Metabolic changes in human muscle denervation: topical 31P NMR spectroscopy studies.

Metabolic changes in human forearm flexor muscle following partial or complete denervation were studied using 31P nuclear magnetic resonance spectroscopy. In resting muscle, patients with electromyographically verified forearm flexor denervation had a lower ratio of PCr/Pi than healthy controls [4.76 +/- 2.50 (SD) versus 6.50 +/- 1.55 (SD); P less than 0.01] and a higher intracellular pH [7.09 +/- 0.06 versus 7.05 +/- 0.04 (SD); P less than 0.01]. These changes were more apparent when the diseased arm was compared to the contralateral healthy arm in patients with strictly unilateral denervation. Five patients with severe denervation had the lowest PCr/Pi ratio (1.94 +/- 0.70) and the highest pH (7.15 +/- 0.04). Four patients with intact innervation and disuse atrophy as a result of a forearm fracture did not exhibit these changes immediately following removal of the forearm cast. The findings show that denervation leads to a reduction in PCr/Pi within muscle and a rise in intracellular pH, and that these changes correlate with the degree of denervation and improve with recovery. 31P MRS may be useful to follow the course of denervation atrophy.