Lee DH, et al. Ann Rehabil Med. 2015 Oct;39(5):726-734. http://dx.doi.org/10.5535/arm.2015.39.5.726

Introduction: Hyoid bone movement can be useful for diagnosing oropharyngeal dysphagia. In most clinical settings, the movement can be evaluated by a video fluoroscopic swallowing study (VFSS) that induces radiation exposure. In contrast with the hyoid bone, the thyroid cartilage is easily seen through the anterior neck surface. We hypothesized that the movement of thyroid cartilage correlates with hyoid bone movement in various axis and can be used as a parameter to evaluate swallowing. The purpose of this study was to investigate whether thyroid cartilage and hyoid bone movement were correlated and to collect basic data to determine if thyroid cartilage can be used as a parameter to evaluate swallowing. Methods: A total of 25 subjects were included, and the VFSS image with normal swallowing function was collected retrospectively. The VFSS image was analyzed by specially developed semi-automatic software. Laryngeal prominence and anterior-superior margins of the hyoid were automatically extracted during swallowing. Two-point sets of the loci during swallowing were obtained in all VFSS frames. The X-coordinates showed an anterior-posterior axis, and the Y-coordinates showed a superior-inferior axis. Pearson correlation coefficients for each X- and Y-coordinate component were computed. Results: X- and Y-coordinates of the thyroid cartilage and hyoid bones in all subjects showed movement in similar patterns, although each subject's movement differed. Pearson correlation coefficients of X- and Y-coordinate components of all subjects ranged from 0.611 to 0.981, which indicated that thyroid cartilage and hyoid bone movement was strongly correlated in anterior-posterior and superior-inferior axes, respectively. Conclusion: We analyzed thyroid cartilage and hyoid bone movement using a specifically developed semi-automatic software and concluded that the movement of thyroid cartilage and hyoid bone was strongly correlated in anterior-posterior and superior-inferior axes, respectively, during swallowing. The present study implies that analysis of thyroid cartilage movement can be used as a parameter for swallowing evaluation.

Rationale: Swallowing apraxia is defined as dysfunction in oral phase caused by the deficit in the coordination of tongue, lip, and chin movements, without motor weakness, sensory loss, and cognitive decline and has not been reported yet. Patient concerns: A 69-year-old male with personal medical history of ischemic stroke about 10 years ago newly developed right striatocapular infarction. He had a problem in the oral phase of swallowing after recurrent ischemic strokes. Diagnoses: He was diagnosed as swallowing apraxia via bed side examination and videofluoroscopic swallowing study. Intervention: Videofluoroscopic swallowing study was done in this case. Outcomes: Symptoms and findings of VFSS were not improved after 2 months treatment. Lessons: This case implies that a clinician should be alert to swallowing apraxia as a possible cause when a patient with recurrent strokes complains of oral phase dysfunction of swallowing and considers proper diagnostic option such as videofluoroscopic swallowing study.

Rationale: Scapular winging is caused by neuromuscular dysfunction of shoulder stabilizer muscles. Clinically, a winged scapula can be easily diagnosed by typical physical findings. We report a case of atypical winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy, which has rarely been reported. Patient concerns: A 25-year-old right-handed male was admitted to the clinic due to right arm weakness for 1 year. On physical examination, right winged scapula with medially rotated inferior angle was observed on flexion. Diagnoses: Under the diagnostic impression of a winged scapula due to long thoracic nerve injury based on physical examination, electrodiagnostic study was performed. However, the results showed right dorsal scapular neuropathy combined with suprascapular neuropathy. Interventions: Neck and right shoulder MRI were also performed to rule out other causes of winged scapula, but these showed only a partial thickness tear of the rotator cuff tendon. The patient received rehabilitation. Outcomes: The symptoms have not improved. Lessons: In this case, combined suprascapular neuropathy might contribute to scapular winging and can confuse the diagnosis of winged scapula based on physical findings. This is the first report that indicates suprascapular neuropathy as a contributing factor of scapular winging.