There is controversy about the effectiveness of treatment strategy. This study was done to compare the effects of diclofenac phonophoresis with ergonomic instructions on neck and shoulder pain and disability in women with myofascial trigger points in trapezius muscle. Materials and Methods: This clinical trial study was conducted on thirty female students with trigger points in trapezius muscle in Razmejo-Moghadam Physiotherapy Clinic, Zahedan University of Medical Sciences, Iran during 2009. Patients were randomly assigned to one of three equal groups: diclofenac phonophoresis, ergonomic instructions, and control groups. In phonophoresis group, after applying diclofenac gel, ultrasound with frequency of 1 MHz, continuous mode, intensity 1.5 W/cm2, and duration 4.5 min was used. Ergonomic group received instructions in order to maintain appropriate posture during activity of daily life. Control group received ultrasound without output. A 12 session treatment program, during 4 weeks, 3 sessions per week was performed. Neck pain was assessed before and after intervention with Northwick Park Neck Pain Questionnaire and shoulder pain and disability with Shoulder Pain and Disability Index. Data were analyzed using SPSS-17, Kolmogorov-Smirnov, paired t-test, One-way ANOVA and Tukey tests. Results: Neck pain score decreased from 18±3.5 to 7.6±4.4 in phonophoresis group and from 17.8±3.5 to 10.5±3.4 in ergonomic group (P<0.05). Also, shoulder pain and disability score decreased from 106.2±28.1 to 36.76±30.7 in phonophoresis group and from 103.3±22.9 to 26.2±12.3 in ergonomic group (P<0.05). There was no significant difference between post and pretreatment results in control group. After treatment, there was no significant difference between two treatment groups regarding neck, shoulder pain and disability. However, after treatment there was significant difference between two treatment groups and control group regarding pain (P<0.05). Conclusion: This study showed that diclofenac phonophoresis and ergonomic instructions are effective in decreasing neck and shoulder pain and disability in patients with myofascial trigger points in trapezius muscle. None of both treatment strategy was superior to other.

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Background and Objective: Sphingosine-1-phosphate (S1P) is involved in regulation of proliferation, differentiation, hypertrophy and anti-apoptosis and activation of satellite cells. This study was done to evaluated the effect of 8 weeks resistance training on sphingosine-1-phosphate level and gene expression of SK1 enzyme, isoforms of MHCs in skeletal muscles of male Wistar rats. Materials and Methods: This experimental study was done on Twenty four 8-week-old 190-250 gr male Wistar rats. The rats were allocated randomly into control (N=12) and training (N=12) groups. Resistance training was done using a 1 meter height ladder with 2 cm grid with an 85 degree incline, and weights attached to rat's tails. The content of S1P present in the chloroform layer was determined by means of high performance liquid chromatography (HPLC). Determination of relative mRNA expression was performed by Real-time PCR. Data were analyzed using SPSS-17, Kolmogorov-Smirnov and independent t-test. Results: Resistance exercise training increased the total content of S1P in FHL (fast-twitch) and soleus (slow-twitch) muscles in comparison with control group (P<0.05). Resistance exercise training changed the gene expression of FHL SK1, SOL SK1, FHL MHC I, Sol MHC I, FHL MHC IIa, Sol MHC IIa, FHL MHC IIb, Sol MHC IIb, FHL MHC IIx, Sol MHC IIx in comparison with control group (P<0.05). Conclusion: This study showed that S1P level and gene expression of SK1, MHCs increased at skeletal muscles after training.

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Background and Objective: Trophic factor family plays a key role for neuromuscular system healthy. This study was carried out to determine the effect of one session of resistance exercise on protein content and mRNA expression of NT4/5 in rat slow and fast muscles. Methods: In this experimental study, sixteen adult male rats randomly were allocated into resistance exercise (T) and control groups. The resistance training protocol consisted of climbing a 1-meter–long ladder, with a weight attached to a tail sleeve. Quantitative Real time RT-PCR for NT-4/5 expression and ELISA Kit for protein assay were used. Results: Resistance training significantly decreased mRNA expression and increased protein of NT4/5 in soleus muscle (P<0.05). Significant alteration was not detected in flexor hallucis longus muscle. Conclusion: One session of resistance training can alter protein and mRNA of NT-4/5 in skeletal muscle and this alteration was dependent on muscle type.

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Background and Objective: An activity performed through a new motional pattern and very intensively often leads to a kind of muscle soreness whose indicator is delayed onset of pain, which is called Delayed Onset Muscle Soreness (DOMS). This study was done to determine the effect of vitamin C and E supplementation on lipid peroxidation and delayed onset muscle soreness in professional basketball players. Methods: In this clinical trial study, 24 male professional basketball players were randomly divided into four groups including vitamin C (1000 mg), vitamin E (800 IU), vitamin C (500 mg) + vitamin E (400 IU) and placebo (Glucose 500 mg). Supplement was consumed two hours before and 24 hours after leg press and scuat exercise. Blood samples were collected before the first supplementation and immediately (post- exercise), 24 hour and 48 hour after exercises. Serum creatine kinase (CK), malondialdehyde (MDA), vitamin C and vitamin E and the level of perceived muscle soreness were evaluated. Results: MDA in Vitamin E group significantly decreased in the 24-hr to 48-hr after the exercise in compared to bignning of exercise (P<0.05). Serum CK significantly increased 24-hr and 48-hr after the exercise in all groups (P<0.05). Muscle pain perception non significantly increased after the exercise in all groups in compare to baseline level. Conclusion: Short period supplementationin of vitamin C and E, either alone or in combination can not reduce pain and muscle damage and lipid peroxidation following the leg press and scuat exercise in professional basketball players.

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Background and Objective: Disabilities in upper limb due to stroke are the major problems in hemiplegic patients. Recently, joystick method as new method is applied for the improvment of upper limb disabilities. This study was carried out to compare the effect of joystick in compination verses routine rehabilitation and routine rehabilitation program on hand muscles stiffness in hemiplegic patients. Methods: In this clinical trial study, 12 hemiplegic patients were randomly divided into two control and interventional groups. Subjects in the control group were received rehabilitation program with placebo joystick. Patients in interventional group were received joystick treatment with routine rehabilitation program for 10 sessions, 3 times a week. Pre and post-treatment evaluation was performed based on Wrist Robo Hab method. Results: Flextion and pronation muscle stiffness in control patients showed non significant improvement, but in the interventional group, significant improvement were observed (P<0.05). At the end of study, there was not any significant difference between control and interventional group. Conclusion: According to this finding, there was not any significant difference between the combination of joystick and rehabilitation treatment and routine rehabilitation program on the hand muscle function in hemiplegic patients.

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Background and Objective: Skeletal muscle expresses several neurotrophin and their receptors which providing the basis for neurotrophin signaling within the muscle compartments. This study was done to evaluate the effect of a session of resistance exercise on mRNA expression of NT-3 and TrkC proteins in soleus muscle of Wistar Rats. Methods: In this experimental study, 16 male Wistar rats were randomly allocated into exercise and control groups. The resistance training protocol consisted of climbing a 1-meter–long ladder, with a weight attached to a tail sleeve. Expressions of NT-4/5 and P75, quantitatively were measured using RT-PCR. Results: There was not any significant alteration in NT-3 mRNA in soleus muscle after resistance exercise. However, one session of resistance exercise significantly increased mRNA expression of TrkC (1.7 Folds) in soleus muscle (P<0.05). Conclusion: Resistance exercise increases TrkC expression in soleuse muscle of wistar rats.

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Background and Objective: Genuvarum is considered as one of the risk factors for the incidence of osteoarthritis. This study was done to compare the knee joint muscles activity during single leg drop landing from different heights among men with genu varum and men with normal knee.

Methods: This case – control study was done on 20 male students with genu varum deformity and 20 male students with normal knee. Genu varum deformity was measured by a kolis and goniometer. Muscle activity of lower limb was recorded with electromyography.

Results: There was significant difference in muscles activity of medialis gastrucnemius, peroneus longus, biceps femoris and gluteus medius in cases and controls (P<0.05), while no significant difference was observed in other muscles.

Conclusion: The changes in the knee normal structure might affect daily activities and possibly lead to in injuries due to physical training.

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Background and Objective: Muscles fatigue around the joint can altere the movment pattern and incrasing the risk of muscle damage. This study was done to determine the effect of hip abductor muscles fatigue on plantar pressure characteristics during stance phase of gait.

Methods:  This quasi-experimental studywas done on 22 males with age ranes of 15-21 years olds. Hip abduction protocol with 50% of one-repetition maximum was used to induce hip abductor muscles fatigue. Average pressure, plantar peak pressure, step duration and the plantar contact area in both feet distribution were collected using before and after the fatigue protocol during gait.

Results: Despite the relative reduction in average pressure, contact area and step duration and plantar increase in peak pressure after abductors fatigue, but these differences were not significant.

Conclusion: This study showed that the hip abductor muscles fatigue can not alter plantar pressure characteristics during stance phase of gait.

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Background and Objective: One of the most common musculoskeletal injuries in modern societies is neck and shoulder pains which often lead to postural disorders and soft tissue shortenings. This study was done to compare the length of shoulder girdle’s muscles in healthy subjects and patients with shoulder and neck pain.

Methods: This case-control study was done on16 patients with chronic neck- shoulder pain as cases and 15 healthy subjects as control group. Length of upper trapezius, pectoralis major and minor muscles was evaluated with functional tests. Also, the range of shoulder abduction and external rotation and cervical flexion and lateral flexion were measured by goniometer.

Results: Significant differences between patient and control groups were found in pectoralis major and minor muscles length in involved side (P<0.05) and also in neck active range of lateral flexion (P<0.05). Furthermore, there were significant differences between shoulder active range of abduction and external rotation (P<0.05) in the groups.

Conclusion: This study confirmed a significant reduction in range of motion in the neck and shoulder and also a remarkably shortening in the muscles of in the involved side.

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Background and Objective: Proprioception an important role in shoulder joint function. Exercise and throat of the upper extremity are complex and skinny movements that apply a great deal of stress on the shoulder joint. This study was done to evaluate the relationship between proprioception and rotator muscles strength in dominant and non-dominant side with shoulder pain of wheelchair basketball athletes.
Methods: In this descriptive-analytic study, 50 wheelchair basketball athletes were selected in non-random sampling way from wheelchair basketball gyms from Alborz and Tehran in Iran. WUSPI, MMT system and repositioning error test with felexometere were used for assessment of shoulder pain, rotator muscles strength and proprioception respectively.
Results: There was a significant difference between dominant and non-dominant side rotators strength and proprioception (P<0.05). There was a significant relationship between internal rotators strength and proprioception in dominate side with shoulder pain (P<0.05). There was not a significant relationship between external rotators strength and proprioception in non-dominate side with shoulder pain.
Conclusion: Repeated pattern of movements in the wheelchair basketball athletes at the long time causes muscle imbalance in strength shoulder joint. It is known as a risk factor in shoulder injuries.

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Background and Objective: Stiffness and restricted range of movement (ROM) affect muscle balance and body alignment. The purpose of this research is the study the relationship between Iliopsoas tightness and hip active range of motion, extensor-flexor muscle strength and thoracolumbar curves.
Methods: This case-control study was carried out on 15 adolescent's male soccer players with short length of Iliopsoas muscle as case group and 15 healthy adolescents witch matched based on age, height, weight, BMI, dominant leg and sport experience as control group. The range of motion was measured with universal goniometer, kyphosis and lordosis with flexible ruler and muscle strength with manual dynamometer.
Results: The range of motion of the hip extension and the strength of the Iliopsoas muscle in the case group were statistically lower than the control group (P<0.05). The rate of lumbar lordosis and the ratio of gluteus maximus to the strength of the Iliopsoas muscle in the case group were significantly higher than the control group (P<0.05). There was no statistically significant difference between the range of motion of hip flexion, dyspnea kyphosis, and gluteus maximus muscle strength in the studied groups.
Conclusion: Adolescents with Iliopsoas tightness have limited hip extension and greater lumbar lordosis and weaker Iliopsoas strength in comparison to healthy counterparts.