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Sample records for carpal bones

  1. [Fractures of carpal bones].

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    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  2. The carpal bones in Poland syndrome

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    Friedman, Talia [University of Manitoba, Department of Diagnostic Imaging, Winnipeg, MB (Canada); Reed, Martin [University of Manitoba, Department of Diagnostic Imaging, Winnipeg, MB (Canada); University of Manitoba, Children' s Hospital, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Children' s Hospital, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); Elliott, Alison M. [University of Manitoba, Children' s Hospital, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Children' s Hospital, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); University of Manitoba, Program of Genetics and Metabolism, Winnipeg, MB (Canada)

    2009-06-15

    Classical Poland syndrome is represented by unilateral aplasia of the sternocostal head of the pectoralis major muscle and ipsilateral simple syndactyly and brachydactyly. Various classifications of the severity of hand involvement have been proposed. Since its initial description, numerous studies have been made of the bony, soft tissue, organ, and hematological disturbances. However, carpal bone involvement has been largely overlooked. The purpose of this study was to evaluate the carpal bones in patients with Poland syndrome from a local (Manitoba) cohort as well as those from the literature. Hand radiographs from local patients and cases identified from the literature with confirmed Poland syndrome were examined for evidence of carpal bone involvement. Only cases with radiographs of adequate quality were included in the analysis. Clinical information (including gender and age) was necessary for evaluation of bone maturation. In total, seven local patients and 23 patients from the literature were evaluated. Ethics approval for study of the local patients was obtained by the Research Ethics Board of the University of Manitoba. Of the 23 literature patients, 12 patients (52%) had abnormal findings. Of the abnormal patients, four of 12 (33%) had carpal fusions, eight of 12 (67%) showed disharmonious ossification between the carpal and tubular bones and seven of 12 (58%) showed delay of carpal ossification. Of the local cohort, three patients were too young to characterize carpal involvement. Of the four remaining patients, two (50%) had abnormal carpal morphology, three out of four had disharmonious ossification and all four had delay of ossification of carpal bones. Carpal fusions, particularly of the scaphoid and trapezium, were common in both groups. Carpal bone anomalies (delay, disharmony, and/or fusions) are frequent in Poland syndrome and can occur in patients with either mild or severe hand involvement. Imaging of the unaffected hand is helpful in

  3. Computerized geometric features of carpal bone for bone age estimation

    Institute of Scientific and Technical Information of China (English)

    Chi-Wen Hsieh; Tai-Lang Jong; Yi-Hong Chou; Chui-Mei Tiu

    2007-01-01

    Background Bone age development is one of the significant indicators depicting the growth status of children.However, bone age assessment is an heuristic and tedious work for pediatricians. We developed a computerized bone age estimation system based on the analysis of geometric features of carpal bones.Methods The geometric features of carpals were extracted and analyzed to judge the bone age of children by computerized shape and area description. Four classifiers, linear, nearest neighbor, back-propagation neural network,and radial basis function neural network, were adopted to categorize bone age. Principal component and discriminate analyses were employed to improve assorting accuracy.Results The hand X-ray films of 465 boys and 444 girls served as our database. The features were extracted from carpal bone images, including shape, area, and sequence. The proposed normalization area ratio method was effective in bone age classification by simulation. Besides, features statistics showed similar results between the standard of the Greulich and Pyle atlas and our database.Conclusions The bone area has a higher discriminating power to judge bone age. The ossification sequence of trapezium and trapezoid bones between Taiwanese and the atlas of the GP method is quite different. These results also indicate that carpal bone assessment with classification of neural networks can be correct and practical.

  4. Morphometrical variations of the carpal bones in thoroughbreds and ponies.

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    Abdunnabi, A H; Ahmed, Y A; Philip, C J; Davies, H M S

    2012-04-01

    There is scant morphological data for equine carpal bones despite the frequent pathology in Thoroughbreds (TB). This study aimed to identify morphological and morphometrical variations and similarities in carpal bones between and within TB and Ponies (Po). Carpal bones from nine TB and 13 Po were prepared by boiling and drying. Lateromedial width, dorsopalmar depth, proximodistal height, relative density and volume of each bone were measured. Normalized measurements of the radial (Cr) and third (C3) carpal bones were significantly different in all dimensions, and there were significant variations in relative sizes of articular facets of the ulnar (Cu), C3 and fourth (C4) carpal bones between the groups. Bilaterally, the proportionate volume of the intermediate carpal bone (Ci) was significantly greater in Po while that of Cu and C4 were significantly greater in TB. Relative density of most bones was greater in Po. The palmar tuberosity of the proximal surface of Ci and palmar tubercle on the palmar surface of Cu were more prominent and relatively larger in TB. In the second carpal bone (C2), the distal extent of the proximal articular surface on the palmar surface was greater in Po. The inconsistent first carpal bone (C1) was relatively larger in Po. Morphometrical similarities and differences in carpal bones between TB and Po indicate potential effects of selection for body size or fast exercise.

  5. Coordinate systems for the carpal bones of the wrist.

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    Coburn, James C; Upal, Mohammad A; Crisco, Joseph J

    2007-01-01

    The eight small and complexly shaped carpal bones of the wrist articulate in six degrees of freedom with each other and to some extent with the radius and the metacarpals. With the increasing number and sophistication of studies of the carpus, a standardized definition for a coordinate system for each the carpal bones would aid in the reporting and comparison of findings. This paper presents a method for defining and constructing a coordinate system specific to each of the eight carpal bones based upon the inertial properties of the bone, derived from surface models constructed from three-dimensional (3-D) medical image volumes. Surface models from both wrists of 5 male and 5 female subjects were generated from CT image volumes in two neutral wrist positions (functional and clinical). An automated algorithm found the principal inertial axes and oriented them according to preset conditions in 85% of the bones, the remaining bones were corrected manually. Six of the eight carpal bones were significantly more extended in the functional neutral position than in the clinical neutral position. Gender had no significant effect on carpal bone posture in either wrist position. Correlations between the 3-D carpal posture and the commonly used 2-D clinical radiographic carpal angles are established. 3-D coordinate systems defined by the anatomy of the carpal bone, such as the ones presented here, are necessary to completely describe 3-D changes in the posture of the carpal bones.

  6. [Numerical variants and congenital fusions of carpal bones].

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    Senecail, B; Perruez, H; Colin, D

    2007-03-01

    The number of carpal bones may be increased or decreased by the fact of anatomical variants or true congenital anomalies. Numerical increment arises from additional or from split bones. Over twenty accessory carpal bones have been described but the commonest are the os centrale carpi, the os radiale externum, the triangular bone and the styloideum bone. Additional carpal bones usually result from a failure of fusion of their ossification centers. A congenital origin is not clearly established for all these ossicles. The scaphoid and lunate may split into two or three bones and several cases of bipartite hamulus of the hamatum have been reported. A carpus with only seven bones results from the congenital absence of a normal bone, which mainly affects the scaphoid, lunate and triquetrum, or from a synostosis between two carpal bones, usually the lunate and triquetrum. Congenital fusions originate from an absence of joint cavitation into the embryo and chondrification of the joint interzone. Numerical carpal variants are uncommon as independent entities but occur with a relative high frequency in association with complex malformations of the hand. These anomalies are detectable on plain radiographs of the wrist, but CT-scan and MR-Imaging are useful to differentiate bipartite and accessory bones from carpal fractures or posttraumatic injuries, carpal fusions having to be distinguished from bony ankylosis.

  7. Carpal Tunnel Cross-Sectional Area Affected by Soft Tissues Abutting the Carpal Bones.

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    Gabra, Joseph N; Li, Zong-Ming

    2013-02-01

    The carpal tunnel accommodates free movement of its contents, and the tunnel's cross-sectional area is a useful morphological parameter for the evaluation of the space available for the carpal tunnel contents and of potential nerve compression in the tunnel. The osseous boundary of the carpal bones as the dorsal border of the carpal tunnel is commonly used to determine the tunnel area, but this boundary contains soft tissues such as numerous intercarpal ligaments and the flexor carpi radialis tendon. The aims of this study were to quantify the thickness of the soft tissues abutting the carpal bones and to investigate how this soft tissue influences the calculation of the carpal tunnel area. Magnetic resonance images were analyzed for eight cadaveric specimens. A medical balloon with a physiological pressure was inserted into an evacuated tunnel to identify the carpal tunnel boundary. The balloon-based (i.e. true carpal tunnel) and osseous-based carpal tunnel boundaries were extracted and divided into regions corresponding to the hamate, capitate, trapezoid, trapezium, and transverse carpal ligament (TCL). From the two boundaries, the overall and regional soft tissue thicknesses and areas were calculated. The soft tissue thickness was significantly greater for the trapezoid (3.1±1.2mm) and trapezium (3.4±1.0mm) regions than for the hamate (0.7±0.3mm) and capitate (1.2±0.5mm) regions. The carpal tunnel area using the osseous boundary (243.0±40.4mm(2)) was significantly larger than the balloon-based area (183.9±29.7mm(2)) with a ratio of 1.32. In other words, the carpal tunnel area can be estimated as 76% (= 1/1.32) of the osseous-based area. The abundance of soft tissue in the trapezoid and trapezium regions can be attributed mainly to the capitate-trapezium ligament and the flexor carpi radialis tendon. Inclusion of such soft tissue leads to overestimations of the carpal tunnel area. Correct quantification of the carpal tunnel area aids in examining carpal

  8. Global point signature for shape analysis of carpal bones

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    Chaudhari, Abhijit J.; Leahy, Richard M.; Wise, Barton L.; Lane, Nancy E.; Badawi, Ramsey D.; Joshi, Anand A.

    2014-02-01

    We present a method based on spectral theory for the shape analysis of carpal bones of the human wrist. We represent the cortical surface of the carpal bone in a coordinate system based on the eigensystem of the two-dimensional Helmholtz equation. We employ a metric—global point signature (GPS)—that exploits the scale and isometric invariance of eigenfunctions to quantify overall bone shape. We use a fast finite-element-method to compute the GPS metric. We capitalize upon the properties of GPS representation—such as stability, a standard Euclidean (ℓ2) metric definition, and invariance to scaling, translation and rotation—to perform shape analysis of the carpal bones of ten women and ten men from a publicly-available database. We demonstrate the utility of the proposed GPS representation to provide a means for comparing shapes of the carpal bones across populations.

  9. Bone age assessment for young children from newborn to 7-year-old using carpal bones

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    Zhang, Aifeng; Gertych, Arkadiusz; Liu, Brent J.; Huang, H. K.

    2007-03-01

    A computer-aided-diagnosis (CAD) method has been previously developed based on features extracted from phalangeal regions of interest (ROI) in a digital hand atlas, which can assess bone age of children from ages 7 to 18 accurately. Therefore, in order to assess the bone age of children in younger ages, the inclusion of carpal bones is necessary. In this paper, we developed and implemented a knowledge-based method for fully automatic carpal bone segmentation and morphological feature analysis. Fuzzy classification was then used to assess the bone age based on the selected features. Last year, we presented carpal bone segmentation algorithm. This year, research works on procedures after carpal bone segmentation including carpal bone identification, feature analysis and fuzzy system for bone age assessment is presented. This method has been successfully applied on all cases in which carpal bones have not overlapped. CAD results of total about 205 cases from the digital hand atlas were evaluated against subject chronological age as well as readings of two radiologists. It was found that the carpal ROI provides reliable information in determining the bone age for young children from newborn to 7-year-old.

  10. Carpal and tarsal bone development is highly sensitive to three antiproliferative teratogens in mice.

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    Rahman, M E; Ishikawa, H; Watanabe, Y; Endo, A

    1996-01-01

    When pregnant mice were given small doses of teratogens (cytosine arabinoside, mitomycin C, or busulfan) that did not induce anomalies of any other organs, a high incidence of carpal and tarsal bone anomalies still occurred. The carpal and tarsal bones may be used as a sensitive target for teratogenicity testing.

  11. Automatic bone age assessment for young children from newborn to 7-year-old using carpal bones.

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    Zhang, Aifeng; Gertych, Arkadiusz; Liu, Brent J

    2007-01-01

    A computer-aided-diagnosis (CAD) method has been previously developed based on features extracted from phalangeal regions of interest (ROI) in a digital hand atlas, which can assess bone age of children from ages 7 to 18 accurately. Therefore, in order to assess the bone age of children in younger ages, the inclusion of carpal bones is necessary. However, due to various factors including the uncertain number of bones appearing, non-uniformity of soft tissue, low contrast between the bony structure and soft tissue, automatic segmentation and identification of carpal bone boundaries is an extremely challenging task. Past research works on carpal bone segmentation were performed utilizing dynamic thresholding. However, due to the limitation of the segmentation algorithm, carpal bones have not been taken into consideration in the bone age assessment procedure. In this paper, we developed and implemented a knowledge-based method for fully automatic carpal bone segmentation and morphological feature analysis. Fuzzy classification was then used to assess the bone age based on the selected features. This method has been successfully applied on all cases in which carpal bones have not overlapped. CAD results of total about 205 cases from the digital hand atlas were evaluated against subject chronological age as well as readings of two radiologists. It was found that the carpal ROI provides reliable information in determining the bone age for young children from newborn to 7-year-old.

  12. Simultaneous distal radial fractures and carpal bones injuries in children: a review article.

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    Pretell-Mazzini, Juan; Carrigan, Robert B

    2011-09-01

    Accurate diagnosis is crucial in effectively managing and treating both the radial and carpal fractures. Injuries to the carpal bones are not usually associated with fractures of the distal radius; however, the presence of a distal radius fracture does not preclude an associated carpal injury. The purpose of this review article is to compile cases of past reported distal radius fractures and simultaneous carpal injuries to restate its low prevalence within the pediatric population while still serving as a collective reference for management and treatment. After an electronic literature search was performed, we identified 18 published articles and 28 cases dealing with combined distal radial and carpal bones injuries in the pediatric population. As the mechanism of injury is similar for both fractures, despite the low incidence, orthopedic surgeons need to rule out carpal injury with a distal forearm fracture. Failure to treat both injuries appropriately may result in an unsatisfactory clinical result.

  13. ANATOMICAL DISPOSITION OF CARPAL BONES OF GOLDEN RETRIEVER DOG BY X-RAY EXPOSURE

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    R. Mandal

    2012-07-01

    Full Text Available The present study was conducted to know the general disposition of bones in carpal region of experimental dogs by X-ray study with an objective that the findings will facilitate to have an in-depth knowledge about the proper positioning of the carpal bones for surgical management of fractures and different types of bone deformities in dogs. In the present study, the anatomical disposition and arrangement pattern of carpal bones playing a pivotal role in providing the structural conformity in the limbs of Golden Retriever dog has been thoroughly confirmed by Xray exposure.

  14. Effects of dividing the transverse carpal ligament on the mechanical behavior of the carpal bones under axial compressive load: a finite element study.

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    Guo, Xin; Fan, Yubo; Li, Zong-Ming

    2009-03-01

    Transecting the transverse carpal ligament (TCL) is a routine procedure to surgically treat carpal tunnel syndrome; yet, its mechanical consequences on carpal bones are unclear. In this study, our intent was to perform a computational analysis of carpal biomechanics resulting from TCL release. A three-dimensional finite element model of the wrist was constructed, which included all the carpal bones, the distal ulna and radius, the proximal metacarpals and the interosseous ligaments. Cartilage layers of each bone were modeled manually according to anatomic visualization software. The TCL was also modeled in three dimensions and added to the bone model. A 100-Newton axial load was applied to the upper section of the second and third metacarpals. The effects of dividing the TCL on the displacements of the carpal bones and the contact stress distribution in the midcarpal joints were studied using a finite element analysis method. When the TCL was divided, the axial compressive load resulted in the carpal bones deviating more radially. More specifically, the carpal bones on the radial side of the capitate and lunate (i.e. the trapezium, trapezoid, and scaphoid) moved further toward the radius, and the carpal bones on the ulnar side of the capitate and lunate (i.e. hamate, triquetrum, and pisiform) moved further toward the metacarpals. The contact stresses and contact locations in the midcarpal joints changed as a result of dividing the TCL. The changes in displacements of carpal bones and the contact stress distributions in the midcarpal joints due to TCL release may be implicated for some of the postoperative complications associated with carpal tunnel release.

  15. Inferring 3D kinematics of carpal bones from single view fluoroscopic sequences.

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    Chen, Xin; Graham, Jim; Hutchinson, Charles; Muir, Lindsay

    2011-01-01

    We present a novel framework for inferring 3D carpal bone kinematics and bone shapes from a single view fluoroscopic sequence. A hybrid statistical model representing both the kinematics and shape variation of the carpal bones is built, based on a number of 3D CT data sets obtained from different subjects at different poses. Given a fluoroscopic sequence, the wrist pose, carpal bone kinematics and bone shapes are estimated iteratively by matching the statistical model with the 2D images. A specially designed cost function enables smoothed parameter estimation across frames. We have evaluated the proposed method on both simulated data and real fluoroscopic sequences. It was found that the relative positions between carpal bones can be accurately estimated, which is potentially useful for detection of conditions such as scapholunate dissociation.

  16. Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones.

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    Yu, Kunlun; Shao, Xinzhong; Tian, Dehu; Bai, Jiangbo; Zhang, Bing; Zhang, Yingze

    2016-09-01

    The aim of the present study was to treat intraosseous ganglia of the carpal bones with injectable bone cement grafting. Between January 2012 and December 2013, 4 patients (3 men and 1 woman) presenting with wrist pain and activity limitation were diagnosed with intraosseous ganglion of the carpal bones by radiography. The patients were treated with minimal invasive curettage and bone cement injection surgery. All patients were followed up for a mean time of 17 months (range, 12-22 months). The wrist pain was significantly reduced in all patients following surgery. In addition, the activity range and grip strength were also improved compared with the preoperative parameters. Subsequent to treatment, the Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score presented mean values of 78.8 (range, 75-80) and 11 (range, 7.7-15.0), respectively. These results suggested that the patients showed a good recovery. All patients were satisfied with the postoperative results and returned to work within 4 weeks. In conclusion, bone cement injection is an effective and safe therapeutic strategy for the treatment of intraosseous ganglia of the carpal bone.

  17. COMPARATIVE EFFECT OF CARPAL BONE MOBILIZATION VERSUS NEURAL MOBILIZATION IN IMPROVING PAIN, FUNCTIONAL STATUS AND SYMPTOMS SEVERITY IN PATIENTS WITH CARPAL TUNNEL SYNDROME

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    Vikranth .G .R

    2015-06-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a constellation of symptoms associated with compression of the median nerve at the wrist in carpal tunnel. The Purpose of this study is to find the comparative effective of carpal bone mobilization and neural mobilization in improving pain, Functional Status and Symptom Severity in patients with CTS. Method: An experimental study design, 30 subjects with carpal tunnel syndrome were randomized into 2 groups with 15 subjects each in Group A and Group B. Subjects in Group A received carpal bone mobilization and subjects in Group B received median nerve mobilization. The duration of intervention was for two weeks. Outcome measurements such as pain using VAS, The Functional Status Score (FSS and Symptom Severity Score (SSS using the Boston’s questionnaire for CTS were measured before and after two weeks of intervention. Results: Analysis using paired ‘t’ test found that there is a statistically significant improvement (p<0.05 in pain, Functional Status score and Symptom Severity score within the groups. Comparative analysis using independent ‘t’ test found that there is no statistically significant difference in improving pain, Functional Status score and Symptom Severity score between both the groups. Conclusion: It is concluded that median nerve mobilization and carpal bone mobilization shown to be effective on improving pain, Functional Status and Symptom Severity in the treatment of patients presenting with carpal tunnel syndrome. However there is no significant difference in improvements obtained between the neural mobilization and carpal bone mobilisation.

  18. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

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    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

  19. A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist).

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    Garcia-López, A; Perez-Ubeda, M J; Marco, F; Molina, M; López-Duran, L

    2001-08-01

    This study reports the outcome of 16 patients treated with a modified four-bone fusion for symptomatic stage II and III advanced carpal collapse. The technique is based on fusion of the capitate, lunate, hamate and triquetrum using an autogenous corticocancellous bone-graft fixed with screws. The void left behind after scaphoid excision was filled with an extensor carpi radialis longus anchovy. After an average follow up of 3 years; there were 13 excellent and three good outcomes. In every patient pain relief was achieved with preservation of joint motion and grip strength. All the patients were able to return to their previous activities and jobs. Radiographic evaluation showed bone fusion in all 16 patients with a slight decrease in carpal height but a well preserved radiolunate joint space. In conclusion, this technique provides immediate stable fixation and early mobilization and assures bone fusion.

  20. Lung cancer presenting as a metastasis to the carpal bones: a case report

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    Rinonapoli Giuseppe

    2012-11-01

    Full Text Available Abstract Introduction A first metastasis to the hand is extremely rare. Usually, an acrometastasis is a sign of very advanced disease, with the presence of previous multiple metastases elsewhere. The present paper is one of the very few case reports of first metastatic location to carpal bones. To date, only Lederer et al., in 1990, and Song and Yao in 2012, have described a metastasis to the trapezium from lung cancer. Case presentation A 74-year-old Caucasian man was submitted to several physical examinations for thumb pain. The first diagnosis was tendonitis and the second diagnosis was thumb carpometacarpal osteoarthritis. Only when the patient was admitted to an internal medicine department for deterioration of his general condition and an enormous mass on his left hand was an open biopsy performed. It revealed a metastasis from large-cell lung carcinoma. A total-body scintigraphy and total-body computed tomography scan were negative for other secondary locations. The patient underwent an amputation at the distal third of the forearm. Conclusion Less than 20 case reports are available in the literature dealing with metastases to carpal bones. Very few cases are described as carpal metastases in the absence of other previous metastases, and only two articles, before the present one, have reported a metastasis to the trapezium. This case report teaches us two things: first, patient adherence to follow-up is extremely important; and, second, a thorough examination of diagnostic findings needs to be carried out at all times.

  1. Bone grafting in four-corner mid-carpal fusion.

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    McBride, T J; Jewell, D P A; Deshmukh, S C

    2012-01-01

    Four-corner fusion is an accepted surgical treatment for established SLAC and SNAC wrist. We describe a technique of bone grafting to be used in conjunction with any of the standard fusion techniques. A step by step, illustrated approach allows the easy placement of an autograft which is in contact with all surfaces of the bones involved in the fusion.

  2. Surgical treatment of multifocal giant cell tumor of carpal bones with preservation of wrist function: case report.

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    Tarng, Yih-Wen; Yang, Shan-Wei; Hsu, Chien-Jen

    2009-02-01

    We report a rare case of multifocal giant cell tumor of bone involving the trapezium, trapezoid, capitate, and scaphoid with soft tissue extension. Following intralesional resection, an autogenous corticocancellous iliac crest bone graft was used to fill the resultant defect and preserve carpal height and radiocarpal motion. Successful union with no recurrence was noted at 1-year follow-up.

  3. Six new examples of the bipartite trapezoid bone: morphology, significant population variation, and an examination of pre-existing criteria to identify bipartition of individual carpal bones.

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    Burnett, Scott E; Stojanowski, Christopher M; Mahakkanukrauh, Pasuk

    2015-03-01

    Carpal bone bipartition is a developmental variant resulting in the division of a normally singular carpal into two distinct segments. Cases involving the scaphoid are best known, though many other carpals can be affected, including the trapezoid. Six new examples of bipartite trapezoids, identified in African and Asian anatomical and archeological samples, are reported here and compared with the eight previously known. While the site of bipartition is consistent, the resulting segments exhibit variability in their articulations with neighboring carpals. Five of the six affected trapezoids were identified in African or African-derived samples, yielding a significantly higher frequency (0.323%) of bipartite trapezoid than seen in anatomical or archeological series of European origin. Bilateral bipartite trapezoids in archeological remains from the Mid Holocene site of Gobero (Niger) are potentially the oldest bipartite carpals yet identified in humans. Their discovery may indicate that trapezoid bipartition is a condition that has been present in African populations since prehistoric times, though more data are needed. Because bipartite carpals may be symptomatic and can occur as part of syndromes, the significant population variation in frequency identified here has potential utility in both anatomical and clinical contexts. However, a comparison of the morphological appearance of bipartite trapezoids with the suggested criteria for bipartite scaphoid diagnosis indicates that these criteria are not equally applicable to other carpals. Fortunately, due to the rarity of fracture, identification of the bipartite trapezoid and separating it from pathological conditions is considerably easier than diagnosing a bipartite scaphoid.

  4. [Four bone versus capito-lunate limited carpal fusion. Report of 40 cases].

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    Kadji, O; Duteille, F; Dautel, G; Merle, M

    2002-01-01

    Fourty patients with limited carpal fusion have been retrospectively reviewed. The aim of this study was to compare the results of four bone fusions (30 wrists) versus capitolunate fusion (11 wrists). Follow-up averaged 30 months with a range of 15-96 months. Twelve patients presented SLAC-wrist (scapho-lunate advanced collapse) and fourteen with SNAC-wrist (sapho-non union advanced collapse). There were seven cases of primitive wrist arthritis, one mid-carpal instability, one sequella of Fenton's syndrome, one Preiser's disease and two Kienbock's disease. All 40 patients were evaluated by the same observer. In terms of range of motion, the capito-lunate fusion led to better results than the four bone fusions with a gain of 10 degrees in volar flexion and 12 degrees in radial deviation. Results in term of post operative pain are similar in the two groups of patients with 90% painless wrist in four bone fusion and 81% with capito-lunate fusion. Results for strength were equivalent. Radiological bone fusion was obtained within nine weeks. Absence of fusion was observed in two patients with capito-lunate fusion. Our result in terms of joint motion and strength are similar to those found in the literature. Correction or not of the DISI deformity during the procedure did not affect the results (on 19 patients). The Four bone fusion procedure is still a good treatment in SLAC or SNAC wrist. Capito-lunate fusion remains a good choice, despite the risk of non-fusion.

  5. Non-invasive magnetic resonance imaging diagnosis of presumed intermedioradial carpal bone avascular necrosis in the dog.

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    Pownder, Sarah L; Cooley, Stacy; Hayashi, Kei; Bezuidenhout, Abraham; Koff, Matthew F; Potter, Hollis G

    2016-08-01

    A 5-year-old, spayed female Weimaraner dog was evaluated for progressive left forelimb lameness localized to the carpus. Magnetic resonance imaging (MRI) was used to arrive at a presumptive diagnosis of intermedioradial carpal (IRC) bone fracture with avascular necrosis (AVN). To the authors' knowledge, this is the first report of naturally occurring AVN of the canine IRC diagnosed using MRI.

  6. Small carpal bone surface area, a characteristic of Turner's syndrome

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    Cleveland, R.H.; Done, S.; Correia, J.A.; Crawford, J.D.; Kushner, D.C.; Herman, T.E.

    1985-02-01

    An abnormality which has received little attention but may be easily recognized on radiographs of the hand of patients with Turner's syndrome is described. Eleven of thirty-one patients (35.5%) with Turner's syndrome were shown on radiographs of the hand to have a visually detectable smallness of the bone surface area of the carpus when compared to the area of the second through fifth metacarpals. Values for the ''C/M'' ratio (the area of the carpals divided by the area of the second through fifth metacarpals) were calculated for films of 31 individuals with gonadal dysgenesis and compared with those from bone age-matched films of seventy-six individuals with normal development of the hand and wrist. A consistent difference with minimal overlap was documented.

  7. [Carpal instability].

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    Redeker, J; Vogt, P M

    2011-01-01

    Carpal instability can be understood as a disturbed anatomical alignment between bones articulating in the carpus. This disturbed balance occurs either only dynamically (with movement) under the effect of physiological force or even statically at rest. The most common cause of carpal instability is wrist trauma with rupture of the stabilizing ligaments and adaptive misalignment following fractures of the radius or carpus. Carpal collapse plays a special role in this mechanism due to non-healed fracture of the scaphoid bone. In addition degenerative inflammatory alterations, such as chondrocalcinosis or gout, more rarely aseptic bone necrosis of the lunate or scaphoid bones or misalignment due to deposition (Madelung deformity) can lead to wrist instability. Under increased pressure the misaligned joint surfaces lead to bone arrosion with secondary arthritis of the wrist. In order to arrest or slow down this irreversible process, diagnosis must occur as early as possible. Many surgical methods have been thought out to regain stability ranging from direct reconstruction of the damaged ligaments, through ligament replacement to partial stiffening of the wrist joint.

  8. Effects of racetrack exercise on third metacarpal and carpal bone of New Zealand thoroughbred horses.

    Science.gov (United States)

    Firth, E C; Rogers, C W; Jopson, N

    2000-12-01

    The response of equine bone to training has not been quantified in racetrack trained horses, only in treadmill exercised horses. Seven two-year-old thoroughbred fillies were trained on sand and grass at a racetrack, in a typical New Zealand flatrace training regime. The horses were exercised 6 days per week for up to 13 weeks. During the day the horses were confined in 4 x 4m sand yards, and were stalled at night. Another 7 fillies of the same age were allowed free exercise in grass yards. The bones of the animals were available after the 13 week experimental period, and were examined using a Siemens Somatom AR CT scanner. To quantify the response of epiphyseal bone, 3mm thick sagittal plane images of the carpus (through the middle of the medial condyle of distal radius) and the distal third metacarpal bone (Mc3) (immediately lateral and medial to the junction of the condyle and the median sagittal ridge) were studied. Appropriate areas of interest were chosen, and the mean tissue density equivalent (Houndsfield Units) was determined. In the carpus, there was a significant effect of exercise in the dorso-distal aspect of the radius (p<0.01), dorsal aspect of radial and third carpal bones (p<0.01 and p<0.001 respectively). In palmaro-distal subchondral bone of Mc3, there was a significant effect on the medial/lateral site (p<0.01), which differed between right and left legs, probably due to the effect of the horses having been trained in one direction around the training track. The mean tissue density of the Mc3 epiphysis of the exercised group was 36.8% greater than that of the non-exercised group (p<0.001). The study demonstrates that bone response is both rapid and substantial, which should prompt the use of non-invasive diagnostic aids to determine the stage of training in which tissue density changes occur.

  9. Symptomatic carpal coalition: scaphotrapezial joint.

    Science.gov (United States)

    Campaigniac, Erin; Eskander, Mark; Jones, Marci

    2013-12-01

    Carpal coalition is an uncommon congenital abnormality that arises from incomplete cavitation of the common cartilaginous precursor that forms the carpal bones. When carpal coalition is discovered, it is typically an asymptomatic incidental radiographic finding, and is often bilateral. We present a case of symptomatic unilateral carpal coalition of the scaphotrapezial joint, which was treated by excising the fibrous coalition and placing an interposition fat graft. This treatment was effective in alleviating the patient's symptoms.

  10. Carpal bone cysts: MRI, gross pathology, and histology correlation in cadavers

    Science.gov (United States)

    Sanal, Hatice Tuba; Chen, Lina; Haghighi, Parviz; Trudell, Debra J.; Resnick, Donald L.

    2014-01-01

    PURPOSE Intraosseous cysts of carpal bones are frequently observed on routine imaging examinations of the wrist. There is controversy regarding the underlying pathogenesis of these cysts. In this study, we aimed to investigate the magnetic resonance imaging (MRI) appearance of intracarpal bone cysts in correlation with histologic analysis, using cadaveric wrists. METHODS Five freshly frozen cadaveric wrist specimens (from three women and two men; mean age at death, 80 years) were studied. Imaging was performed with T1-weighted fast spin-echo, and proton density-weighted fast spin-echo with and without fat-suppression. The existence of cysts was confirmed by comparing MRI and histology findings. Hematoxylin and eosin stain was performed on tissue slices of 3 mm thickness to analyze the structure of cysts and their communication with the joint cavity. RESULTS Ten cysts were observed. In all cases, cysts were eccentrically located either in the subchondral bone or beneath the cortex. On histologic examination, there were regions of fat necrosis without inflammation or increased vascularity, surrounded by fibrous walls. There were no giant cells, cholesterol granules, or a true synovial lining. Mucoid change was rare. Fibrous component of cysts varied from small fibrous septa to well-formed walls. Some cysts communicated with the joint cavity. Two cysts were adjacent to ligamentous attachments. Those cysts with fibrous tissue demonstrated variable hypointensity on T2. CONCLUSION In contrast to previous reports that described a mucoid composition of intracarpal bone cysts with occasional foamy macrophages, our observations support the concept that these lesions reflect a spectrum of fat necrosis and fibrous changes, without inflammation or hypervascularity. These cysts are typically surrounded by fibrous walls without a true synovial lining. PMID:25205027

  11. Multi-temporal MRI carpal bone volumes analysis by principal axes registration

    Science.gov (United States)

    Ferretti, Roberta; Dellepiane, Silvana

    2016-03-01

    In this paper, a principal axes registration technique is presented, with the relevant application to segmented volumes. The purpose of the proposed registration is to compare multi-temporal volumes of carpal bones from Magnetic Resonance Imaging (MRI) acquisitions. Starting from the study of the second-order moment matrix, the eigenvectors are calculated to allow the rotation of volumes with respect to reference axes. Then the volumes are spatially translated to become perfectly overlapped. A quantitative evaluation of the results obtained is carried out by computing classical indices from the confusion matrix, which depict similarity measures between the volumes of the same organ as extracted from MRI acquisitions executed at different moments. Within the medical field, the way a registration can be used to compare multi-temporal images is of great interest, since it provides the physician with a tool which allows a visual monitoring of a disease evolution. The segmentation method used herein is based on the graph theory and is a robust, unsupervised and parameters independent method. Patients affected by rheumatic diseases have been considered.

  12. 手腕骨三维图像分割方法%A 3D Segmentation Technique for Carpal Bone Images

    Institute of Scientific and Technical Information of China (English)

    李晶; 赵海燕

    2013-01-01

    Targeted at kinematic analysis of the carpal bones and design of fracture fixation for corresponding surgeries, this paper proposes a 3D (Three-Dimensional) technique for segmentation of the carpal bone images on the basis of the spatial position, which contributes to independent investigation of each segmented carpal bone on kinematic features and load-carrying capabilities under different circumstances. As a new segmentation technique in diagnosis and treatment of carpal bone diseases, it can divide the carpal bone images into eight segments that are available separately for review, conifguration, analysis and measurement.%为了对手腕骨进行运动学分析并对骨折手术固定辅助设计,本文提出一种对手腕骨的三维分割方法,即采用基于空间位置的方法将手腕骨独立分开,以便独立研究各部分在不同情况下的运动与受力。该方法将手腕8块腕骨分割开来,并能独立显示控制测量。为手腕骨疾病的诊断治疗提供,新的技术方法。

  13. Semiautomated three-dimensional segmentation software to quantify carpal bone volume changes on wrist CT scans for arthritis assessment.

    Science.gov (United States)

    Duryea, J; Magalnick, M; Alli, S; Yao, L; Wilson, M; Goldbach-Mansky, R

    2008-06-01

    Rapid progression of joint destruction is an indication of poor prognosis in patients with rheumatoid arthritis. Computed tomography (CT) has the potential to serve as a gold standard for joint imaging since it provides high resolution three-dimensional (3D) images of bone structure. The authors have developed a method to quantify erosion volume changes on wrist CT scans. In this article they present a description and validation of the methodology using multiple scans of a hand phantom and five human subjects. An anthropomorphic hand phantom was imaged with a clinical CT scanner at three different orientations separated by a 30-deg angle. A reader used the semiautomated software tool to segment the individual carpal bones of each CT scan. Reproducibility was measured as the root-mean-square standard deviation (RMMSD) and coefficient of variation (CoV) between multiple measurements of the carpal volumes. Longitudinal erosion progression was studied by inserting simulated erosions in a paired second scan. The change in simulated erosion size was calculated by performing 3D image registration and measuring the volume difference between scans in a region adjacent to the simulated erosion. The RMSSD for the total carpal volumes was 21.0 mm3 (CoV = 1.3%) for the phantom, and 44.1 mm3 (CoV = 3.0%) for the in vivo subjects. Using 3D registration and local volume difference calculations, the RMMSD was 1.0-3.0 mm3 The reader time was approximately 5 min per carpal bone. There was excellent agreement between the measured and simulated erosion volumes. The effect of a poorly measured volume for a single erosion is mitigated by the large number of subjects that would comprise a clinical study and that there will be many erosions measured per patient. CT promises to be a quantifiable tool to measure erosion volumes and may serve as a gold standard that can be used in the validation of other modalities such as magnetic resonance imaging.

  14. Carpal instability nondissociative.

    Science.gov (United States)

    Wolfe, Scott W; Garcia-Elias, Marc; Kitay, Alison

    2012-09-01

    Carpal instability nondissociative (CIND) represents a spectrum of conditions characterized by kinematic dysfunction of the proximal carpal row, often associated with a clinical "clunk." CIND is manifested at the midcarpal and/or radiocarpal joints, and it is distinguished from carpal instability dissociative (CID) by the lack of disruption between bones within the same carpal row. There are four major subcategories of CIND: palmar, dorsal, combined, and adaptive. In palmar CIND, instability occurs across the entire proximal carpal row. When nonsurgical management fails, surgical options include arthroscopic thermal capsulorrhaphy, soft-tissue reconstruction, or limited radiocarpal or intercarpal fusions. In dorsal CIND, the capitate subluxates dorsally from its reduced resting position. Dorsal CIND usually responds to nonsurgical management; refractory cases respond to palmar ligament reefing and/or dorsal intercarpal capsulodesis. Combined CIND demonstrates signs of both palmar and dorsal CIND and can be treated with soft-tissue or bony procedures. In adaptive CIND, the volar carpal ligaments are slackened and are less capable of inducing the physiologic shift of the proximal carpal row from flexion into extension as the wrist ulnarly deviates. Treatment of choice is a corrective osteotomy to restore the normal volar tilt of the distal radius.

  15. In-vivo three-dimensional carpal bone kinematics during flexion-extension and radio-ulnar deviation of the wrist: Dynamic motion versus step-wise static wrist positions

    NARCIS (Netherlands)

    M. Foumani; S.D. Strackee; R. Jonges; L. Blankevoort; A.H. Zwinderman; B. Carelsen; G.J. Streekstra

    2009-01-01

    An in-vivo approach to the measurement of three-dimensional motion patterns of carpal bones in the wrist may have future diagnostic applications, particularly for ligament injuries of the wrist. Static methods to measure carpal kinematics in-vivo only provide an approximation of the true kinematics

  16. Carpal Fusion

    Directory of Open Access Journals (Sweden)

    Jalal Jalalshokouhi*

    2012-05-01

    Full Text Available Carpal fusion may be seen in hereditary and nonhereditary conditions such as acrocallosal syndrome,acromegaly, Apert syndrome, arthrogryposis, Carpenter syndrome, chromosomal abnormalities, ectrodactyly-ectodermal dysplasia-cleft (EEC syndrome, the F form of acropectorovertebral dysgenesis or the F syndrome, fetal alcohol syndrome, Holt-Oram syndrome, Leopard syndrome, multiple synostosis syndrome, oligosyndactyly syndrome, Pfeiffer-like syndrome, scleroderma, split hand and foot malformation, Stickler syndrome, thalidomide embryopathy, Turner syndrome and many other conditions as mentioned in Rubinstein-Taybi's book. Sometimes there is no known causative disease.Diagnosis is usually made by plain X-ray during studying a syndrome or congenital disease or could be an incidental finding like our patients. Hand bone anomalies are more common in syndromes or other congenital or non-hereditary conditions, but polydactyly, syndactyly or oligodactyly and carpal fusions are interesting. X-ray is the modality of choice, but MRI and X-ray CT with multiplanar reconstructions may be used for diagnosis.

  17. The short-term outcome of the modified Sauvé-Kapandji procedure regarding range of motion, carpal bone translation and bony shelf size.

    Science.gov (United States)

    Toyama, Shogo; Tamai, Kazuo; Sakamoto, Atsuto; Hirashima, Toshiko

    2011-02-01

    The Sauvé-Kapandji (S-K) procedure is a common treatment for rheumatoid wrists, but in some cases severe bone destruction makes this operative modality difficult to perform, while also resulting in a poor outcome. A modified S-K procedure for these wrists has been reported, but the clinical outcomes of the modified procedure are unclear. This study evaluated 24 wrists in 20 patients who underwent the modified S-K procedure. The mean follow-up period was 34.5 months. The clinical assessments were range of motion, carpal bone translation and bony shelf size. The range of motion and carpal bone translation were similar to those produced by the S-K procedure. In regard to bony shelf size, wrists with an excessively large bony shelf tended to have a progression of carpal bone translation toward the palmar direction due to the residual malposition of the ECU tendon. The modified S-K procedure appears to be a safe and effective surgical alternative for the treatment of severely destroyed rheumatoid wrists. Although the modified procedure allows for the adjustment of the bony shelf size, it should not be used with wrists that have an excessively large bony shelf.

  18. In-vivo three-dimensional carpal bone kinematics during flexion-extension and radio-ulnar deviation of the wrist: Dynamic motion versus step-wise static wrist positions.

    Science.gov (United States)

    Foumani, M; Strackee, S D; Jonges, R; Blankevoort, L; Zwinderman, A H; Carelsen, B; Streekstra, G J

    2009-12-11

    An in-vivo approach to the measurement of three-dimensional motion patterns of carpal bones in the wrist may have future diagnostic applications, particularly for ligament injuries of the wrist. Static methods to measure carpal kinematics in-vivo only provide an approximation of the true kinematics of the carpal bones. This study is aimed at finding the difference between dynamically and statically acquired carpal kinematics. For eight healthy subjects, static and a dynamic measurements of the carpal kinematics were performed for a flexion-extension and a radio-ulnar deviation movement. Dynamic scans were acquired by using a four-dimensional X-ray imaging system during an imposed cyclic motion. To assess static kinematics of the wrists, three-dimensional rotational X-ray scans were acquired during step-wise flexion-extension and radio-ulnar deviation. The helical axis rotations and the rotation components. i.e. flexion-extension, radio-ulnar deviation and pro-supination were the primary parameters. Linear mixed model statistical analysis was used to determine the significance of the difference between the dynamically and statically acquired rotations of the carpal bones. Small and in most cases negligible differences were observed between the dynamic motion and the step-wise static motion of the carpal bones. The conclusion is that in the case of individuals without any pathology of the wrist, carpal kinematics can be studied either dynamically or statically. Further research is required to investigate the dynamic in-vivo carpal kinematics in patients with dynamic wrist problems.

  19. Diagnostic Value of Digital Tomosynthesis in Carpal Bones Fracture%X线数字断层融合技术在腕骨骨折中的应用

    Institute of Scientific and Technical Information of China (English)

    戴冬晴; 邓士杰

    2014-01-01

    目的:探讨基于平板探测器下的数字断层融合技术(Dightal Tomosynthesis,简称DTS)(以下简称断层融合)在腕骨骨折中的应用。方法:对30例腕骨外伤患者进行普通DR及断层融合摄影的进行对比性摄片。结果:断层融合检查技术图像清晰,细节显示良好、价格低廉,骨折阳性检出率高,显著提高影像诊断质量。结论:在腕骨骨折影像诊断中,数字断层融合技术是一种准确的方法。%Objective: To explore the diagnostic value of digital tomosynthesis (DTS) in carpal bones fracture. Methods: Compare the diagnosis of the DTS and the ordinary DR of 30 wrist injured patients. Results: DTS has clear image, low price, high positive rate in carpal bones fracture, It can significantly improve the quality of diagnostic imaging. Conclusion: DTS is an accurate inspection method in carpal bones fracture.

  20. High Density Infill in Cracks and Protrusions from the Articular Calcified Cartilage in Osteoarthritis in Standardbred Horse Carpal Bones

    Directory of Open Access Journals (Sweden)

    Sheila Laverty

    2015-04-01

    Full Text Available We studied changes in articular calcified cartilage (ACC and subchondral bone (SCB in the third carpal bones (C3 of Standardbred racehorses with naturally-occurring repetitive loading-induced osteoarthritis (OA. Two osteochondral cores were harvested from dorsal sites from each of 15 post-mortem C3 and classified as control or as showing early or advanced OA changes from visual inspection. We re-examined X-ray micro-computed tomography (µCT image sets for the presence of high-density mineral infill (HDMI in ACC cracks and possible high-density mineralized protrusions (HDMP from the ACC mineralizing (tidemark front (MF into hyaline articular cartilage (HAC. We hypothesized and we show that 20-µm µCT resolution in 10-mm diameter samples is sufficient to detect HDMI and HDMP: these are lost upon tissue decalcification for routine paraffin wax histology owing to their predominant mineral content. The findings show that µCT is sufficient to discover HDMI and HDMP, which were seen in 2/10 controls, 6/9 early OA and 8/10 advanced OA cases. This is the first report of HDMI and HDMP in the equine carpus and in the Standardbred breed and the first to rely solely on µCT. HDMP are a candidate cause for mechanical tissue destruction in OA.

  1. High density infill in cracks and protrusions from the articular calcified cartilage in osteoarthritis in standardbred horse carpal bones.

    Science.gov (United States)

    Laverty, Sheila; Lacourt, Mathieu; Gao, Chan; Henderson, Janet E; Boyde, Alan

    2015-04-28

    We studied changes in articular calcified cartilage (ACC) and subchondral bone (SCB) in the third carpal bones (C3) of Standardbred racehorses with naturally-occurring repetitive loading-induced osteoarthritis (OA). Two osteochondral cores were harvested from dorsal sites from each of 15 post-mortem C3 and classified as control or as showing early or advanced OA changes from visual inspection. We re-examined X-ray micro-computed tomography (µCT) image sets for the presence of high-density mineral infill (HDMI) in ACC cracks and possible high-density mineralized protrusions (HDMP) from the ACC mineralizing (tidemark) front (MF) into hyaline articular cartilage (HAC). We hypothesized and we show that 20-µm µCT resolution in 10-mm diameter samples is sufficient to detect HDMI and HDMP: these are lost upon tissue decalcification for routine paraffin wax histology owing to their predominant mineral content. The findings show that µCT is sufficient to discover HDMI and HDMP, which were seen in 2/10 controls, 6/9 early OA and 8/10 advanced OA cases. This is the first report of HDMI and HDMP in the equine carpus and in the Standardbred breed and the first to rely solely on µCT. HDMP are a candidate cause for mechanical tissue destruction in OA.

  2. Increases in discontinuous rib cartilage and fused carpal bone in rat fetuses exposed to the teratogens, busulfan, acetazolamide, vitamin A, and ketoconazole.

    Science.gov (United States)

    Dodo, T; Uchida, K; Hirose, T; Fukuta, T; Kojima, C; Shiraishi, I; Kato, E; Horiba, T; Mineshima, H; Okuda, Y; Maeda, M; Katsutani, N; Hirano, K; Aoki, T

    2010-06-01

    Skeletal changes induced by treatment of pregnant rats with four potent teratogens, busulfan, acetazolamide, vitamin A palmitate, and ketoconazole, were evaluated using Alizarin Red S and Alcian Blue double-staining to investigate the relationship between drug-induced skeletal malformations and cartilaginous changes in the fetuses. Pregnant rats (N = 8/group) were treated once or twice between gestation days (GDs) 10 to 13 with busulfan at doses of 3, 10, or 30 mg/kg; acetazolamide at 200, 400, or 800 mg/kg; vitamin A palmitate at 100,000, 300,000, or 1,000,000 IU/kg; or ketoconazole at doses of 10, 30, or 100 mg/kg. Uterine evaluations and fetal external and skeletal examinations were conducted on GD 20. Marked skeletal abnormalities in ribs and hand/forelimb bones such as absent/ short/bent ribs, fused rib cartilage, absent/fused forepaw phalanx, and misshapen carpal bones were induced at the mid- and high-doses of busulfan and acetazolamide and at the high-dose of vitamin A palmitate and ketoconazole. Increased incidences of discontinuous rib cartilage (DRC) and fused carpal bone (FCB) were observed from the low- or mid-dose in the busulfan and acetazolamide groups, and incidences of FCB were increased from the mid-dose in the vitamin A palmitate and ketoconazole groups. Therefore, DRC and FCB were detected at lower doses than those at which ribs and hand/forelimb malformations were observed in the four potent teratogens.

  3. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... arm. Just a passing cramp? It could be carpal tunnel syndrome. The carpal tunnel is a narrow passageway of ligament and ... difficult. Often, the cause is having a smaller carpal tunnel than other people do. Other causes include ...

  4. Arthroscopy of the wrist: anatomy and classification of carpal instability.

    Science.gov (United States)

    Cooney, W P; Dobyns, J H; Linscheid, R L

    1990-01-01

    Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

  5. Carpal-tarsal osteolysis with elbow involvement

    Energy Technology Data Exchange (ETDEWEB)

    McDonald, Kirsteen; Toms, Andoni P.; Marshall, Thomas J. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich, Norfolk (United Kingdom); Armon, Kate [Norfolk and Norwich University Hospital, Department of Paediatrics, Norwich, Norfolk (United Kingdom); Johnson, Karl [Birmingham Children' s Hospital, Department of Radiology, Birmingham, West Midlands (United Kingdom)

    2007-11-15

    Carpal-tarsal osteolysis is a rare condition that manifests as the progressive resorption of carpal and tarsal bones in young children. The diagnosis of this condition is often difficult and delayed as the initial clinical presentation is non-specific. Radiographic changes occur gradually, are often not seen at presentation and depend on recognising loss of bone in the ossification centres of the carpus and tarsus. MRI demonstrates morphological abnormalities in the cartilaginous, as well as the osseous components, of the developing carpal and tarsal bones and therefore may be helpful in predating the radiographic changes. Ultrasound appears to contribute little to the diagnosis and may be misleading. Exclusion of other conditions, particularly juvenile idiopathic arthritis, is important in making the diagnosis. MRI can be useful in excluding an inflammatory arthropathy, and suggesting the diagnosis of carpal-tarsal osteolysis. (orig.)

  6. Carpal Fusion

    OpenAIRE

    2012-01-01

    Carpal fusion may be seen in hereditary and nonhereditary conditions such as acrocallosal syndrome,acromegaly, Apert syndrome, arthrogryposis, Carpenter syndrome, chromosomal abnormalities, ectrodactyly-ectodermal dysplasia-cleft (EEC) syndrome, the F form of acropectorovertebral dysgenesis or the F syndrome, fetal alcohol syndrome, Holt-Oram syndrome, Leopard syndrome, multiple synostosis syndrome, oligosyndactyly syndrome, Pfeiffer-like syndrome, scleroderma, split hand and foot malformatio...

  7. [Mechanics of the perilunate carpal bones and their injury patterns including post-traumatic instability with reference to rare clinical cases].

    Science.gov (United States)

    Zilch, H

    1985-01-01

    There is given a survey of recent findings of the biomechanics of the carpal bones of which the complex of the os scaphoideum, lunatum and capitatum has the key role. The mechanism of injury and posttraumatic instability of the wrist are presented. Rare injuries like subluxation of the os scaphoideum with DISI instability, "scapho-capitate fracture" syndrome, and perilunar dislocation associated with scaphoid fracture (de Quervain) with a proximal fragment of the scaphoid which is turned over about 180 and 90 degrees, are reported in form of clinical cases. In case of subluxation of the os scaphoideum the operation described by Dobyns is recommended, using a split of ECRB tendon for dorsal ligament reconstruction.

  8. 螺旋CT及X线平片在腕骨隐匿性骨折诊断中的比较分析%Spiral CT and X-ray plain film in the diagnosis of carpal bone occult fracture

    Institute of Scientific and Technical Information of China (English)

    宋春华

    2015-01-01

    Objective To study the carpal bone occult fracture characteristics of spiral CT and X-ray plain film. Methods A retrospective analysis of 46 carpal bone occult fracture cases X-ray films, CT data. Including the review of the data. Results X-ray, suspicious 19 cases of fracture and CT examination all positive, typically characterized by bone cortex lifted, interruption of trabecular bone. Conclusion CT has important significance in avoiding misdiagnosis and carpal bone occult fracture.%目的 探讨螺旋CT及X线平片在腕骨隐匿性骨折检查中的特点.方法 回顾性分析46例腕骨隐匿性骨折的X线片、CT资料. 结果 X线检查阳性1例, 可疑骨折19例,CT阳性后复核X线阳性2例,CT检查44例阳性,典型表现为骨皮质掀起,骨小梁中断.结论 CT检查在避免腕骨隐匿性骨折漏诊中有重要作用,CT阴性应引起重视.

  9. Carpal Ligament Injuries, Pathomechanics, and Classification.

    Science.gov (United States)

    Lee, Daniel J; Elfar, John C

    2015-08-01

    Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including 2 of the most common malalignment patterns: volar intercalated segment instability and the more common dorsal intercalated segment instability. Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research is likely to unify the disparate paradigms used to describe wrist instability.

  10. Complex carpal malformation without a cause.

    Science.gov (United States)

    Swanger, Ronald; Faulkner, Christyna; Maldjian, Catherine; Schlesinger, Iris; Magill, Richard; Weinberg, Brighita

    2009-11-01

    Carpal dislocation is an uncommon event. We present a 4-year-old male child who had the clinical appearance of a Madelung's deformity; however, he failed to fulfill the radiological criteria for a Madelung's deformity. The carpal bones had not yet ossified making it difficult to arrive at a diagnosis using radiograph alone. Magnetic resonance imaging was diagnostic because of the ability to delineate the carpal cartilaginous ossification centers. Chronic wrist dislocation should be considered in the differential diagnosis of a long-standing wrist deformity that clinically resembles a Madelung's deformity in a young child.

  11. High resolution sonography of the carpal tunnel syndrome; Ecografia con alta risoluzione nello studio della sindrome del tunnel carpale

    Energy Technology Data Exchange (ETDEWEB)

    Ferrari, Francesco Saverio; Guazzi, Gianni; Belcapo, Luigi; Stefani, Paolo [Siena, Univ. (Italy). Istituto di Scienze Eidologiche e Radiologiche; Della Sala, Luca; Cozza, Sabino [Ospedale di Volterra, Pisa (Italy). Servizio di Radiologia; Mariottini, Aldo; Bolognini, Andrea [Siena, Univ. (Italy). Istituto di Neurochirurgia

    1997-04-01

    They investigated the reliability of some US signs in the diagnosis of the carpal tunnel syndrome. They carried out a single-blind study with 13-MHz high resolution probes and electromyography on 132 patients with clinical evidence of the carpal tunnel syndrome; a control group of 20 asymptomatic patients was also submitted to US. Eighty-six of 107 patients with US signs of the carpal tunnel syndrome were then submitted to surgical decompression while the extant 21 patients underwent conservative treatment and clinical follow-up. To diagnose the carpal tunnel syndrome they considered the following US patterns: median nerve changes palmar bowing of the flexor retinaculum, thickening of the transverse carpal ligament and increased depth of the carpal tunnel, as measured from the apex of the transverse carpal ligament convexity to the underlying carpal bone. Median nerve changes were unreliable signs and were missing in many cases: only 45 of 107 patients exhibited median nerve swelling before and/or its flattening in the carpal tunnel (42 %). Such indirect signs as the thickening of the transverse carpal ligament in chronic cases were demonstrated in 94 of 107 patients with the carpal tunnel syndrome (88 %) and canal depending in all unilateral carpal tunnel syndromes was shown in 92 of 107 patients (87 %); both these signs proved to be much more reliable. The palmar bowling of the flexor retinaculum was also difficult to demonstrate in surgical patients or in those with connective tissue fibrosis within the tunnel: this sign was demonstrated in 80 of 107 patients with the carpal tunnel syndrome confirmed with electromyography (75 %). Tanzer and Rietze reported median nerve changes observed at surgery in 43 % and 66 % of their patients. Recent MR findings in asymptomatic wrists have demonstrated that the normal median nerve has an elliptical shape inside the carpal tunnel. (Abstract Truncated)

  12. Multislice CT in diagnosis of associated carpal bone fractures in distal radial fractures%螺旋CT对桡骨远端骨折合并腕骨骨折的临床诊断价值

    Institute of Scientific and Technical Information of China (English)

    李会侠; 屈瑾; 雷新玮

    2016-01-01

    Clinical data and radiological findings of 78 patients with distal radial fractures,who underwent plain X-ray film and muhislice CT (MSCT) examinations,were retrospectively analyzed.Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases;while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P < 0.05).The missed diagnosis rate of X-ray was 38%.Results indicate that MSCT can significantly improve the detect rate,which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.%对2013年5月至2015年5月就诊的78例桡骨远端骨折患者的X线片和多层螺旋CT影像资料,进行回顾性对比分析.X线平片明确合并腕骨骨折21例29处;多层螺旋CT扫描明确合并腕骨骨折29例47处,两组腕骨骨折检出率比较差异有统计学意义(x2 =8.313,P<0.05).X线平片与CT扫描相比,漏诊率为38%.多层螺旋CT可提高对桡骨远端骨折中合并腕骨骨折的诊断准确率,为临床的诊断和治疗提供可靠依据.

  13. Movement of the distal carpal row during narrowing and widening of the carpal arch width.

    Science.gov (United States)

    Gabra, Joseph N; Domalain, Mathieu; Li, Zong-Ming

    2012-10-01

    Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3 deg, 5.3 ± 1.3 deg, and 5.5 ± 3.5 deg, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components.

  14. Scaphoid dislocation with hamate fracture and proximal migration of distal carpal row

    Institute of Scientific and Technical Information of China (English)

    Soral Aditya; Varshney Manish Kumar

    2013-01-01

    Scaphoid dislocation is a rare injury.Traditionally it has been classified into isolated dislocation and dislocation associated with axial carpal disruption.We present a unique case of scaphoid dislocation associated with proximal migration of the entire distal carpal row as a single unit and hamate fracture with no axial carpal disruption.This injury complex has not been previously described in the literature.The purpose of this case report is to emphasize that in absence of axial carpal dissociation with scaphoid dislocation,a careful evaluation of injury to other bones should be done and treated accordingly to maximize the chances of favourable outcome with reconstructive surgery.

  15. 腕骨脱位的X线平片及40层螺旋CT诊断比较%Diagnostic comparison of X-ray plain film and 40-multidetector CT in dislocation of carpal bones

    Institute of Scientific and Technical Information of China (English)

    于宝江; 曹立福; 骈文婷; 郭健; 宋伟兴; 白振武

    2012-01-01

    Objective To study the imaging manifestations and detecting rates of dislocation of carpal bones on X- ray plain film and 40-multidetector CT (MDCT), to improve the diagnostic accuracy and to reduce the missed diagnosis and misdiagnosis. Materials and Methods The X -ray plain films, MDCT, volume rendering (VR) and multiplanar reconstruction (MPR) of 21 patients with dislocation of carpal bones were retrospectively studied. 19 cases were male and two were female, mean age 31±7 years old (19-45 years). Dislocation was in left side in 14 cases, in right in seven cases. Result Eight cases of lunate dislocation, 13 cases of perilunar dislocation, three cases of simple perilunar dislocation , four cases of perilunar dislocation per navicular bone, One case of perilunar dislocation per navicular and triangular bones, three cases of perilunar dislocation per triangular bones, two cases of perilunar dislocation per styloid process of radius. Among the cases with fracture of other carpal bones, the diagnosis of fractures of radial styloid process and navicular bones were correctly detected on X-ray plain film. But in three cases with fracture of triangular bone, the fractures were indetectable or the original place of the bone fragments were unable to determine on X-ray plain film, but could be correctly detected with MDCT and reconstruct technology. Conclusion Diagnosis of dislocation of carpal bones can be correctly made with X-ray plain film in the most cases. But for the cases with fracture of carpal bones, especially with tiny fracture, X-ray plain film produces high rate of missed diagnosis. MDCT, VR and MPR can accurately show dislocations and fractures in three-dimension having high clinical value.%目的 探讨腕骨脱位X线平片及多层螺旋CT的影像学表现,并对两者的检出情况进行比较,以提高对腕骨脱位的诊断水平,减少漏诊误诊.资料与方法对2006年8月-2009年11月共21例腕骨脱位病人的X线平片、多层螺旋CT薄

  16. Three-dimensional stiffness of the carpal arch.

    Science.gov (United States)

    Gabra, Joseph N; Li, Zong-Ming

    2016-01-01

    The carpal arch of the wrist is formed by irregularly shaped carpal bones interconnected by numerous ligaments, resulting in complex structural mechanics. The purpose of this study was to determine the three-dimensional stiffness characteristics of the carpal arch using displacement perturbations. It was hypothesized that the carpal arch would exhibit an anisotropic stiffness behavior with principal directions that are oblique to the conventional anatomical axes. Eight (n=8) cadavers were used in this study. For each specimen, the hamate was fixed to a custom stationary apparatus. An instrumented robot arm applied three-dimensional displacement perturbations to the ridge of trapezium and corresponding reaction forces were collected. The displacement-force data were used to determine a three-dimensional stiffness matrix using least squares fitting. Eigendecomposition of the stiffness matrix was used to identify the magnitudes and directions of the principal stiffness components. The carpal arch structure exhibited anisotropic stiffness behaviors with a maximum principal stiffness of 16.4±4.6N/mm that was significantly larger than the other principal components of 3.1±0.9 and 2.6±0.5N/mm (pcarpal tunnel which is accounted for by the stiff transverse ligaments that tightly bind distal carpal arch. The minimal principal stiffness is attributed to the less constraining articulation between the trapezium and scaphoid. This study provides advanced characterization of the wrist׳s three-dimensional structural stiffness for improved insight into wrist biomechanics, stability, and function.

  17. A three-dimensional quantitative analysis of carpal deformity in rheumatoid wrists.

    Science.gov (United States)

    Arimitsu, S; Murase, T; Hashimoto, J; Oka, K; Sugamoto, K; Yoshikawa, H; Moritomo, H

    2007-04-01

    We have measured the three-dimensional patterns of carpal deformity in 20 wrists in 20 rheumatoid patients in which the carpal bones were shifted ulnarwards on plain radiography. Three-dimensional bone models of the carpus and radius were created by computerised tomography with the wrist in the neutral position. The location of the centroids and rotational angle of each carpal bone relative to the radius were calculated and compared with those of ten normal wrists. In the radiocarpal joint, the proximal row was flexed and the centroids of all carpal bones translocated in an ulnar, proximal and volar direction with loss of congruity. In the midcarpal joint, the distal row was extended and congruity generally well preserved. These findings may facilitate more positive use of radiocarpal fusion alone for the deformed rheumatoid wrist.

  18. Idiopathic Carpal Tunnel Syndrome: Evaluation of the Depth of the Carpal Tunnel by Ultrasonography.

    Science.gov (United States)

    Elsaman, Ahmed Mohammed Mahrous Yousif; Thabit, Mohamed Nasreldin; Radwan, Ahmed Roshdy Al-Agamy; Ohrndorf, Sarah

    2015-11-01

    The objective of the work described here was to evaluate the depth of the carpal tunnel (DCT) in patients with idiopathic carpal tunnel syndrome (CTS) and healthy volunteers by ultrasonography (US), through measurement of the distance from the flexor retinaculum to the surface of the capitate bone at the carpal tunnel outlet, and compare it with other ultrasonographic and electrophysiologic parameters in CTS. The study was conducted in 60 non-diabetic patients with idiopathic carpal tunnel syndrome (unilateral n = 37, bilateral n = 23) evidenced by electrophysiologic diagnosis according to the criteria of the American Association of Electrodiagnostic Medicine (AAEM). Furthermore, 40 hands from 20 healthy volunteers were examined. Median nerve cross-sectional area (CSA); flattening ratio (FR), the ratio of the length to the width of the median nerve; and DCT at the canal outlet were measured for all participants. The mean age was 35.6 ± 9.48 y. The female-to-male ratio was 47:13 in the CTS patients. The sensitivity and specificity were 82% and 95% for CSA, 75% and 60% for FR and 75% and 87.5% for DCT, respectively. Differences between patients and healthy controls were significant for all three parameters, greatest for DCT, followed by CSA and then FR. We conclude that DCT increased in CTS and this new parameter is comparable in sensitivity and specificity to CSA and FR. DCT increased independently of the cause of the CTS (decrease in size of canal or increase in contents).

  19. Carpal tunnel syndrome and acromegaly.

    Science.gov (United States)

    Baum, H; Lüdecke, D K; Herrmann, H D

    1986-01-01

    50 patients with acromegaly and carpal tunnel syndrome have been examined electrophysiologically before and after transnasal operation of the pituitary adenoma. 32 of the 50 patients (64%) had symptoms of carpal tunnel syndrome. 13 of them had neurological deficits. 28 of the examined patients had pathological neurographical findings only. About 1 week post-operatively DL was decreased in 43%; in 10 out of 13 patients with neurological deficits DL decreased. GH was normalized in 80% and reduced to 5-10 micrograms/l in a further 10%. The investigation did not show whether the carpal tunnel syndrome only depended on a GH increase or on other factors also such as e.g., on the duration of symptoms or tissue changes. None of the patients had the transversal carpal ligament operated on. The coincidence between acromegaly and carpal tunnel syndrome was 64%. In 3 cases the carpal tunnel syndrome was the leading sign to the diagnosis of acromegaly.

  20. Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment.

    Science.gov (United States)

    Sauerbier, M; Tränkle, M; Linsner, G; Bickert, B; Germann, G

    2000-08-01

    Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

  1. A rare case of massive carpal osteoblastoma requiring complex reconstructive surgery.

    Science.gov (United States)

    Dunda, S E; Kauczok, J; Demir, E; Braunschweig, T; Pallua, N

    2013-07-01

    An osteoblastoma is a rare, commonly benign, osteoid-producing neoplasm of the bone with an incidence of 2% of all primary bone tumours. We present a case of a 54-year-old patient with persisting carpal pain and massive swelling of the hand for a period of 4 years. Incision biopsies revealed the histopathological finding of a carpal osteoblastoma. After complete tumour excision, including the carpal and, in parts, metacarpal bones, reconstructive surgery was performed with a free osteocutaneous iliac crest flap to obtain a natural hand contour and the best possible hand function. Follow-up revealed improvement of the hand function in terms of flexion, extension and strength without discomfort or further pain. Thus, ongoing carpal pain should lead to an intensive search with further diagnostic measures such as magnetic resonance imaging (MRI) scan as well as biopsies, if necessary, to obtain the correct diagnosis.

  2. Carpal tunnel and transverse carpal ligament stiffness with changes in wrist posture and indenter size.

    Science.gov (United States)

    Holmes, Michael W R; Howarth, Samuel J; Callaghan, Jack P; Keir, Peter J

    2011-11-01

    This study investigated the effects of loading and posture on mechanical properties of the transverse carpal ligament (TCL). Ten fresh-frozen cadaver arms were dissected to expose the TCL and positioned in the load frame of a servo-hydraulic testing machine, equipped with a load cell and custom made indenters. Four cylindrical indenters (5, 10, 20, and 35 mm) loaded the TCL in three wrist postures (30° extension, neutral and 30° flexion). Three loading cycles with a peak force of 50 N were applied at 5 N/s for each condition. The flexed wrist posture had significantly greater TCL stiffness (40.0 ± 3.3 N/mm) than the neutral (35.9 ± 3.5 N/mm, p = 0.045) and extended postures (34.9 ± 2.8 N/mm, p = 0.025). TCL stiffness using the 10 and 20 mm indenters was larger than the 5 mm indenter. Stiffness was greatest with the 20 mm indenter, which had the greatest indenter contact area on the TCL. The 35 mm indenter covered the carpal bones, compressed the carpal tunnel and produced the lowest stiffness. The complexity of the TCL makes it an important part of the carpal tunnel and the mechanical properties found are essential to understanding mechanisms of carpal tunnel syndrome. 

  3. Carpal tunnel syndrome treatment

    Directory of Open Access Journals (Sweden)

    Emilio Filippucci

    2011-09-01

    Full Text Available Carpal tunnel syndrome, the most common peripheral neuropathy, results from compression of the median nerve at the wrist, and is a cause of pain, numbness and tingling in the upper extremities and an increasingly recognized cause of work disability. If carpal tunnel syndrome seems likely, conservative management with splinting should be initiated. Moreover, it has suggested that patients reduce activities at home and work that exacerbate symptoms. Pyridoxine and diuretics, since are largely utilised, are no more effective than placebo in relieving the symptoms. Non steroidal anti-inflammatory drugs and orally administered corticosteroids can be effective for short-term management (two to four weeks, but local corticosteroid injection may improve symptoms for a longer period. Injection is especially effective if there is no loss of sensibility or thenar-muscle atrophy and weakness, and if symptoms are intermittent rather than constant. If symptoms are refractory to conservative measures, the option of surgical therapy may be considered.

  4. [Carpal tunnel syndrome treatment].

    Science.gov (United States)

    De Angelis, Rossella; Salaffi, Fausto; Filippucci, Emilio; Grassi, Walter

    2006-01-01

    Carpal tunnel syndrome, the most common peripheral neuropathy, results from compression of the median nerve at the wrist, and is a cause of pain, numbness and tingling in the upper extremities and an increasingly recognized cause of work disability. If carpal tunnel syndrome seems likely, conservative management with splinting should be initiated. Moreover, it has suggested that patients reduce activities at home and work that exacerbate symptoms. Pyridoxine and diuretics, since are largely utilised, are no more effective than placebo in relieving the symptoms. Non steroidal anti-inflammatory drugs and orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injection may improve symptoms for a longer period. Injection is especially effective if there is no loss of sensibility or thenar-muscle atrophy and weakness, and if symptoms are intermittent rather than constant. If symptoms are refractory to conservative measures, the option of surgical therapy may be considered.

  5. Carpal tunnel release

    DEFF Research Database (Denmark)

    Larsen, Morten Bo; Sørensen, A I; Crone, K L;

    2013-01-01

    A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopi...... incision could be found. There were no serious complications in either group. The results indicate that the endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work....

  6. [Acute carpal tunnel syndrome in a patient with Marfan syndrome].

    Science.gov (United States)

    Franke, J; Wenzel, W; Rehfuss, D; Keiner, H P; Manncke, K

    2008-05-01

    Acute carpal tunnel syndrome (ACTS) is rare and is mostly the result of fractures of the distal radius or the carpal bones. This paper gives the first report of an ACTS following contusion of the wrist as the result of an extensive haematoma of the flexor tendon sheath, which did not appear until 50 hours after the injury was sustained but then developed rapidly. The patient suffers from Marfan syndrome. This disease is associated with pathologic changes to the major vessels, and especially the aorta, and of the smaller peripheral vessels. It is assumed that the haematoma arose from an aneurysm of such a small vessel. The treatment of choice in ACTS is emergency incision of the carpal tunnel.

  7. Carpal ontogeny in Monodelphis domestica and Caluromys philander (Marsupialia).

    Science.gov (United States)

    Prochel, J A N; Sánchez-Villagra, Marcelo R

    2003-01-01

    Carpal bones have experienced numerous changes during marsupial evolution, even though their diversity and development remain poorly studied. The aim of this work was to document adult form and the pattern of mesenchymal tissue condensation and formation of chondrification and ossification centers in the hand of two marsupials. Two fundamental questions were asked: whether the loss of embryonic precursors was associated with the loss of adult elements, or whether there were developmental signs of ancestral mammalian elements that have been fused or lost in marsupial taxa. We were also interested to find out whether there is sexual dimorphismus in the carpals, as has been reported for some didelphids. Histological sections, cleared and stained specimens and macerated skeletons representing an ontogenetic series of Monodelphis domestica were used to document carpal development. Comparisons were made with perinatal stages of Caluromys philander and with adult specimens of other marsupials. A prenatal M. domestica in the 13th day after conception has a cell condensation that because of its position is homologized with a centrale, which is at birth already lost or fused. Neonatal M. domestica and C. philander have the number and arrangement of their adult carpal anatomy. Trapezium and trapezoid start ossification later than most other carpals, while pisiform and prepollex are the last to do so. Adult males of M. domestica have relatively larger and more robust pisiforms, compared to other carpals, than females. This sexual dimorphism develops relatively late as it was not recorded in male specimens around 160 days old. An extra sesamoid bone located just distal to the radius and proximo-palmar to the scaphoid was recorded in specimens of C. philander, C. derbianus and Didelphis virginiana.

  8. The effect of tendon loading on in-vitro carpal kinematics of the wrist joint.

    Science.gov (United States)

    Foumani, M; Blankevoort, L; Stekelenburg, C; Strackee, S D; Carelsen, B; Jonges, R; Streekstra, G J

    2010-06-18

    Measurements of in-vitro carpal kinematics of the wrist provide valuable biomechanical data. Tendon loading is often applied during cadaver experiments to simulate natural stabilizing joint compression in the wrist joint. The purpose of this study was to investigate the effect of tendon loading on carpal kinematics in-vitro. A cyclic movement was imposed on 7 cadaveric forearms while the carpal kinematics were acquired by a 4-dimensional rotational X-ray imaging system. The extensor- and flexor tendons were loaded with constant force springs of 50 N, respectively. The measurements were repeated without a load on the tendons. The effect of loading on the kinematics was tested statistically by using a linear mixed model. During flexion and extension, the proximal carpal bones were more extended with tendon loading. The lunate was on the average 2.0 degrees (p=0.012) more extended. With tendon loading the distal carpal bones were more ulnary deviated at each angle of wrist motion. The capitate was on the average 2.4 degrees (p=0.004) more ulnary deviated. During radioulnar deviation, the proximal carpal bones were more radially deviated with the lunate 0.7 degrees more into radial deviation with tendon loading (pcarpal kinematics during flexion-extension and radioulnar deviation.

  9. The advantage of throwing the first stone: how understanding the evolutionary demands of Homo sapiens is helping us understand carpal motion.

    Science.gov (United States)

    Rohde, Rachel S; Crisco, Joseph J; Wolfe, Scott W

    2010-01-01

    Unlike any other diarthrodial joint in the human body, the "wrist joint" is composed of numerous articulations between eight carpal bones, the distal radius, the distal ulna, and five metacarpal bones. The carpal bones articulate with each other as well as with the distal radius, distal ulna, and the metacarpal bases. Multiple theories explaining intercarpal motion have been proposed; however, controversy exists concerning the degree and direction of motion of the individual carpal bones within the two carpal rows during different planes of motion. Recent investigations have suggested that traditional explanations of carpal bone motion may not entirely account for carpal motion in all planes. Better understanding of the complexities of carpal motion through the use of advanced imaging techniques and simultaneous appreciation of human anatomic and functional evolution have led to the hypothesis that the "dart thrower's motion" of the wrist is uniquely human. Carpal kinematic research and current developments in both orthopaedic surgery and anthropology underscore the importance of the dart thrower's motion in human functional activities and the clinical implications of these concepts for orthopaedic surgery and rehabilitation.

  10. Complex Regional Pain Syndrome (CRPS Type II After Carpal Tunnel Release Surgery: Case Report

    Directory of Open Access Journals (Sweden)

    Hakan Tunç

    2010-08-01

    Full Text Available Summary Complex regional pain syndrome is a chronic syndrome characterised with dystrophic changes and neurovascular disordes of bone and skin of extremities. The most common etiological factors are trauma, ischemic heart disease, cerebral lesions, servical region disorders, infections, and surgical treatments. Carpal tunnel syndrome is the most common compressive neuropaty of the upper extremity. There are various surgical and conservative alternatives in the treatment of carpal tunnel syndrome. Complex regional pain syndrome has been reported as a complication of surgical carpal tunnel release in 2-5% of patients. In this case report clinical characteristics and rehabilitation outcomes of a patient with complex regional pain syndrome after carpal tunnel release surgery is presented. (Osteoporoz Dünyasından 2010;16:41-3

  11. Pressure-morphology relationship of a released carpal tunnel.

    Science.gov (United States)

    Kim, Dong Hee; Marquardt, Tamara L; Gabra, Joseph N; Shen, Zhilei Liu; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2013-04-01

    We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure-morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p 62 mm(2) at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery.

  12. The recurrent carpal tunnel syndrome.

    Science.gov (United States)

    Kern, B C; Brock, M; Rudolph, K H; Logemann, H

    1993-01-01

    Sixteen out of 720 patients with carpal tunnel syndrome who had undergone surgery since 1979 were reoperated for a "recurrence" (2.2%). Twelve of these patients had been originally operated on in our department. Thus, our own recurrence rate is 1.7%. Three patients deteriorated following surgery, 6 had an unsatisfactory improvement, and in 7 the symptoms recurred after initial improvement. Eight of the reoperated patients had a predisposing disease (terminal renal insufficiency, insulin-dependent diabetes mellitus, acromegaly). In 10 of the 16 cases the initial operation had been carried out by surgeons in the first three years of training. Reoperation revealed incomplete splitting of the transverse carpal ligament in 10 cases, compression of the median nerve by the scar in 4, injury of the muscular branch in 1, and an anatomical variant as cause of incomplete decompression in 1 patient. "Recurrences" after carpal tunnel surgery are predominantly due to inadequacies of the first procedure. A remarkable number of patients (50%) has predisposing diseases. Interfascicular or epineural neurolysis and complete exposure and neurolysis of the median nerve and its branches is necessary only in cases of recurrence. Their omission at the first surgery does not result in an increased recurrence rate. Our observations indicate that the number of operations for recurrent carpal tunnel syndrome can probably be reduced when the first operation is performed with care and experience. Patients with carpal tunnel syndrome secondary to a systemic disease are particularly at risk.

  13. Carpal tunnel syndrome: A rare manifestation of distal radius osteoid osteoma.

    Science.gov (United States)

    Basran, Sukhvinder Singh; Kumar, Sandeep; Jameel, Javed; Sajid, Imran

    2015-09-01

    Osteoid Osteoma is a benign bone tumor that normally affects long bones and rarely affects distal radius. Because of its nonspecific presentation in the wrist, it remains a diagnostic challenge. We report an unusual case of Osteoid Osteoma at distal radius having symptoms resembling that of carpal tunnel syndrome. The diagnosis was confirmed preoperatively with X-rays; bone scintigraphy, CT, and MRI, later histological examination confirmed the diagnoses. Surgical excision lead to a dramatic improvement in the condition of the patient.

  14. Reference values of differences between TW3-C RUS and TW3-C Carpal bone ages of children from five cities of China%中国五城市儿童手腕部桡、尺、掌指骨骨龄与腕骨骨龄差异参考值

    Institute of Scientific and Technical Information of China (English)

    张绍岩; 刘丽娟; 韩一三; 刘刚; 马振国; 沈勋章; 许瑞龙; 花纪青

    2008-01-01

    目的 观察中国城市儿童手腕部桡、尺、掌指骨骨龄与腕骨骨龄差异,为临床应用提供参考.方法 抽取上海、广州、温州、大连、石家庄5城市汉族健康儿童9408名,男5066名,女4342名,年龄1.5~13.5岁.采用桡、尺、掌指骨(BUS)骨龄标准(TW3-C RUS)和腕骨(Carpal)骨龄标准(TW3-C Carpal),分别评价儿童的桡、尺、掌指骨骨龄和腕骨骨龄.采用Box-Cox幂指数分布模型(Box-Cox power exponential distribution,BCPE)建立TW3-CRUS与TW3-C Carpal骨龄差值的Z分值曲线评价图表,以Q检验和拟合的百分位数曲线下样本例数的百分数检验BCPE模型的拟合优度.结果男2.0~13.5岁、女1.5~11.5岁,各年龄组TW3-CBUS与TW3-C Carpal骨龄差值的平均数均接近于零,男童平均数范围在-0.19~0.17岁,女童平均数范围在-0.12~0.13岁;男童年龄组骨龄差值的标准差在0.47~1.01岁之间,达最大标准差时4.5岁;女童骨龄差值的标准差在0.49~0.82岁之间,达最大标准差时3.5岁.经Q检验,选择出了男女儿童骨龄差值BCPE模型,所拟合的百分位数曲线下样本例数的百分数与其理论百分位相差很小,除女第90百分位数相差1.00%外,均在0.66%以下.结论 男女儿童TW3-C RUS与TW3-CCarpal骨龄差值随年龄而增加,分别在男4.5岁和女3.5岁左右达到最大,其后逐渐下降至腕骨发育成熟.但变异程度存在性别差异,男性大于女性,10岁后性别差异减小.%Objective The determination of skeletal maturity has an important role in pediatricclinical practice, especially in relation to endocrinological problems and growth disorders, and it is frequentlyuseful in diagnosis and monitoring treatment. It has been suggested that the difference between radius, ulnaand short bonse (RUS) and carpal may be of differential diagnostic significance. However, no data oncomparison among bone ages of Chinese children are available. The differences between TW3-Chinese RUS(TW3-C BUS) and

  15. Surgical efficacy of carpal tunnel release for carpal tunnel syndrome in acromegaly: report of four patients.

    Science.gov (United States)

    Iwasaki, N; Masuko, T; Ishikawa, J; Minami, A

    2005-12-01

    Although carpal tunnel syndrome is frequent in acromegaly, few acromegalics will be encountered by most hand surgeons. This paper considers the treatment of four cases of acromegaly in whom carpal tunnel syndrome arose, to discuss aspects of management of carpal tunnel syndrome in this patient group.

  16. Raynaud's syndrome and carpal tunnel syndrome.

    OpenAIRE

    Waller, D G; Dathan, J R

    1985-01-01

    We report three cases of Raynaud's syndrome with digital ischaemic ulceration, in association with carpal tunnel syndrome. In all cases, the aetiology of the Raynaud's syndrome was probably unrelated to the nerve compression. However, symptoms were worse on the side of the median nerve lesion in two patients and worse on the side with the most severe nerve dysfunction in the third; symptoms were relieved by carpal tunnel decompression in two patients. We suggest that carpal tunnel syndrome ma...

  17. Electromyographic diagnosis of the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    K. Toyonaga

    1978-06-01

    Full Text Available Sensory conduction velocities of the median nerVe were studied from digit to palm and from palm to wrist in normal subjects and in patients with the carpal tunnel syndrome. Definite slowing was noted in the palm to wrist segment, even in the early carpal tunnel syndrome. It was noted that 37% of normal women over 40 years of age had electrophysiological evidence of the carpal tunnel syndrome.

  18. Electrodiagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Wang, Leilei

    2013-02-01

    This article discusses the historical aspects related to the understanding of carpal tunnel syndrome (CTS) and its diagnosis, highlighting observations about this disease that have yet to be challenged. This is followed by a discussion regarding the use of electrodiagnostic testing as a diagnostic tool for CTS, as well as the author's approach to making the diagnosis of CTS. Finally, conclusions about future directions in the diagnosis and treatment of this disorder are presented.

  19. [Carpal tunnel syndrome. Current approaches].

    Science.gov (United States)

    Kouyoumdjian, J A

    1999-06-01

    A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal) or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low significance. Magnetic resonance could be a useful tool for selected atypical cases. Conservative treatment and controversies on surgery timing are discussed. Classical conduction studies on median nerve reveal a prolonged distal segmental sensory latency and also on distal motor latency. Increasing sensitivity may be reach using additional methods such as, median mixed mid-palm latency, comparative mid-palm latency median/ulnar, comparative sensory latency median/radial and median/ulnar, inching method from wrist to palm recording on index/middle finger and comparative motor median/ulnar recording on lumbrical/interosseous muscle.

  20. Pharmacotherapy of carpal tunnel syndrome.

    Science.gov (United States)

    de Pablo, Paola; Katz, Jeffrey N

    2003-06-01

    Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. CTS is a compression neuropathy caused by elevated pressure in the carpal tunnel. CTS has the potential to substantially limit performance of activities of daily living for some individuals. The goal of therapy for CTS is to improve symptoms and reduce signs of the disease, as well as prevent progression and loss of hand function. There are several treatment alternatives to relieve the pressure on the median nerve, both surgical and conservative. The most common measures employed in the initial treatment of CTS are NSAIDs, local and systemic corticosteroids, diuretics and pyridoxine. However, CTS treatment usually includes a combination of pharmacotherapy with other strategies such as splinting and activity modification. Injections of corticosteroids into the carpal tunnel are often employed for cases not responding to conservative treatment. Surgery is superior to conservative therapies for most persistently symptomatic patients. The aim of this paper is to review the pharmacological agents used for relieving the symptoms of CTS.

  1. Extraskeletal chondroma casuing carpal tunnel syndrome: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ok Hwa; Kim, Yeon Hee [Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2014-03-15

    Carpal tunnel syndrome caused by extraskeletal chondroma has been scarcely reported in the literature. Authors report a case of carpal tunnel syndrome as a result of an extraskeletal chondroma arising within the carpal tunnel, and describe the radiological and pathological findings of the mass. We also discuss the differential diagnosis of the calcified space, occupying lesions that may occur in carpal tunnel.

  2. Ultrasonographic assessment of carpal tunnel biomechanics

    NARCIS (Netherlands)

    van Doesburg, M.H.M.

    2012-01-01

    In this thesis, we searched for a way to assess flexor tendon and median nerve biomechanics, as well as subsynovial connective tissue thickness (SSCT) in the carpal tunnel with ultrasound, and tried to see if these patterns would give a clue towards understanding the etiology of carpal tunnel syndro

  3. Condroblastoma de escafoides carpiano Chondroblastoma of the carpal scaphoids

    Directory of Open Access Journals (Sweden)

    F.J. Repáraz

    2008-12-01

    Full Text Available El condroblastoma es un tumor benigno de origen cartilaginoso que representa menos del 1% de todos los tumores óseos primarios. Se localiza típicamente en la epífisis de los huesos largos. Un 10% de los condroblastomas afectan a huesos del pie y de la mano. El asiento de esta lesión en el carpo es extraordinariamente raro. Se presenta un caso de condroblastoma del escafoides del carpo que fue tratado mediante curetaje de la lesión y relleno con injerto óseo autólogo de cresta iliaca.A chondroblastoma is a benign tumour of cartilaginous origin which represents less than 1% of all primary osseous tumours. It is typically localised in the epiphysis of the long bones. Some 10% of chondroblastomas affect the bones of the foot and the hand. It is extremely rare for the seat of this lesion to be in the carpal bones. We present a case of chondroblastoma of the carpal scaphoids that was treated through curretage of the lesion and filling with autologous osseous graft from the iliac crest.

  4. Studying primate carpal kinematics in three dimensions using a computed-tomography-based markerless registration method.

    Science.gov (United States)

    Orr, Caley M; Leventhal, Evan L; Chivers, Spencer F; Marzke, Mary W; Wolfe, Scott W; Crisco, Joseph J

    2010-04-01

    The functional morphology of the wrist pertains to a number of important questions in primate evolutionary biology, including that of hominins. Reconstructing locomotor and manipulative capabilities of the wrist in extinct species requires a detailed understanding of wrist biomechanics in extant primates and the relationship between carpal form and function. The kinematics of carpal movement, and the role individual joints play in providing mobility and stability of the wrist, is central to such efforts. However, there have been few detailed biomechanical studies of the nonhuman primate wrist. This is largely because of the complexity of wrist morphology and the considerable technical challenges involved in tracking the movements of the many small bones that compose the carpus. The purpose of this article is to introduce and outline a method adapted from human clinical studies of three-dimensional (3D) carpal kinematics for use in a comparative context. The method employs computed tomography of primate cadaver forelimbs in increments throughout the wrist's range of motion, coupled with markerless registration of 3D polygon models based on inertial properties of each bone. The 3D kinematic principles involved in extracting motion axis parameters that describe bone movement are reviewed. In addition, a set of anatomically based coordinate systems embedded in the radius, capitate, hamate, lunate, and scaphoid is presented for the benefit of other primate functional morphologists interested in studying carpal kinematics. Finally, a brief demonstration of how the application of these methods can elucidate the mechanics of the wrist in primates illustrates the closer-packing of carpals in chimpanzees than in orangutans, which may help to stabilize the midcarpus and produce a more rigid wrist beneficial for efficient hand posturing during knuckle-walking locomotion.

  5. Carpal tunnel syndrome - anatomical and clinical correlations.

    Science.gov (United States)

    Iskra, Tomasz; Mizia, Ewa; Musial, Agata; Matuszyk, Aleksandra; Tomaszewski, Krzysztof A

    2013-01-01

    Carpal tunnel syndrome (CTS) is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed. Common symptoms of CTS involve the hand and result from compression of the median nerve within the carpal tunnel. In general, CTS develops when the tissues around the median nerve irritate or compress on the nerve along its course through the carpal tunnel, however often it is very difficult to determine cause of CTS. Proper treatment (conservative or surgical) usually can relieve the symptoms and restore normal use of the wrist and hand.

  6. CARPAL TUNNEL SYNDROME IN CYCLISTS

    Science.gov (United States)

    Sousa, Daniel; Sassul, Nicolás

    2017-01-01

    Objectives: About a group of cyclists, professionals / amateurs, Mountain bike, road and triathlon; achieve a good diagnosis of the disease, with a good clinical examination and sectorized according EGM injury evoked potentials. Methods: Clinical examination and accurate test with different signs of pathology. EGM with evocative potential and conduction velocity. Results: After 25 track cyclists, 18 professionals, 22 male and 3 female; for 24 months. Through good clinical examination and EMG. We got that 70% had direct compression injuries Carpal tunnel for poor support on the handlebars. The rest were cervical praxis, by poor body position on the bike, taking cervico very steep angles / dorsal, during competitions or training for more than 2 hrs. Conclusion: A good prevention work with our teacher / cyclist in the position of deposrtista in ciclo simulador. Work in the gym, on tone and elongation of the upper limb. A good EGM, made with a specialist physiatrist. It leads to the correct diagnosis, leads to a good final treatment; which agreed that:* Cervical praxis, had good results with treatment Conservative / FST / vit.B12.* The Carpal tunnel own injuries, treatment was quirúrg. (Open surgery) with subsequent FST / vit..B12 with satisfactory return in time to sporting activity.

  7. Post-traumatic carpal instability.

    Science.gov (United States)

    Chantelot, C

    2014-02-01

    The complexity of the carpus explains the difficulty treating carpal injuries. Lesions are dominated by perilunate dislocation, scapholunate dislocation, and scaphoid fractures. The other injuries are trivial. Symptoms include pain and loss of wrist strength, reversible for an acute and well-treated lesion. Too often, these ligament injuries are diagnosed late. For delays longer than 6 weeks, ligament repair is ineffective. These old, complex lesions are potentially highly arthritic in the radiocarpal and mediocarpal joints. Improvements in wrist surgery have mitigated these chronic lesions. Various surgical techniques can preserve a functional wrist; wrist arthrodesis is no longer the only solution for these arthritic wrists. Over the past decade, arthroscopy has contributed to better understanding the injuries of the carpus as well as to better healing them. For acute or chronic ligament injuries without degenerative osteoarthritis, arthroscopy is the treatment of the future. This technique involves a long learning curve and the various arthroscopic techniques must be validated.

  8. Carpal tunnel syndrome after 22 years of Colle's fracture

    Directory of Open Access Journals (Sweden)

    Goyal V

    2003-01-01

    Full Text Available Delayed carpal tunnel syndrome is rare. We describe the electrophysiological findings in a patient with Colle's fracture, who developed carpal tunnel syndrome 22 years after a wrist injury.

  9. Carpal tunnel syndrome: an unusual presentation of brachial hypertrophy.

    OpenAIRE

    Shenoy, K. T.; Saha, P. K.; Ravindran, M

    1980-01-01

    A patient with carpal tunnel syndrome in association with congenital hypertrophy of right upper limb is described. The median nerve also showed hypertrophy. The symptoms were relieved by decompression of the carpal tunnel.

  10. Electrodiagnostic approach to carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Cherian Ajith

    2006-01-01

    Full Text Available An algorithm for an electrophysiological approach to carpal tunnel syndrome is proposed. This technical note takes into account the standard tests, comparison tests and needle electromyography. If the standard tests are negative, a comparison study can be done to identify cases of minimal or very mild carpal tunnel syndrome (CTS. If comparison studies are negative, CTS can be ruled out and a search for other causes have to be made. If the standard tests are positive, carpal tunnel syndrome can be divided into extreme, severe,moderate and mild cases. Motor comparison study is useful in extreme CTS cases. Needle electromyography is a must in all cases where the standard tests are positive. This streamlined approach allows accurate diagnosis with minimum essential tests.

  11. Prevalence of carpal tunnel syndrome in motorcyclists.

    Science.gov (United States)

    Manes, Harvey R

    2012-05-01

    Carpal tunnel syndrome is prevalent in patients who have a repetitive motion, vibration, or pressure exerted on the wrist joint for an extended period of time. The prevalence of this condition in the general population is approximately 5%. Motorcyclists subject themselves to high levels of vibration from the road and use their wrists to control the motorcycle's brakes, gas intake, and gears via the handlebars. Under these conditions, the author hypothesized that an increased prevalence of carpal tunnel syndrome would be observed in this population.

  12. Treatment of repetitive use carpal tunnel syndrome

    Science.gov (United States)

    Smith, Chadwick F.; Vangsness, C. Thomas; Anderson, Thomas; Good, Wayne

    1995-05-01

    In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit low level laser therapy unit was utilized in Group A, while an actual low level laser therapy unit was utilized in Group B. The difference between Groups A and B was statistically significant in terms of return to work, conduction study improvement, and certain range of motion and strength studies.

  13. Myofascial release of carpal tunnel syndrome.

    Science.gov (United States)

    Sucher, B M

    1993-01-01

    Current treatment for carpal tunnel syndrome may be ineffective or associated with complications or recurrence. In the case reported here, a myofascial release by the physician combined with the patient's self-stretch reduced pain and numbness and improved electromyographic results. The manipulative approach releases the transverse carpal ligament,-and "opens" or dilates the canal. The patient stretches the wrist, digits, and thumb, including myofascial components. An aggressive, conservative approach lessens the need for surgery in mild to moderate cases. Studies with magnetic resonance imaging may be helpful to document canal size before and after treatment.

  14. Carpal erosions in children with juvenile idiopathic arthritis: repeatability of a newly devised MR-scoring system

    Energy Technology Data Exchange (ETDEWEB)

    Boavida, Peter [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Lambot-Juhan, Karen [Hospital Necker Enfants Malades, Department of Radiology, Paris (France); Ording Mueller, Lil-Sofie [Oslo University Hospital, Department of Radiology, Oslo (Norway); Damasio, Beatrice; Malattia, Clara [Ospedale Pediatrico Gaslini, Department of Rheumatology, Genoa (Italy); Tanturri de Horatio, Laura [Ospedale Pediatrico Bambino Gesu, Department of Radiology, Rome (Italy); Owens, Catherine M. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); UCL, Institute of Child Health, London (United Kingdom); Rosendahl, Karen [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Department of Clinical Medicine, Bergen (Norway)

    2015-12-15

    Juvenile idiopathic arthritis (JIA) is characterized by synovial inflammation, with potential risk of developing progressive joint destruction. Personalized state-of-the-art treatment depends on valid markers for disease activity to monitor response; however, no such markers exist. To evaluate the reliability of scoring of carpal bone erosions on MR in children with JIA using two semi-quantitative scoring systems. A total of 1,236 carpal bones (91 MR wrist examinations) were scored twice by two independent pediatric musculoskeletal radiologists. Bony erosions were scored according to estimated bone volume loss using a 0-4 scale and a 0-10 scale. An aggregate erosion score comprising the sum total carpal bone volume loss was calculated for each examination. The 0-4 scoring system resulted in good intra-reader agreement and moderate to good inter-observer agreement in the assessment of individual bones. Fair and moderate agreement were achieved for inter-reader and intra-reader agreement, respectively, using the 0-10 scale. Intra- and particularly inter-reader aggregate score variability were much less favorable, with wide limits of agreement. Further analysis of erosive disease patterns compared with normal subjects is required, and to facilitate the development of an alternative means of quantifying disease. (orig.)

  15. [Anterior traumatic axial disruption of the middle carpal joint. Case report with literature review].

    Science.gov (United States)

    Shimi, M; Mechchat, A; Elmrini, A

    2012-12-01

    We report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after falling from a height. We performed open reduction and wire fixation. At 12months follow-up, functional outcome was satisfactory with good muscle strength (clamping force, grip strength and pinch grip: 90% compared to the opposite side) and good range of motion was preserved. Work was resumed at the tenth week. Radial midcarpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second and third metacarpal bones from the remaining wrist. This pattern of carpal derangement has not been previously described in the literature. Mechanism of the injury and treatment are discussed.

  16. Acute carpal tunnel syndrome of the hand following a cat bite.

    Science.gov (United States)

    Sbai, Mohamed Ali; Dabloun, Slim; Benzarti, Sofien; Khechimi, Myriam; Jenzeri, Abdesselem; Maalla, Riadh

    2015-01-01

    Cat bites at the hand are common situation in emergency departments. Neglected or poorly supported, these lesions sometimes lead to serious injuries that may compromise the function of the hand. Pasteurellamultocida is the most offending germ in these lesions, despite their sensitivity to antibiotics; it can sometimes lead to deep infections involving the skin, bones and joints. Acute carpal tunnel syndrome is exceptional after cat bite. We report a case of a 56 Year old female presenting with an acute carpal tunnel syndrome associated with compartment syndrome of the right hand 6 days after a cat bite of her right thumb. The patient was treated by surgery to relieve the median nerve. Microbiology identified PasteurellaMultocida.

  17. Carpal Tunnel Syndrome in ARL Libraries.

    Science.gov (United States)

    Thornton, Joyce K.

    1997-01-01

    A survey of 72 member libraries in the Association of Research Libraries revealed the incidence of carpal tunnel syndrome (CTS) and the measures taken to cope with it. Recommends implementing proactive ergonomics programs; soliciting staff input for solutions; providing report guidelines; using external help; stressing preventive measures and…

  18. Employees' Knowledge of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Gandy-Goldston, Terrie M.

    A study examined employees' knowledge of the causes of carpal tunnel syndrome (CTS), its prevention, and their legal rights after being diagnosed with CTS. A 24-item questionnaire was administered to a random sample of 30 Chicago-area employees who had been afflicted with CTS. Of those surveyed, 99% considered their CTS injury related to their…

  19. Bilateral carpal tunnel syndrome in Graves' disease.

    Science.gov (United States)

    Manganelli, P; Pavesi, G; Salaffi, F

    1987-01-01

    Carpal tunnel syndrome (CTS) may be associated with endocrinopathies, such as hypothyroidism and acromegaly. A direct relationship between CTS and hyperthyroidism has recently been suggested. We now report a case in which bilateral CTS developed after treatment of Graves' disease, thus, questioning the possibility of a relationship between these two disease processes.

  20. Bone

    Science.gov (United States)

    Helmberger, Thomas K.; Hoffmann, Ralf-Thorsten

    The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1:2000.

  1. Pictorial essay: Role of ultrasound in failed carpal tunnel decompression

    Directory of Open Access Journals (Sweden)

    Rajesh Botchu

    2012-01-01

    Full Text Available USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.

  2. Subclinical carpal tunnel syndrome in acromegaly.

    Science.gov (United States)

    Kameyama, S; Tanaka, R; Hasegawa, A; Tamura, T; Kuroki, M

    1993-08-01

    Median nerve conduction was studied in 16 acromegalic patients with asymptomatic carpal tunnel syndrome (CTS) to examine the incidence of subclinical CTS. Thirteen patients (81%) and 23 hands (72%) demonstrated subclinical CTS, 10 bilaterally and three unilaterally in the dominant hand. The incidence reflects the greater sensitivity of the inching method for detecting focal conduction abnormalities. Two of three patients without subclinical CTS showed normal plasma somatomedin-C concentration despite growth hormone hypersecretion. Following adenomectomy, nerve conduction normalized in only six hands (26%). The postoperative persistence of the conduction delay implies that irreversible narrowing of the carpal tunnel rather than reversible soft tissue edema is the principal cause of CTS associated with acromegaly.

  3. Development of a Kinematic 3D Carpal Model to Analyze In Vivo Soft-Tissue Interaction Across Multiple Static Postures

    OpenAIRE

    Marai, G. Elisabeta; Crisco, Joseph J; Laidlaw, David H.

    2009-01-01

    We developed a subject-specific kinematic model to analyze in vivo soft-tissue interaction in the carpus in static, unloaded postures. The bone geometry was extracted from a reference computed tomography volume image. The soft-tissue geometry, including cartilage and ligament tissues, was computationally modeled based on kinematic constraints; the constraints were extracted from multiple computed tomography scans corresponding to different carpal postures. The data collected in vivo was next ...

  4. Trophic ulcers in the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Abelardo Q.-C. Araújo

    1993-09-01

    Full Text Available A patient with carpal tunnel syndrome (CTS and trophic ulcers is described. Despite the healing of the ulcers after surgery for CTS, the severe sensory deficit and the electrophysiological tests have not shown any significant improvement. We think these findings argue against the hypothesis of the sensory deficit being responsible for the trophic ulcers. We favor a major role for the sympathetic disturbances as the main cause for those lesions.

  5. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid.

    Science.gov (United States)

    Notarnicola, A; Moretti, L; Tafuri, S; Gigliotti, S; Russo, S; Musci, L; Moretti, B

    2010-08-01

    The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves should therefore be considered the treatment of choice of this disorder.

  6. Subclinical Carpal Tunnel Syndrome in Patients with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Soroosh Dabiri

    2012-07-01

    Full Text Available Background: Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients.Methods: The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied.Results: After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides.Conclusion: The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients.

  7. Carpal pseudoerosions: a plain X-ray interpretation pitfall

    Energy Technology Data Exchange (ETDEWEB)

    Wawer, Richard [Univ. Catholique de Lille (France). Service d' Imagerie Medicale; Budzik, Jean Francois [Univ. Catholique de Lille (France). Service d' Imagerie Medicale; Univ. Nord de France, Boulogne sur Mer (France). Unite de Recherche EA 4490, Physiopathologie des Maladies Osseuses Inflammatoires; Demondion, Xavier [Univ. Lille 2 (France). Service d' Imagerie Musculosquelettique; CHRU Lille (France). Lab. d' Anatomie; Forzy, Gerard [Univ. Catholique de Lille, Lomme (France). Lab. de Biologie; Cotten, Anne [Univ. Lille 2 (France). Service d' Imagerie Musculosquelettique; Univ. Nord de France, Boulogne sur Mer (France). Unite de Recherche EA 4490, Physiopathologie des Maladies Osseuses Inflammatoires

    2014-10-15

    To examine in detail images of pseudoerosion of the wrist and hand on plain radiographs. The study was conducted with 28 cadaver wrists. During a single imaging session three techniques - plain radiography, tomosynthesis, and computed tomography - were used to visualize the wrist and hand specimens. For each technique, 20 radio-ulno-carpo-metacarpal sites known to present bone erosions in rheumatoid arthritis were analyzed by two radiologists using a standard system to score the cortical bone: normal, pseudoerosion, true erosion, or other pathology. Cohen's concordance analysis was performed to determine inter-observer and intra-observer (for the senior radiologist) agreement by site and by technique. Serial sections of two cadaver specimens were examined to determine the anatomical correlation of the pseudoerosions. On the plain radiographs, the radiologists scored many images as pseudoerosion (7.3 %), particularly in the distal ulnar portion of the capitate, the distal radial portion of the hamate, the proximal ulnar portion of the base of the third metacarpal, the proximal radial portion of the base of the fourth metacarpal, the distal ulnar portion of the hamate, and the proximal portion of the base of the fifth metacarpal. The computed tomography scan revealed that none of these doubtful images corresponded to true erosions. The anatomical correlation study showed that these images could probably be attributed to ligament insertions, thinner lamina, and enhanced cortical bone transparency. Knowledge of the anatomical carpal localizations where pseudoerosions commonly occur is a necessary prerequisite for analysis of plain radiographs performed to diagnose or monitor rheumatoid arthritis. (orig.)

  8. Delayed ulnar neuropathy at the wrist following open carpal tunnel release.

    Science.gov (United States)

    Pingree, Matthew J; Bosch, E Peter; Liu, Patrick; Smith, Benn E

    2005-03-01

    Open carpal tunnel release is a common and successful treatment of median neuropathy at the wrist (carpal tunnel syndrome). We report a case of delayed ulnar neuropathy at the wrist with onset 2 months after open carpal tunnel release. Clinical findings, electrophysiological studies, magnetic resonance imaging, and surgical exploration demonstrated ulnar nerve compression at Guyon's canal resulting from translocation of the carpal tunnel contents. To our knowledge, this is an unreported complication of open carpal tunnel release that merits wide appreciation.

  9. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?☆

    OpenAIRE

    2013-01-01

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) accord...

  10. Bilateral angular carpal deformity in a dog with craniomandibular osteopathy.

    Science.gov (United States)

    Pettitt, R; Fox, R; Comerford, E J; Newitt, A

    2012-01-01

    A four-month-old West Highland White Terrier was presented to the Small Animal Teaching Hospital at the University of Liverpool with the complaint of a bilateral angular carpal deformity. A 20° valgus deformity was present in both thoracic limbs, centred on the distal radial physes. Both distal ulnas were grossly thickened and there was concomitant thickening of the rostral mandible and calvarium. The dog exhibited signs of resentment on palpation of the mandible and signs of pain were elicited on flexion and extension of both elbow joints. No signs of pain were evident on palpation of the ulnas or calvarium. Radiographic images of both ulnas showed marked amorphous periosteal new bone formation. The distal ulnar physes were closed centrally and both elbow joints had humeroulnar subluxation. Radiographic changes to the calvarium and mandibular rami were consistent with a diagnosis of craniomandibular osteopathy. A bilateral ulna ostectomy was performed to correct the angular limb deformity and elbow subluxations. Histology of the ostectomised pieces showed changes consistent with craniomandibular osteopathy.

  11. Osteopathic manipulative medicine for carpal tunnel syndrome.

    Science.gov (United States)

    Siu, Gilbert; Jaffe, J Douglas; Rafique, Maryum; Weinik, Michael M

    2012-03-01

    Carpal tunnel syndrome (CTS) is 1 of the most common peripheral nerve entrapment disorders. Osteopathic manipulative medicine can be invaluable in diagnosing and managing CTS. Combined with a patient's history and a standard physical examination, an osteopathic structural examination can facilitate localizing the nerve entrapment, diagnosing CTS, and monitoring the disease process. Osteopathic manipulative treatment is noninvasive and can be used to supplement traditional CTS treatment methods. The authors also review the relevant anatomy involving CTS and the clinical efficacy of osteopathic manipulative medicine in the management of this disorder.

  12. Ultrasound assessment of posttraumatic pseudoarthrosis of the carpal scaphoid; Valoracion ecografica de la seudoartrosis postraumatica del escafoides carpiano

    Energy Technology Data Exchange (ETDEWEB)

    Sarria, L.; Garcia, S.; Cozcolluela, R.; Martinez-Berganza, T.; Villacampa, V. [Hospital Reina Sofia. Tudela Navarra (Spain)

    2001-07-01

    to evaluate the utility of ultrasonography in the diagnosis of posttraumatic pseudoarthrosis of the carpal scaphoid, describing the ultrasound findings observed in the patients. Eleven patients diagnosed as having pseudoarthrosis of the carpal scaphoid were studied using a 7.5-MHz probe. The features assessed were irregularity of the cortical surface, presence of a gap in its continuity and swelling of periscaphoid soft tissue, the vascularity of which was studied by means of color Doppler. The findings were compared with those observed in the contralateral hand. Cortical irregularity was observed in all the patients and six presented a gap in the cortex of the palmar surface of the scaphoid. Ten had soft tissue swelling with increased vascularity. One patient with an ununited fracture showed no gap or soft tissue swelling: the bone cortex was found to be intact intraoperatively. Ultrasound is useful in the diagnosis of pseudoarthrosis of the carpal scaphoid. Swelling of the periscaphoid soft tissue with increased vascularity in patients whose fracture occured more than 6 to 8 weeks earlier suggests nonunion of the injured bone. (Author) 13 refs.

  13. The carpal stretch test at the rheumatoid wrist.

    Science.gov (United States)

    Shimizu, Hiroyuki; Beppu, Moroe; Matsusita, Kazuhiko; Arai, Takeshi; Yoshida, Noriyuki

    2012-01-01

    The purpose of this study was to evaluate the radiographic changes of the carpus for rheumatoid wrists in patients who underwent the Sauvé-Kapandji procedure by examining the clinical results and comparing pre- and postoperative radiographic measurements. We studied 43 wrists in 37 patients who showed vertical laxity in the radiocarpal and midcarpal joint on preoperative carpal stretch test. Pain was improved in all patients and the forearm rotation angles of the wrist were significantly improved after the operation. The carpal collapse ratio was significantly reduced after the operation. The carpal collapse reduction rate was significantly greater in the group with than that in the group without midcarpal joint vertical laxity on the carpal stretch test. Although the Sauvé-Kapandji procedure was not sufficiently effective in preventing carpal collapse, it did have a protective effect against ulnar carpal shift. The results of our study showed that vertical laxity of the midcarpal joint was the risk factor of the carpal collapse after Sauvé-Kapandji procedure.

  14. Treatment considerations in carpal tunnel syndrome with coexistent Dupuytren's disease.

    Science.gov (United States)

    Nissenbaum, M; Kleinert, H E

    1980-11-01

    Twenty-nine patients with involvement of 31 hands presented with coexisting carpal tunnel syndrome and ipsilateral Dupuytren's disease. Analysis of the patient population showed a high proportion of women, dominant hand involvement, and repetitive manual trauma. Various treatment combinations were used and the results evaluated. Simultaneous surgical excision of Dupuytren's contracture and carpal tunnel release gave compromised long-term results, particularly among the women. To minimize complications, it is advised that carpal tunnel release not be performed at the same time as excision of Dupuytren's contracture.

  15. Description, reliability and validity of a novel method to measure carpal tunnel pressure in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Coppieters, Michel W; Schmid, Annina B; Kubler, Paul A; Hodges, Paul W

    2012-12-01

    Elevated carpal tunnel pressure is an important pathomechanism in carpal tunnel syndrome (CTS). Several invasive methods have been described for direct measurement of carpal tunnel pressure, but all have two important limitations. The pressure gauge requires sterilisation between uses, which makes time-efficient data collection logistically cumbersome, and more importantly, the reliability of carpal tunnel pressure measurements has not been evaluated for any of the methods in use. This technical note describes a new method to measure carpal tunnel pressure using inexpensive, disposable pressure sensors and reports the within and between session reliability of the pressure recordings in five different wrist positions and during typing and computer mouse operation. Intraclass correlation coefficients (ICC[3,1]) were calculated for recordings within one session for healthy participants (n = 7) and patients with CTS (n = 5), and for recordings between two sessions for patients with CTS (n = 5). Overall, the reliability was high. With the exception of two coefficients, the reliability of the recordings at different wrist angles varied from 0.63 to 0.99. Reliability for typing and mouse operation ranged from 0.86 to 0.99. The new method described in this report is inexpensive and reliable, and data collection can be applied more efficiently as off-site sterilisation of equipment is not required. These advances are likely to promote future research into carpal tunnel pressure, such as investigation of the therapeutic mechanisms of various conservative treatment modalities that are believed to reduce elevated carpal tunnel pressure.

  16. PERSISTENT MEDIAN ARTERY IN THE CARPAL TUNNEL

    Directory of Open Access Journals (Sweden)

    Raviprasanna.K.H

    2014-09-01

    Full Text Available Introduction: Persistent median artery originates from the anterior interosseous artery in proximal one-third of the forearm and accompanies median nerve. Median artery may regress in the forearm or enter palm through the carpal tunnel deep to flexor retinaculum of wrist and supply palm by anastomosing with the superficial palmar arch. Objective: In present study the objective was to study presence of persistent median artery accompanying median nerve and its termination Materials and Methods: The study included 50 human cadaver upper limb specimens at the Department of Anatomy, Mysore Medical College & Research Institute, Mysore during 2011-13. These specimens fixed in 10% formalin were finely dissected and persistent median artery was traced from origin to termination. Results: Out of 50 human cadaver specimens, persistent median artery was present in 4 specimens (8%. All the 4 median arteries originated from anterior interosseous artery and were of palmar type which reached palm. Out of 4 median arteries, 3 median arteries (6% took part in completion of superficial palmar arch, supplying the distal aspect of palm and 1 median artery (2% directly supplied radial two and half fingers without forming arch. Conclusion: Knowledge of unusual variations helps in proper treatment of disorders of the median nerve. Presence of persistent median artery usually will be asymptomatic but may cause symptoms of carpal tunnel syndrome or pronator teres syndrome when subjected to compression. Rarely this artery can be taken for reconstruction

  17. The role of proprioception and neuromuscular stability in carpal instabilities.

    Science.gov (United States)

    Hagert, E; Lluch, A; Rein, S

    2016-01-01

    Carpal stability has traditionally been defined as dependent on the articular congruity of joint surfaces, the static stability maintained by intact ligaments, and the dynamic stability caused by muscle contractions resulting in a compression of joint surfaces. In the past decade, a fourth factor in carpal stability has been proposed, involving the neuromuscular and proprioceptive control of joints. The proprioception of the wrist originates from afferent signals elicited by sensory end organs (mechanoreceptors) in ligaments and joint capsules that elicit spinal reflexes for immediate joint stability, as well as higher order neuromuscular influx to the cerebellum and sensorimotor cortices for planning and executing joint control. The aim of this review is to provide an understanding of the role of proprioception and neuromuscular control in carpal instabilities by delineating the sensory innervation and the neuromuscular control of the carpus, as well as descriptions of clinical applications of proprioception in carpal instabilities.

  18. Carpal Tunnel Syndrome: The Risk to Educational Interpreters.

    Science.gov (United States)

    Stedt, Joe D.

    1989-01-01

    This paper describes Carpal Tunnel Syndrome and its ramifications for sign language users, in particular, educational interpreters. Discussed are the syndrome's incidence, causes, diagnostic procedures, medical and surgical interventions, and prevention guidelines. (JDD)

  19. Carpal tunnel syndrome associated with Kienböck disease

    Science.gov (United States)

    Shinohara, Takaaki; Nakamura, Ryogo; Nakao, Etsuhiro; Hirata, Hitoshi

    2016-01-01

    ABSTRACT We retrospectively reviewed 12 patients (3 men and 9 women, with a mean age of 72 years) who were surgically treated for carpal tunnel syndrome associated with Kienböck disease. All patients except 1 were incidentally diagnosed with Kienböck disease and had little or no wrist pain. Radiographic tests revealed advanced Kienböck disease in all patients. Intraoperative findings indicated that the site of maximum compression on the median nerve was located at the level of the carpal tunnel inlet in 11 patients, and the volar dislocated fragment of the lunate was located proximally adjacent to the floor of the carpal tunnel inlet. This disorder is most prevalent in elderly women, and even advanced Kienböck disease can present without wrist pain. Our findings suggest that palmar protrusion of the lunate may be the primary cause of carpal tunnel syndrome associated with Kienböck disease. PMID:27578910

  20. Vacuum phenomenon in equine carpal, metacarpophalangeal and metatarsophalangeal joints

    Directory of Open Access Journals (Sweden)

    R.D. Gottschalk

    1999-07-01

    Full Text Available In order to establish the incidence of vacuum phenomenon in horses' carpal, metacarpophalangeal and metatarsophalangeal joints, stress-flexed radiographs were madeof normal joints, joints withknownpathology and in anaesthetised horses with joints under traction. Focal intra-articular radiolucencies were identified in normal stress-flexed carpal, metacarpophalangeal and metatarsophalangeal joints. These radiolucencies can be confused with those associated with pathological conditions.

  1. Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome.

    Science.gov (United States)

    Imai, Shinji; Kodama, Narihito; Matsusue, Yoshitaka

    2008-01-01

    Triggering of the flexor tendon at the wrist is rare. We report a case of intrasynovial lipoma that caused a trigger wrist. As far as we know it is unique in that the intrasynovial lipoma simultaneously caused carpal tunnel syndrome. The massive tenosynovitis and adhesion of flexors tendons after the locking of the intrasynovial lipoma may have resulted from inflammation caused by attrition within the carpal tunnel.

  2. A manual therapy intervention improves symptoms in patients with carpal tunnel syndrome: a pilot study.

    Science.gov (United States)

    Maddali Bongi, Susanna; Signorini, Massimo; Bassetti, Massimo; Del Rosso, Angela; Orlandi, Martina; De Scisciolo, Giuseppe

    2013-05-01

    In carpal tunnel syndrome (CTS), manual therapy interventions (MTI) reduce tissue adhesion and increase wrist mobility. We evaluated the efficacy of a MTI in relieving CTS signs and symptoms. Twenty-two CTS patients (pts) (41 hands) were treated with a MTI, consisting in 6 treatments (2/week for 3 weeks) of soft tissues of wrist and hands and of carpal bones. Pts were assessed for hand sensitivity, paresthesia, hand strength, hand and forearm pain, night awakening; Phalen test, thenar eminence hypotrophy and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Median nerve was studied by sensory nerve conduction velocity (SNCV) and distal motor latency (DML). CTS was scored as minimal, mild, medium, severe and extreme. We considered as control group the same pts assessed before treatment: at baseline (T0a) and after 12 weeks (T0b). Pts were evaluated at the end of treatment (T1) and after 24-week (T2) follow-up. At T0b, versus T0a, forearm pain and Phalen test positivity were increased and hand strength reduced (p < 0.05). BCTQ-SSS and BCTQ-FSS scores improved at T1 versus T0b (p < 0.05) with the amelioration maintained at T2. At T1, the number of pts with paresthesia, night awakening, hypoesthesia, Phalen test, hand strength reduction and hand sensitivity was reduced with the lacking of symptoms maintained at T2 (p < 0.05). No changes in SNCV, DML and CTS scoring were shown. MTI improved CTS signs and symptoms, with benefits maintained at follow-up. Thus, it may be valid as a conservative therapy.

  3. Osteonecrosis of the trapezium treated with a vascularized distal radius bone graft.

    Science.gov (United States)

    Zafra, Manuel; Carpintero, Pedro; Cansino, Daniel

    2004-11-01

    A 20-year-old man presented with early stage osteonecrosis of the trapezium, diagnosed by magnetic resonance imaging. A vascularized distal radius bone graft was performed, with good clinical and radiologic results over a 1-year follow-up period. The authors believe that a vascularized distal radius bone graft is an ideal treatment for early stage carpal bone necrosis.

  4. Description of patients with carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Aydelián Jevey González

    2015-11-01

    Full Text Available A descriptive study of patients diagnosed with carpal tunnel syndrome was carried out at “Manuel Piti Fajardo” Teaching Polyclinic of Las Tunas, from January to December, 2008. The study was aimed at describing them clinically and epidemiologically. The sample was made up of 50 patients older than 14 years old, who were characterized according to: age, sex, individual pathological antecedents factors associated to the triggering of theirsymptomatology, as well as clinical signs and symptoms. The results were processed using the descriptive statistics by means of percentage analysis. The prevailing results were: female patients, for a 76%; 41 to 50 age group, for a 40%; antecedents of osteoarthrosis, for a 34%. The factor which triggered the onset of the symptoms was the occupation of office worker, for a 46%, while 4 patients (8% came to the consultation office with more than 6 months of symptom evolution.

  5. Computer professionals and Carpal Tunnel Syndrome (CTS).

    Science.gov (United States)

    Ali, K Mohamed; Sathiyasekaran, B W C

    2006-01-01

    Carpal Tunnel Syndrome (CTS) is an important problem among computer professionals. Hence the prevalence of CTS among computer professionals and risk factors were studied. 648 subjects were selected from 4,276 computer professionals from 21 companies by with simple random sampling method. CTS was diagnosed based on clinical features. The prevalence of CTS was found to be 13.1% (95% CI 10.5-15.7%). Subjects with over 8 years of computer work, over 12 hrs of work per day and system administrators were at a higher risk for CTS (OR 3.3, 4.9 and 2.5 respectively). Flexed or extended hand position had higher risk for CTS. Higher risk for CTS was found with higher exposure to computer work. Ergonomic considerations are important in facilitating proper positioning of hand while working with a computer. Further studies on CTS risk factors among computer professionals are essential for planning prevention.

  6. Carpal tunnel syndrome - Part II (treatment,

    Directory of Open Access Journals (Sweden)

    Michel Chammas

    2014-10-01

    Full Text Available The treatments for non-deficit forms of carpal tunnel syndrome (CTS are corticoid infiltration and/or a nighttime immobilization brace. Surgical treatment, which includes sectioning the retinaculum of the flexors (retinaculotomy, is indicated in cases of resistance to conservative treatment in deficit forms or, more frequently, in acute forms. In minimally invasive techniques (endoscopy and mini-open, and even though the learning curve is longer, it seems that functional recovery occurs earlier than in the classical surgery, but with identical long-term results. The choice depends on the surgeon, patient, severity, etiology and availability of material. The results are satisfactory in close to 90% of the cases. Recovery of strength requires four to six months after regression of the pain of pillar pain type. This surgery has the reputation of being benign and has a complication rate of 0.2–0.5%.

  7. Magnetic resonance neurography of median neuropathies proximal to the carpal tunnel

    Energy Technology Data Exchange (ETDEWEB)

    Thawait, Gaurav K. [Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Subhawong, Ty K.; Eng, John; Carrino, John A.; Chhabra, Avneesh [Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Thawait, Shrey K. [Yale University, Bridgeport Hospital, Department of Radiology, Bridgeport, CT (United States); Andreisek, Gustav [University Hospital Zurich, Department of Radiology, Zurich (Switzerland); Belzberg, Alan J. [Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, MD (United States)

    2012-06-15

    This review provides magnetic resonance neurography (MRN) imaging appearances of median neuropathy proximal to the carpal tunnel. Carpal tunnel syndrome (CTS) and its imaging have been extensively described in the literature; however, there is a relative paucity of information on the MR imaging appearances of different pathologies of the median nerve proximal to the carpal tunnel. (orig.)

  8. Gliding resistance of flexor tendon associated with carpal tunnel pressure: a biomechanical cadaver study.

    NARCIS (Netherlands)

    Zhao, C.; Ettema, A.M.; Berglund, L.J.; An, K.N.; Amadio, P.C.

    2011-01-01

    The purpose of this study was to investigate the effect of carpal tunnel pressure on the gliding characteristics of flexor tendons within the carpal tunnel. Eight fresh human cadaver wrists and hands were used. A balloon was inserted into the carpal tunnel to elevate the pressure. The mean gliding r

  9. Pyridoxine as an adjunct in the treatment of carpal tunnel syndrome.

    Science.gov (United States)

    Amadio, P C

    1985-03-01

    Nineteen consecutive patients with carpal tunnel syndrome were treated with pyridoxine. Two thirds of the patients who specifically presented symptoms of median neuropathy eventually required surgical release. Although pyridoxine may have a place alongside other nonsurgical modalities in the treatment of carpal tunnel syndrome, surgical release continues to be indicated in many patients with carpal tunnel syndrome.

  10. Automated bone age assessment of older children using the radius

    Science.gov (United States)

    Tsao, Sinchai; Gertych, Arkadiusz; Zhang, Aifeng; Liu, Brent J.; Huang, Han K.

    2008-03-01

    The Digital Hand Atlas in Assessment of Skeletal Development is a large-scale Computer Aided Diagnosis (CAD) project for automating the process of grading Skeletal Development of children from 0-18 years of age. It includes a complete collection of 1,400 normal hand X-rays of children between the ages of 0-18 years of age. Bone Age Assessment is used as an index of skeletal development for detection of growth pathologies that can be related to endocrine, malnutrition and other disease types. Previous work at the Image Processing and Informatics Lab (IPILab) allowed the bone age CAD algorithm to accurately assess bone age of children from 1 to 16 (male) or 14 (female) years of age using the Phalanges as well as the Carpal Bones. At the older ages (16(male) or 14(female) -19 years of age) the Phalanges as well as the Carpal Bones are fully developed and do not provide well-defined features for accurate bone age assessment. Therefore integration of the Radius Bone as a region of interest (ROI) is greatly needed and will significantly improve the ability to accurately assess the bone age of older children. Preliminary studies show that an integrated Bone Age CAD that utilizes the Phalanges, Carpal Bones and Radius forms a robust method for automatic bone age assessment throughout the entire age range (1-19 years of age).

  11. A vertical mouse and ergonomic mouse pads alter wrist position but do not reduce carpal tunnel pressure in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Schmid, Annina B; Kubler, Paul A; Johnston, Venerina; Coppieters, Michel W

    2015-03-01

    Non-neutral wrist positions and external pressure leading to increased carpal tunnel pressure during computer use have been associated with a heightened risk of carpal tunnel syndrome (CTS). This study investigated whether commonly used ergonomic devices reduce carpal tunnel pressure in patients with CTS. Carpal tunnel pressure was measured in twenty-one patients with CTS before, during and after a computer mouse task using a standard mouse, a vertical mouse, a gel mouse pad and a gliding palm support. Carpal tunnel pressure increased while operating a computer mouse. Although the vertical mouse significantly reduced ulnar deviation and the gel mouse pad and gliding palm support decreased wrist extension, none of the ergonomic devices reduced carpal tunnel pressure. The findings of this study do therefore not endorse a strong recommendation for or against any of the ergonomic devices commonly recommended for patients with CTS. Selection of ergonomic devices remains dependent on personal preference.

  12. Carpal tunnel syndrome assessed with diffusion tensor imaging: Comparison with electrophysiological studies of patients and healthy volunteers

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Chien-Kuo, E-mail: n044206@mail.hosp.ncku.edu.tw [Department of Radiology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Jou, I-Ming, E-mail: jming@mail.ncku.edu.tw [Department of Orthopedics, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Huang, Han-Wei, E-mail: veivei@mail.ncku.edu.tw [Department of Neurology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Chen, Pei-Yin, E-mail: chenpeiyin@gmail.com [Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, 345 Zhuangjing Road, Douliu City, Yunlin County 640, Taiwan (China); Tsai, Hong-Ming, E-mail: sjfhmt@mail.ncku.edu.tw [Department of Radiology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Liu, Yi-Sheng, E-mail: sanderz@ms60.url.com.tw [Department of Radiology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China); Lin, Chou-Ching K., E-mail: cxl45@mail.ncku.edu.tw [Department of Neurology, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 701, Taiwan (China)

    2012-11-15

    The main goal of this study was to investigate the applicability of parameters derived from diffusion tension imaging (DTI) in diagnosing carpal tunnel syndrome (CTS). Forty subjects were recruited, of which 19 were normal controls and 21 belonged to the CTS group. DTI of median nerves evaluated at 4 levels of the wrist (distal radius, pisiform bone, middle portion of the carpal tunnel, and hamate bone) and conventional MRI of the wrist was performed in normal and CTS subjects in two finger postures (extension and flexion). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were derived from DTI, and parameters related to abnormal hyperintensity of the median nerve were derived from conventional MRI. Electrophysiological tests, including nerve conduction velocity and F wave were also performed for comparison. The results of FA and ADC measurements did not depend on the measuring location and finger posture. Mean FA was decreased while mean ADC was increased by CTS. FA and ADC at the middle portion of the carpal tunnel was 0.47 {+-} 0.05 and 1.37 {+-} 0.12 ( Multiplication-Sign 10{sup -3} mm{sup 2}/s) for the control group and 0.42 {+-} 0.04 and 1.50 {+-} 0.15 ( Multiplication-Sign 10{sup -3} mm{sup 2}/s) for the CTS group, respectively. The linear correlations of FA and ADC versus electrophysiological indicators of CTS were significant (R{sup 2} ranged from 0.09 to 0.36), indicating FA and ADC from DTI had significant correlation with the existence and severity of CTS.

  13. Ulnar neuropathy at the wrist in a patient with carpal tunnel syndrome after open carpal tunnel release.

    Science.gov (United States)

    Kim, Nack Hwan; Kim, Dong Hwee

    2012-04-01

    Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5(th) digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic tests such as segmental nerve conduction studies of the ulnar nerve at the wrist were useful for localization of the lesion, and ultrasonography helped to confirm the presence of the lesion. After conservative management, patient symptoms were progressively relieved. Combined electrodiagnostic studies and ultrasonography may be helpful for diagnosing and detecting ulnar neuropathies of the wrist following carpal tunnel release surgery.

  14. Intraosseous ganglion in the first metacarpal bone

    Energy Technology Data Exchange (ETDEWEB)

    Nakano, H.; Itoh, Tatsuo; Katoh, Y.; Munakata, Y. [Dept. of Orthopaedic Surgery, Tokyo Women' s Medical Univ. (Japan)

    2001-10-01

    Intraosseous ganglia occur most frequently in the long bones of the lower limbs, particularly in the medial malleolus of the tibia. They usually appear as radiographically well circumscribed juxta-articular cystic lesions, containing myxoid fibrous tissue histologically. Intraosseous ganglia in the hand are very rare. Most reported cases have involved the carpal bones, in particular the lunate and scaphoid. To our knowledge, the present case is the third report of an intraosseous ganglion appearing in the first metacarpal bone; it arose in a patient who had been on dialysis for 25 years, mimicking amyloidosis of bone. (orig.)

  15. Detection of rheumatoid arthritis bone erosions by 2 different dedicated extremity MRI units and conventional radiography

    DEFF Research Database (Denmark)

    Duer, Anne; Vestergaard, Aage; Døhn, Uffe Møller;

    2008-01-01

    and carpal bones. MagneVu and CR detected 100% and 89%, respectively, of large erosions (OMERACT-RAMRIS-score > 1 on Artoscan) in MCP-joints, and 69% and 15.8% of large erosions in wrists. CONCLUSIONS: Both E-MRI units detected more erosions than CR, particularly due to a higher sensitivity in metacarpal...... heads and carpal bones. The MagneVu detected fewer erosions than the Artoscan, due to a lower average image quality and a smaller proportion of bones being visualized....

  16. Ulnar Neuropathy at the Wrist in a Patient with Carpal Tunnel Syndrome after Open Carpal Tunnel Release

    OpenAIRE

    2012-01-01

    Ulnar neuropathy at the wrist is rarely reported as complications of carpal tunnel release. Since it can sometimes be confused with recurrent median neuropathy at the wrist or ulnar neuropathy at the elbow, an electrodiagnostic study is useful for detecting the lesion in detail. We present a case of a 51-year-old woman with a two-week history of right ulnar palm and 5th digit tingling sensation that began 3 months after open carpal tunnel release surgery of the right hand. Electrodiagnostic t...

  17. Quantitative Muscle Ultrasonography in Carpal Tunnel Syndrome

    Science.gov (United States)

    2016-01-01

    Objective To assess the reliability of quantitative muscle ultrasonography (US) in healthy subjects and to evaluate the correlation between quantitative muscle US findings and electrodiagnostic study results in patients with carpal tunnel syndrome (CTS). The clinical significance of quantitative muscle US in CTS was also assessed. Methods Twenty patients with CTS and 20 age-matched healthy volunteers were recruited. All control and CTS subjects underwent a bilateral median and ulnar nerve conduction study (NCS) and quantitative muscle US. Transverse US images of the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) were obtained to measure muscle cross-sectional area (CSA), thickness, and echo intensity (EI). EI was determined using computer-assisted, grayscale analysis. Inter-rater and intra-rater reliability for quantitative muscle US in control subjects, and differences in muscle thickness, CSA, and EI between the CTS patient and control groups were analyzed. Relationships between quantitative US parameters and electrodiagnostic study results were evaluated. Results Quantitative muscle US had high inter-rater and intra-rater reliability in the control group. Muscle thickness and CSA were significantly decreased, and EI was significantly increased in the APB of the CTS group (all p<0.05). EI demonstrated a significant positive correlation with latency of the median motor and sensory NCS in CTS patients (p<0.05). Conclusion These findings suggest that quantitative muscle US parameters may be useful for detecting muscle changes in CTS. Further study involving patients with other neuromuscular diseases is needed to evaluate peripheral muscle change using quantitative muscle US. PMID:28119835

  18. A distinct subtype of ``metatropic dysplasia variant`` characterised by advanced carpal skeletal age and subluxation of the radial heads

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, G. [Department of Radiology, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu Shimotsuga-gun, Tochigi-ken 321-02 (Japan); Satoh, Masato [Department of Orthopedics, Saitama Children`s Medical Center, Saitama (Japan); Aihara, Toshinori [Department of Radiology, Saitama Children`s Medical Center, Saitama (Japan); Aida, Noriko [Department of Radiology, Kanagawa Children`s Medical Center, Yokohama (Japan); Yamamoto, Takehisa [Department of Pediatrics, Osaka University School of Medicine, Osaka (Japan); Ozono, Keiichi [Department of Environmental Medicine, Osaka Medical Center and Institute for Maternal and Child Health, Osaka (Japan)

    1998-02-01

    Background. ``Metatropic dysplasia variants`` are a group of bone dysplasias whose skeletal abnormalities are similar to, but milder than, those of classical metatropic dysplasia. The genetic and phenotypic heterogeneity has not been thoroughly elucidated. Objective. The objective was to designate a distinct subtype of these metatropic dysplasia variants. Materials and methods. The subjects were four Japanese patients, two sporadic cases and two siblings, who all had identical skeletal changes. The radiological features in these patients were compared with those of previously reported metatropic dysplasia variants. Results. Moderate platyspondyly with pear-shaped and/or anterior-tongued vertebral bodies, halberd pelvis, and dumbbell deformity of the tubular bones were regarded as hallmarks of metatropic dysplasia variants. The peculiar skeletal change in our patients was advanced carpal skeletal age in childhood, unlike most patients reported as metatropic dysplasia variants who manifest delayed carpal ossification. Another hallmark was congenital dislocation of the radial heads. A description of a patient with similar skeletal changes was found in the literature. Conclusion. These patients are considered to represent a distinct subgroup of metatropic dysplasia variants. It remains unknown whether the present siblings represent an autosomal recessive trait or an autosomal dominant trait with germinal mosaicism related to increased paternal age. (orig.) With 3 figs., 10 refs.

  19. Carpal tunnel syndrome - electrodiagnostic aspects of fifty seven symptomatic hands.

    OpenAIRE

    1999-01-01

    Electrodiagnostic data of fifty seven symptomatic extremities with carpal tunnel syndrome (CTS) are described. Practice recommendations made by American Academy of Neurology, American Association of Electrodiagnostic Medicine and American Academy of Physical Medicine and Rehabilitation regarding electrodiagnostic studies were considered while confirming CTS diagnosis by electrodiagnostic studies. Median sensory nerve conduction studies were the commonest abnormalities noted. The median orthod...

  20. Electrophysiological studies in mild idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Girlanda, P; Quartarone, A; Sinicropi, S; Pronestì, C; Nicolosi, C; Macaione, V; Picciolo, G; Messina, C

    1998-02-01

    Many techniques have been reported to improve the diagnosis of carpal tunnel syndrome (CTS), but there is no agreement on the diagnostic yield of these different methods. We used an electrophysiological protocol including the assessment of the orthodromic sensory conduction velocity of the median nerve along the carpal tunnel, comparison of median and ulnar sensory conduction between the ring finger and wrist, short segment incremental median sensory nerve conduction across the carpal tunnel recording from the III digit ('inching test'), the study of the refractory period of transmission (RPT) and calculation of the distoproximal ratio obtained by dividing the nerve conduction velocity in the median nerve between the third digit and the palm and between the palm and wrist in 41 patients with mild CTS (75 symptomatic hands) and in 45 control subjects. The distoproximal ratio calculation was the most sensitive technique (81%), but was also the least specific. The 'inching test', even though less sensitive, had the advantage of localising focal abnormalities of the median nerve along the carpal tunnel. RPT was abnormal in patients with recent symptoms. Combining the different techniques, an overall sensitivity of 92% was reached, 11% higher than the yield of the single best test suggesting that a multimodal approach could be useful. The best procedure for electrodiagnosis of mild CTS was to combine the median/ulnar comparison test with calculation of the disto-proximal ratio.

  1. Carpal Tunnel Release in Diabetic and Non-Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Mohammad H Ebrahimzadeh

    2013-09-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a compression neuropathy that causes paresthesia, pain or numbness in the territory of median nerve. The aim of this study is to compare the open surgery outcome and patients` satisfaction in carpal tunnel syndrome among diabetic and non-diabetic patients. Methods: In a retrospective cohort study from April 2011 to June 2012, patients suffered from carpal tunnel syndrome at least 6 months, without response to conservative treatment, who had the inclusion and exclusion criteria, were evaluated by the usage of MHQ and WHOQOL-BREEF tests, one month before surgery and three months after that. Carpal tunnel decompression surgery was performed by two surgeons, experienced in hand surgery, which used the same surgical method. Statistical analysis was performed by SPSS 19.0. Results: 24 of patient (34.2% were male and 46 (65.8% were female and there was no significant difference between two groups (P>0.05. MHQ total score before and after surgery was respectively 50.22±7.13 and 63.49±11.28 and this difference was significant (P

  2. EXTRACORPOREAL SHOCKWAVE THERAPY FOR POST BURN CARPAL TUNNEL SYNDROME

    Directory of Open Access Journals (Sweden)

    Hesham Galal Mahran

    2015-04-01

    Full Text Available Background: Carpal tunnel syndrome is considered the most common compression neuropathy of the upper extremity. It may lead to work disability and functional impairment. Burns are associated with swelling and eschar which forms a tight band constricting the circulation distally. Purpose: To investigate the effect of shockwave therapy on the carpal tunnel syndrome post burn. Subjects: Thirty male and female patients selected with manifestation of carpal tunnel syndrome post burn evaluated by electromyography, patients were divided randomly into two equal groups (A & B; group (A received shockwave therapy plus traditional physical therapy, while group (B received only traditional physical therapy (heating and stretching; Shock wave therapy protocol was two sessions per week for 12 weeks. Traditional physiotherapy was applied for both groups, 20 min for session 3times per week for 12 weeks. Evaluation: Electro diagnostic evaluation was done before treatment, one and three months post treatment. Results: There were improvement and significant increase in motor and sensory conduction velocities in shockwave group compared to those in the control group (p<0.05, also there were improvement and significant decrease in motor and sensory latencies in shockwave group compared to those in control group (p<0.05. Conclusion: Extracorporeal shockwave therapy provided a non-invasive, satisfied treatment option for carpal tunnel syndrome post burn.

  3. The illusion of severe carpal tunnel syndrome (CTS).

    Science.gov (United States)

    Gutmann, Ludwig; Nance, Christopher

    2010-02-01

    Thenar atrophy occurs in patients with severe carpal tunnel syndrome (CTS) of long-standing duration. In this report we present a young woman with mild bilateral CTS, based on electrophysiological studies, in whom marked thenar atrophy was on a congenital basis related to the VATER association (vertebral anomalies, anal atresia, tracheoesophageal fistula, and radial or renal abnormalities).

  4. Prevalence of Carpal Tunnel Syndrome among Individuals with Down Syndrome.

    Science.gov (United States)

    Christensen, Jens Erik Just; Peter, Peter Johannsen; Nielsen, Viggo Kamp; Mai, Jesper

    1998-01-01

    Forty-eight patients with Down syndrome were examined clinically and electrophysiologically for occurrence of carpal tunnel syndrome. Twenty-seven patients had normal findings, 13 had prolonged distal motor latency and reduced distal nerve conduction velocity, and 8 patients had one of these signs. Results show that prevalence of…

  5. Carpal myxosarcoma and forelimb amputation in a ferret

    NARCIS (Netherlands)

    van Zeeland, Y.R.A.; Hernandez-Divers, S.J.; Blasier, M.W.; Vila-Garcia, G.; Delong, D.; Stedman, N.L.

    2006-01-01

    Vet Rec. 2006 Dec 2;159(23):782-5. Carpal myxosarcoma and forelimb amputation in a ferret (Mustela putorius furo). van Zeeland YR, Hernandez-Divers SJ, Blasier MW, Vila-Garcia G, Delong D, Stedman NL. Department of Small Animal Medicine, Faculty of Veterinary Medicine, University of Utrecht, Utrecht

  6. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

    Institute of Scientific and Technical Information of China (English)

    Radwa Mahmoud Azmy; Amira Ahmed Labib; Saly Hassan Elkholy

    2013-01-01

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4th and 5th fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4th and 5th fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve.

  7. Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers

    Directory of Open Access Journals (Sweden)

    Adham do Amaral e Castro

    2015-10-01

    Full Text Available AbstractObjective:To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations.Materials and Methods:Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome.Results:Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001, paresthesia (p < 0.0001, Tinel's test (p < 0.0001, Phalen's test (p< 0.0001, BCTQ score (p < 0.0001, and years of formal education (p < 0.0001. Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24.Conclusion:The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.

  8. Axonal degeneration of the ulnar nerve secondary to carpal tunnel syndrome: fact or fiction?

    Science.gov (United States)

    Azmy, Radwa Mahmoud; Labib, Amira Ahmed; Elkholy, Saly Hassan

    2013-05-25

    The distribution of sensory symptoms in carpal tunnel syndrome is strongly dependent on the degree of electrophysiological dysfunction of the median nerve. The association between carpal tunnel syndrome and ulnar nerve entrapment is still unclear. In this study, we measured ulnar nerve function in 82 patients with carpal tunnel syndrome. The patients were divided into group I with minimal carpal tunnel syndrome (n = 35) and group II with mild to moderate carpal tunnel syndrome (n = 47) according to electrophysiological data. Sixty-one age- and sex-matched subjects without carpal tunnel syndrome were used as a control group. There were no significant differences in ulnar sensory nerve peak latencies or conduction velocities from the 4(th) and 5(th) fingers between patients with carpal tunnel syndrome and the control group. The ulnar sensory nerve action potential amplitudes from the 4(th) and 5(th) fingers were lower in patients with carpal tunnel syndrome than in the control group. The ratios of the ulnar sensory nerve action potential amplitudes from the 4(th) and 5(th) fingers were almost the same in patients with carpal tunnel syndrome as in the control group. These findings indicate that in patients with minimal to moderate carpal tunnel syndrome, there is some electrophysiological evidence of traction on the adjacent ulnar nerve fibers. The findings do not indicate axonal degeneration of the ulnar nerve.

  9. Clinical auxiliary diagnosis value of high frequency ultrasonographic measurements of the thickness of transverse carpal ligaments in carpal tunnel syndrome patients%高频超声测量腕横韧带厚度对腕管综合征的临床辅助诊断价值

    Institute of Scientific and Technical Information of China (English)

    徐林; 陈方民; 王蕾; 张培训; 姜晓锐

    2016-01-01

    Objective:To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS).Methods:In this study,48 patients (unilateral hand)with CTS were analyzed.The thickness of transverse carpal ligaments at the pisiform bone was measured using high-fre-quency ultrasound.Open carpal tunnel release procedure was performed in the 48 CTS patients,and the thickness of transverse carpal ligaments at the hamate hook bone measured using vernier caliper under di-rect vision.The accuracy of thickness of transverse carpal ligaments was evaluated using high-frequency ultrasound.High-frequency ultrasound measurement of thickness of transverse carpal ligaments at the ha-mate hook bone and pisiform bone,and determination of the diagnostic threshold measurement index using receiver operating characteristic (ROC)curve,sensitivity and specificity were performed and the correlation between the thickness of transverse carpal ligaments and nerve conduction study (NCS)ana-lyzed.Results:The thickness of transverse carpal ligaments in the CTS patients were (0.42 ±0.08)cm (high-frequency ultrasound)and (0.41 ±0.06)cm (operation)at hamate hook bone,and there was no significant difference between the two ways (t =0.672,P>0.05 ).The optimal cut-off value of the transverse carpal ligaments at hamate hook bone was 0.385 cm,the sensitivity 0.775,and the specificity 0.788.The optimal cut-off value of the transverse carpal ligaments at the pisiform bone was 0.315 cm, the sensitivity 0.950,and the specificity 1 .000.The transverse carpal ligaments thickness and wrist-in- dex finger sensory nerve conduction velocity (SCV),wrist-middle finger SCV showed a negative correla-tion.Conclusion:High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.%目的:评价高频超声对诊断腕管综合征(carpal tunnel syndrome,CTS)的价值及意义。方法:选择48例(单侧)CTS患者

  10. [Carpal tunnel syndrome, amyloid tenosynovitis and periodic hemodialysis].

    Science.gov (United States)

    Clanet, M; Mansat, M; Durroux, R; Testut, M F; Guiraud, B; Rascol, A; Conte, J

    1981-01-01

    Since 1975, various entrapment neuropathies have been reported in patients undergoing periodic haemodialysis, the most frequent being the carpal tunnel syndrome. Ten patients on chronic haemodialysis developing 15 carpal tunnel syndromes (5 unilateral and 5 bilateral) are reported. Various causes for the renal failure were present and clinical signs of the carpal tunnel syndrome developed at a late stage. The arteriovenous fistula required for extrarenal epuration was antebrachial and of the laterolateral type, except in one case when it was lateroterminal. The carpal tunnel syndrome was always on the same side as the fistula, developing at a later stage on th contralateral side in the 5 cases of bilateral disorders. Lesions were severe, in 11 of the 15 cases. Some patients noted fluctuations in pain symptoms during haemodialysis, either improving or becoming worse. Gross pathological findings during operation (13 cases) were tenosynovitis with epineural hypervascularisation on the opposite side. In 9 cases, however, atypical hypertrophic tenosynovitis was observed. Histological examination in 12 cases demonstrated typical tenosynovitis in 3 patients, but granulomatous tenosynovitis with amyloid deposits was reported in 9 patients. Lesions were bilateral in 2 cases thus present, on the side opposite to the fistula. Ultrastructural study confirmed the amyloid nature of the deposits in 3 cases, the microfibrillary appearance (80 to 100 A) being characteristic of amyloid substance. This rare complication does not represent a common carpal tunnel syndrome, and three mechanisms may be involved in its induction : peripheral uraemic neuropathy, haemodynamic modifications resulting from the antebrachial arteriovenous shunt, and amyloid formation in the flexor synovial sheaths. In the latter case, the type of amyloid disease may be a primary systemic amyloidosis not previously detected, or an elective amyloid process localised to the tenosynovial and periarticular tissues.

  11. Transverse Plane Tendon and Median Nerve Motion in the Carpal Tunnel : Ultrasound Comparison of Carpal Tunnel Syndrome Patients and Healthy Volunteers

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Henderson, Jacqueline; van der Molen, Aebele B. Mink; An, Kai-Nan; Amadio, Peter C.

    2012-01-01

    Background: The median nerve and flexor tendons are known to translate transversely in the carpal tunnel. The purpose of this study was to investigate these motions in differential finger motion using ultrasound, and to compare them in healthy people and carpal tunnel syndrome patients. Methods: Tra

  12. Characteristics of the electrophysiological activity of muscles attached to the transverse carpal ligament in carpal tunnel syndrome.

    Science.gov (United States)

    Horiguchi, Gen; Aoki, Takafumi; Ito, Hiromoto

    2011-01-01

    The main cause of carpal tunnel syndrome (CTS) remains unknown. Stiffness of the subcutaneous area of the volar aspect of the carpal tunnel is present in many patients and suggests that the stiffness of muscles attached to the transverse carpal ligament is increased. We performed an electrophysiological study to investigate muscle activities and to clarify whether the stiffness of muscles attached to the transverse carpal ligament is involved in the pathogenesis of CTS. The subjects of this study included 16 patients with early CTS showing no motor dysfunction. Both thenar muscles (opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis) and hypothenar muscles (opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis) were investigated. Surface electrodes were placed on each muscle, and maximum voluntary contractions with the thumb and little finger in opposition were maintained for 3 seconds in all patients and in 7 control subjects. Electromyographs were subjected to fast Fourier transform analysis, and the root mean square (RMS) and the mean power frequency (MPF) were determined for each muscle. The RMS of the opponens pollicis was significantly less in hands affected by CTS (292.8 µV) than in healthy hands (405.9 µV). The RMS did not differ between affected hands and healthy hands for the other 2 thenar muscles but did differ significantly for the hypothenar muscles. The MPF did not differ between affected hands and healthy hands for any muscle. The results show that electrophysiological differences are present among muscles innervated by the median nerve and that hypothenar muscles originally unrelated to median nerve dysfunction are also affected in early CTS. These results suggest that modulation of muscles attached to the transverse carpal ligament is involved in the pathogenesis of CTS.

  13. Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve relfect carpal tunnel syndrome severity?

    Institute of Scientific and Technical Information of China (English)

    Li Zhang; Aierken Rehemutula; Feng Peng; Cong Yu; Tian-bin Wang; Lin Chen

    2015-01-01

    Although ultrasound measurements have been used in previous studies on carpal tunnel syn-drome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately relfects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5–17 MHz was used to assess 77 pa-tients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Signiifcant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-section-al areas of the median nerve was 1.29 between mild and more severe (moderate and severe) carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% speciifcity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% speciifcity. These results suggest that the inlet-to-outlet ratio relfected the severity of carpal tunnel syndrome.

  14. Does the ratio of the carpal tunnel inlet and outlet cross-sectional areas in the median nerve reflect carpal tunnel syndrome severity?

    Directory of Open Access Journals (Sweden)

    Li Zhang

    2015-01-01

    Full Text Available Although ultrasound measurements have been used in previous studies on carpal tunnel syndrome to visualize injury to the median nerve, whether such ultrasound data can indicate the severity of carpal tunnel syndrome remains controversial. The cross-sectional areas of the median nerve at the tunnel inlet and outlet can show swelling and compression of the nerve at the carpal. We hypothesized that the ratio of the cross-sectional areas of the median nerve at the carpal tunnel inlet to outlet accurately reflects the severity of carpal tunnel syndrome. To test this, high-resolution ultrasound with a linear array transducer at 5-17 MHz was used to assess 77 patients with carpal tunnel syndrome. The results showed that the cut-off point for the inlet-to-outlet ratio was 1.14. Significant differences in the inlet-to-outlet ratio were found among patients with mild, moderate, and severe carpal tunnel syndrome. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.29 between mild and more severe (moderate and severe carpal tunnel syndrome patients with 64.7% sensitivity and 72.7% specificity. The cut-off point in the ratio of cross-sectional areas of the median nerve was 1.52 between the moderate and severe carpal tunnel syndrome patients with 80.0% sensitivity and 64.7% specificity. These results suggest that the inlet-to-outlet ratio reflected the severity of carpal tunnel syndrome.

  15. Er:YAG laser for the surgical treatment of the carpal tunnel syndrome

    Science.gov (United States)

    Russ, Detlef; Ebinger, Thomas; Illich, Wolfgang; Steiner, Rudolf W.

    2003-10-01

    We developed a new surgical procedure to improve the recurrence rate using an Er:YAG laser as dissection tool for the carpal ligament with the objective to ablate a small amount of the carpal ligament and to denaturate its ends. The Er:YAG Laser was transmitted to the applicator via a GeO fiber. With this system we proceeded 10 carpal ligament dissections without any complications in the follow-up period. All patients were free of pain and recurrence.

  16. Area and shape changes of the carpal tunnel in response to tunnel pressure.

    Science.gov (United States)

    Li, Zong-Ming; Masters, Tamara L; Mondello, Tracy A

    2011-12-01

    Carpal tunnel mechanics is relevant to our understanding of median nerve compression in the tunnel. The compliant characteristics of the tunnel strongly influence its mechanical environment. We investigated the distensibility of the carpal tunnel in response to tunnel pressure. A custom balloon device was designed to apply controlled pressure. Tunnel cross sections were obtained using magnetic resonance imaging to derive the relationship between carpal tunnel pressure and morphological parameters at the hook of hamate. The results showed that the cross-sectional area (CSA) at the level of the hook of hamate increased, on average, by 9.2% and 14.8% at 100 and 200 mmHg, respectively. The increased CSA was attained by a shape change of the cross section, displaying increased circularity. The increase in CSA was mainly attributable to the increase of area in the carpal arch region formed by the transverse carpal ligament. The narrowing of the carpal arch width was associated with an increase in the carpal arch. We concluded that the carpal tunnel is compliant to accommodate physiological variations of the carpal tunnel pressure, and that the increase in tunnel CSA is achieved by increasing the circularity of the cross section.

  17. Carpal tunnel syndrome caused by a giant cell tumour of the flexor tendon sheath.

    Science.gov (United States)

    Meek, Marcel F; Sheikh, Zahid A; Quinton, David N

    2014-02-01

    A 76-year-old woman developed right carpal tunnel syndrome after being conservatively treated for tenosynovitis of the flexor tendons with associated mild carpal tunnel syndrome. A magnetic resonance imaging scan showed a tumour in the carpal tunnel. Re-exploration showed that the median nerve was being compressed by a giant cell tumour of the flexor tendon sheaths. Appropriate imaging is advised in patients with additional findings (such as swelling) or in patients with secondary carpal tunnel syndrome and incomplete response to conservative treatment, to exclude a space-occupying lesion.

  18. Detection of rheumatoid arthritis bone erosions by two different dedicated extremity MRI units and conventional radiography

    DEFF Research Database (Denmark)

    Duer-Jensen, A.; Vestergaard, A.; Dohn, U.M.;

    2008-01-01

    was particularly more sensitive than CR for metacarpal heads and carpal bones. MagneVu MRI and CR detected 100% and 89%, respectively, of large erosions (Outcome Measures in Rheumatoid Arthritis Clinical Trials-Rheumatoid Arthritis MRI Scoring System (OMERACT-RAMRIS) score >1 on Artoscan) in MCP joints and 69......% and 15.8% of large erosions in wrists. Conclusions: Both E-MRI units detected more erosions than CR, in particular due to a higher sensitivity in metacarpal heads and carpal bones. The MagneVu unit detected fewer erosions than the Artoscan unit due to a lower average image quality and a smaller...

  19. Electrophysiological evaluation of ulnar nerve in carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    刘娜

    2014-01-01

    Objective To evaluate the impairment of ulnar nerve and its relationship with sensory symptoms in the ulnar territory in patients with carpal tunnel syndrome(CTS)through electrophysiological approach.Methods We retrospectively reviewed 55 cases with CTS admitted in our hospital from January 2012 to February 2013.Patients with CTS were graded as mild-moderate(35 cases)andsevere(20 cases)according to Stevens standard and were divided into symptomatic and non-symptomatic group according

  20. CARPAL TUNNEL SYNDROME PADA PEKERJA GARMEN DI JAKARTA

    Directory of Open Access Journals (Sweden)

    Lusianawaty Tana

    2012-10-01

    Full Text Available Carpal tunnel syndrome (CTS is a disorder caused by medianus nerve entrapment in carpal tunnel in the wrist and gives many symptoms as painfully, numbness, hyperesthesia at nerve medianus area. The objective of this study was to asses CTS in garment factory workers and determine the prevalence of CTS, CTS relation to age, sex, workhour, and repeated biomechanical pressure in hand/wrist. A cross sectional design was used in the study conducted in Jakarta in 2002, to 814 person sample with simple random sampling method. Data collection was done through interviews, inspections, and examinations. The study found that prevalence of CTS was 20.3% (n= 814 in work unit. Workers who worked with high repeated biomechanical pressure in right hand/wrist was 74.1%, in left hand/wrist were 65.5%. Carpal tunnel syndrome in female higher than CTS in male (p=0.04. There was 110 significant correlation between increased of age, workhour, repeated biomechanical pressure in hand/wrist and increased of CTS. For confirmation 10% cases CTS were examined by electroneurography and electromyography, and found that CTS was 35,3%.

  1. Median nerve deformation in differential finger motions : Ultrasonographic comparison of carpal tunnel syndrome patients and healthy controls

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Henderson, Jacqueline; Yoshii, Yuichi; van der Molen, Aebele B. Mink; Cha, Stephen S.; An, Kai-Nan; Amadio, Peter C.

    2012-01-01

    We investigated the median nerve deformation in the carpal tunnel in patients with carpal tunnel syndrome and controls during thumb, index finger, middle finger, and a four finger motion, using ultrasound. Both wrists of 29 asymptomatic volunteers and 29 patients with idiopathic carpal tunnel syndro

  2. Ultrasound evaluation of patients with carpal tunnel syndrome before and after endoscopic release of the transverse carpal ligament

    Energy Technology Data Exchange (ETDEWEB)

    Abicalaf, C.A. [Department of Radiology, University of Sao Paulo (Brazil)]. E-mail: abicalaf@uol.com.br; Barros, N. de [Department of Radiology, University of Sao Paulo (Brazil); Sernik, R.A. [Department of Radiology, University of Sao Paulo (Brazil); Pimentel, B.F. [Department of Orthopedic Surgery, University of Taubate, Sao Paulo (Brazil); Braga-Baiak, A. [Department of Radiology, University of Sao Paulo (Brazil); Braga, L. [Department of Radiology, University of Nebraska Medical Center (United States); Houvet, P. [Department of Radiology, Pitie Salpetriere Hospital, Paris (France); Brasseur, J.-L. [Department of Radiology, Pitie Salpetriere Hospital, Paris (France); Roger, B. [Clinique des Lilas, Paris (France); Cerri, G.G. [Department of Radiology, University of Sao Paulo (Brazil)

    2007-09-15

    Aim: To evaluate the cross-sectional area of the median nerve using ultrasound in carpal tunnel syndrome patients before and after endoscopic intervention. Material and methods: Twenty patients with carpal tunnel syndrome (15 women and five men; mean age 55 years) were prospectively evaluated. Informed consent was obtained from all participants. The study was approved by our Institutional Review Board (IRB). Median nerve cross-sectional area was evaluated at the proximal level before and at 4, 8, and 12 weeks after endoscopic release of the transverse ligament. In the present study, the median nerve cross-sectional area cut-off point was 10 mm{sup 2}. Repeated measures analysis of variance test (ANOVA) was applied to compare the reproducibility of ultrasound measurements before and after intervention. Results: The mean cross-sectional area of the median nerve was 15 mm{sup 2} (SD {+-} 2.1) before surgery; and 11.1 mm{sup 2} (SD {+-} 3); 9.2 mm{sup 2} (SD {+-} 2); and 8.6 mm{sup 2} (SD {+-} 1.6) at 4, 8, and 12 weeks after surgery. Repeated measures analyses of variance were found to be statistically significant (p < 0.001). Conclusion: The results of the present study demonstrated that there was a decrease in the cross-sectional area of the median nerve after the release of the transverse carpal ligament.

  3. Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: evidence of central processing in unilateral neuropathy.

    Science.gov (United States)

    Fernández-de-las-Peñas, César; de la Llave-Rincón, Ana Isabel; Fernández-Carnero, Josué; Cuadrado, María Luz; Arendt-Nielsen, Lars; Pareja, Juan A

    2009-06-01

    The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22-60 years), and 20 healthy matched females (aged 21-60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5-C6 zygapophyseal joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome.

  4. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  5. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  6. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  7. Occurrence of myofascial pain in patients with possible carpal tunnel syndrome - a single-blinded study

    DEFF Research Database (Denmark)

    Qerama, Erisela; Kasch, Helge; Fuglsang-Frederiksen, Anders

    2009-01-01

    There exits some similarity between symptoms of carpal tunnel syndrome (CTS) and myofascial pain related to trigger points (TPs) in the infraspinatus muscle.......There exits some similarity between symptoms of carpal tunnel syndrome (CTS) and myofascial pain related to trigger points (TPs) in the infraspinatus muscle....

  8. Development of a Kinematic 3D Carpal Model to Analyze In Vivo Soft-Tissue Interaction Across Multiple Static Postures

    Science.gov (United States)

    Marai, G. Elisabeta; Crisco, Joseph J.; Laidlaw, David H.

    2012-01-01

    We developed a subject-specific kinematic model to analyze in vivo soft-tissue interaction in the carpus in static, unloaded postures. The bone geometry was extracted from a reference computed tomography volume image. The soft-tissue geometry, including cartilage and ligament tissues, was computationally modeled based on kinematic constraints; the constraints were extracted from multiple computed tomography scans corresponding to different carpal postures. The data collected in vivo was next coupled with numerical simulation in order to analyze the role of soft-tissues in different postures. The resulting model extends the state of biomecanical modeling by incorporating soft-tissue constraints across the carpus range of motion, while successfully using only physiological constraints. The model results suggest that soft-tissue wrapping constraints have substantial impact on carpus stability. PMID:19965271

  9. Diagnostic value by high-frequency ultrasound for carpal tunnel syndrome%高频超声对腕管综合征的诊断价值

    Institute of Scientific and Technical Information of China (English)

    刘彦芝; 叶志宏; 杨婉玲; 朱吉修; 卢琼洁; 苏伟兰

    2016-01-01

    目的:探讨高频超声在腕管综合征(CTS)诊断中的临床价值。方法17例(24腕)职业性手臂振动病所致CTS患者作为观察组,20例(40腕)健康志愿者为对照组。采用高频超声观察腕管正中神经、9条肌腱及腕横韧带的形态、回声;在钩骨钩水平测量腕横韧带厚度、正中神经的内径;并在豌豆骨水平测量正中神经的横截面积并比较。结果观察组豌豆骨水平正中神经横截面积为(0.16±0.02)cm2、钩骨水平腕横韧带厚度为(0.40±0.05)cm,对照组分别为(0.09±0.02)cm2、(0.32±0.05)cm,比较差异均有统计学意义(P<0.05)。结论高频超声可清楚显示CTS患者腕管内容物的影像学变化,在CTS的诊断上具有很大价值。%ObjectiveTo investigate clinical value by high-frequency ultrasound in diagnosis of carpal tunnel syndrome (CTS).MethodsThere were 17 patients (24 wrists) with occupational hand-arm vibration disease-induced CTS as observation group and 20 healthy volunteers (40 wrists) as control group. Form and echo of carpal canal median nerve and 9 tendons and transverse carpal ligament were observed by high-frequency ultrasound. Transverse carpal ligament thickness and median nerve inner diameter were detected at hamate bone level, and median nerve cross sectional area was detected at pisiform bone level for comparison.ResultsThe observation group had median nerve cross sectional area at pisiform bone level as (0.16±0.02) cm2 and transverse carpal ligament thickness at hamate bone level as (0.40±0.05) cm, which were respectively (0.09±0.02) cm2 and (0.32±0.05) cm in the control group. Their differences all had statistical significance (P<0.05).Conclusion High-frequency ultrasound can clearly show imaging changes of carpal tunnel contents in CTS patients, and this method contains high value in diagnosis of CTS.

  10. A Comparison of Hand Pain and Hand Function after Z-plasty Reconstruction of the Transverse Carpal Ligament with Traditional Median Neurolysis in Carpal Tunnel Syndrome

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    Majid Sajjadi Saravi

    2016-04-01

    Full Text Available Background: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome.   Methods: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period.   Results: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213. But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P

  11. New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Hansen, Michael; Stoltenberg, Michael;

    2003-01-01

    progression on CR associated with the presence of MRI erosions. METHODS: In 10 patients with rheumatoid arthritis, MRI and CR of the dominant wrist were performed annually for 5 years. In each image set, each wrist bone (metacarpal bases, carpal bones, radius, and ulna) was assessed for the absence...

  12. Supracubital perineurioma misdiagnosed as carpal tunnel syndrome: case report

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    Schols Ludger

    2004-11-01

    Full Text Available Abstract Background Perineuriomas have been defined as tumorous lesions of the peripheral nerves which derive from perineurial cell proliferation and may be associated with abnormalities on chromosome 22. Case presentation Three years after a painful cubital vein procaine injection, a 33 year-old man developed a median nerve lesion, initially diagnosed as carpal tunnel syndrome. Symptoms progressed despite appropriate surgery. Clinical and electrophysiological re-evaluation revealed a fusiform mass at the distal upper arm, confirmed by MRI. Immunohistochemical studies classified the tumor as a mixed perineurioma and neuroma. Conclusions Perineurioma mixed with neuroma may potentially caused by the previous trauma or cytotoxic effects of procaine.

  13. Effect of metabolic syndrome on the outcome of corticosteroid injection for carpal tunnel syndrome.

    Science.gov (United States)

    Roh, Y H; Lee, B K; Baek, J R; Park, M H; Noh, J H; Gong, H S; Baek, G H

    2016-11-01

    Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome.

  14. 武术功力运动对腕骨角结构影响的螺旋CT分析%A spiral CT-image study on the effects of stress induced by Wushu power on carpal angle

    Institute of Scientific and Technical Information of China (English)

    刘鸿宇; 贾素素; 张杰; 陈雁卉; 宋晓霞

    2011-01-01

    Objective To observe the specific structure of carped angle undergoing various exercise stress suchas Wushu by use of the spiral CT. Methods Eight male athletes of Wushu power were selected from the national game, whose skills were to strike off bricks with their hands. There were 12 sports enthusiasts in the control group. All of their hands were scanned by the spiral CT. The two-dimensional images were filtered, screening reduced, enlarged, enhanced, splited, etc. And then the carpal angle was measured. Results The carpal angles were (131.55±7.35)° (right hand) and (133.30±5.68)° (left hand) in the wushu power group, and (136.99±7.22)° (right hand) and (137.38±6.80)° (left hand) in the control. The carpal angle in wushu power was less than that in the control (P < 0.05). Conclusion The stress from the different exercise may induce the different stimuli on the morphology and structure of carpal bones. The Wushu power may lead to a decrease of carpal angle and a contraction of volume and row to human carpal bones.%目的 观测武术功力运动产生的应力对腕骨角结构的影响.方法 选择全国武术功力大赛(单掌断砖项目)男性运动员8人、普通体育运动者12人.用螺旋CT扫描受试者腕骨,对其二维图像进行过滤、筛减、放大、增强、分割等处理,然后测量腕骨角.结果 功力运动员腕骨角为右手(131.55±7.35)°、左手为(133.30±5.68)°;对照组运动员右手为(136.99±7.22)°、左手为(137.38±6.80)°,功力运动员腕骨角小于普通人(P<0.05).结论 不同运动方式对腕骨形态结构产生不同的应力刺激,功力运动可引起腕骨角减小,腕骨体积和排列发生紧缩.

  15. Ulnar nerve entrapment in Guyon's canal due to recurrent carpal tunnel syndrome: case report.

    Science.gov (United States)

    Ozdemir, Ozgur; Calisaneller, Tarkan; Gulsen, Salih; Caner, Hakan

    2011-01-01

    Guyon's canal syndrome is a compression neuropathy of the ulnar nerve entrapment at the wrist. Compression of the ulnar nerve at the wrist by a ganglion, lipomas, diseases of the ulnar artery, fractures of the hamate and trauma are common etiologcal factors. Unlike Guyon's canal syndrome, carpal tunnel syndrome (CTS) is the most common nerve entrapment of the upper extremity. Although, open (OCTR) or endoscopic carpal tunnel release (ECTR) is highly effective in relieving pain, failure with carpal tunnel release is seldom seen. In this paper, we presented a patient with ulnar nerve entrapment associated with recurrent CTS and discussed the possible pathomechanism with a review of current literature.

  16. Experience of the treating application on transposition of pedicled periosteal flap for repairing the scaphoid bone nonunion%带蒂骨膜瓣移位修复手舟骨骨不连改善患者腕部背伸功能26例

    Institute of Scientific and Technical Information of China (English)

    于杰; 李素平; 钟桂舞; 闫毅; 范少地; 周凤金

    2003-01-01

    AIM: To explore the clinical result treating the scaphoid bone nonunion with vascularized periosteal flap. METHODS: 26 cases of scaphoid bone nonunion underwent transplantation with the periosteal flap with dorsal carpal branch of anterior interosseous artery. RESULTS: Following up 4 months to 18 months, in the 26 cases of scaphoid bone nonunion, 19 cases appeared excellent (73%), 7 cases appeared good(27% ) . CONCLUSION: The periosteal flap with dorsal carpal branch of anterior interosseous were used in repairing of scaphoid bone nonunion, the effect is food.

  17. A persisting median artery in a patient with symbrachydactyly and carpal tunnel syndrome.

    Science.gov (United States)

    Tollan, C J; Sivarajan, V

    2008-07-01

    A persisting median artery associated with carpal tunnel syndrome in a patient with symbrachydactyly has not been previously described in the literature. It is unclear whether there may be a developmental association between persistence of a median artery and Symbrachydactyly.

  18. A descriptive study of 972 consecutive cases of carpal tunnel release: role of ancillary procedures

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    Berkan Mersa

    2013-04-01

    Conclusion: Additional procedures is advocated as adjuncts to the carpal ligament release, in an effort to decrease the failure rate after operation in indicated cases. [Hand Microsurg 2013; 2(1.000: 18-22

  19. Acute calcifying tendonitis--an unusual cause of carpal tunnel syndrome.

    Science.gov (United States)

    Din, R; Giannikas, K; El-Hadidi, M

    2001-03-01

    We report a rare case of acute calcifying tendinitis resulting in acute carpal tunnel syndrome. Acute medical staff should be aware of this condition and the importance of early referral to avoid long term median nerve neuropathy.

  20. Clinical study on treatment of Carpal tunnel syndrome using Scolopendrid herbal acupuncture

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    Lim Jeong a

    2005-02-01

    Full Text Available Objective : This study is performed for the purpose of examining into the efficacy of the scolopendrid herbal acupucture which has been used among the Korean people for the Carpal tunnel syndrome. Methods : 40 carpal tunnel syndrome patients who visited Won-kwang University Hospital during the period from January 1998 to December 2004 were analysed for clinical manifestations. After we divided patients into two classes at random, we treated them with scolopendrid herbal acupucture or not. Treatment efficiency was monitored through VAS(Visual Analog Scale and clinical symptom. Conclusion : We brought to the conclusion that the scolopendrid herbal acupucture has possibility to be efficient to cure the carpal tunnel syndrome patients. So we suggest the possibility to use this new remedy for the carpal tunnel syndrome.

  1. 部分腕关节韧带的生物力学特性%Biomechanical properties of partial carpal ligaments

    Institute of Scientific and Technical Information of China (English)

    徐永清; 钟世镇; 赵卫东; 徐达传

    2005-01-01

    simple specimen study.SETTING: Department of Orthopaedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, and Institute of Clinical Anatomy, First Military Medical University of Chinese PLA.PARTICIPANTS: Sixteen fresh specimens from Chinese adult wrists were obtained from the Departmentof Anatomy, First MilitaryMedical University of Chinese PLA and the experiment was performed in the Laboratory of Biomechanics. INTERVENTIONS: The partial carpalligaments were stretched till fragmentation of ligaments by using the SWD-10materialtesting machine, at the rated velocity of 5 mm per minute so as to determine the biomechanical properties of carpal ligaments. MAIN OUTCOME MEASURES: The tolerated maximum tension and rigidity during fragmentation of radioscaphoid ligament, radioscaphocapitate (RSC) ligament, radiolunate ligament, ulnolunate (UL) ligament, ulnotriquetral(UT) ligament, ulnar bursa, scapholunate interosseous(SLI) ligament,and lunotriquetral interosseous(LTI) ligament. RESULTS: Among the ligaments attached between distal radioulnar bone and carpal bone, the maximum tension and rigidity of UL ligament were the strongest, (219.2 ±55.4) N and (65.5 ± 19.6) N/mm2, of UT ligament and ulnar bursa were the weakest, (54.0 ±25.5) N, (17.8 ± 6.0) N/mm2and (58.7 ± 17.6) N, (13.4 ±4.7) N/mm2 respectively, of SLI ligament was stronger, (286. 1 ±90.8) N, (95.5 ±40.0) N/mm2, and of LTI ligament were more stronger, (375.3 ± 52.6)N, (179.0 ± 39.0 N/mm2.CONCLUSION: Among carpal ligaments, the maximum tension and rigidity of proximal row of intercarpal ligaments were stronger than those of the ligaments attached between distal radioulnar bone and carpal bone. Of proximal row of intercarpal ligaments, the maximum tension and rigidity of LTI ligament were stronger than those of SLI ligament. Of the ligaments attached between distal radioulnar bone and carpal bone, the maximum tension and rigidity of UL ligament were the strongest.

  2. Practical approach to electrodiagnosis of the carpal tunnel syndrome: A review

    Directory of Open Access Journals (Sweden)

    Keivan Basiri

    2015-01-01

    Full Text Available Despite being the most common entrapment neuropathy and the most common reason for referral to the electromyography (EMG laboratory, the diagnosis of carpal tunnel syndrome (CTS continues to be challenging due to a large number of electrodiagnostic (EDX tests available. We present a flowchart and propose a practical approach to the diagnosis of CTS using the available literature and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM guidelines and the Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome.

  3. Microsurgical open mini uniskin incision technique in the surgical treatment of carpal tunnel syndrome

    OpenAIRE

    Keramettin Aydin; Cengiz Cokluk; Nilgun Cengiz; Ayhan Bilgici

    2006-01-01

    Background: Patients who undergo carpal tunnel surgery sometimes complain of the restriction of the grip and pinch function, palmar tenderness, cosmetic problems, and scar formation at the site of the incision. Aims: We used a modified mini uni-skin incision with appropriate hand position for microscopic view in the surgical treatment of carpal tunnel syndrome to prevent cosmetic problems related with scar formation after surgery. Settings and Design: In this study we used two different ...

  4. Practical approach to electrodiagnosis of the carpal tunnel syndrome: A review.

    Science.gov (United States)

    Basiri, Keivan; Katirji, Bashar

    2015-01-01

    Despite being the most common entrapment neuropathy and the most common reason for referral to the electromyography (EMG) laboratory, the diagnosis of carpal tunnel syndrome (CTS) continues to be challenging due to a large number of electrodiagnostic (EDX) tests available. We present a flowchart and propose a practical approach to the diagnosis of CTS using the available literature and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) guidelines and the Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome.

  5. Finite element simulation of the mechanical impact of computer work on the carpal tunnel syndrome.

    Science.gov (United States)

    Mouzakis, Dionysios E; Rachiotis, George; Zaoutsos, Stefanos; Eleftheriou, Andreas; Malizos, Konstantinos N

    2014-09-22

    Carpal tunnel syndrome (CTS) is a clinical disorder resulting from the compression of the median nerve. The available evidence regarding the association between computer use and CTS is controversial. There is some evidence that computer mouse or keyboard work, or both are associated with the development of CTS. Despite the availability of pressure measurements in the carpal tunnel during computer work (exposure to keyboard or mouse) there are no available data to support a direct effect of the increased intracarpal canal pressure on the median nerve. This study presents an attempt to simulate the direct effects of computer work on the whole carpal area section using finite element analysis. A finite element mesh was produced from computerized tomography scans of the carpal area, involving all tissues present in the carpal tunnel. Two loading scenarios were applied on these models based on biomechanical data measured during computer work. It was found that mouse work can produce large deformation fields on the median nerve region. Also, the high stressing effect of the carpal ligament was verified. Keyboard work produced considerable and heterogeneous elongations along the longitudinal axis of the median nerve. Our study provides evidence that increased intracarpal canal pressures caused by awkward wrist postures imposed during computer work were associated directly with deformation of the median nerve. Despite the limitations of the present study the findings could be considered as a contribution to the understanding of the development of CTS due to exposure to computer work.

  6. PROSPECTIVE COMPARISON OF ENDOSCOPIC AND OPEN SURGICAL METHODS FOR CARPAL TUNNEL SYNDROME

    Institute of Scientific and Technical Information of China (English)

    Ye Tian; Hong Zhao; Ting Wang

    2007-01-01

    Objective To compare outcomes of patients undergoing either open or endoscopic carpal tunnel release for the treatment of idiopathic carpal tunnel syndrome.Methods A prospective, randomized study was performed on 70 hands in 62 patients with idiopathic carpal tunnel syndrome from April 2000 to April 2004. Either open (36 hands in 30 patients) or endoscopic (34 hands in 32 patients) carpal tunnel release was performed randomly. Symptom improvement, complications, and the time of operation , in-hospital stay, and return to work between the two groups were assessed with average 2 years of follow-up. The electromyography was tested pre- and 3 months post-operation.Results There were no significant differences between the two surgical groups with regard to postoperative improvements of symptom, electromyography tests, and the incidence of complications. But it was statistically less in the rate of scar tenderness, the time of operation, in-hospital stay, and return to work in the endoscopic group compared with the open group (P< 0. 05).Conclusions The endoscopic carpal tunnel release is a reliable method in the treatment of idiopathic carpal tunnel syndrome. And it has the advantages of slight scar tenderness, less operation time, less in-hospital stay, early functional recovery, safety, and high satisfaction rate compared with open methods.

  7. Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Michael Alexander Malahias

    2015-01-01

    Full Text Available Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

  8. Bone tumor

    Science.gov (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

  9. Lumbrical and interossei recording in carpal tunnel syndrome.

    Science.gov (United States)

    Preston, D C; Logigian, E L

    1992-11-01

    Median motor studies are commonly "normal" in mild carpal tunnel syndrome (CTS). This reflects either the sparing of motor compared to sensory fibers, or the inability of conventional studies to detect an abnormality. A novel approach to demonstrate early motor fiber involvement in CTS is the placement of the same active electrode lateral to the third metacarpal, allowing recording from the second lumbrical or the deeper interossei, when stimulating the median or ulnar nerves at the wrist, respectively. We compared the difference between these latencies in 51 normal control hands to 107 consecutive patient hands referred with symptoms and signs suggestive of CTS, who were subsequently proven to have electrophysiologic CTS by standard nerve conduction criteria. A prolonged lumbrical-interossei latency difference (> 0.4 ms) was found to be a sensitive indicator of CTS in all patient groups. It was also helpful in patients with coexistent polyneuropathy, where localization at the wrist was otherwise difficult.

  10. Carpal tunnel syndrome - electrodiagnostic aspects of fifty seven symptomatic hands.

    Directory of Open Access Journals (Sweden)

    Murthy J

    1999-10-01

    Full Text Available Electrodiagnostic data of fifty seven symptomatic extremities with carpal tunnel syndrome (CTS are described. Practice recommendations made by American Academy of Neurology, American Association of Electrodiagnostic Medicine and American Academy of Physical Medicine and Rehabilitation regarding electrodiagnostic studies were considered while confirming CTS diagnosis by electrodiagnostic studies. Median sensory nerve conduction studies were the commonest abnormalities noted. The median orthodromic sensory latencies were prolonged in 86% and sensory nerve action potential amplitude abnormalities were seen in 82%. Prolongation of the conduction in the short segment across the wrist in the median nerve was seen in 96.5% and the difference in the conduction between median and ulnar nerve across the wrist was significant in all the 57 extremities. The median motor latencies were prolonged in 67% of hands. Higher incidence of electrodiagnostic abnormalities observed in this study might be due to inclusion of patients with severe disease.

  11. Pyridoxine hydrochloride treatment of carpal tunnel syndrome: a review.

    Science.gov (United States)

    Aufiero, Elaine; Stitik, Todd P; Foye, Patrick M; Chen, Boqing

    2004-03-01

    It has been hypothesized that idiopathic carpal tunnel syndrome (CTS) is a manifestation of vitamin B6 deficiency. Some claim that B6 supplementation can alleviate symptoms. Others argue that pain relief occurs because of vitamin B6's anti-nociceptive properties or because B6 supplementation addresses an unrecognized peripheral neuropathy. Few studies on CTS and B6 employed electrodiagnostic techniques in diagnosis, and few showed a correlation between symptoms and improved electrodiagnostic parameters with supplementation. Other studies failed to measure or estimate B6 levels. Nevertheless, it appears reasonable to recommend vitamin B6 supplementation to people with CTS. Some patients will improve symptomatically with low risks of toxicity in recommended doses.

  12. Splinting after Carpal Tunnel Release: Does it really Matter?

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    Shalimar A

    2015-07-01

    Full Text Available Splinting of the wrist after carpal tunnel release (CTR has been practised by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR have had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks or too short (48 hours only. The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting. Methods: All 30 of our patients underwent a standardized limited open CTR by a designated surgeon. Post operatively, they were randomized into a splinted (n=16 and a nonsplinted (n=14 group. The splint was kept for a week. Patients were reviewed at regular intervals of one week, two months and six months. At each follow up, these patients were clinically assessed for the following outcome measures: VAS (visual analogue score, 2PD (two-point discrimination, pinch grip, grip, Abductor Pollicis Brevis (APB power and completion of the Boston questionnaire. Results: All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release.

  13. [Diagnostics of the skeletal massiveness and human somatotype using hand bones].

    Science.gov (United States)

    Zviagin, V N; Zamiatina, A O; Galitskaia, O I

    2003-01-01

    The skeleton massiveness (SM) and the somatotype of human constitution were determined on the basis of osteometry of bones of carpal and metacarpal bones (MB) and of phalanxes. Seventy male and 13 female skeletons from the collection of the chair for anthropology, Moscow State University, were investigated. Described are the results of examinations of 8 carpal bones made according to 3 signs (length, width, and height), and of 5 metacarpal bones made according to 4 signs (length, base and head width, and base height); investigation findings of finger phalanxes (in full) are also presented. Methods of current multidimensional statistics were used within the case study, i.e. related with the key components--for SM specification and the discriminative analysis--for constitution specification. The SM determination accuracy according to type A was 40%, according to type B--80%, according to type C--37.5% and according to type D--52.9%. The classification accuracy of constitutions by carpal bones was 50.0%, by MB--46.4%, and by MB plus finger phalanxes--48.1%. It is pointed out that it was for the first time that the elaborated quantitative criteria of osteometry of hand bones could be used in the expertise practice for the purpose of personality identification by osseous remains.

  14. Corrección quirúrgica de una luxo-fractura congénita de carpo con un fijador biplanar-bilateral con banda de tensión ligamentaria- Surgical correction of congenital luxo-fracture of carpal-biplane with fixing band tension with bilateral ligament

    Directory of Open Access Journals (Sweden)

    Mejía Durango, María Adelaida

    2012-02-01

    Full Text Available RESUMENLa luxofractura carpiana es una lesión traumática, la cual involucra, la cápsula articular, segmento del hueso y demás estructuras relacionadas como ligamentos, elementos neurovasculares, líquido sinovial y musculo.SUMARYThe carpal luxofracture is a traumatic injury, which involves the joint capsule, a segment of bone and other related structures such as ligaments, neurovascular elements, synovial fluid and muscle.

  15. Corrección quirúrgica de una luxo-fractura congénita de carpo con un fijador biplanar-bilateral con banda de tensión ligamentaria- Surgical correction of congenital luxo-fracture of carpal-biplane with fixing band tension with bilateral ligament

    OpenAIRE

    Mejía Durango, María Adelaida; Parra Cardozo, Yeison Alberto; Polania Avila, Sindy Julieth

    2012-01-01

    RESUMENLa luxofractura carpiana es una lesión traumática, la cual involucra, la cápsula articular, segmento del hueso y demás estructuras relacionadas como ligamentos, elementos neurovasculares, líquido sinovial y musculo.SUMARYThe carpal luxofracture is a traumatic injury, which involves the joint capsule, a segment of bone and other related structures such as ligaments, neurovascular elements, synovial fluid and muscle.

  16. Median nerve cross-sectional area and MRI diffusion characteristics: normative values at the carpal tunnel

    Energy Technology Data Exchange (ETDEWEB)

    Yao, Lawrence; Gai, Neville [Clinical Center, Radiology and Imaging Sciences, Bethesda, MD (United States)

    2009-04-15

    Enlargement of the median nerve is an objective potential imaging sign of carpal tunnel syndrome. Diffusion tensor MRI (DTI) may provide additional structural information that may prove useful in characterizing median neuropathy. This study further examines normal values for median nerve cross-sectional area (CSA), apparent diffusion coefficient (ADC), and fractional anisotropy (FA). Twenty-three wrists in 17 healthy volunteers underwent MRI of the wrist at 3 T. In 13 subjects, DTI was performed at a B value of 600 mm{sup 2}/s. Median nerve CSA, ADC, and FA were analyzed at standardized anatomic levels. Mean (SD) median nerve CSA within the proximal carpal tunnel was 10.0 (3.4) mm{sup 2}. The mean (SD) FA of the median nerve was 0.71 (0.06) and 0.70 (0.13) proximal to and within the carpal tunnel, respectively. There was a significant difference between nerve CSA and ADC, but not FA, at the distal forearm and proximal carpal tunnel. Nerve CSA, ADC, and FA did not differ between men and women or between dominant and non-dominant wrists. Nerve CSA at the proximal carpal tunnel was positively correlated with subject age and body mass index. Our results suggest a 90% upper confidence limit for normal median nerve CSA of 14.4 mm{sup 2} at the proximal carpal tunnel, higher than normal limits reported by many ultrasound studies. We observed a difference between the CSA and ADC, but not the FA, of the median nerve at the distal forearm and proximal carpal tunnel levels. (orig.)

  17. Transverse plane tendon and median nerve motion in the carpal tunnel: ultrasound comparison of carpal tunnel syndrome patients and healthy volunteers.

    Directory of Open Access Journals (Sweden)

    Margriet H M van Doesburg

    Full Text Available BACKGROUND: The median nerve and flexor tendons are known to translate transversely in the carpal tunnel. The purpose of this study was to investigate these motions in differential finger motion using ultrasound, and to compare them in healthy people and carpal tunnel syndrome patients. METHODS: Transverse ultrasounds clips were taken during fist, index finger, middle finger and thumb flexion in 29 healthy normal subjects and 29 CTS patients. Displacement in palmar-dorsal and radial-ulnar direction was calculated using Analyze software. Additionally, the distance between the median nerve and the tendons was calculated. RESULTS: We found a changed motion pattern of the median nerve in middle finger, index finger and thumb motion between normal subjects and CTS patients (p<0.05. Also, we found a changed motion direction in CTS patients of the FDS III tendon in fist and middle finger motion, and of the FDS II and flexor pollicis longus tendon in index finger and thumb motion, respectively (p<0.05. The distance between the median nerve and the FDS II or FPL tendon is significantly greater in patients than in healthy volunteers for index finger and thumb motion, respectively (p<0.05. CONCLUSION: Our results suggest a changed motion pattern of the median nerve and several tendons in carpal tunnel syndrome patients compared to normal subjects. Such motion patterns may be useful in distinguishing affected from unaffected individuals, and in studies of the pathomechanics of carpal tunnel syndrome.

  18. Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis

    NARCIS (Netherlands)

    Vasiliadis, Haris S.; Nikolakopoulou, Adriani; Shrier, Ian; Lunn, Michael P.; Brassington, Ruth; Scholten, Rob J. P.; Salanti, Georgia

    2015-01-01

    Background The Endoscopic Release of Carpal Tunnel Syndrome (ECTR) is a minimal invasive approach for the treatment of Carpal Tunnel Syndrome. There is scepticism regarding the safety of this technique, based on the assumption that this is a rather "blind" procedure and on the high number of severe

  19. Carpal tunnel syndrome in general practice 1987 and 2001: incidence and the role of occupational and non-occupational factors.

    NARCIS (Netherlands)

    Bongers, F.J.M.; Schellevis, F.G.; Bosch, W.J.H.M. van den; Zee, J. van der

    2007-01-01

    Most studies on the incidence of the carpal tunnel syndrome and the relation of this disorder with occupation are population-based. In this study we present data from general practice. Aim: to compare incidence rates of carpal tunnel syndrome in 1987 and 2001, and to study the relationship between c

  20. High Resolution Ultrasonography of Carpal Tunnel Syndrome Before and After Endoscopic Release of the Transverse Carpal Ligament: Correlation of Ultrasonography (US)Findings with Surgical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jang Gyu; Im, Soo Bin; Seok, Hyun; Yi, Beom Ha; Choi, Na Mi; Lee, Hae Kyung [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jin, Wook [East-West Neo Medical Center, Kyung Hee University, Seoul (Korea, Republic of)

    2008-03-15

    The aim of this study is to evaluate morphological changes of the medial nerve in patients with carpal tunnel syndrome (CTS) before and after endoscopic release of the transverse carpal ligament, and to correlate the ultrasonography (US) findings with the use of high resolution US and the surgical outcome for the median nerve. Thirty patients with CTS confirmed by a clinical and electrophysiological study underwent high resolution US. The US instrumentation was equipped with a high frequency linear transducer to measure the cross sectional area, flattening ratio and swelling ratio of the medial nerve at the distal radioulnar joint, proximal and distal carpal tunnel before and three months after surgery. The cross sectional area (CSA) of the median nerve at the distal radioulnar level showed a decrease from 0.13 {+-} 0.03 cm2 before surgery to 0.11 {+-} 0.03 cm2 after surgery, and the CSA of the proximal carpal tunnel showed a decrease from 0.17 {+-} 0.07 cm2 to 0.14 {+-} 0.05 cm2: these differences were statistically significant. There was no statistically significant correlation between the morphological change and symptom improvement. This study confirmed a decreasing CSA of the medial nerve at the distal radioulnar and proximal carpal tunnel in a postoperative patient with CTS, as determined by the use of high resolution US. No association was found between a change in the CSA of the median nerve and symptom improvement. A further study based on multiple measurements of the median nerve with a longer period is necessary to establish the association between a change in the CSA of the median nerve and symptom improvement

  1. Can carpal malalignment predict early and late instability in nonoperatively managed distal radius fractures?

    Science.gov (United States)

    Batra, Sameer; Debnath, U; Kanvinde, R

    2008-10-01

    The purpose of this study was to assess the frequency of carpal instability as a concomitant lesion in distal radius fractures and identify other factors including carpal malalignment in an attempt to predict the final radiological outcome more accurately following conservative treatment of distal radius fractures. An observational study from patient records and standardised radiological follow-up examinations as data sources was used. The alignment of each wrist was checked radiographically immediately post-reduction and subsequently at 1- and 6-week follow-up assessments. Serial measurements of radial length, dorsal tilt, radial inclination, scapho-lunate, radio-lunate, radioscaphoid, scapho-capitate angles and effective radiolunate flexion angle were made. Regression analysis showed high correlation among the severity of axial shortening, pre-reduction dorsal angulation and radio-carpal malalignment pattern with early loss of reduction at 1 week. We found the age, severity of axial radial shortening, dorsal angulation, presence of dorsal comminution and radio-carpal malalignment pattern to be significant predictors of adverse radiological outcome at 6 weeks (late instability). Our study highlights the importance of radio-carpal instability pattern on post-reduction radiographs as a predictor of early and late instability.

  2. Effects of perineural steroid injections on median nerve conduction during the carpal tunnel release

    Directory of Open Access Journals (Sweden)

    Stepić Nenad

    2008-01-01

    Full Text Available Background/Aim. The treatment outcome of the median nerve compressive neuropathy in the carpal zone due to carpal tunnel syndrome (CTS is represented by recovering the nerves sensibility, conductivity, condition and strength. Perineural application of betamethasone during the surgical decompression might result in faster recovery of compressed median nerve's conduction speed. Methods. In this study 40 patients with CTS were randomly divided in the two groups. In the first group (n = 20 we performed the surgical decompression of the median nerve by the open release of the carpal tunnel, and in the second group (n = 20 we applicated a perineural injection of 1 ml of betamethason immediately after the surgical decompression. We performed the electrodiagnostic (ED examinations 7, 30 and 90 days after the surgery, and measured the conduction speed of the median nerve in the carpal tunnel zone and the sensitivity conduction speed of the median nerve. Results. Significant differences in examined ED respective variable values in different time intervals were obtained. At the final measurements, 90 days after the surgical procedure, both groups evidenced a full recovery of the conduction speed in the carpal tunnel with statistically significant better results in the second group of the patients (t = -2.116; p = 0.043. Conclusion. Intraoperative application of the corticosteroid injection during the surgical decompression results in faster regaining of conduction speed of the median nerve.

  3. Effectiveness of low-level laser on carpal tunnel syndrome

    Science.gov (United States)

    Li, Zhi-Jun; Wang, Yao; Zhang, Hua-Feng; Ma, Xin-Long; Tian, Peng; Huang, Yuting

    2016-01-01

    Abstract Background: Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review. Methods: We conducted electronic searches of PubMed (1966–2015.10), Medline (1966–2015.10), Embase (1980–2015.10), and ScienceDirect (1985–2015.10), using the terms “carpal tunnel syndrome” and “laser” according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes. Results: Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MD = 2.04; 95% CI: 0.08–3.99; P = 0.04; I2 = 62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MD = 0.97; 95% CI: 0.84–1.11; P 95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups. Conclusion: This study revealed that low-level laser improve hand grip, VAS, and SNAP after 3 months of follow-up for mild to moderate CTS. More high-quality studies using the same laser intervention protocol are needed to

  4. Ulnar nerve entrapment at wrist associated with carpal tunnel syndrome.

    Science.gov (United States)

    Gozke, E; Dortcan, N; Kocer, A; Cetinkaya, M; Akyuz, G; Us, O

    2003-11-01

    In this study, ulnar nerve entrapments at the wrist were investigated using nerve conduction studies in cases with established diagnosis of carpal tunnel syndrome (CTS). Cases with cervical radiculopathy and polyneuropathy as well as patients with ulnar nerve entrapment at elbow were excluded from the study. Fifty-three cases (46 females, seven males) whose ages ranged between 20 and 72 years (mean: 49.31 +/- 13.78) were evaluated. Among 53 cases, 12 (22.6%) bilateral and 41 (77.3%) unilateral CTS were detected. Totally 65 wrists evaluated and prolongation of median nerve wrist-3rd digit distal sensory latencies (DSL; N: 59; 90.7%) and wrist-abductor pollicis brevis distal motor latencies (N: 48; 73.8%) were seen. In six wrists, diagnoses were established with the detection of an increase in the differences between wrist-4th digit DSL of median and ulnar nerve. This test was used if other test results were in normal limits. Prolongation of ulnar nerve wrist-5th digit DSL were found in 12 wrists (18.4%) in cases with CTS. Among these 12 wrists mild (N: 2), moderate (N: 7) and severe (N: 3) CTS were detected. Ulnar nerve motor conduction studies provided normal results. In conclusion, we are in the opinion that for the detection of associated ulnar nerve wrist entrapments, ulnar nerve conduction studies paying special attention to DSL convey importance in established cases with CTS.

  5. Concoradance of clinical and neurophysiologic diagnoses of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Martić Vesna

    2015-01-01

    Full Text Available Introduction/Aim. Clinical presentation and neurophysiological examination are crucial in diagnosing carpal tunnel syndrome (CTS. The aim of this study was to determine sensitivity and specificity of clinical examination for diagnosing of CTS in relation to neurophysiological evaluation. Methods. The sample included 181 patients referred to the neurologist for further diagnosis of pain and parestesias in the arm (81 women and 100 men mean age 42 ± 14 years and 52 ± 16 years, respectively. All the patients were neurophysiologicly tested. Results. Out of 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiological findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0,51; specificity 0,95. Conclusion. Low sensitivity and high specificity suggest that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is the need for neurophysiological evaluation of patients with complains in the arm.

  6. The prevalence and severity of carpal tunnel syndrome during pregnancy

    Directory of Open Access Journals (Sweden)

    Saeid Khosrawi

    2012-01-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is the most common compression neuropathy of median nerve, which can occur or aggravate during pregnancy and sometimes needs surgery. Since early diagnosis leads to simpler and less risky treatments, this study evaluated the frequency and severity of CTS in pregnancy. Materials and Methods: In this descriptive cross-sectional study, 100 pregnant women who came to gynecology clinic of university hospitals were randomly selected. At first, they were asked for presence of clinical symptoms, and then clinical tests including Phalen and Tinel were conducted to diagnose CTS. Then, electrodiagnostic studies including sensory and motor distal latencies of median nerve were measured and compared with those of ulnar nerve, and then, nerve conduction velocity of median nerve across wrist was evaluated. Results: Among the studied pregnant women, 19% had CTS, out of whom 47.5% were bilateral and 26.3% had severe CTS. The prevalence in the first, second, and third trimesters were 11%, 26%, and 63%, respectively, and 42% were asymptomatic. Sensitivity and specificity of clinical signs as compared with electrodiagnostic findings were 52% and 23%, respectively. Conclusions: The prevalence of CTS is relatively high in pregnant women. The prevalence and severity of CTS increase and the rate of asymptomatic cases reduces with the age of pregnancy. Clinical examination and history taking could not diagnose all cases, and their sensitivity and specificity are much less than electrodiagnostic tests. Therefore, it is recommended that electrodiagnostic studies be conducted in pregnant women during the third trimester.

  7. [Carpal tunnel syndrome in acromegaly--4-case report and review of literature].

    Science.gov (United States)

    Imamura, H; Isu, T; Iwasaki, Y; Sugimoto, S; Abe, H; Tashiro, K

    1989-09-01

    Four cases of carpal tunnel syndrome in acromegaly were reported. These 4 cases were found in 21 acromegalies (19%). Besides change of features, they complained bilateral sensory disturbances of their hands. After transsphenoidal removal of pituitary adenoma, GH levels returned to the normal range and sensory disturbances were improved in all cases. Mechanism of carpal tunnel syndrome in acromegaly is that edematous synovial tissues compress the median nerve because oversecretion of growth hormone causes increase of sodium and water retention in the extracellular fluid. The patient who showes high basal level of growth hormone and/or acromegalic pattern by various tolerance tests does not always have the carpal tunnel syndrome. But this syndrome is apt to be found in active acromegaly. So the detection of the symptom showed by this activity such as hypersudation in our cases leads to the early diagnosis of acromegaly.

  8. Sensory Conduction Along The Fourth Finger in Patients with Carpal Tunnel Syndrome

    OpenAIRE

    1998-01-01

    The aim of this study was to examine the value of sensory conduction along the median and ulnar nerves of the fourth finger in the diagnosis of carpal tunnel syndrome. 20 females with carpal tunnel syndrome as diagnosed by clinical and routine electrophysiological examinations were included in the study. By using the near-nerve technique, orthodromic sensory conduction along the thumb, 3rd, and 4th fingers for median; and 4th and 5th fingers for ulnar nerve study was performed. &ap...

  9. Capitolunate arthrodesis maintaining carpal height for the treatment of SNAC wrist.

    Science.gov (United States)

    Giannikas, D; Dimitrios, G; Karageorgos, A; Athanasios, K; Karabasi, A; Ageliki, K; Syggelos, S; Spiridon, S

    2010-03-01

    The clinical and radiological results of a modified midcarpal fusion technique for scaphoid nonunion advance collapse were retrospectively studied in eight patients. All had partial resection of the proximal part of the fractured scaphoid, limited radial styloidectomy, scaphocapitate and lunocapitate arthrodesis, using a block of iliac crest graft to maintain carpal height. All united without complications and wrist motion, grip strength and carpal height were improved postoperatively. The modified Mayo wrist score at follow-up was 70%. Three patients continued to have some pain and one patient had a poor result.

  10. [Carpal tunnel syndrome and "trigger wrist" revealing a tendinous sheath fibroma].

    Science.gov (United States)

    Benhima, M A; Ait Essi, F; Abkari, I; Najeb, Y; Fikry, T

    2014-02-01

    The tendinous sheath fibroma (TSF) is a rare benign tumor, exceptionally responsible for carpal tunnel syndrome and "trigger" wrist: we found this association less than ten times in the English and French literature. We report the case of a 63-year-old right-handed carpenter who featured a triggering phenomenon of the right wrist during the flexion-extension movements and compression of the median nerve at the carpal tunnel, secondary to a TSF of the flexor digitorum superficialis. The diagnosis was suspected at the sonography and MRI, the tumor was excised and proven histologically to be a TSF. One year later, the patient remained free of symptoms.

  11. Disabling hand injuries in boxing: boxer's knuckle and traumatic carpal boss.

    Science.gov (United States)

    Melone, Charles P; Polatsch, Daniel B; Beldner, Steven

    2009-10-01

    This article describes the treatment of the two most debilitating hand-related boxing injuries: boxer's knuckle and traumatic carpal boss. Recognition of the normal anatomy as well as the predictable pathology facilitates an accurate diagnosis and precision surgery. For boxer's knuckle, direct repair of the disrupted extensor hood, without the need for tendon augmentation, has been consistently employed; for traumatic carpal boss, arthrodesis of the destabilized carpometacarpal joints has been the preferred method of treatment. Precisely executed operative treatment of both injuries has resulted in a favorable outcome, as in the vast majority of cases the boxers have experienced relief of pain, restoration of function, and an unrestricted return to competition.

  12. Bone Biopsy

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Bone Biopsy Bone biopsy uses a needle and imaging ... the limitations of Bone Biopsy? What is a Bone Biopsy? A bone biopsy is an image-guided ...

  13. Demographic Characteristics of Our Patients with Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Ebru Umay

    2011-09-01

    Full Text Available Aim: Carpal tunnel (CTS is the most common trap neuropathy but, still fully understood the cause of this and effective factors. In this study was aimed to the evaluation demographic features of the cases with CTS admitted to our electroneuromyography (ENMG laboratory. Material and Methods: In the study, 119 patients with CTS to evaluate our ENMG laboratory were received. All patients age, sex, dominant and affected hand, duration of education, marital status, height, weight, additional diseases, occupational, hand and wrist repetitive motion made, use of computer and smoking status was assessed. Patients’ body mass index (BMI was calculated. Results: 102 cases (85.7% females, mean age was 46.32 years ± 12: 18. While in 115 (96.6% cases using the right hand is dominant, in 85 cases (76.6% with bilateral involvement were at hand. While the rate of patient who between five to eight year duration of education had was 47.1%, 84% patients were married. Also, BMI were determined as 29.33± 3.01. According to the state in 22 patients with additional diseases, diabetes mellitus in 22, hypothyroidism in 4, also 1 patient had arthritis. The majority of our patients (70.6% housewives formed. The 67.2% rate of repetetive activities as making crafts, the computer usage at a rate of 11.8% had history. The rate of smoking was 19.3%.  Conclusions:  As a result, CTS, especially in middle-aged housewives and obese is a common syndrome. Despite many reasons to be reported in the etiology of idiopathic 85%. At a rate of 25.4% of women in our society is considered paid work, especially in terms of determining the etiology of the more detailed studies are needed to ousewives.

  14. The value of SPECT/CT in carpal boss

    Energy Technology Data Exchange (ETDEWEB)

    Bhure, Ujwal; Huellner, Martin W.; Gruenig, Hannes; Zander, Andrea; Sol Perez Lago, Maria del; Strobel, Klaus [Cantonal Hospital Lucerne, Nuclear Medicine and Radiology, Lucerne (Switzerland); Hug, Urs [Cantonal Hospital Lucerne, Department of Hand and Plastic Surgery, Lucerne (Switzerland)

    2015-11-15

    To assess the value of SPECT/CT in patients with carpal boss (CB). In 24 wrists with CB (18 right-sided, 6 left-sided) in 21 patients, planar images and SPECT/CT images were obtained. Three patients had bilateral CB. The grade of uptake (0 absent, 1 low, 2 moderate, 3 high) on planar imaging and SPECT/CT was assessed and compared with CT findings, clinical symptoms and follow-up findings. CB affected carpometacarpal joint II in 4 wrists, carpometacarpal joint III in 17 wrists and both carpometacarpal joints II and III in 3 wrists. Of the 24 CB, 12 (50 %) were active (i.e. increased radionuclide uptake) on planar images and 18 (75 %) on SPECT/CT images. Of the 17 symptomatic CB, 10 (59 %) were active on planar images and 14 (82 %) were active (mean grade 1.9, range 1 - 3) on SPECT/CT images. Of the 7 asymptomatic CB, 2 were active on planar images and 4 were active (mean grade 1.25, range 1 - 2) on SPECT/CT images. CT alone showed CB in all patients and an accessory ossicle (os styloideum) in 8 wrists. MR imaging was available in 7 patients and positive for CB in 5 (sensitivity 71 %). Plain radiographs were available in 17 patients and positive in 10 (59 %). Therapeutic infiltration of the CB was performed in 9 patients, and resection of the CB in 7 patients. SPECT/CT provides important morphological and metabolic information for the clinical assessment of CB, but because SPECT/CT tends to overestimate the clinical importance of CB, we recommend that planar images should still be obtained. (orig.)

  15. Bone Densitometry (Bone Density Scan)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Bone Densitometry (DEXA) Bone densitometry, also called dual-energy ... limitations of DEXA Bone Densitometry? What is a Bone Density Scan (DEXA)? Bone density scanning, also called ...

  16. Chondroblastoma with secondary aneurysmal bone cyst of the hamate: case report.

    Science.gov (United States)

    Rhee, Peter C; Novais, Eduardo N; Shives, Thomas C; Shin, Alexander Y

    2012-03-01

    Chondroblastoma of the carpals is rare, can mimic other benign bone tumors, and presents a diagnostic challenge. There have been few cases of benign tumors involving the hamate, with only one reported case of chondroblastoma, which was treated with complete hamate excision. We present a case of chondroblastoma with secondary aneurysmal bone cyst of the hamate treated with curettage, high-speed burring, phenol, and autogenous iliac crest bone grafting. At the time of the most recent radiographic follow-up, there was full graft incorporation, preserved hamate morphology, and no evidence of recurrence.

  17. Correlation of segmental carpal tunnel pressures with changes in hand and wrist positions in patients with carpal tunnel syndrome and controls.

    Science.gov (United States)

    Luchetti, R; Schoenhuber, R; Nathan, P

    1998-10-01

    We investigated pressures at 1 cm intervals along the carpal tunnel in 39 patients with carpal tunnel syndrome (CTS) and 12 controls. Pressures were measured for relaxed and gripping hand positions in combination with neutral, extended, and flexed wrist positions. Patient pressures exceeded control pressures, were below the previously reported 30 mmHg threshold for four of five locations in the relaxed neutral position and were typically greater in extension than in flexion. In the neutral position, both patient and control pressures were slightly above threshold levels just distal to the tunnel. Maximum intratunnel pressures were generally found in the central part of the tunnel and minimum pressures in the distal tunnel. Gripping hand pressures in the tunnel were lowest with the wrist flexed. In both controls and CTS patients, only in the neutral wrist and relaxed hand positions were pressures highest at the point where nerve conduction studies have indicated the nerve is most likely to be compromised (in the midpalm just distal to the distal margin of the carpal tunnel).

  18. Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness

    Directory of Open Access Journals (Sweden)

    Al-Khayat Jehad

    2008-04-01

    Full Text Available Abstract Background Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988 can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view. Purpose The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia. Methods 33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS (ranging from 0 = no pain to 10 = maximum pain. Results One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min. The pain score related to injection was 2.5 (0.8 and to tourniquet was 3.6 (0.9. Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred. Conclusion Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.

  19. Scaphoid dislocation associated with axial carpal dissociation during volar flexion of the wrist: a case report.

    Science.gov (United States)

    Kanaya, Kohei; Wada, Takuro; Yamashita, Toshihiko

    2010-01-01

    We present the first report of a patient with an isolated scaphoid dislocation with axial carpal dissociation sustained during volar flexion of the wrist. The scaphoid was dislocated to the radial side of the radial styloid process and was slightly shifted to the dorsal side. It was shown that the position of the wrist played an irrelevant role for occurring scaphoid dislocation.

  20. Interpreter's Wrist: Repetitive Stress Injury and Carpal Tunnel Syndrome in Sign Language Interpreters.

    Science.gov (United States)

    Stedt, Joe D.

    1992-01-01

    In a survey concerning repetitive stress injury (RSI) and carpal tunnel syndrome, 87 percent of the 40 sign language interpreters reported that they had at some time experienced at least 2 symptoms associated with RSI, and most interpreters knew others with RSI problems. Data indicate that RSI is a severe problem among sign language interpreters.…

  1. Sonographic Measurements of Subsynovial Connective Tissue Thickness in Patients With Carpal Tunnel Syndrome

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; van der Molen, Aebele Mink; Henderson, Jacqueline; Cha, Stephen S.; An, Kai Nan; Amadio, Peter C.

    2012-01-01

    Objectives-A major pathologic finding in patients with idiopathic carpal tunnel syndrome is noninflammatory fibrosis and thickening of the subsynovial connective tissue. The objective of this study was to determine the ability of sonography to depict this thickening by comparing subsynovial connecti

  2. Yoga Asanas for the Relief and Prevention of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Beleu, Steve

    This collection of yoga asanas (exercises) can help relieve the pain of carpal tunnel syndrome (CTS) and help prevent CTS among people who work on computer terminals. For maximum benefit, the exercises should be practiced daily or on as regular a schedule as possible. They are not intended to replace surgery or a physician's prescribed care. They…

  3. Dynamic sonographic measurements at the carpal tunnel inlet: Reliability and reference values in healthy wrists

    NARCIS (Netherlands)

    A. Filius (Anika); J.-W.H. Korstanje (Jan-Wiebe); R.W. Selles (Ruud); S.E.R. Hovius (Steven); H.P. Slijper

    2013-01-01

    textabstractIntroduction: Reliability and reference values are not well-established for most dynamic sonographic measurements of the median nerve (MN) and flexor tendons that may be used for diagnosing carpal tunnel syndrome (CTS). Methods: Wrists of 20 healthy participants were imaged using ultraso

  4. Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients

    Directory of Open Access Journals (Sweden)

    Mark van Suchtelen

    2014-09-01

    There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.

  5. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study.

    NARCIS (Netherlands)

    Ettema, A.M.; Zhao, C.; Amadio, P.C.; O'Byrne, M.M.; An, K.N.

    2007-01-01

    The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the u

  6. Median Nerve Deformation and Displacement in the Carpal Tunnel during Index Finger and Thumb Motion

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Yoshii, Yuichi; Villarraga, Hector R.; Henderson, Jacqueline; Cha, Stephen S.; An, Kai-Nan; Amadio, Peter C.

    2010-01-01

    The purpose of this study was to investigate the deformation and displacement of the normal median nerve in the carpal tunnel during index finger and thumb motion, using ultrasound Thirty wrists from 15 asymptomatic volunteers were evaluated Cross-sectional images during motion from full extension t

  7. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals.

    Science.gov (United States)

    Kearns, Gary; Wang, Sharon

    2012-05-01

    This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS.

  8. Bilateral hand/wrist heat and cold hyperalgesia, but not hypoesthesia, in unilateral carpal tunnel syndrome.

    Science.gov (United States)

    de la Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César; Fernández-Carnero, Josué; Padua, Luca; Arendt-Nielsen, Lars; Pareja, Juan A

    2009-10-01

    The aim of the current study was to evaluate bilaterally warm/cold detection and heat/cold pain thresholds over the hand/wrist in patients with carpal tunnel syndrome (CTS). A total of 25 women with strictly unilateral CTS (mean 42 +/- 10 years), and 20 healthy matched women (mean 41 +/- 8 years) were recruited. Warm/cold detection and heat/cold pain thresholds were assessed bilaterally over the carpal tunnel and the thenar eminence in a blinded design. Self-reported measures included both clinical pain history (intensity, location and area) and Boston Carpal Tunnel Questionnaire. No significant differences between groups for both warm and cold detection thresholds in either carpal tunnel or thenar eminence (P > 0.5) were found. Further, significant differences between groups, but not between sides, for both heat and cold pain thresholds in both the carpal tunnel and thenar eminence were found (all P < 0.001). Heat pain thresholds (P < 0.01) were negatively correlated, whereas cold pain thresholds (P < 0.001) were positively correlated with hand pain intensity and duration of symptoms. Our findings revealed bilateral thermal hyperalgesia (lower heat pain and reduced cold pain thresholds) but not hypoesthesia (normal warm/cold detection thresholds) in patients with strictly unilateral CTS when compared to controls. We suggest that bilateral heat and cold hyperalgesia may reflect impairments in central nociceptive processing in patients with unilateral CTS. The bilateral thermal hyperalgesia associated with pain intensity and duration of pain history supports a role of generalized sensitization mechanisms in the initiation, maintenance and spread of pain in CTS.

  9. Carpal tunnel syndrome: Assessment of correlation between clinical, neurophysiological and ultrasound characteristics

    Directory of Open Access Journals (Sweden)

    B Hemeshwar Rao

    2012-01-01

    Full Text Available Objectives: To evaluate the relationship between symptoms, clinical severity, neurophysiological characteristics with median nerve cross-sectional area (CSA at the level of carpal tunnel inlet at ultrasonography (USG and its utility in diagnosis of carpal tunnel syndrome (CTS. Materials and Methods: Prospective study of 30 patients with symptoms of CTS, attending to the Neurology out patient department (OPD at University Teaching Hospital. A multidimensional assessment of CTS was done using historic and objective scale (Hi-Ob scale for clinical severity, Boston carpal tunnel questionnaire (BCTQ for patient-oriented measures, neuro physiologic studies of median nerve at wrist and USG to measure median nerve CSA at carpal tunnel inlet. Results: Thirty patients included in the study (22 women and 8 men. Mean of CSA was 12.69 mm 2 (SD2.67. Association between BCTQ score value and inlet values was assessed by Karl Pearson correlation coefficient ( r = 0.376, P = 0.04. There was positive association with BCTQ scores and CSA of median nerve at carpal tunnel inlet. To compare clinical severity scale (Hi-Ob and USG CSA, analysis of variance was performed (F value and Scheffe′s multiple comparison test was used to find group difference (grades 1 and 2 P < 0.001, grades1 and 2P P < 0.001, grade 2 differs with grade 2P P < 0.006. As the number of patients is less in minimal, mild and severe groups, the difference between neurophysiological groups and mean of CSA was not statistically significant. Conclusion: A positive correlation exists between USG findings and all the conventional measures of CTS severity.

  10. The Effect of Naproxen and Prednisolone in the Treatment of Mild to Moderate Carpal Tunnel Syndrome

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    P yazdan panah

    2016-03-01

    Full Text Available Background & aim: Carpal tunnel syndrome is the entrapment of the median nerve in carpal tunnel of the wrist. Symptoms of this syndrome are numbness, tingling, weakness or pain in the fingers and wrist. Treatment includes rest, avoiding the many activities available, splints, non-steroidal anti-inflammatory drugs, oral steroids, steroid injection in wrist and surgery. This study compared the effects of oral prednisolone and naproxen (non-steroidal anti-inflammatory drugs in the treatment of mild to moderate carpal tunnel syndrome. Methods: In the present clinical-trial study, 44 patients who had mild to moderate carpal tunnel syndrome were selected and randomly assigned into two treatment groups: group 1(n = 22 received naproxen 1000 mg daily for 4 weeks and the group 2 (n = 22 received oral prednisolone 20 mg, daily, in the first 2 weeks and 10 mg daily for 2 weeks. The 3 persons of the second group dropped out of treatment. Re-evaluation of treatment outcome was performed 2 months later. Collected data were analyzed using SPSS software. To describe the data, frequency tables were used. Furthermore, the Chi-square test was used to analyze the data. Results: 36(87.8% of the patients were males and 12.2% were females. The electro diagnostic studies were shown 16 hands (19.5% normal, 19 hands (23.2% had mild and 47 (57.3% had moderate involvement in beginning of treatment. Tingling fingers and pain in the prednisolone group had significantly lower rate than naproxen group (p< 0.05, but the symptoms were not significantly different in the two groups. Conclusion: The effects of treatments, relief of symptoms and the decrease intensity of carpal tunnel syndrome in patients who received prednisolone were more than naproxen.

  11. [Resection of the first row of carpal bones: post-traumatic wrist and Kienbock's disease].

    Science.gov (United States)

    Welby, F; Alnot, J Y

    2003-06-01

    This study reports the outcomes of 27 proximal row carpectomies for stage II (Watson) scapholunate--(10 Slac) and scaphoid non union--(8 Snac) advanced collapse and stage III (Lichtman) Kienböck's disease (9 cases) followed for an average of respectively 72 and 50 months. Following surgical treatment, more than 80% of patients in both groups were pain free. The total arc of motion averaged 67 degrees (unchanged), for the post-traumatic arthritis, and 59 degrees for Kienböck's, a decrease of 17%. Grip strength averaged a 17% increase in comparison to the opposite size for both groups. Proximal row carpectomy showed a high degree of patient satisfaction and is a motion-preserving and grip-preserving procedure used in stage II post-traumatic arthritis but Lichtman III stage in Kienböck's disease had a comparatively poor result. Proximal row carpectomy simplifies the structure of the radiocarpal joint. When the cartilage on the capitate head and the radial lunate facet are not worn, this procedure provides a good result with respect to pain, range of motion and strength which is stable with time.

  12. Bilateral hand malformations with absence of carpal bones with fusion of proximal metacarpals.

    Science.gov (United States)

    Gurav, Ravindra Muralidhar; Patil, Annasaheb B

    2012-01-01

    A 14-year-old boy presented with a deformity of his left hand since birth. His parents were nonconsanguineous and his early history was uneventful. The mother was not exposed to any teratogenic drugs during pregnancy. His other siblings are normal. The parents noticed the hand deformity at birth but he had not come to medical attention until he complained of restricted movement of the left hand at the wrist. On examination he did not have any pain on movement of the wrist nor tenderness over the wrist joint. Palmar flexion was restricted completely and active dorsiflexion was restricted in the last 30°. Further passive dorsiflexion was exaggerated and the middle finger could touch the dorsal aspect of the forearm. The hand was deviated to the ulnar side. The patient was of normal stature and had no dysmorphic features. The index finger of the right hand was noted to be small. His feet were normal

  13. A Case Report of Carpal Tunnel Syndrome with Raynaud's Phenomenon Treated by Bee Venom and Carthami Flos Pharmacopuncture

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    Choi Seok-woo

    2009-03-01

    Full Text Available Objectives : This study is to report the effect of Pharmacopuncture therapy on a patient suffering from the pain and cold intolerance of hand caused by Carpal tunnel syndrome with Raynaud's phenomenon. Methods : We had treated the patient diagnosed as Carpal tunnel syndrome with Raynaud's phenomenon by Sweet BV and CF pharmacopuncture. We injected Sweet BV and CF into acupuncture points on both hands - Sweet BV into Baxie (EX-UE9, CF into Naegwan (PC6 and Daereung (PC7.And then we evaluated her symptoms by VAS (Visual Analog Scale. Results : Clinical symptoms about Carpal tunnel syndrome with Raynaud's phenomenon were remarkably improved by Sweet BV and CF Pharmacopuncture. Conclusion : Therefore, we concluded that pharmacopuncture therapy - Sweet BV, CF etc. - may be useful to treat Carpal tunnel syndrome with Raynaud's phenomenon.

  14. Letter to Editor: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

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    Caliandro Pietro

    2008-02-01

    Full Text Available Abstract A response to Chalidis et al: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement. World J Surg Oncol 2007, 5:92.

  15. Third trimester of pregnancy: Carpal tunnel syndrome, anxiety and depression

    Directory of Open Access Journals (Sweden)

    Tupković Emir

    2013-03-01

    Full Text Available This study measured the frequency of carpal tunnel syndrome (CTS and the levels of anxiety and depression in the third trimester of healthy pregnant women having regular prenatal visits. The study was performed at the Department of Neurophysiology Health Centre Tuzla in the period of January through April 2006. The group consisted of 40 pregnant women in the third trimester of pregnancy, age range of 25.6 ± 4.9 years. The control group consisted of healthy women, ages 31.1 ± 4.4 years. The electrophysiological parameters n. medians, the Beck Depression Inventory (BDI and Beck Anxiety Inventory (BAI were measured. The diagnosis of CTS is neurophysiologically confirmed in 12 pregnant women (30% and 75% showed clinical signs and symptoms of disease. Pain was measured by subjective pain scale ranked from 0 (absence of pain to 10 (severe pain. The mean value of BAI in control group was 8.6 ± 6.5, while in the group of pregnant women was 12.9 ± 6.9, which was significantly higher (p = 0.011. The mean value of BDI in control group was 4.2 ±4.4 and in the group of pregnant women was 8.7 ±5.9. which was significantly higher (p = 0.0008, The mean value of BAI in the group of women with CTS was 12.25 ± 6.7 which was not significantly higher than the compared to the control group (p = 0.113. The mean value of BDI in the group of pregnant women with CTS was 7.9 ± 6.4,which was significantly higher when compared to the control group (p = 0.037. The subjective assessment of pain in the group of women with CTS was 2.4 ±2.1. There was a slight correlation between pain intensity and degree of BAI (r = 0.289 and a negative correlation with the level of depression (r = - 0.297. The conclusion is that pregnant women with normal risk should make an extra effort in the treatment of unpleasant conditions such as CTS, anxiety and depression, which may impair the quality of life and have physical and psychological side effects on the future mother.

  16. Association Between Carpal Tunnel Syndrome and Abdominal Obesity

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    Ertuğrul Uzar

    2010-12-01

    Full Text Available OBJECTIVE: Obesity has been suggested as a risk factor for carpal tunnel syndrome (CTS. Previous studies on the association of CTS and obesity have generally considered body mass index (BMI. However, the relationships between CTS and waist circumference or waist-to-hip ratio (WHR, which are known as more sensitive measures for abdominal obesity, have not been studied previously. In this study, it was aimed to evaluate the role of BMI and abdominal obesity in patients with CTS. METHODS: Female patients who applied to the neurology outpatient clinics with pain, numbness, paresthesia, or dysesthesia in the hands were included. The patients were divided into two groups, according to the clinical evaluation, as CTS or non-CTS. CTS diagnosis was electrophysiologically confirmed in 44 patients. Thirty-one subjects who were not diagnosed as CTS electrophysiologically were recruited as the control group. Clinical findings, nerve conduction studies and anthropometric measurements (height, weight, BMI, hip circumference, waist circumference and WHR of CTS patients were compared with those of the control group. RESULTS: The CTS group had significantly higher BMI, waist circumference and WHR values compared to the control group (for each parameter, p< 0.0001. The rates of obesity in the CTS group were 55.8%, 47.7% and 34.9%, respectively, according to waist circumference, BMI and WHR measurements. In the CTS group, 16% of the patients, who were defined as non-obese according to BMI, were determined as obese according to waist circumference. In the CTS group, significant positive correlations were found between BMI and WHR and median-ulnar sensory interpeak latency of the fourth digit (r= 0.26, p< 0.05; r= 0.25, p< 0.05, respectively. CONCLUSION: In this study, it was found that abdominal obesity is an important risk factor for CTS, and nerve conduction may be affected by waist circumference, BMI and WHR. In addition to general obesity, abdominal obesity may

  17. 轻度手臂振动病患者腕管超声检查%Carpal canal ultrasound examination in patients with mild hand-arm vibration disease

    Institute of Scientific and Technical Information of China (English)

    刘彦芝; 叶志宏; 杨婉玲; 朱吉修; 卢琼洁; 苏伟兰

    2016-01-01

    Objective To investigate the clinical value of ultrasound examination of carpal canal structure in patients with mild hand-arm vibration disease.Methods A total of 29 patients (58 wrists) with mild hand-arm vibration disease who were treated in Shenzhen Prevention and Treatment Center for Occupational Diseases from May to December,2015 were enrolled as observation group,and 20 healthy volunteers (40 wrists) were enrolled as the control group.Color Doppler ultrasound was used to observe the morphology and echo of the median nerve in the carpal canal and 9 muscle tendons and transverse carpal ligament.The thickness of transverse carpal ligament and diameter of the median nerve at the level of the hamulus of hamate bone were measured,as well as the cross-sectional area of the median nerve at the level of pisiform bone.Results In the 29 patients with hand-arm vibration disease patients in the observation group,8 experienced entrapment of the median nerve in the carpal canal,among whom 5 had entrapment in both wrists;there were 13 wrists (23%) with nerve entrapment and 45 wrists (77%) without nerve entrapment.Compared with the control group,the patients with hand-arm vibration disease and nerve entrapment in the observation group showed significant thickening of the transverse carpal ligament at the level of the hamulus of hamate bone and a significant increase in the crosssectional area of the median nerve at the level of pisiform bone (P<0.05),while there were no significant differences in the thickness of transverse carpal ligament at the level of the hamulus of hamate bone and the crosssectional area of the median nerve at the level of pisiform bone (t=-9.397 and-4.385,both P>0.05).Conclusion Ultrasound examination can clearly show the radiological changes of carpal canal contents in patients with mild hand-arm vibration disease and has a certain diagnostic value in nerve damage in patients with hand-arm vibration disease.%目的 探讨超声检查轻度手

  18. Chondroblastoma with secondary aneurysmal bone cyst of the capitate.

    Science.gov (United States)

    Sato, Eiichi; Ichikawa, Jiro; Ando, Takashi; Sato, Nobutaka; Kawasaki, Tomonori; Haro, Hirotaka

    2014-05-01

    Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment.

  19. Transverse Ultrasound Assessment of Median Nerve Deformation and Displacement in the Human Carpal Tunnel during Wrist Movements

    OpenAIRE

    2013-01-01

    The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. In order to better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images...

  20. Study of tactile sensitivity by Semmes–Weinstein monofilaments in patients with carpal tunnel syndrome and healthy individuals

    Directory of Open Access Journals (Sweden)

    I. G. Mikhailyuk

    2014-01-01

    Full Text Available Surface sensitivity disorders are observed in many diseases of the central and peripheral nervous system. Surface sensitivity thresholds were estimated in healthy individuals and patients with carpal tunnel syndrome. There was a statistically significant (p < 0.001 increase in the sensitivity threshold in the distal phalanx of the index finger in patients with carpal tunnel syndrome as compared to healthy individuals, by evaluating the surface sensitivity by Semmes–Weinstein monofilaments.

  1. Diagnosis and treatment of distal radius fractures with concomitant carpal fractures%桡骨远端骨折合并腕骨骨折的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    陈一衡; 陈时益; 陈星隆; 宋永焕; 李士; 褚庭纲; 蒋良福; 杨景全; 高伟阳

    2015-01-01

    Objective To investigate the incidence and the risk factors of carpal fractures occurring concurrently with distal radius fractures and to explore the treatment options for these concomitant fractures.Methods A retrospectively analysis was carried out of 204 cases of distal radius fractures treated from January 2010 to January 2012.Posteroanterior and lateral radiographs of the wrist were examined,as were computed tomography scans when available.Cases with concomitant single or multiple carpal fractures were identified.The incidence of these concomitant fractures was calculated.AO classification and the energy of injury of these cases were analyzed to identify the risk factors.The clinical outcomes of various treatment options were assessed using the wrist function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association.Results A total of 15 cases of the 204 distal radius fractures (7.35%) had concomitant carpal fractures.Of these fractures,8 involved scaphoid,2 involved triquetrum,1 involved capitate,1 involved lunate,1 involved hamate and 2 involved more than one carpal bones.Plain wrist X-rays missed 8 of these carpal fractures which were diagnosed by computed tomography scans.Risk factor analysis revealed that male patients,AO type B distal radius fractures and high-energy injuries more likely led to concomitant fractures of both the distal radius and carpals.Treatment options included open reduction and internal fixation (ORIF) or closed reduction and cast immobilization.The average bone healing time was 4 months.Delayed union of carpal fractures was seen in 3 cases.Wrist function was markedly improved after the treatment in all the cases.Conclusion The incidence of carpal fractures occurring concurrently with distal radius fractures is low.Diagnosis can be missed if neglected.Computed tomography should be considered to increase the rate of correct diagnosis.Male patients,AO type B distal radius fractures and high

  2. Bone within a bone

    Energy Technology Data Exchange (ETDEWEB)

    Williams, H.J.; Davies, A.M. E-mail: wendy.turner@roh.nhs.uk; Chapman, S

    2004-02-01

    The 'bone within a bone' appearance is a well-recognized radiological term with a variety of causes. It is important to recognize this appearance and also to be aware of the differential diagnosis. A number of common conditions infrequently cause this appearance. Other causes are rare and some remain primarily of historical interest, as they are no longer encountered in clinical practice. In this review we illustrate some of the conditions that can give the bone within a bone appearance and discuss the physiological and pathological aetiology of each where known.

  3. Adequacy and long-term prognosis of endoscopic carpal tunnel release.

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    Hirooka T

    1999-02-01

    Full Text Available Forty-one hands of 37 patients with idiopathic carpal tunnel syndrome treated by endoscopic carpal tunnel release (ECTR were followed up for more than one year after surgery. Surgical results were evaluated using Kelly's criteria, the Semmes-Weinstein test, the static and moving 2-point discrimination tests, tip-pinch strength, and motor and sensory nerve conduction studies. Clinical results, according to Kelly's criteria three months after surgery, were excellent or good in 36 hands, and fair or poor in five hands. No recovery was evident at six months and 12 months after surgery in fair and poor hands. Based on these findings, we conclude that a neurolysis of the median nerve and release of constriction of the thenar muscle branch should be performed using the conventional open technique for patients with poor results three months after ECTR if the patients are dissatisfied with ECTR results.

  4. Ulnar sensory nerve impairment at the wrist in carpal tunnel syndrome.

    Science.gov (United States)

    Ginanneschi, Federica; Milani, Paolo; Mondelli, Mauro; Dominici, Federica; Biasella, Alessia; Biasella, Alessio; Rossi, Alessandro

    2008-02-01

    In previous studies, changes in impulse transmission of ulnar motor axons have been documented in patients with carpal tunnel syndrome (CTS). We examined ulnar sensory conduction in 144 CTS hands. In particular, conduction parameters of the dorsal ulnar cutaneous branch (DUC) running outside Guyon's canal were compared with those of the superficial sensory branches (U4 and U5) passing through the canal. U4 and U5 response amplitudes and U5 conduction velocity were significantly lower than in controls. Conduction parameters of the DUC were similar in both groups. Patients with more severely impaired median conduction had smaller ulnar sensory action potentials. We propose that the ulnar nerve may be subject to compression in Guyon's canal as a consequence of high pressure in the carpal tunnel of CTS patients. This may provide insights into the mechanisms underlying extra-median spread of sensory symptoms in CTS patients.

  5. Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome

    Science.gov (United States)

    Ott, Florian; Mattiassich, Georg; Kaulfersch, Christian; Ortmaier, Reinhold

    2013-01-01

    A patient was admitted reporting tingling pain and numbness in the right hand. Neurological examination—including nerve conduction studies—diagnosed carpal tunnel syndrome. Operative carpal tunnel release was performed without complications. Four months postoperatively the otherwise healthy patient presented again due to persistent complaints, although preoperative symptoms had improved. On this occasion, the patient reported loss of strength accompanied by rigidity in the wrist. Clinical examination showed some swelling adjacent to the operation wound. A postoperative ganglion cyst was suspected and a conservative treatment option—splinting the wrist—was chosen. Four weeks later the patient presented again with further swelling and increasing rigidity of the wrist. Surgical intervention was planned. Preoperative plain radiographs of the wrist revealed chronic palmar dislocation of the lunate to be the cause of the symptoms in our patient. Radiological signs of scapholunate advanced collapse arthritis (SLAC wrist) were also observed. PMID:23513027

  6. Bromocriptine for an acromegalic patient. Improvement in cardiac function and carpal tunnel syndrome.

    Science.gov (United States)

    Luboshitzky, R; Barzilai, D

    1980-10-17

    A 64-year-old woman with active acromegaly of 33 years' duration, severe carpal tunnel syndrome, and subclinical heart disease was treated with bromocriptine mesylate. Within eight months of therapy, basal growth hormone (GH) levels decreased from 90.0 to 7.0 ng/mL, and hand volume was reduced from 375 to 295 mL. Concomitantly, echocardiographic studies showed normal left ventricular size and function. Electromyographic studies demonstrated normal function in both median nerves. Bromocriptine may correct cardiac dysfunction and carpal tunnel syndrome in acromegaly either by reduction of GH oversecretion or by a direct effect of bromocriptine on dopamine receptors in the heart and peripheral nerve endings.

  7. Prevalence of Asymptomatic Neurophysiological Carpal Tunnel Syndrome in 130 Healthy Individuals

    Science.gov (United States)

    Alrawashdeh, Omar

    2016-01-01

    Diagnosis of carpal tunnel syndrome (CTS) is frequently confirmed by performing nerve conduction studies. Previous studies demonstrated that abnormal nerve conduction study (NCS) is suggestive of CTS among asymptomatic individuals. However, previous studies included individuals with risk factors for the syndrome. A NCS was performed on the median and ulnar nerves in 130 healthy individuals. About 15% of individuals in this study demonstrated electrodiagnostic evidence of carpal tunnels syndrome. Four cases have shown signs of isolated median neuropathy with normal median sensory component. Results indicated that the most widely used method for confirming diagnosis of CTS may have up to 15% of false positives. However, most of those showed changes of minimal CTS. Isolated prolongation of the median motor latency should be investigated further as they are usually classified as moderate to severe CTS and may undergo unnecessary surgeries. PMID:27994828

  8. Prevalence of asymptomatic neurophysiological carpal tunnel syndrome in 130 healthy individuals

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    Omar Alrawashdeh

    2016-11-01

    Full Text Available Diagnosis of carpal tunnel syndrome (CTS is frequently confirmed by performing nerve conduction studies. Previous studies demonstrated that abnormal nerve conduction study (NCS is suggestive of CTS among asymptomatic individuals. However, previous studies included individuals with risk factors for the syndrome. A NCS was performed on the median and ulnar nerves in 130 healthy individuals. About 15% of individuals in this study demonstrated electrodiagnostic evidence of carpal tunnels syndrome. Four cases have shown signs of isolated median neuropathy with normal median sensory component. Results indicated that the most widely used method for confirming diagnosis of CTS may have up to 15% of false positives. However, most of those showed changes of minimal CTS. Isolated prolongation of the median motor latency should be investigated further as they are usually classified as moderate to severe CTS and may undergo unnecessary surgeries.

  9. Etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype wrist movements

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    Magdalena Lewańska

    2014-04-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is the most common neuropathy of upper limbs and a leading cause of upper extremity musculoskeletal disorders, in terms of work exposure, repetitive and forceful exertions of the hand and use of vibrating hand tools. The aim of the study was to evaluate etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype movements in wrist. Material and Methods: We conducted the retrospective analysis of 300 patients (261 women, 39 men, mean age 52 years (standard deviation: ±6.93 hospitalized with the suspicion of occupational CTS. Results: The study revealed high percentage (68.7% of diseases and systemic factors involved in the pathogenesis of CTS in the analyzed population, especially obesity (32%, thyroid diseases (28.7%, hormone replacement therapy and/or oophorectomy (16.3% and diabetes mellitus (12%. In 111 patients the coexistence of at least a couple of potential etiological factors of the neuropathy was recognized. Clinical analysis and occupational exposure allowed to diagnose occupational carpal tunnel syndrome in 18 (6% patients only. The undeniable long-term (20.2±9.3 years occupational exposure to repetitive, forceful movements in the wrist was observed in this group. Conclusion: The results of our study indicated that non-occupational etiological factors of CTS predominated and in 37% of patients at least several factors were found. The analysis showed the high prevalence of CTS in workers employed in various sectors of industry, including so called "blue collar" workers. Our study confirmed the multifactorial etiology of carpal tunnel syndrome, however, occupational agents contributed to only 6% of cases. Med Pr 2014;65(2:261–270

  10. Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases.

    Science.gov (United States)

    Quaglietta, P; Corriero, G

    2005-01-01

    Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. Follow-up was performed at 1, 3 and 6 months and overall results were backed up by telephone questionnaire (Health Outcomes Carpal Tunnel Questionnaire, Health Outcomes, Bloomington, MN, USA). Results were favourable in 98% and 2% unfavorable for persistent pain. Rate of satisfaction of the patients was 90%. Average time of patient's return to work was 20 days. Eleven procedures (2.8%) were converted to open release. There was one case (0.2%) of incompleted section of the perineurium due to failure of endoscopic visualization of the ligament. In this case the procedure was converted to open and was completed with perineurium sutura. In six cases (1.5%) there were injury to superficial palmar arch. During the follow-up period there were no recurrences and no re-exploration. The mean preoperatively obtainable distal motor latency (DML) and sensory conduction velocity (SCV) values were 6.7 m/s and 29.2 m/s, respectively. The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.

  11. Adaptation of the Transverse Carpal Ligament Associated with Repetitive Hand Use in Pianists.

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    Christiane Mhanna

    Full Text Available The transverse carpal ligament (TCL plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL's mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV. ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p < 0.05. Additionally, the increased SWV was location dependent for both pianist and non-pianist groups (p < 0.05, with the rTCL having a significantly greater SWV than the uTCL. Between groups, the rTCL SWV of pianists was 22.2% greater than that of the non-pianists (p < 0.001. This localized increase of TCL SWV, i.e. stiffening, may be primarily attributable to focal biomechanical interactions that occur at the radial TCL aspect where the thenar muscles are anchored. Progressive stiffening of the TCL may become constraining to the carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome.

  12. Efficacy of kinesiotaping in patients with the initial signs of carpal tunnel syndrome

    OpenAIRE

    I. G. Mikhaylyuk; N. N. Spirin; E. V. Sal’nikov

    2016-01-01

    Background. Carpal tunnel syndrome (CTS) is one of the most common tunnel neuropathies. Early symptoms are often limited by periodic and slight discomfort in the area of innervation of a median nerve on the hand, so the patients are not willing to be treated invasively. Thus, a noninvasive therapy, such as kinesiotaping, could be perspective.Objective. Assessment of the efficiency of a kinesiotaping monotheraphy of patients on initial stage of CTS.Materials and methods. We included 120 patien...

  13. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome

    OpenAIRE

    2003-01-01

    Abstract Background Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS), with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and deter...

  14. Early diagnosis of Carpal Tunnel Syndrome (CTS) in Indian patients by nerve conduction studies

    OpenAIRE

    2010-01-01

    The present study was carried out for early confirmation of clinically diagnosed patients of Carpal Tunnel Syndrome (CTS) by electro-diagnostic tests which included motor conduction, sensory conduction studies and F-wave studies. The aim of the study was early confirmation of clinically suspected patients of CTS by motor and sensory conduction studies of median and ulnar nerves. Eighty subjects of age group 30-50 years (40 clinically suspected patients of CTS, 40 as control group) were studie...

  15. The satisfactory effects of the other operations with carpal tunnel operation of the same hand

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    Atakan Aydin

    2012-08-01

    Conclusion: Comparison of pre- and postoperative DASH scores between the patients who underwent only carpal tunnel surgery and the patients who underwent combined surgery was statistically insignificant different (ANOVA F=0.022, p=0.883 and F=0.471, p=0.496, respectively. In both groups, none of our patients encountered with reflex sympathetic dystrophy, because of extreme sensitivity, desensitisation treatment was applied to 4 patients. [Hand Microsurg 2012; 1(2.000: 43-48

  16. Multiple Volar Carpometacarpal Dislocations with Associated Carpal Tunnel Syndrome: A Case Report

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    C Fletcher

    2015-09-01

    Full Text Available We report a rare injury involving volar fracture dislocations of the second to fifth carpometacarpal dislocations. Carpometacarpal dislocations are usually dorsally displaced and most commonly only involve the fourth and fifth joints. An associated carpal tunnel syndrome adds another dimension to the complexity and rarity of the injury in this index case. A high index of clinical suspicion and subsequent emergent management is of utmost importance to treat this unusual combination of injuries in order to avoid significant morbidity.

  17. Carpal kinematics in quadrupedal monkeys: towards a better understanding of wrist morphology and function.

    Science.gov (United States)

    Daver, Guillaume; Berillon, Gilles; Grimaud-Hervé, Dominique

    2012-01-01

    The purpose of this study is to provide new data on carpal kinematics in primates in order to deepen our understanding of the relationships between wrist morphology and function. To that end, we provide preliminary data on carpal kinematics in seven species of quadrupedal monkeys that have not been previously investigated in this regard (cercopithecoids, n = 4; ceboids, n = 3). We radiographed wrists from cadavers at their maximum radial and ulnar deviations, as well as at maximum flexion and extension. We took angular measurements to quantify the contribution of the mobility of the two main wrist joints (antebrachiocarpal and midcarpal) with respect to total wrist mobility. We also recorded qualitative observations. Our quantitative results show few clear differences among quadrupedal monkeys for radioulnar deviation and flexion-extension: all the primates studied exhibit a greater midcarpal mobility (approximately 54-83% of the total range of motion) than antebrachiocarpal mobility; however, we identified two patterns of carpal kinematics that show the functional impact of previously recognised morphological variations in quadrupedal monkeys. Firstly, qualitative results show that the partition that divides the proximal joint of the wrist in ceboids results in less mobility and more stability of the ulnar part of the wrist than is seen in cercopithecoids. Secondly, we show that the olive baboon specimen (Papio anubis) is characterised by limited antebrachiocarpal mobility for extension; this effect is likely the result of a radial process that projects on the scaphoid notch, as well as an intraarticular meniscus. Because of these close relationships between carpal kinematics and morphology in quadrupedal monkeys, we hypothesise that, to some extent, these functional tendencies are related to their locomotor hand postures.

  18. Ultrasound assessment of transverse carpal ligament thickness: a validity and reliability study.

    Science.gov (United States)

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-06-01

    The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiologic factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measure the TCL thickness and to test the validity and reliability of this method. Three operators conducted two sessions of ultrasound examination on eight cadaveric specimens and eight healthy volunteers. A custom script was used to calculate TCL thickness along the TCL length from the ultrasound images. The ultrasound based TCL thickness of the cadaveric specimens was compared with the dissection based TCL thickness for validation. The results showed Pearson's correlation coefficients of 0.867-0.928, intraclass correlation coefficient (ICC) values of 0.726-0.865, a standard error of measurement of 0.02-0.07 mm and a minimal detectable difference of 0.05-0.15 mm. The high correlation coefficients and small errors indicate that the ultrasound based method is valid for measuring TCL thickness. Furthermore, ultrasound measurements showed excellent intraoperator and interoperator reliability with ICC values as 0.826-0.933 and 0.840-0.882, respectively. The ultrasound based TCL thickness was in the range of 0.93-2.34 (1.54 ± 0.33) mm and agreed well with previous studies. The ultrasound method developed in this study is a valuable tool to examine morphologic properties of healthy and pathologic TCLs.

  19. Gouty wrist arthritis causing carpal tunnel syndrome--a case report.

    Science.gov (United States)

    Sikkandar, M F; Sapuan, J; Singh, R; Abdullah, S

    2012-06-01

    A 63 year old male with a history of gout and hypertension presented with carpal tunnel syndrome. He gave history of bilateral wrist pain associated with numbness over the median nerve distribution of the hand. Tinels sign and Phalens test were positive with no obvious thenar muscle wasting on examination. Tophaceous deposits in the flexor tendons and within the synovium of the wrist joint was seen during surgery and this established gout as the cause of median nerve entrapment in this patient.

  20. Comparison of high-resolution sonography and electrophysiology in the diagnosis of carpal tunnel syndrome

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    Meena Angamuthu Kanikannan

    2015-01-01

    Full Text Available Background: The diagnostic accuracy of high-resolution ultrasonography (HRUS in comparison to electro-diagnostic testing (EDX in carpal tunnel syndrome (CTS is debatable. Objective: The aim of this study was to compare the diagnostic accuracy of HRUS with EDX in patients with various grades of CTS and CTS associated with peripheral neuropathy (CTS + PNP. Materials and Methods: A prospective cohort of 57 patients with possible CTS was studied along with matched controls. The cross-sectional area (CSA of the median nerve at the inlet of carpal tunnel was assessed by a sonologist blinded to the clinical and EDX data. Palm wrist distal sensory latency difference (PWDSLD, second lumbrical-interosseus distal motor latency difference (2LIDMLD and CSA were compared in patients with different grades of severity of CTS and CTS+PNP. Results: Total 92 hands of 57 patients met the clinical criteria for CTS. Mean CSA at the inlet of carpal tunnel was 0.11 ± 0.0275 cm 2 . It had the sensitivity, specificity, positive predictive value and negative predictive values of 76.43%, 72.72%, 89.47% and 68%, respectively (P < 0.0001. Overall, HRUS had good correlation with PWDSLD and 2LIDMLD electro-diagnostic studies in all grades of CTS and CTS + PNP. Conclusion: HRUS can be used as a complementary screening tool to EDX. However, EDX has been found to be more sensitive and specific in mild CTS.

  1. Ultrasound features of carpal tunnel syndrome: a prospective case-control study

    Energy Technology Data Exchange (ETDEWEB)

    Sernik, Renato A.; Abicalaf, Claudia A.; Cerri, Giovanni G. [University of Sao Paulo, Department of Radiology, Sao Paulo (Brazil); Pimentel, Benedito F. [University of Taubate, Department of Orthopedics, Sao Paulo (Brazil); Braga-Baiak, Andresa [University of Sao Paulo, Post Graduation Program, Department of Radiology, Sao Paulo (Brazil); Braga, Larissa [University of Nebraska Medical Center, Omaha, NE (United States)

    2008-01-15

    The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29-78) in the symptomatic and 45.1 years (range 24-82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm{sup 2} (DT) and 9 mm{sup 2} (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm{sup 2} (DT) and 9 mm{sup 2} (IT) and several additional findings. (orig.)

  2. Pre- and post-operative diffusion tensor imaging of the median nerve in carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hiltunen, Jaana [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); Aalto University School of Science, Advanced Magnetic Imaging Centre, Aalto (Finland); Kirveskari, Erika [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); Helsinki University Central Hospital, Department of Clinical Neurophysiology, Helsinki (Finland); Numminen, Jussi [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); University of Helsinki, Helsinki Medical Imaging Center, Helsinki (Finland); Lindfors, Nina; Goeransson, Harry [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Hari, Riitta [Aalto University School of Science, Brain Research Unit, Low Temperature Laboratory, Aalto (Finland); Aalto University School of Science, Advanced Magnetic Imaging Centre, Aalto (Finland); Helsinki University Central Hospital, Department of Clinical Neurophysiology, Helsinki (Finland)

    2012-06-15

    To use pre- and post-operative diffusion tensor imaging (DTI) to monitor median nerve integrity in patients suffering from carpal tunnel syndrome (CTS). Diffusivity and anisotropy images along the median nerve were compared among 12 patients, 12 age-matched and 12 young control subjects and correlated with electrophysiological neurography results. Slice-wise DTI parameter values were calculated to focus on local changes. Results of pre-operative patients and age-matched control subjects differed only in the distal nerve. Moreover, pre-operative patients differed significantly from young controls and post-operative patients. The main abnormalities were increased diffusivity and decreased anisotropy in the carpal tunnel and distal median nerve. Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. Slice-wise analysis showed high pre-operative diffusivity at the distal nerve. All groups had relatively large inter-subject variation in both diffusivity and anisotropy. DTI can provide information complementary to clinical examination, electrophysiological recordings and anatomical MRI of diseases and injuries of peripheral nerves. However, similar age-related changes in diffusivity and anisotropy may weaken DTI specificity. Slice-wise analysis is necessary for detection of local changes in nerve integrity. circle Diffusion tensor magnetic resonance imaging provides information complementary to conventional diagnostic methods. circle Age caused similar changes to diffusivity and anisotropy as carpal tunnel syndrome. circle Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. circle Inter-subject variation in diffusivity and anisotropy was considerable. (orig.)

  3. Effect of wrist position on the measurement of carpal indices on the lateral radiograph.

    Science.gov (United States)

    Koh, K H; Lee, H I; Lim, K S; Seo, J S; Park, M J

    2013-06-01

    The purpose of this study was to find out whether the carpal indices measured on lateral radiographs with a slightly malpositioned wrist are the same as those measured in the true neutral position. Lateral radiographic views of 25 wrists were taken with 5° intervals from 20° of flexion to 20° of extension. Most carpal indices measured in the flexed or extended position were significantly different from the wrist in zero flexion-extension, except scapholunate angle at 5° of extension and scaphocapitate angle at 5° and 10° of flexion. Starting from the flexed position, there was an average of -4.0° change in radioscaphoid angle, -1.0° in scapholunate angle, -1.0° in scaphocapitate angle, +3.0° in radiolunate angle, and +2.0° in lunocapitate angle for each 5° of extension with linear trends. The results from this study suggest that even minimal degrees of flexion-extension can affect the measurements of carpal indices on lateral radiographs.

  4. Ultrasonic Assessment of Females with Carpal Tunnel Syndrome Proved by Nerve Conduction Study

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    Ihsan M. Ajeena

    2013-01-01

    Full Text Available Introduction. Carpal tunnel syndrome (CTS is the most commonly diagnosed entrapment neuropathy of the upper extremity. The objective of this study was to diagnose CTS and to assess its severity using high resolution ultrasound (HRUS depending on the results of nerve conduction study (NCS. Methods. A prospective cross-sectional study, in which HRUS was performed at 63 wrists of 35 female patients with different severity of CTS (as proved by NCS. Furthermore, 40 healthy volunteers (80 wrists underwent the same tests as the patients and have been chosen to match the patients in gender, age, and body mass index (BMI. The cross section area (CSA of the median nerve (MN was obtained using HRUS at the carpal tunnel inlet by direct tracing method. Results. There was a significant difference in the CSA of the MN at the tunnel inlet in CTS patients when compared with the control group. In fact, the CSA of the control group showed a significant difference from each of patients subgroups. Furthermore, a significant difference in the CSA was seen in between these subgroups. In conclusion, the US examination of the MN seems to be a promising method in diagnosing and grading of carpal tunnel syndrome.

  5. Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

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    Adham do Amaral e Castro

    2014-12-01

    Full Text Available Objective: To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods: We studied three groups of individuals: 1 patients waiting for bariatric surgery (preoperative; 2 individuals who had already undergone the procedure (postoperative; and 3 control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results: We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls. There was a higher prevalence of paresthesias (p=0.0003, clinical tests (p=0.0083 on the preoperative group when compared with controls (p<0.00001. There were lowe levels of paresthesias (p=0.0002 and median nerve area (p=0.04 in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05 in those who performed non-manual work. Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

  6. Low-power laser therapy for carpal tunnel syndrome:effective optical power

    Institute of Scientific and Technical Information of China (English)

    Yan Chen; Cheng-qiang Zhao; Gang Ye; Can-dong Liu; Wen-dong Xu

    2016-01-01

    Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efifca-cy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efifcacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside relfection and scattering laser power from human skin at the wrist, the effective laser power can be inferred. Using clinical measurements from 30 cases, we found that the effective laser power differed signiifcantly among cases, with the measured laser relfection coefifcient ranging from 1.8%to 54%. The relfection coefifcient for 36.7%of these 30 cases was in the range of 10–20%, but for 16.7%of cases, it was higher than 40%. Consequently, monitoring the effective optical power during laser irradiation is necessary for the laser therapy of carpal tunnel syndrome.

  7. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia

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    Marco Felipe Francisco Honorato Barros

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. MATERIAL AND METHODS: This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. RESULTS: The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01. In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. CONCLUSION: Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result.

  8. Anomalies of ulnar nerve conduction in different carpal tunnel syndrome stages.

    Science.gov (United States)

    Ginanneschi, F; Milani, P; Rossi, A

    2008-09-01

    Impairment of ulnar sensory fibers at the wrist has recently been documented in moderate/severe carpal tunnel syndrome (CTS). This has been interpreted as a consequence of compressive forces transmitted to Guyon's canal by high pressure in the carpal tunnel or comorbidity between ulnar neuropathy and CTS. The main aim of the present study was to identify any ulnar nerve conduction impairment in the early stages of CTS. The relation between ulnar and median nerve conduction in all CTS severity stages was also assessed. Ulnar nerve sensory conduction at the wrist was investigated in 580 hands with CTS. Significant changes in ulnar nerve conduction were present even in the early stages of CTS. A significant, positive correlation was also found between CTS severity and conduction abnormalities of ulnar sensory fibers. These findings make the hypothesis of comorbidity weak. Based on the above results and on reports of high pressure in Guyon's canal in CTS, ulnar nerve conduction abnormalities may be caused in part by compressive forces progressively transmitted to the canal by increasing pressure in the carpal tunnel with increasing CTS severity. This does not exclude other causative factors such as subclinical traumatic damage acting on median and ulnar fibers.

  9. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia☆

    Science.gov (United States)

    Barros, Marco Felipe Francisco Honorato; da Rocha Luz Júnior, Aurimar; Roncaglio, Bruno; Queiróz Júnior, Célio Pinheiro; Tribst, Marcelo Fernandes

    2015-01-01

    Objective To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. Material and methods This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. Results The DASH score improved from 65.17 to 16.53 six months after the operation (p dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. Conclusion Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result. PMID:26962490

  10. Association of Dental Practice as a Risk Factor in the Development of Carpal Tunnel Syndrome

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    Borhan Haghighi A.

    2013-03-01

    Full Text Available Statement of Problem: Carpal tunnel syndrome (CTS is an important cause of work disability. There is controversy over the relation between carpal tunnel syndrome and occupation. The aim of this study was to assess the relationship between the time-span of practicing dentistry and the role of dominant hands in the development of carpal tunnel syndrome.Materials and Method: In this descriptive cross sectional study, 40 dentists and dental students (15 women and 25 men undertook the electroneuro-diagnostic test in both hands by an electromyogram (EMG and they were also evaluated in terms of self- reported clinical symptoms.Results: 17.5% of participants were diagnosed to have decreased nerve conduction velocity while10% had reported clinical symptoms of CTS. Both dominant and non-dominant hands were involved. Within cases who were diagnosed as having median nerve neuropathy, 87.5% worked more than 20 hours per week. 57% had 17-23 years of dental practice experience and 14.2% of cases had10-16 years of practice in dentistry.Conclusion: The high rate of CTS symptoms, in both dominant and non-dominant hand among dental practitioners with more years of dental practice, indicates a prequisite for particular attention, then sufficient education on the major risk factors causing this problem. Early diagnosis of these symptoms may improve the future management of the disease.

  11. A prospective study of prognostic factors for duration of sick leave after endoscopic carpal tunnel release

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    Dalsgaard Jesper

    2009-11-01

    Full Text Available Abstract Background Endoscopic carpal tunnel release with a single portal technique has been shown to reduce sick leave compared to open carpal tunnel release, claiming to be a less invasive procedure and reducing scar tenderness leading to a more rapid return to work, and the purpose of this study was to identify prognostic factors for prolonged sick leave after endoscopic carpal tunnel release in a group of employed Danish patients. Methods The design was a prospective study including 75 employed patients with carpal tunnel syndrome operated with ECTR at two hospitals. The mean age was 46 years (SD 10.1, the male/female ratio was 0.42, and the mean preoperative duration of symptoms 10 months (range 6-12. Only 21 (28% were unable to work preoperatively and mean sick leave was 4 weeks (range 1-4. At base-line and at the 3-month follow-up, a self-administered questionnaire was collected concerning physical, psychological, and social circumstances in relation to the hand problem. Data from a nerve conduction examination were collected at baseline and at the 3-month follow-up. Significant prognostic factors were identified through multiple logistic regression analysis. Results After the operation, the mean functional score was reduced from 2.3 to 1.4 (SD 0.8 and the mean symptom score from 2.9 to 1.5 (SD 0.7. The mean sick leave from work after the operation was 19.8 days (SD 14.3. Eighteen patients (24% had more than 21 days of sick leave. Two patients (3% were still unable to work after 3 months. Significant prognostic factors in the multivariate analysis for more than 21 days of postoperative sick leave were preoperative sick leave, blaming oneself for the hand problem and a preoperative distal motor latency. Conclusion Preoperative sick leave, blaming oneself for the hand problem, and a preoperative distal nerve conduction motor latency were prognostic factors for postoperative work absence of more than 21 days. Other factors may be important

  12. Dupuytren’s disease digital radius IV right hand and carpal tunnel syndrome on ipsilateral hand

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    Teona Sebe Ioana

    2015-11-01

    Full Text Available Dupuytren’s contracture is a fibroproliferative disease whose etiology and pathophysiology are unclear and controversial. It is a connective tissue disorder, which takes part in the palmar’s fibromatosis category and has common characteristics with the healing process. Dupuytren’s disease is characterized by the flexion contracture of the hand due to palmar and digital aponevrosis. It generally affects the 4th digital radius, followed by the 5th one. Without surgery, it leads to functional impotence of those digital rays and/or hand. It is associated with other diseases and situational conditions like Peyronie’s disease, the Lederhose disease (plantar fibromatosis, Garrod’s digital knuckle-pads, diabetes, epilepsy, alcoholism, micro traumatisms, stenosing tenosynovitis and not the least with carpal tunnel syndrome. The carpal tunnel syndrome is a peripheral neuropathy with the incarceration of the median nerve at the ARC level, expressed clinically by sensory and motor disturbances in the distribution territory of the median nerve, which cause functional limitations of daily activities of the patient. After the failure of the nonsurgical treatment or the appearance of the motor deficit, is established the open or endoscopic surgical treatment with the release of the median nerve. Postoperative recovery in both diseases is crucial to the functionality of the affected upper limb and to the quality of the patient’s life. The patient, a 61 years old man, admitted to the clinic for the functional impotence of the right hand, for the permanent flexion contracture of the metacarpophalangeal joint (MCP and proximal interphalangeal joint (PIP of the 4th finger with extension deficit, for the damage of the thumb pulp clamp of the 4th finger, for nocturnal paresthesia of fingers I-III and pain that radiates into the fingertips. After clinical, paraclinical, imagistic and electrical investigations, surgery is practiced partial aponevrectomy

  13. Unicameral bone cyst of the lunate in an adult: case report

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    Alici Tugrul

    2010-10-01

    Full Text Available Abstract We report a case of a symptomatic unicameral (simple bone cyst of the lunate in a 42-year- old woman. The lesion was treated with curettage and cancellous autogenous iliac bone grafting. At five years of follow-up the wrist was pain free, there were no limitations of motion, and the radiographs showed complete obliteration of the cavity. To the best of our knowledge, no other unicameral bone cyst of the lunate has been reported in an adult. Cysts with significant cavities at the carpal bones in an adult should be approached cautiously, as they may require early curettage and bone grafting for healing, before collapse and degenerative changes occur.

  14. Bone Markers

    Science.gov (United States)

    ... markers may be seen in conditions such as: Osteoporosis Paget disease Cancer that has spread to the bone (metastatic bone disease) Hyperparathyroidism Hyperthyroidism Osteomalacia in adults and rickets in children—lack of bone mineralization, ...

  15. Bone scan

    Science.gov (United States)

    ... legs, or spine fractures) Diagnose a bone infection (osteomyelitis) Diagnose or determine the cause of bone pain, ... 2015:chap 43. Read More Broken bone Metabolism Osteomyelitis Review Date 12/10/2015 Updated by: Jatin ...

  16. Bone Cancer

    Science.gov (United States)

    Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another ... more common. There are three types of bone cancer: Osteosarcoma - occurs most often between ages 10 and ...

  17. Bone Diseases

    Science.gov (United States)

    Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly ... childhood and your teens, your body adds new bone faster than it removes old bone. After about ...

  18. [Diffuse tenosenovial giant cell tumor of the wrist revealed by carpal tunnel syndrome: report of a case].

    Science.gov (United States)

    Ait Essi, F; Younsi, A; Abkari, I; Benhima, M A; Najeb, Y; Latifi, M; Fakhri, A; Belaabidia, B

    2012-10-01

    Giant cell tumour of tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. It is the second most common soft tissue tumor of the hand after ganglion cyst. The localised (nodular) form is the most common. However, the less-common diffuse-type giant cell tumour is usually located in the peri-articular soft tissue. The authors report the case of a giant cell tumor of the tendon sheath arising from the carpal tunnel of the wrist in a 42-year-old woman. The patient presented a mild carpal tunnel syndrome and a mid-palmar swelling. We present an unusual localization of giant cell tumor of the tendon sheath, causing carpal tunnel syndrome.

  19. New wrist bones of the Malagasy giant subfossil lemurs.

    Science.gov (United States)

    Hamrick, M W; Simons, E L; Jungers, W L

    2000-05-01

    Recently discovered wrist bones of the Malagasy subfossil lemurs Babakotia radofilai, Palaeopropithecus ingens, Mesopropithecus dolichobrachion, and Megaladapis madagascariensis shed new light on the postcranial morphologies and positional behaviors that characterized these extinct primates. Wrist bones of P. ingens resemble those of certain modern hominoids in having a relatively enlarged ulnar head and dorsally extended articular surface on the hamate, features related to a large range of rotation at the inferior radioulnar and midcarpal joints. The scaphoid of P. ingens is also similar to that of the extant tree sloth Choloepus in having an elongate, palmarly directed tubercle forming a deep radial margin of the carpal tunnel for the passage of large digital flexors. In contrast, wrist remains of Megaladapis edwardsi and M. madagascariensis exhibit traits observed in the hands of extant pronograde, arboreal primates; these include a dorsopalmarly expanded pisiform and well-developed "spiral" facet on the hamate. Moreover, Megaladapis spp. and Mesopropithecus dolichobrachion possess bony tubercles (e.g., scaphoid tubercle and hamate hamulus) forming the carpal tunnel that are relatively similar in length to those of modern pronograde lemurs. Babakotia and Mesopropithecus differ from Megaladapis in exhibiting features of the midcarpal joint related to frequent supination and radioulnar deviation of the hand characteristic of animals that use vertical and quadrumanous climbing in their foraging behaviors. Comparative analysis of subfossil lemur wrist morphology complements and expands upon prior inferences based on other regions of the postcranial skeleton, and suggests a considerable degree of locomotor and postural heterogeneity among these recently extinct primates.

  20. Prevalence of carpal tunnel syndrome and wrist osteoarthritis in long-term paraplegic patients compared with controls.

    Science.gov (United States)

    Akbar, M; Penzkofer, S; Weber, M A; Bruckner, T; Winterstein, M; Jung, M

    2014-02-01

    We compared functional and structural changes in the hands, in particular the prevalence of carpal tunnel syndrome, in 56 paraplegic patients who had been wheelchair dependent for over 25 years with a group of able-bodied volunteers (with matching criteria for gender and age). The hands were assessed by clinical examination, electrophysiology, disabilities of the arm shoulder and hand score and magnetic resonance imaging. Hand function was worse and wrist pain was experienced more often in the paraplegic patients, and they also had a significantly higher prevalence of carpal tunnel syndrome both clinically and electrophysiologically. The prevalence of wrist and trapeziometacarpal osteoarthritis was significantly higher in the right hand.

  1. Randomized clinical trial of surgery versus conservative therapy for carpal tunnel syndrome [ISRCTN84286481

    Directory of Open Access Journals (Sweden)

    Turner Judith A

    2005-01-01

    Full Text Available Abstract Background Conservative treatment remains the standard of care for treating mild to moderate carpal tunnel syndrome despite a small number of well-controlled studies and limited objective evidence to support current treatment options. There is an increasing interest in the usefulness of wrist magnetic resonance imaging could play in predicting who will benefit for various treatments. Method and design Two hundred patients with mild to moderate symptoms will be recruited over 3 1/2 years from neurological surgery, primary care, electrodiagnostic clinics. We will exclude patients with clinical or electrodiagnostic evidence of denervation or thenar muscle atrophy. We will randomly assign patients to either a well-defined conservative care protocol or surgery. The conservative care treatment will include visits with a hand therapist, exercises, a self-care booklet, work modification/ activity restriction, B6 therapy, ultrasound and possible steroid injections. The surgical care would be left up to the surgeon (endoscopic vs. open with usual and customary follow-up. All patients will receive a wrist MRI at baseline. Patients will be contacted at 3, 6, 9 and 12 months after randomization to complete the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ. In addition, we will compare disability (activity and work days lost and general well being as measured by the SF-36 version II. We will control for demographics and use psychological measures (SCL-90 somatization and depression scales as well as EDS and MRI predictors of outcomes. Discussion We have designed a randomized controlled trial which will assess the effectiveness of surgery for patients with mild to moderate carpal tunnel syndrome. An important secondary goal is to study the ability of MRI to predict patient outcomes.

  2. Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel.

    Science.gov (United States)

    Kociolek, Aaron M; Tat, Jimmy; Keir, Peter J

    2015-02-05

    Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0° and 30° flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures.

  3. A new tool for mini-open carpal tunnel release – the PSU retractor

    Directory of Open Access Journals (Sweden)

    Yuenyongviwat Varah

    2008-09-01

    Full Text Available Abstract Background Mini-open carpal tunnel release has become increasingly popular for the treatment of carpal tunnel surgery. The main advantages are shortening recovery time and return-to-work time. However, the risk of neurovascular injury still remains worrisome. Methods In this study, we developed a new retractor (herein called the PSU retractor modified from the widely used Senn retractor, with the aim of decreasing the risk of neurovascular problems from normal procedure. 3-Dimensional computer design software (SolidWorks® Office Premium 2007 SP3.1 was used to construct a 3-D PSU retractor prototype. An amputated arm from a 30-year-old woman diagnosed as synovial sarcoma at the shoulder was used to test the maximal visual length. A mini-surgical incision was performed at 3 cm distal to the transverse wrist crease and a tiny flexible ruler was inserted through the tunnel beneath the skin to measure the maximal visual length. Results Our new retractor showed significantly better maximal visual length compared to the Senn retractor (47.7(8.1 mm vs. 39.2(6.5 mm. In addition, most assessors expressed a higher satisfaction rate with the PSU retractor than with the Senn retractor (7.3 (1.9 vs. 6.3 (1.1. Conclusion In conclusion, we have developed a promising new retractor using a computer design program, which appears to be an improvement on the currently available equipment used for mini-open carpal tunnel surgery. However, further clinical studies are needed to confirm our initial findings.

  4. [Effect of age and anti-osteoporotic drugs on bone strength and structure of the distal radius].

    Science.gov (United States)

    Uchiyama, Shigeharu

    2013-07-01

    The distal radius constitutes a proximal part of the wrist joint, which bears axial load from the carpal bones. Based on the biomechanical experiments, the load transmitted from the carpal bones to the distal articular surface of the radius is greater to the lunate fossa than the scaphoid fossa. The findings are consistent with the results obtained from HR-pQCT analysis of the distal radius. As ageing, bone mineral densities of the distal radius decrease, and structures of the cortical and trabecular bones also deteriorate. Such deterioration can be prevented by osteoporotic medicines such as PTH or bisphosphonate. Denosumab has been shown to increase mechanical indices of the bone structure of the distal radius. The distal radius of the individual is fractured when the load over approximately 5 times (2.5SD) of the weight is applied. It is possible to predict load of fracture in the distal radius from the results of DXA derived BMD or HR-pQCT derived bone parameters. We should not miss the opportunity of treatment for osteoporosis when the patients with fragility distal radius fracture are seen.

  5. Carpal tunnel syndrome during pregnancy%妊娠合并腕管综合征

    Institute of Scientific and Technical Information of China (English)

    孙丽洲; 刘丽萍

    2009-01-01

    文章提出了腕管综合征的病因与妊娠期水肿及体内激素水平变化有关,阐述了其临床表现、分级以及诊断,且目前以保守治疗为主.%The paper presents the etiology of carpal tunnel syndrome (CTS) is more likely to be rehted to edema and hormonal changes during pregnancy, and emphasizes the elinieal manifestation, classification and diagnosis. Conservative therapies are the most common initial treatments, especially during pregnancy.

  6. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture.

    Science.gov (United States)

    Maeda, Yumi; Kim, Hyungjun; Kettner, Norman; Kim, Jieun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Ong-Sutherland, Rebecca; Mezzacappa, Pia; Libby, Alexandra; Mawla, Ishtiaq; Morse, Leslie R; Kaptchuk, Ted J; Audette, Joseph; Napadow, Vitaly

    2017-03-02

    Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist. Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. Eligible patients (n = 80, 65 female, age: 49.3 ± 8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture 'local' to the more affected hand; (ii) verum electro-acupuncture at 'distal' body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro-acupuncture using non-penetrating placebo needles. Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up. Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy. Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5). While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance). Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up. We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor

  7. Critical analysis of the manoeuvres proposed for the diagnosis of the tunnel carpal syndrome

    Directory of Open Access Journals (Sweden)

    T. Vangelista

    2011-09-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy. It is mainly due to the compression of median nerve at the wrist and it may be idiopathic or secondary to different rheumatic or non rheumatic diseases, including occupational activities. Since signs and symptoms of CTS are characteristic, a careful examination of the affected patient may be very satisfactory for the diagnosis, in particular by mean of some manoeuvres. In this review we described and commented the tests considered most useful in the diagnosis of CTS. We also analysed the diagnostic values of electromiography, the most important electrodiagnostic study for the CTS.

  8. Low-power laser therapy for carpal tunnel syndrome: effective optical power

    OpenAIRE

    Yan Chen; Cheng-qiang Zhao; Gang Ye; Can-dong Liu; Wen-dong Xu

    2016-01-01

    Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efficacy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efficacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective op...

  9. Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors.

    Science.gov (United States)

    Andréu, José-Luis; Otón, Teresa; Silva-Fernández, Lucía; Sanz, Jesús

    2011-02-01

    Some occupational factors have been implicated in the development of disorders manifested as hand pain. The associations seem to be well documented in processes such as hand-arm vibration syndrome (HAVS) or writer's cramp. There are contradictory data in the literature about the relationships of trigger finger, De Quervain's tenosynovitis (DQT) and tenosynovitis of the wrist with occupational factors. In this article, we review current knowledge about clinical manifestations, case definition, implicated occupational factors, diagnosis and treatment of the most relevant hand pain disorders that have been associated with occupational factors, excluding carpal tunnel syndrome (CTS).

  10. Medical diagnosis of cubital tunnel syndrome ameliorated with thrust manipulation of the elbow and carpals

    OpenAIRE

    Kearns, Gary; Wang, Sharon

    2012-01-01

    This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomec...

  11. Bone Densitometry (Bone Density Scan)

    Science.gov (United States)

    ... of DXA Bone Densitometry? What is a Bone Density Scan (DXA)? Bone density scanning, also called dual-energy x-ray absorptiometry ( ... is today's established standard for measuring bone mineral density (BMD). An x-ray (radiograph) is a noninvasive ...

  12. Bone marrow aspiration

    Science.gov (United States)

    Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

  13. Type 2 diabetes seems not to be a risk factor for the carpal tunnel syndrome : a case control study

    NARCIS (Netherlands)

    Hendriks, Steven H.; van Dijk, Peter R.; Groenier, Klaas H.; Houpt, Peter; Bilo, Henk J. G.; Kleefstra, Nanne

    2014-01-01

    BACKGROUND: Previous studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycaemic control. Primary aim was to determine if type

  14. Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout.

    Science.gov (United States)

    Hernández-Cortés, P; Caba, M; Gómez-Sánchez, R; Gómez-Morales, M

    2011-11-09

    The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.

  15. Speckle-Tracking Sonographic Assessment of Longitudinal Motion of the Flexor Tendon and Subsynovial Tissue in Carpal Tunnel Syndrome

    NARCIS (Netherlands)

    van Doesburg, Margriet H. M.; Yoshii, Yuichi; Henderson, Jacqueline; Villarraga, Hector R.; Moran, Steven L.; Amadio, Peter C.

    2012-01-01

    Objectives-The aim of this study was to image both tendon and subsynovial connective tissue movement in patients with carpal tunnel syndrome and healthy control volunteers, using sonography with speckle tracking. To estimate accuracy of this tracking method, we used in vivo measurements during surge

  16. Battling Carpal Tunnel Syndrome through Ergonomics: A Case Study of Texas A&M's Library Provides Insights and Answers.

    Science.gov (United States)

    Thornton, Joyce K.

    1995-01-01

    Current library automation practices and new technologies have forced library managers to seek some means of reducing carpal tunnel syndrome, and a case study of Texas A&M's library provides insights. Highlights include identifying and assessing the injuries, adjusting work surfaces, testing and selecting new keyboards, and developing adjustable…

  17. Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements

    NARCIS (Netherlands)

    Y. Wang (Yuexiang); C. Zhao; S.M. Passe (Sandra); A. Filius (Anika); A.R. Thoreson (Andrew); P. An (Ping); P.C. Amadio (Peter )

    2014-01-01

    textabstractThe symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. To better understand the biomechanics of the abnormal nerve, it is first necessary to und

  18. [Assessment of quality of pre- and postoperative information documents about carpal tunnel syndrome].

    Science.gov (United States)

    Facca, S; Sauleau, E; Robert, E; Gouzou, S; Clavert, P; Liverneaux, P

    2014-02-01

    Before surgery for carpal tunnel syndrome, oral patient information is partially understood and accepted. The objective of this study was to perform a documentation for patients, as recommended by the High Authority in Healthcare (HAS), then to compare the effectiveness of oral information. Our series included 37 patients who received the same information: preoperative shower, pathophysiology, and postoperative instructions. The first 18 (group 1) received only oral information. The following 19 (group 2) received oral, written and visual information. The information in Group 2 followed the methodology of McClune: promoter (Department of Hand Surgery), organizing committee (two teachers from the School of Decorative Arts, two teachers of the School of Medicine), group work (five art students, five medical students), panel of experts (three surgeons, two occupational therapists, one physiotherapist). Four documents were developed: a booklet, a diagram, an animation, a poster. Satisfaction was higher in group 2. Understanding and memorization were better in group 2. Fifty-six percent of patients in group 1 would have liked a paper, 12.5% videos, none went on the Internet. Twelve and a half percent of the patients in group 2 went on the Internet, 18.8% would have liked videos. Our results show that in terms of carpal tunnel syndrome, the written and visual information materials for patients significantly improve the efficacy of oral information. These documents may be extended to other pathologies in Hand Surgery.

  19. Conservative treatment of carpal tunnel syndrome: comparison between laser therapy and Fascial Manipulation(®).

    Science.gov (United States)

    Pratelli, Elisa; Pintucci, Marco; Cultrera, Pina; Baldini, Enrico; Stecco, Antonio; Petrocelli, Antonio; Pasquetti, Pietro

    2015-01-01

    The etiopathogenesis of Carpal Tunnel Syndrome (CTS) is multifactorial and most cases are classified as idiopathic (Thurston 2013). A randomized controlled trial was performed to compare the effectiveness of Fascial Manipulation(®) (FM) and Low-Level Laser Therapy (LLLT) for CTS. This prospective trial included 42 patients (70 hands with symptoms) with clinical and electroneuromyographic diagnosis of CTS. The patients were randomly assigned to receive multiple sessions of FM or multiple session of LLLT. The Visual Analogic Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) were performed at baseline, end of treatment and after three months. The group that received FM showed a significant reduction in subjective pain perception and an increased function assessed by BCTQ at the end of the treatment and follow-up. The group that received LLLT showed an improvement in the BCTQ at the end of the treatment but the improvement level was not sustained at the three month follow-up. FM is a valid alternative treatment for CTS.

  20. Carpal tunnel syndrome and the use of computer mouse and keyboard: A systematic review

    Directory of Open Access Journals (Sweden)

    Atroshi Isam

    2008-10-01

    Full Text Available Abstract Background This review examines evidence for an association between computer work and carpal tunnel syndrome (CTS. Methods A systematic review of studies of computer work and CTS was performed. Supplementary, longitudinal studies of low force, repetitive work and CTS, and studies of possible pathophysiological mechanisms were evaluated. Results Eight epidemiological studies of the association between computer work and CTS were identified. All eight studies had one or more limitation including imprecise exposure and outcome assessment, low statistical power or potentially serious biases. In three of the studies an exposure-response association was observed but because of possible misclassification no firm conclusions could be drawn. Three of the studies found risks below 1. Also longitudinal studies of repetitive low-force non-computer work (n = 3 were reviewed but these studies did not add evidence to an association. Measurements of carpal tunnel pressure (CTP under conditions typically observed among computer users showed pressure values below levels considered harmful. However, during actual mouse use one study showed an increase of CTP to potentially harmful levels. The long term effects of prolonged or repeatedly increased pressures at these levels are not known, however. Conclusion There is insufficient epidemiological evidence that computer work causes CTS.

  1. Levels of endocrine hormones and lipids in male patients with carpal tunnel syndrome

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    Hülya Uzkeser

    2011-12-01

    Full Text Available Objectives: This study was performed to evaluate the relationship between endocrine hormones, lipid levels and clinical parameters in male patients with carpal tunnel syndrome (CTS.Materials and methods: Fifteen male patients with CTS and 16 healthy controls were included in the study. Serum free T3, free T4, thyroid-stimulating hormone (TSH, free testosterone, dehydroepiandrosterone sulfate, triglyceride and total cholesterol levels were analyzed. Symptom severity and hand function were assessed using the Boston Carpal Tunnel Questionnaire in clinical examination.Results: Serum free T3, free T4, TSH, free testosterone, dehydroepiandrosterone sulfate, triglyceride and total cholesterol levels were similar between CTS patients and controls (p> 0.05. Also, there was no statistically significant correlation between laboratory parameters and clinical characteristics in patients with CTS (p> 0.05.Conclusion: The serum free T3, free T4, TSH, free testosterone, dehydroepiandrosterone sulfate, triglyceride and total cholesterol levels seem within normal range in male CTS patients. Further studies are needed to investigate association endocrine factors, lipid levels such as triglyceride and total cholesterol with CTS in male and female patients.

  2. Duration of symptomatology and median segmental sensory latency in 993 carpal tunnel syndrome hands (668 cases

    Directory of Open Access Journals (Sweden)

    KOUYOUMDJIAN JOAO ARIS

    1999-01-01

    Full Text Available According to median sensory nerve action potential onset-latency to index finger in a 140 mm fixed distance, 993 carpal tunnel syndrome (CTS hands from 668 patients were grouped into MIld (3.0 to 3.5 ms, 384 hands, MOderate (3.6 to 4.4 ms, 332 hands, SEvere (> 4.4 ms, 135 hands and UNrecordable (142 hands and correlated with CTS symptomatology duration. All patients have sensory antidromic median-radial latency difference (MRD e > or = 1.0 ms without any doubt about CTS diagnosis. Patients with systemic disease, trauma or previous surgery were excluded. There is a remarkable cumulative percentage increase from 1 to 12 months in group UN (3.5% to 38.7%, 11 folds, much less than the group MI (13.8% to 54.6%, 3.9 folds. There is also a remarkable non-cumulative percentage increase in group UN, from 1 to 4-12 months; the group MI had a relatively uniform distribution in all symptomatic duration groups from 1 to > 60 months. The conclusion is that median nerve compression at carpal tunnel can lead to unrecordable potentials in a relatively short period from 1 to 12 months of evolution, suggesting acute/subacute deterioration. Electrophysiological evaluation must be done periodically in patients that underwent clinical treatment, since cumulative 38.7% of group UN was found in 12 months period.

  3. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Khalil, C.; Hancart, C.; Thuc, V.Le; Cotten, A. [Service de Radiologie Osteoarticulaire, Hopital Roger Salengro, CHRU de Lille (France); Chantelot, C. [Clinique d' Orthopedie, Hopital Roger Salengro, CHRU de Lille (France); Chechin, D. [Philips Medical Systems, Suresnes (France)

    2008-10-15

    The purpose was to demonstrate the feasibility of in vivo diffusion tensor imaging (DTI) and tractography of the human median nerve with a 1.5-T MR scanner and to assess potential differences in diffusion between healthy volunteers and patients suffering from carpal tunnel syndrome. The median nerve was examined in 13 patients and 13 healthy volunteers with MR DTI and tractography using a 1.5-T MRI scanner with a dedicated wrist coil. T1-weighted images were performed for anatomical correlation. Mean fractional anisotropy (FA) and mean apparent diffusion coefficient (ADC) values were quantified in the median nerve on tractography images. In all subjects, the nerve orientation and course could be detected with tractography. Mean FA values were significantly lower in patients (p=0.03). However, no statistically significant differences were found for mean ADC values. In vivo assessment of the median nerve in the carpal tunnel using DTI with tractography on a 1.5-T MRI scanner is possible. Microstructural parameters can be easily obtained from tractography images. A significant decrease of mean FA values was found in patients suffering from chronic compression of the median nerve. Further investigations are necessary to determine if mean FA values may be correlated with the severity of nerve entrapment. (orig.)

  4. The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics

    Directory of Open Access Journals (Sweden)

    Marc A. Tanner

    2012-01-01

    Full Text Available Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined. Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly. Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.

  5. An epidemiological profile of cashiers holders carpal tunnel syndrome in a grocery store chain.

    Science.gov (United States)

    Costa, R; Barros, R; Campos, D; Lima, D; Barbosa, Geórgia

    2012-01-01

    Occupational diseases are those acquired in the work. Statistics show an increase number of cases, victims like typists, telephone's operators, cashiers and many others with varied levels of involvement. It is composed of disorders affecting the upper limbs being recognized by the Ministry of Social Welfare. Among these diseases stands out for its high occurrence Carpal Tunnel Syndrome (CTS). It has been considered a disease of the century, because its incidence has increased in 40.8% of repetitive stress disorders, with prevalence in females, and predominant age ranging from 25 to 40 years. It is characterized by pain and paresthesia in the first four fingers and wrists, and arm pain, weakness, numbness in the territory of the median nerve, preserving or not the palmar sensation and numbness in the median sensory distribution. This study aims to assess functional capacity and severity of symptoms presented by cashiers diagnosed with CTS. It is a descriptive and quantitative in nature. The population consists of 13 grocery store cashiers of both sexes, with a workload of 42 hours. We will be used as an instrument called the Boston Carpal Tunnel Questionnaire. That purports to be an effective means of measuring the numbness and pain in hands and wrists. Exclusion criteria we consider the subjects who have other diseases associated with CTS. The collection is with the possibility of partial results to be entered in a spreadsheet in Microsoft Excel for data analysis and subsequent discussion and correlation with the current literature.

  6. High-resolution MRI predicts steroid injection response in carpal tunnel syndrome patients

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Takatoshi; Oki, Hodaka; Kinoshita, Shunsuke; Yamashita, Yoshiko; Takahashi, Hiroyuki; Hayashida, Yoshiko; Korogi, Yukunori [University of Occupational and Environmental Health School of Medicine, Department of Radiology, Kitakyushu (Japan); Oshige, Takahisa; Sakai, Akinori [University of Occupational and Environmental Health School of Medicine, Department of Orthopaedic Surgery, Kitakyushu (Japan); Matsuyama, Atsushi; Hisaoka, Masanori [University of Occupational and Environmental Health School of Medicine, Department of Pathology and Oncology, Kitakyushu (Japan)

    2014-03-15

    To correlate median nerve T2 signal and shape at the carpal tunnel with steroid injection (SI) response in carpal tunnel syndrome (CTS) patients. One hundred and sixty-three CTS wrists of 92 consecutive patients who were scheduled to undergo SI were prospectively evaluated with 3-T magnetic resonance imaging (MRI) and a nerve conduction study. All patients underwent axial high-resolution T2-weighted MRI (in-plane resolution of 0.25 x 0.25 mm). The CTS wrists were classified into three groups according to the nerve T2 signal and the flattening ratio at the hook of hamate level: group 1, high and oval; group 2, high and flat; group 3, low and flat. Clinical response to SI was evaluated at 6 months after injection. One hundred and thirteen of the 163 wrists (69.3 %) responded well to SI. The percentage of improvement was 81.7 % (49/60) in group 1, 69.9 % (51/73) in group 2, and 43.3 % (13/30) in group 3 (P < 0.01). On stepwise logistic regression analysis high-resolution MRI was the only significant independent factor for SI response in CTS patients (P < 0.01). High-resolution MRI correlates well with SI response in CTS patients and seems useful for predicting SI response. (orig.)

  7. Evaluation of the function status of the ulnar nerve in carpal tunnel syndrome.

    Science.gov (United States)

    Zhang, J; Liu, N; Wang, Y W; Zhang, Z C; Zheng, L N; Zhu, J

    2015-04-17

    Many carpal tunnel syndrome (CTS) patients have symptoms in both the median and ulnar digits more frequently than in the median digits alone. This is possibly because of close anatomical contiguity of the carpal tunnel and Guyon's canal, and the high pressure may also affect the latter, causing indirect compression of ulnar nerve fibers. Thus, we evaluated the functional status of the ulnar nerve in patients with CTS in order to investigate the relationship between ulnar nerve impairment and sensory symptoms of the ulnar territory. Electrophysiological studies were conducted in CTS patients and healthy controls. CTS patients were divided into the mild/moderate group and severe group; they were further divided into the symptomatic and asymptomatic subgroups according to the sensory symptom of the fifth digit region. The findings suggest that CTS patients could have coexisting ulnar nerve wrist entrapments that might exacerbate the severity of CTS. Sensory impairment in the ulnar territory was observed more frequently in the mild/moderate stage of CTS, which is associated with ulnar nerve involvement. These findings also suggest that damage to the ulnar nerve fibers caused by compression forces in Guyon's canal may underlie the ulnar spread of symptoms in CTS.

  8. Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients

    Directory of Open Access Journals (Sweden)

    Mark van Suchtelen

    2014-09-01

    Full Text Available Background:  This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS over time according to median nerve distal motor latency (DML on two electrodiagnostic tests.   Methods:  This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and  tober 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results: The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months. The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038. The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P =0.015.  Conclusions: There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.

  9. Clinical Outcome and Wound Healing following Carpal Tunnel Decompression: A Comparison of Two Common Suture Materials

    Directory of Open Access Journals (Sweden)

    Robert J. MacFarlane

    2014-01-01

    Full Text Available Introduction. Debate exists amongst surgeons regarding the ideal suture material for skin closure in carpal tunnel decompression (CTD. This study compares wound related complications, patient satisfaction, and functional outcome following open carpal tunnel decompression in patients undergoing wound closure with either of two common absorbable and nonabsorbable suture types. Materials and Methods. 53 patients underwent CTD with either 4/0 polypropylene (ProleneTM, n = 28 or 4/0 polyglactin (Vicryl RapideTM, n = 25 for skin closure. QuickDASH, VAS satisfaction scores, and Southampton wound scores were assessed preoperatively and at 2 and 6 weeks postoperatively. Results. At 6 weeks the mean QuickDASH scores postoperatively were 18.54 and 17.70 for absorbable and nonabsorbable sutures, respectively, (P = 0.86. The mean VAS scores were 0.61 and 0.42 (P = 0.91, respectively. All patients achieved a Southampton wound score of 0 by 6 weeks except one, who achieved 1C in the nonabsorbable group, equivalent to mild erythema. There were no complications in either group. Conclusion. Both suture types are safe and effective materials for CTD, and we recommend surgeons to choose according to personal preference, handling properties, and resources available for suture removal.

  10. 一种新的指腕骨ROI的定位算法研究——基于k余弦和形状信息%Novel location algorithm research for phalange and carpal ROI based on k-cosine and shape information

    Institute of Scientific and Technical Information of China (English)

    冉隆科; 周丽华; 陈忠

    2011-01-01

    In the research of automatic bone age assessment,how to locate and extract phalangeal Regions Of Interest(ROI) and carpal ROI efficiently has become one of the most difficult and urgent key problems.The two-dimensional third order polynomial linear regression based on shape information for phalanges and carpals is proposed,though which the background images can be fitted and removed.And it locates the key points of phalangeal ROI and carpal ROI accurately by using k-cosine algorithm, so phalangeal ROI and carpal ROI can be extracted. Experiments on more than 60 left hand radiograph data show that the correct extracted rates of the proposed method are higher than 93%.Moreover,the method is robust for gray value variation of background, the position and orientation of the hand, so it can be used directly for automatic skeletal bone age assessment in the follow-up study.%在骨龄自动化评价的研究中,如何对指骨 ROI 和腕骨 ROI 的有效定位和成功提取是其研究的难点和急需解决的关键问题之一.在利用手指骨和腕骨形状信息的基础上,提出了用二元三次线性回归方法来拟合图像背景,从而移除图像背景;用基于k 余弦的方法来定位腕骨 ROI 和指骨 ROI 的关键点,最后成功提取出腕骨 ROI 和指骨 ROI.通过超过 60 例的临床骨龄 X 光片图像数据验证最后提取的正确率在 93% 以上.使用该方法不用考虑骨龄图像背景灰度值的改变.图像位置和方向的变化,因而具有极大的鲁棒性,可以直接应用到骨龄自动化评价的后续研究中.

  11. The role of extrinsic ligaments in maintaining carpal stability - A prospective statistical analysis of 85 arthroscopic cases.

    Science.gov (United States)

    Van Overstraeten, Luc; Camus, Emmanuel J

    2016-02-01

    Several biomechanical studies have shown that the scapholunate (SL) and lunotriquetral (LT) ligaments are not the only stabilizers of the proximal carpal row. However, no study has yet analyzed the range of ligament lesions leading to instability in vivo. Arthroscopy has been used to assess the condition of the wrist's extrinsic ligaments by palpating and tensioning the various ligament and capsule structures. In this prospective study, this arthroscopic method was used in 85 cases of wrist sprain without static instability to evaluate the correlation between lesions of the intrinsic and extrinsic carpal ligaments and carpal instability. In SL instability, a scapholunate interosseous ligament (SLIL) lesion was statistically correlated with lesions of the long radiolunate ligament (P<0.05). There also was a statistically significant correlation between lesions of the SLIL and the radioscaphocapitate, scaphotrapezial and dorsal intercarpal ligaments. There was a correlation between the stage of SL instability and the number of lax extrinsic ligaments (P<0.05) but not with the severity of the extrinsic ligament lesions. In LT instability, a LT interosseous ligament lesion was statistically correlated with lesions of the dorsal intercarpal ligament (P<0.05). There also was a correlation between the stage of LT instability and the number (P<0.005) and severity (P<0.001) of the extrinsic ligament lesions. Arthroscopy can reveal hidden radiographic instability and can also be used to define the number and severity of injured ligaments. In carpal instability, a lesion of one intrinsic carpal ligament was associated with a lesion of one or more extrinsic ligaments.

  12. 超声对腕管综合征和肘管综合征的诊断价值%Diagnostic value of ultrasonography for carpal tunnel and cubital tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    王战业; 曹洪弘; 夏炳兰

    2014-01-01

    Objective To explore the diagnostic value of ultrasonography for carpal tunnel and cubital tunnel syndrome. Method Twenty-five healthy subjects were enrolled as control group and 35 patients with suspected carpal tunnel syndrome and 22 patients with suspected ulnar nerve compression were enrolled as disease group. The median nerve was examined by ultrasonography. The cross sectional area (CSA) at peas bone level and anteroposterior diameters (D1), anteroposterior diameters at hook bone level (D2) and distal level (D3) of median nerve, and CSA of the elbow ulnar nerve were measured. The difference values between D1 and D2 (D), D3 and D2 (d) were calculated. The ultrasonography findings in lesion group were compared with those observed during operation. Results Ultrasonography can display the morphological changes of median and ulnar nerves after compression. The CSA of median and ulnar nerves、D、d in lesion group were bigger than those in control group (P<0.03). The diagnostic accurate rates of ultrasonography for carpal tunnel and cubital tunnel syndromes were 97.9%and 95.4%, respectively. Conclusion High-frequency ultrasonography can diagnose carpal tunnel and cubital tunnel syndromes effectively.%目的:探讨超声对腕管综合征、肘管综合征的诊断价值。方法25例体检健康者为对照组,临床疑诊35例腕管综合征和22例尺神经卡压患者为病变组,超声探查正中神经豌豆骨水平横断面积及其前后径(D1)、钩骨勾水平前后径(D2)、钩骨勾水平远端前后径(D3),肘部尺神经横断面积,计算D1与D2差值(D),D3与D2差值(d),将病变组超声检查结果与术中所见进行比较。结果超声可显示正中神经、尺神经卡压后的形态变化,病变组正中神经横断面积、D、d及尺神经横断面积均大于对照组(P<0.03)。与术中所见比较,超声诊断腕管综合征、肘管综合征准确率分别为97.9%、95.4%。结

  13. Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit.

    Science.gov (United States)

    Kim, J H; Gong, H S; Lee, H J; Lee, Y H; Rhee, S H; Baek, G H

    2013-01-01

    We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

  14. New developmental evidence clarifies the evolution of wrist bones in the dinosaur-bird transition.

    Science.gov (United States)

    Botelho, João Francisco; Ossa-Fuentes, Luis; Soto-Acuña, Sergio; Smith-Paredes, Daniel; Nuñez-León, Daniel; Salinas-Saavedra, Miguel; Ruiz-Flores, Macarena; Vargas, Alexander O

    2014-09-01

    From early dinosaurs with as many as nine wrist bones, modern birds evolved to develop only four ossifications. Their identity is uncertain, with different labels used in palaeontology and developmental biology. We examined embryos of several species and studied chicken embryos in detail through a new technique allowing whole-mount immunofluorescence of the embryonic cartilaginous skeleton. Beyond previous controversy, we establish that the proximal-anterior ossification develops from a composite radiale+intermedium cartilage, consistent with fusion of radiale and intermedium observed in some theropod dinosaurs. Despite previous claims that the development of the distal-anterior ossification does not support the dinosaur-bird link, we found its embryonic precursor shows two distinct regions of both collagen type II and collagen type IX expression, resembling the composite semilunate bone of bird-like dinosaurs (distal carpal 1+distal carpal 2). The distal-posterior ossification develops from a cartilage referred to as "element x," but its position corresponds to distal carpal 3. The proximal-posterior ossification is perhaps most controversial: It is labelled as the ulnare in palaeontology, but we confirm the embryonic ulnare is lost during development. Re-examination of the fossil evidence reveals the ulnare was actually absent in bird-like dinosaurs. We confirm the proximal-posterior bone is a pisiform in terms of embryonic position and its development as a sesamoid associated to a tendon. However, the pisiform is absent in bird-like dinosaurs, which are known from several articulated specimens. The combined data provide compelling evidence of a remarkable evolutionary reversal: A large, ossified pisiform re-evolved in the lineage leading to birds, after a period in which it was either absent, nonossified, or very small, consistently escaping fossil preservation. The bird wrist provides a modern example of how developmental and paleontological data illuminate

  15. New Developmental Evidence Clarifies the Evolution of Wrist Bones in the Dinosaur–Bird Transition

    Science.gov (United States)

    Botelho, João Francisco; Ossa-Fuentes, Luis; Soto-Acuña, Sergio; Smith-Paredes, Daniel; Nuñez-León, Daniel; Salinas-Saavedra, Miguel; Ruiz-Flores, Macarena; Vargas, Alexander O.

    2014-01-01

    From early dinosaurs with as many as nine wrist bones, modern birds evolved to develop only four ossifications. Their identity is uncertain, with different labels used in palaeontology and developmental biology. We examined embryos of several species and studied chicken embryos in detail through a new technique allowing whole-mount immunofluorescence of the embryonic cartilaginous skeleton. Beyond previous controversy, we establish that the proximal–anterior ossification develops from a composite radiale+intermedium cartilage, consistent with fusion of radiale and intermedium observed in some theropod dinosaurs. Despite previous claims that the development of the distal–anterior ossification does not support the dinosaur–bird link, we found its embryonic precursor shows two distinct regions of both collagen type II and collagen type IX expression, resembling the composite semilunate bone of bird-like dinosaurs (distal carpal 1+distal carpal 2). The distal–posterior ossification develops from a cartilage referred to as “element x,” but its position corresponds to distal carpal 3. The proximal–posterior ossification is perhaps most controversial: It is labelled as the ulnare in palaeontology, but we confirm the embryonic ulnare is lost during development. Re-examination of the fossil evidence reveals the ulnare was actually absent in bird-like dinosaurs. We confirm the proximal–posterior bone is a pisiform in terms of embryonic position and its development as a sesamoid associated to a tendon. However, the pisiform is absent in bird-like dinosaurs, which are known from several articulated specimens. The combined data provide compelling evidence of a remarkable evolutionary reversal: A large, ossified pisiform re-evolved in the lineage leading to birds, after a period in which it was either absent, nonossified, or very small, consistently escaping fossil preservation. The bird wrist provides a modern example of how developmental and paleontological

  16. 腕管内压测量及其临床意义%Carpal tunnel internal pressure measurement and its clinical significance

    Institute of Scientific and Technical Information of China (English)

    罗特坚; 刘冬强; 全金海; 肖亮; 徐运碧; 伍日萍

    2011-01-01

    Objective To research into the etiology of carpal tunnel syndrome and seek for the best therapy. Methods The internal pressure of carpal tunnel above and under transverse carpal ligament were measured by blood pressure monitor and the thickness of transverse carpal ligament was observed. Results The internal pressure of carpal runnel was ( 1.39 ±1.14) mmHg and ( 1.81 ±0.72)mmHg above the ligament while it was (3.02 ± 1.12) mmHg and ( 3.15 ± 1.23 ) mmHg below the ligament. The thickness of transverse carpal ligament was (0.13 ±0.06)mm. No results of internal pressure could be detected by this blood pressure monitor after cutting off transverse carpal ligament. Conclusion The internal pressure of carpal tunnel is connected with the thickness of transverse carpal ligament. The factor that makes transverse carpal ligament thicker is one of the inducing factors of carpal tunnel syndrome.%目的探讨腕管综合症的发病原因,寻找治疗腕管综合症的最佳方法.方法利用通过造改的血压测量器,测量腕管在碗横韧带上、下方的内压;观察测量腕横韧带的厚度.结果腕管内压力在韧带上方左侧为(1.39±1.14)mmHg,右侧为(1.81±0.72)mmHg,在韧带下方左侧为(3.02±1.12)mmHg,右侧为(3.15±1.23)mmHg;腕横韧带的厚度为(0.13±0.06)mm.切断腕横韧带后用此种压力测量器尚未测出腕管内压.结论腕管内压的维持与腕横韧带的厚度有一定关系,某种因素造成腕横韧带的增厚是腕管综合症的发病原因之一.

  17. Trabecular bone structure in the primate wrist.

    Science.gov (United States)

    Schilling, Ann-Marie; Tofanelli, Sergio; Hublin, Jean-Jacques; Kivell, Tracy L

    2014-05-01

    Trabecular (or cancellous) bone has been shown to respond to mechanical loading throughout ontogeny and thus can provide unique insight into skeletal function and locomotion in comparative studies of living and fossil mammalian morphology. Trabecular bone of the hand may be particularly functionally informative because the hand has more direct contact with the substrate compared with the remainder of the forelimb during locomotion in quadrupedal mammals. This study investigates the trabecular structure within the wrist across a sample of haplorhine primates that vary in locomotor behaviour (and thus hand use) and body size. High-resolution microtomographic scans were collected of the lunate, scaphoid, and capitate in 41 individuals and eight genera (Homo, Gorilla, Pan, Papio, Pongo, Symphalangus, Hylobates, and Ateles). We predicted that particular trabecular parameters would 1) vary across suspensory, quadrupedal, and bipedal primates based on differences in hand use and load, and 2) scale with carpal size following similar allometric patterns found previously in other skeletal elements across a larger sample of mammals and primates. Analyses of variance (trabecular parameters analysed separately) and principal component analyses (trabecular parameters analysed together) revealed no clear functional signal in the trabecular structure of any of the three wrist bones. Instead, there was a large degree of variation within suspensory and quadrupedal locomotor groups, as well as high intrageneric variation within some taxa, particularly Pongo and Gorilla. However, as predicted, Homo sapiens, which rarely use their hands for locomotion and weight support, were unique in showing lower relative bone volume (BV/TV) compared with all other taxa. Furthermore, parameters used to quantify trabecular structure within the wrist scale with size generally following similar allometric patterns found in trabeculae of other mammalian skeletal elements. We discuss the challenges

  18. The responsiveness of sensibility and strength tests in patients undergoing carpal tunnel decompression

    Directory of Open Access Journals (Sweden)

    Miller Leanne

    2011-10-01

    Full Text Available Abstract Background Several clinical measures of sensory and motor function are used alongside patient-rated questionnaires to assess outcomes of carpal tunnel decompression. However there is a lack of evidence regarding which clinical tests are most responsive to clinically important change over time. Methods In a prospective cohort study 63 patients undergoing carpal tunnel decompression were assessed using standardised clinician-derived and patient reported outcomes before surgery, at 4 and 8 months follow up. Clinical sensory assessments included: touch threshold with monofilaments (WEST, shape-texture identification (STI™ test, static two-point discrimination (Mackinnon-Dellon Disk-Criminator and the locognosia test. Motor assessments included: grip and tripod pinch strength using a digital grip analyser (MIE, manual muscle testing of abductor pollicis brevis and opponens pollicis using the Rotterdam Intrinsic Handheld Myometer (RIHM. The Boston Carpal Tunnel Questionnaire (BCTQ was used as a patient rated outcome measure. Results Relative responsiveness at 4 months was highest for the BCTQ symptom severity scale with moderate to large effects sizes (ES = -1.43 followed by the BCTQ function scale (ES = -0.71. The WEST and STI™ were the most responsive sensory tests at 4 months showing moderate effect sizes (WEST ES = 0.55, STI ES = 0.52. Grip and pinch strength had a relatively higher responsiveness compared to thenar muscle strength but effect sizes for all motor tests were very small (ES ≤0.10 or negative indicating a decline compared to baseline in some patients. Conclusions For clinical assessment of sensibility touch threshold assessed by monofilaments (WEST and tactile gnosis measured with the STI™ test are the most responsive tests and are recommended for future studies. The use of handheld myometry (RIHM for manual muscle testing, despite more specifically targeting thenar muscles, was less responsive than grip or tripod

  19. Wrist Ultrasonography vs. Electrophysiological Studies in the Diagnosis of Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Amirhossein Hashemi Attar

    2009-01-01

    Full Text Available   "nIntroduction: The carpal tunnel syndrome (CTS is the most common entrapment neuropathy and is caused by compression of the median nerve in the carpal tunnel. It is characterized by pain or paresthesia in areas innervated by the median nerve. Electrophysiological studies are gold standard diagnostic tests for CTS. The objective of this study was to compare ultrasonography and electrophysiological studies in the diagnosis of CTS. "nMaterials and Methods: This cross sectional study was conducted on 100 wrists of 50 consecutive patients referred to 22-Bahman hospital (Mashhad with the clinical diagnosis of CTS from spring 2007 to summer 2008. These patients suspicious for CTS in at least one of their wrists (based on their complaints and neurological examination including Tinel’s test and Phallen test, were referred for electrophysiological studies including nerve conduction velocity and electromyography. All the patients underwent ultrasonography of both wrists within a week after electrophysiological studies. Ultrasonographies were performed by a radiologist using a high frequency (12 MHz linear probe (PHILIPS Envisor C. The cross sectional area of the median nerve was measured at the carpal tunnel. Measurements equal or more than 10 mm2 were considered as the CTS. Ultrasonographic findings and also clinical examination (Tinel’s test and Phalen’s test were compared with electrophysiological studies (as the gold standard diagnostic test for each wrist separately. "nResults: Of the 100 wrists (50 patients, 53 wrists were diagnosed as CTS based on the electrophysiological studies. Ninety one percent of the wrists with CTS were in female patients. The mean age was 52.1 years (23-75 years. There was no predisposing factor for most cases; however, 6% were affected by diabetes, 6% by hypertriglyceridemia, and 2% by hypothyroidism. The sensitivity, specificity and accuracy of clinical examination (Tinel’s test and Phalen’s test were 59%, 88

  20. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

    Science.gov (United States)

    Chung, Vincent C.H.; Ho, Robin S.T.; Liu, Siya; Chong, Marc K.C.; Leung, Albert W.N.; Yip, Benjamin H.K.; Griffiths, Sian M.; Zee, Benny C.Y.; Wu, Justin C.Y.; Sit, Regina W.S.; Lau, Alexander Y.L.; Wong, Samuel Y.S.

    2016-01-01

    Background: The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods: We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results: Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] −0.20, 95% confidence interval [CI] −0.36 to −0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD −6.72, 95% CI −10.9 to −2.57), function (Functional Status Scale score MD −0.22, 95% CI −0.38 to −0.05), dexterity (time to complete blinded pick-up test MD −6.13 seconds, 95% CI −10.6 to −1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale −0.70, 95% CI −1.34 to −0.06), and not significant for sensation (first finger monofilament test −0.08 mm, 95% CI −0.22 to 0.06). Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting. Trial registration: Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health

  1. Open Defective Trapezium Fracture Treated with Local Bone Graft: A Case Report

    Directory of Open Access Journals (Sweden)

    Omer Ersen

    2014-12-01

    Full Text Available Generally fractures of trapezium are uncommon and account for 3-5% of all carpal fractures. About 20% of these are vertical sagittal split fractures and rarely occur isolated. The number of reported cases of open trapezium fractures is few. Open trapezium injuries of thumb are demanding injuries that need accurate restoration of damaged stuructures to gain normal thumb function. Otherwise it results in impairment of funtion due to limitation of motion, pain and weakness of the thumb. In this case report treatment of trapezium fracture with corticocancellous bone grafting from distal radius presented.

  2. Morphology of the thoracic limb bones in the giant anteater

    Directory of Open Access Journals (Sweden)

    Fabrício Singaretti de Oliveira

    2013-11-01

    Full Text Available The giant anteater has a grayish-brown pelage with white and black tones, its skull is elongated, cylindrical, and there are no teeth. Its tail is long, with thick and long bristles, resembling a flag. This is an endangered species, due to the constant degradation of its habitat, in addition to deaths caused by fires and roadkills. Thus, this paper aimed to describe the morphology of the thoracic limb bones in Myrmecophaga tridactyla, focusing on its main bone accidents. We used two specimens of giant anteater collected on highways in the state of Minas Gerais, Brazil, after death due to being run over. The scapula, humerus, radius, ulna, and the hand bones showed particular characteristics adapted to the species’ lifestyle and habits. In general, the scapula resembles that in human beings and the humerus is similar to that in armadillo, the radius and ulna exhibit articular surfaces which enable a wide range of rotational movements in the forearm, the carpal bones are also similar in number and shape to those in human beings, and the fingers are well developed in the giant anteater, having long, strong and sharp claws, especially in the third finger. Thus, the anatomical description of the thoracic limb bones in the giant anteater showed to be important, providing a deeper understanding both of the functional aspects of the thoracic limb and the comparative anatomy of wild animals.

  3. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors

    Science.gov (United States)

    Bongers, Frans JM; Schellevis, Francois G; van den Bosch, Wil JHM; van der Zee, Jouke

    2007-01-01

    Background Most studies on the incidence of the carpal tunnel syndrome and the relation of this disorder with occupation are population-based. In this study we present data from general practice. Aim To compare incidence rates of carpal tunnel syndrome in 1987 with those in 2001, and to study the relationship between carpal tunnel syndrome and occupation. Design of study Analysis of the data of the first and second Dutch National Survey of General Practice, conducted in 1987 and 2001, respectively. Setting General practices in The Netherlands. Method One hundred and three general practices in 1987 with 355 201 listed patients, and 96 practices with 364 998 listed patients in 2001, registered all patients who presented with a new episode of carpal tunnel syndrome. Patient and GP populations were representative for The Netherlands. Results The crude incidence rate was 1.3 per 1000 (95% confidence interval [CI] = 1.0 to 1.5) in 1987, and 1.8 per 1000 (95% CI = 1.7 to 2.0) in 2001. In males it was 0.6 (95% CI = 0.5 to 0.7) and 0.9 (95% CI = 0.8 to 1.0) respectively; in females 1.9 (95% CI = 1.7 to 2.1) and 2.8 (95% CI = 2.6 to 3.1). At both study periods, peak incidence rate occurred in the 45–64-year age group: in 2001 this peak reached 4.8 per 1000 (95 CI = 4.1 to 5.4) for females and 1.6 (95 CI = 1.2 to 2.0) for males. Women who performed unskilled and semi-skilled work had 1.5 times greater risk of acquiring carpal tunnel syndrome than women with higher-skilled jobs (P<0.001). In men no relationship of this kind was found. Conclusion In 2001 the crude incidence rate of carpal tunnel syndrome was 1.5 times higher than in 1987, but the difference was not statistically significant after subdividing by age and sex. In both years the female:male ratio was 3:1. Incidence rates were related to the job level of women, but not of men. PMID:17244422

  4. Clinical analysis on endoscopic carpal tunnel release and double incision carpal tunnel release for carpal tunnel syndrome%内镜下和双小切口手术方法治疗腕管综合征的疗效分析

    Institute of Scientific and Technical Information of China (English)

    周军; 杨丽; 于宝占; 王明钢

    2014-01-01

    目的:探讨内镜下腕管松解术和双小切口腕管松解术治疗腕管综合征的临床疗效和安全性差异。方法:将70例腕管综合征患者随机分为内镜下腕管松解术组(A组,35例)和双小切口腕管松解术组(B组,35例),随访24个月,采用Kelly分级评定法评价比较两种手术的术后临床疗效和安全性差异。结果:A组优良率为91.4%,B组优良率为88.6%,两组的优良率比较差异无统计学意义(x2=0.328,P>0.05);A组的住院时间及术后恢复工作时间显著优于B组,差异有统计学意义(t=3.859,t=2.293;P<0.05)。结论:双小切口腕管松解术及内镜下腕管松解术治疗腕管综合征均为有效的手术治疗方法,但内镜下腕管松解术的住院时间短、术后恢复更快。%Objective:To investigate the differences of clinical efficacy and safty for carpal tunnel syndrome with two different surgical methods. Methods: Seventy patients with carpal tunnel syndrome were randomly divided into two groups: endoscopic carpal tunnel release (A group, 35 patients) and double incision carpal tunnel release (B group, 35 patients), during the course of follow-up, the clinical efficacy and complications were analyzed and evaluated. Result: The excellent rate of A group and B group were 91.4%and 88.6%respectively, there was no significant difference between two groups(x2=0.328, P>0.05), but hospital stay and recovering time of A group were shorter than Group B (t=0.328, t=0.328; P<0.05). Conclusion: The endoscopic carpal tunnel release and double incision carpal tunnel release are both effective and safe for carpal tunnel syndrome, but endoscopic carpal tunnel release is superior with double incision carpal tunnel release with shorter hospital stay and recovering time.

  5. CARPAL TUNNEL SYNDROME. ETIOLOGICAL, CLINICAL AND ELECTROPHYSIOLOGICAL ASPECTS OF 262 CASES

    Institute of Scientific and Technical Information of China (English)

    卢祖能; 汤晓芙

    1995-01-01

    Two hundred and sixty-two patients with carpal turmel syndrome (CTS) were analyzed retrospeetively. Results showed that middia-and older-age women were more apt to have CTS than men, and that the dominant hand was more frequently affected. Hormonal changes, repetitive and forceful movements, awkward positions of hand and wrist, and other factors may be associated with CTS. Typical clinical manifestations include pain and pareathesia in the median nerve territory, worsening at night or in the early morning, and being relieved by shaking the hand. Although the patients may localize the discomfort beyond the territory, sensory changes are variable and not entirely reliable. Conduction abnormalities often appeared selectively in the median nerve distal to the wriat in CTS. If the patient who is clinically suggestive of CTS shows normal conduction with conventional methods, palmar stimulation and inching technique is recommended. The diagnosis of CTS requires confirmation of illness history, symptoms and signs with objective electrodiagnostic tests.

  6. [Post-traumatic carpal collapse (SLAC- and SNAC-wrist)--stage classification and therapeutic possibilities].

    Science.gov (United States)

    Krimmer, H; Krapohl, B; Sauerbier, M; Hahn, P

    1997-09-01

    Longstanding scaphoid nonunion or scapholunate ligament injuries can lead to carpal collapse. SLAC-wrist (scapholunate advanced collapse) following scapholunate dissociation and SNAC-wrist (scaphoid nonunion advanced collapse) after missed fusion of scaphoid fracture should be differentiated. Severity of degenerative changes is classified by three stages. In stage I where arthrosis is limited to the radial styloid reconstructive procedures of the scaphoid or scapholunate ligament are the treatment of choice. In stage II including arthrosis of the radioscaphoid joint and stage III with additional arthrosis in the midcarpal joint these procedures are excluded. Salvage procedures preserving wrist mobility like midcarpal fusion or proximal row carpectomy are preferable to total wrist fusion which represents the last line of defence.

  7. Spatial-temporal features of thermal images for Carpal Tunnel Syndrome detection

    Science.gov (United States)

    Estupinan Roldan, Kevin; Ortega Piedrahita, Marco A.; Benitez, Hernan D.

    2014-02-01

    Disorders associated with repeated trauma account for about 60% of all occupational illnesses, Carpal Tunnel Syndrome (CTS) being the most consulted today. Infrared Thermography (IT) has come to play an important role in the field of medicine. IT is non-invasive and detects diseases based on measuring temperature variations. IT represents a possible alternative to prevalent methods for diagnosis of CTS (i.e. nerve conduction studies and electromiography). This work presents a set of spatial-temporal features extracted from thermal images taken in healthy and ill patients. Support Vector Machine (SVM) classifiers test this feature space with Leave One Out (LOO) validation error. The results of the proposed approach show linear separability and lower validation errors when compared to features used in previous works that do not account for temperature spatial variability.

  8. Wheelchair ergonomic hand drive mechanism use improves wrist mechanics associated with carpal tunnel syndrome.

    Science.gov (United States)

    Zukowski, Lisa A; Roper, Jaimie A; Shechtman, Orit; Otzel, Dana M; Hovis, Patty W; Tillman, Mark D

    2014-01-01

    Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression.

  9. Prevalence of carpal tunnel syndrome in cases with migraine and tension type headache

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    Volkan Solmaz

    2015-02-01

    Full Text Available Background: Carpal Tunnel Syndrome (CTS is the most frequent entrapment neuropathy; also Tension Type Headache (TTH and migraine headache are the most common forms of headaches. The aim of this study is to determine whether there is a relationship between carpal tunnel syndrome and migraine and/or TTH, and if so, to determine the factors causing this relationship. Methods: This study included 201 patients who were electro-physiologically diagnosed with idiopathic CTS and 100 controls. In addition to being examined for headaches, each patient's Body Mass Index (BMI was determined, and each was evaluated with Boston Questionnaire Form (BQF and a Beck Depression Scale (BDS. Results: The CTS group had significantly more patients with TTH and migraine headache than did the control group. In addition, the CTS group had a significantly higher frequency of headaches, and significantly higher BDS and BMI than did the controls. There were no significant differences in headache type and frequency of headache between those with mild CTS and those with mild-serious CTS. In addition, the Boston scores of CTS patients with headache were higher than those CTS patients without headache. Further, the monthly income levels of patients with CTS were lower than those of the control group. Conclusion: We found that primary headache is more frequent in CTS patients than in controls. This may be due to somato-autonomic reflexes and other common risk factors that can be seen in both CTS patients and those with headache, including obesity, depression and low level of income. [Int J Res Med Sci 2015; 3(2.000: 456-460

  10. [Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)].

    Science.gov (United States)

    Sauerbier, M; Bickert, B; Tränkle, M; Kluge, S; Pelzer, M; Germann, G

    2000-07-01

    Longstanding and untreated scaphoid fractures and scapholunate dissociations lead to painful destruction of the wrist with carpal collapse. The severity of degenerative arthrosis is classified in three stages and can be treated adequate operatively. SNAC wrist (scaphoid nonunion advanced collapse) after failed fusion of the scaphoid and SLAC wrist (scapholunate advanced collapse) after scapholunate dissociation should be differentiated. The reconstruction of the scaphoid or scapholunate ligament in stage II and III is no reasonable option. Motion preserving procedures such as proximal row carpectomy or midcarpal arthrodesis are preferable in this situation. Thirty-one male patients (average 41 years) were treated for SNAC or SLAC wrist with midcarpal arthrodesis. All patients were reexamined, the mean follow-up was 15 months. Grip strength was measured with the Dexter-System, pain was evaluated by a visual analogue scale (VAS 0-100). Patients' daily activities and general quality of life were estimated with the DASH-questionnaire. Pain was reduced to 50% compared to the preoperative situation. Grip strength improved to 60% of the opposite side. Active range of motion reached 50% of the contralateral wrist. Total DASH-score reached 39.0. Nonunion at the fusion site necessitated additional surgery in four patients resulting in total wrist arthrodesis. 80% of the patients returned to their original occupation. Midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed. The DASH-score reflects the subjective impressions of the patients in daily life and justifies the choice of a salvage procedure preserving wrist mobility. Total wrist fusion represents the last line of defense.

  11. A study of interpolation method in diagnosis of carpal tunnel syndrome

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    Alireza Ashraf

    2013-01-01

    Full Text Available Context: The low correlation between the patients′ signs and symptoms of carpal tunnel syndrome (CTS and results of electrodiagnostic tests makes the diagnosis challenging in mild cases. Interpolation is a mathematical method for finding median nerve conduction velocity (NCV exactly at carpal tunnel site. Therefore, it may be helpful in diagnosis of CTS in patients with equivocal test results. Aim: The aim of this study is to evaluate interpolation method as a CTS diagnostic test. Settings and Design: Patients with two or more clinical symptoms and signs of CTS in a median nerve territory with 3.5 ms ≤ distal median sensory latency <4.6 ms from those who came to our electrodiagnostic clinics and also, age matched healthy control subjects were recruited in the study. Materials and Methods: Median compound motor action potential and median sensory nerve action potential latencies were measured by a MEDLEC SYNERGY VIASIS electromyography and conduction velocities were calculated by both routine method and interpolation technique. Statistical Analysis Used: Chi-square and Student′s t-test were used for comparing group differences. Cut-off points were calculated using receiver operating characteristic curve. Results: A sensitivity of 88%, specificity of 67%, positive predictive value (PPV and negative predictive value (NPV of 70.8% and 84.7% were obtained for median motor NCV and a sensitivity of 98.3%, specificity of 91.7%, PPV and NPV of 91.9% and 98.2% were obtained for median sensory NCV with interpolation technique. Conclusions: Median motor interpolation method is a good technique, but it has less sensitivity and specificity than median sensory interpolation method.

  12. Predictors of normal electrodiagnostic testing in the evaluation of suspected carpal tunnel syndrome.

    Science.gov (United States)

    Watson, Jeffrey; Zhao, Meijuan; Ring, David

    2010-12-01

    Electrodiagnostic studies (electromyography and nerve conduction velocity; EMG/NCV) are used to confirm the diagnosis of carpal tunnel syndrome (CTS) and to evaluate its severity. We investigated the hypothesis that normal electrodiagnostic median nerve testing is predicted by 1) Physician pre-test confidence in the diagnosis of CTS, and 2) Puzzling patient factors. One hundred and forty consecutive patients who underwent electrodiagnostic testing to evaluate for possible CTS were reviewed retrospectively. Both physician confidence in the diagnosis of CTS and puzzling patient factors (heightened illness concern, disproportionate complaints, and vague/nonanatomical/noncharacteristic symptoms) were recorded. Electrodiagnostic testing was used as the reference standard for diagnosis of CTS. Electrodiagnostic testing confirmed CTS in 115 patients and was within normal limits in 25 patients. Low physician confidence in the diagnosis of CTS was highly predictive of a normal electrodiagnostic test (p < 0.001), with high sensitivity (97%), moderate specificity (40%), and high overall accuracy (87%). Puzzling patient factors were moderately predictive of normal electrodiagnostic testing (p < 0.001), with low sensitivity (16%), high specificity (96%), and high overall accuracy (81%). The best multivariable model retained younger age, negative Phalen's test, and low physician confidence as the best predictors of normal electrodiagnostic testing and explained 35% of the variation in test results. A model with low confidence alone explained 19% of the variation in test results. Physician intuition as recorded in the medical record in terms of puzzlement and low confidence are very specific and accurate predictors of normal electrodiagnostic testing in the setting of suspected carpal tunnel syndrome.

  13. A Cross-Sectional Study of Musculoskeletal Health Literacy in Patients With Carpal Tunnel Syndrome.

    Science.gov (United States)

    Rosenbaum, Andrew J; Dunkman, Andrew; Goldberg, Daniel; Uhl, Richard L; Mulligan, Michael

    2016-09-01

    Background: Approximately 33% of Americans have inadequate health literacy, which is associated with infrequent use of preventative services, increased hospitalization and use of emergency care, and worse control of chronic diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients undergoing carpal tunnel release (CTR), as these individuals may be at increased risk of inferior outcomes. Methods: This cross-sectional study included individuals older than or equal to 18 years of age who were scheduled for elective CTR. Participants completed a demographic survey and the LiMP questionnaire during their preoperative office visit. The prevalence of limited health literacy was determined, with chi-square analysis used to determine the influence of demographic parameters. Results: The mean LiMP score was 6 ± 1.40. Limited musculoskeletal literacy was seen in 34% of participants (22/65). Analysis identified race (Caucasian), gender (female), higher education levels (≥college), current or prior employment in a health care field, and a prior physician visit for a non-carpal tunnel musculoskeletal complaint as being associated with higher literacy rates. Conclusions: Approximately one-third of patients scheduled for elective CTR have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning, as CTR is performed in the United States on roughly 500 000 individuals annually, at an estimated cost of 2 billion dollars. The identification of those most at risk is thus crucial, and will facilitate the development of education campaigns and interventions geared toward those who are most vulnerable.

  14. Short-distance sensory stimulation technique in the early diagnosis of carpal tunnel syndrome

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    Betül Çevik

    2013-12-01

    Full Text Available Aim. Normal results obtained from nerve conduction studies do not exclude the diagnosis of carpal tunnel syndrome (CTS. We intended to increase diagnostic sensitivity of nerve conduction studies in the early stage CTS by stimulating shorter palm-wrist segment, and excluding distal region outside the entrapment site of the median nerve which is unaffected from pathologic changes. Methods. In this prospective study, 41 patients (66 hands with clinically diagnosed CTS with normal conventional electrophysiologic examinations were stimulated with electrodes placed at 8, 7, 6, 5, 4 cm from the distal wrist crease (DWC on the palm-wrist segment, and the conduction velocities, latencies, and the differential latencies (conduction delay were compared with those of 34 patients (68 hands in the control group. Results. Conduction delay recorded between 4-5, 5-6, 6-7, 7-8 cm. away from DWC of both groups was statistically insignificant (p>0.1, while the conduction velocities and the latencies obtained from the electrodes placed on 4, 5, 6, 7, and 8 cm away from DWC differed statistically significantly between two groups (p<0.001. Conclusion. In electrophysiologic examinations performed to confirm the diagnosis of CTS, assessment of shorter palm-wrist segment, and stimulation of a predetermined location 4 or 5 cm distal to DWC are sufficient to detect a slight and localized conduction delay in the carpal tunnel. This method eliminated slowing-down effect of distal segment on normal nerve conduction velocities yielding higher degrees of (up to 92.4 % sensitivity.

  15. Enhanced expression of Wnt9a in the flexor tenosynovium in idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Yamanaka, Yoshiaki; Menuki, Kunitaka; Zenke, Yukichi; Hirasawa, Hideyuki; Sakai, Akinori

    2015-10-01

    This study aimed to clarify the association between abnormal Wnt signaling and the cause of idiopathic carpal tunnel syndrome (ICTS) and whether an association exists between Wnt signaling and cell proliferation in the flexor tenosynovium. The subjects included nine patients with ICTS; the controls were nine patients with distal radius fractures without any symptoms of carpal tunnel syndrome. We extracted mRNA from the flexor tenosynovium and compared the expression levels of genes encoding 17 types of Wnt in both subjects and controls via quantitative real-time polymerase chain reaction (PCR). Expression levels of factors involved in cell proliferation, such as estrogen-responsive finger protein, epidermal growth factor receptor, heparin binding-epidermal growth factor-like growth factor, insulin-like growth factor-1, and vascular endothelial growth factor (VEGF) were also measured using quantitative real-time PCR. In addition, we compared the Wnt and MIB-1 protein expression levels to clarify the effect of Wnt on cell proliferation. Quantitative real-time PCR revealed significantly greater expression of the gene encoding Wnt9a in subjects with ICTS than in controls and also revealed a positive correlation between the expression of genes encoding Wnt9a and VEGF in subjects with ICTS. Quantitative evaluation using immunohistochemical staining also indicated more marked Wnt9a expression in subjects than in controls. However, there was no relationship between the expression of Wnt9a and the cell proliferation index MIB-1. These results indicate that Wnt9a expression is enhanced in ICTS and that Wnt9a may be involved in VEGF expression in ICTS.

  16. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome.

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    Tai-Tzung Kuo

    Full Text Available Carpal tunnel syndrome (CTS is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS. Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion-extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for

  17. Early diagnosis of Carpal Tunnel Syndrome (CTS in Indian patients by nerve conduction studies

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    Dr. Geetanjali Sharma MD

    2010-07-01

    Full Text Available The present study was carried out for early confirmation of clinically diagnosed patients of Carpal Tunnel Syndrome (CTS by electro-diagnostic tests which included motor conduction, sensory conduction studies and F-wave studies. The aim of the study was early confirmation of clinically suspected patients of CTS by motor and sensory conduction studies of median and ulnar nerves. Eighty subjects of age group 30-50 years (40 clinically suspected patients of CTS, 40 as control group were studied. Motor and Sensory conduction velocities, distal motor and sensory latencies and F wave latencies of median and ulnar nerves were performed using RMS EMG EP Mark –II. Statistically significant (P < 0.001 slowing of motor conduction velocities for both nerves was seen in the CTS group as compared to control group. Decrease in sensory conduction velocity was more pronounced in CTS group as compared to Control group. Statistically significant (P < 0.001 increase in distal motor and sensory latencies was also observed for both median and ulnar nerves in the CTS group as compared to Control group, with more increase in distal motor latency than sensory latency. Increase in F wave latencies of both nerves was seen in the CTS group. Electrophysiological studies confirmed the early diagnosis of CTS with a high degree of sensitivity. Present results confirm selective slowing of sensory & motor conduction within wrist to palm segment in patients of CTS which is attributable to compression by the transverse carpal ligament or to a disease process of the terminal segment.

  18. Effect of Wrist Deviation on Median Nerve Cross-Sectional Area at Proximal Carpal Tunnel Level

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    Ping Yeap LOH

    2015-10-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is one of the most common musculoskeletal disorders among computer users. Computer users exhibit various wrist angles while typing. Dynamic changes of wrist angle may cause different degrees of median nerve compression. The objective of this study was thus to investigate the effects of the combination of wrist flexion-extension with wrist deviation on median nerve cross-sectional area (MNCSA.Methods:  Eight right-handed participants were recruited in this study. Both wrists were examined by sonographic ultrasound (US at the proximal carpal tunnel level in the transverse plane. A total of nine wrist positions were examined, including wrist neutral (WN, wrist flexion (WF30°, and wrist extension (WE30°, together with three wrist deviation conditions, namely, without radial deviation (RD and ulnar deviation (UD, with maximal RD and with maximal UD. MNCSA was measured by tracing method with ImageJ.Results: Paired t-test showed a significant difference of WN MNCSA between the dominant hand (7.93 ± 0.63 mm2 and the non-dominant hand (6.98 ± 0.42 mm2 (P<0.001. Two-way repeated-measures ANOVA (handedness as an independent factor showed that WF30° and WE30° caused significant differences of MNCSA when compared with WN (P<0.001. However, wrist RD/UD did not have a significant interaction with the changes of MNCSA in WN, WF and WE positions.Conclusion: The results indicate a significant reduction of MNCSA when WN changed to WF and WE. Wrist RD and UD did not cause significant changes of MNCSA at different wrist positions. Keywords: Median nerve, Ultrasound, Wrist active holding, Nerve deformation

  19. Bone cutting.

    Science.gov (United States)

    Giraud, J Y; Villemin, S; Darmana, R; Cahuzac, J P; Autefage, A; Morucci, J P

    1991-02-01

    Bone cutting has always been a problem for surgeons because bone is a hard living material, and many osteotomes are still very crude tools. Technical improvement of these surgical tools has first been their motorization. Studies of the bone cutting process have indicated better features for conventional tools. Several non-conventional osteotomes, particularly ultrasonic osteotomes are described. Some studies on the possible use of lasers for bone cutting are also reported. Use of a pressurised water jet is also briefly examined. Despite their advantages, non-conventional tools still require improvement if they are to be used by surgeons.

  20. A randomized prospective study to assess the efficacy of two cold-therapy treatments following carpal tunnel release.

    Science.gov (United States)

    Hochberg, J

    2001-01-01

    A prospective randomized study was performed comparing the efficacy of controlled cold therapy (CCT) with the efficacy of ice therapy in the postoperative treatment of 72 patients with carpal tunnel syndrome. Immediately after surgery, patients applied either a temperature-controlled cooling blanket (CCT) or a standard ice pack over their surgical dressings. Pain was assessed by visual analog scale and swelling by wrist circumference preoperatively, immediately after surgery, and on postoperative day 3. Patients kept log books of daily treatment times. Narcotic use (of Vicodin ES) was determined by pill count at day 3 and by daily log book recordings. Patients who used CCT showed significantly greater reduction in pain, edema (wrist circumference), and narcotic use at postoperative day 3 than did those using ice therapy. This study indicates that after carpal tunnel surgery, the use of CCT, compared with traditional ice therapy, provides patients with greater comfort and lessens the need for narcotics.

  1. RESEARCH PROGRESS OF TREATMENT OF CARPAL TUNNEL SYNDROME%腕管综合征治疗研究进展

    Institute of Scientific and Technical Information of China (English)

    冯仕明; 高顺红

    2011-01-01

    Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent literature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist splinting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more clinical researches, and surgical treatment is one method recommended by some scholars.%目的 对腕管综合征(carpal tunnel syndrome,CTS)的治疗研究现状作一综述.方法 查阅近年来国内外CTS治疗的相关文献,进行分析总结.结果 腕夹板、类固醇适用于轻、中度CTS患者,近期效果显著;治疗后复发的CTS患者需采取手术治疗.主要术式为腕管松解术,包括腕管切开松解减压术(传统型和小切口型)、内镜下腕管松解减压术等.结论 CTS的最佳治疗方法 尚无定论,部分学者推荐首选手术治疗.

  2. Comparison of the Effects between Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome (Randomized, Controlled Clinical Trial

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    Ji-young Ku

    2010-12-01

    Full Text Available Objectives : The purpose of this study is to compare the effects of Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture on Carpal Tunnel Syndrome. Methods : From February to September 2010, the number of patients with Carpal Tunnel Syndrome who volunteered for this clinical study was 16 and 7 out of 16 patients complained both hands. Total 23 cases of hands were randomly divided by 2 groups. We injected Sweet Bee Venom Pharmacopuncture on PC7(Daereung twice a week for 4weeks for experimental group(n=11, and Scolopendrid Pharmacopuncture with the same methods for control group(n=12. One case was dropped out due to itchiness of allergic response in the experimental group. Improvement of the symptoms was evaluated by Visual Analogue Scale, Pain Rating Scale, Tinel’s sign, Phalen’s sign and Nerve Conduction Velocity. Nerve Conduction Velocity was checked at baseline and the end of the trial and others were checked at baseline, after 2 and 4 weeks. Results : Both groups showed significant improvement in Visual Analogue Scale, Pain Rating Scale, but no significant difference between two groups. Only the control group showed significant reduction of the‘ poitive response’in the Tinel’s sign and Phalen’s sign. However, no groups improved in Nerve Conduction Velocity. Conclusions : These results showed that Sweet Bee Venom Pharmacopuncture and Scolopendrid Pharmacopuncture could decrease the symptoms of Carpal Tunnel Syndrome. Further studies will be required to examine more cases for the long period and use more various concentration and amount pharmacopuncture for the effect on Carpal Tunnel Syndrome.

  3. [Carpal tunnel syndrome in workers engaged in the assembly of manufactured products in various industries in the province of Brescia].

    Science.gov (United States)

    Barbieri, P G

    1996-01-01

    Tests were carried out on five manual assembly departments in a variety of different factories, in order to assess the risks associated with the onset of Carpal Tunnel Syndrome and to describe the prevalence of this disorder among exposed workers. The application of the risk analysis method proposed by the EPM Research Unit in Milan (Italy) demonstrated the presence of numerous jobs featuring both a high frequency of actions per minute and a total lack of recovery times, in addition to a variety of incongrous upper limb postures. The clinical and instrumental investigation diagnosed 76 cases of Carpal Tunnel Syndrome among the 170 exposed workers. 62% of the cases was bilateral and 24% was associated with Guyon Channel Syndrome. In two of the five departments reviewed, the carpal tunnel disorders detected were endemic, and featured unusually high prevalence. The situation had been seriously underestimated by the company technical and medical staff, resulting in a failure to call for the urgent adoption of individual protection and collective prevention measures. The authors recommend that an extensive and adequate occupational risk assessment analysis be performed: the local occupational health services could play a critical role in identifying the highest risk industries and the diseases diagnosed in a hospital environment.

  4. Age dependent T2 changes of bone marrow in pediatric wrist MRI

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    Shabshin, Nogah [Chaim Sheba Medical Center, Department of Diagnostic Imaging, Tel-HaShomer (Israel); Schweitzer, Mark E. [The Ottawa Hospital, The University of Ottawa, Department of Diagnostic Imaging, Ottawa (Canada)

    2009-12-15

    Hyperintensity of the bone marrow on fluid-sensitive sequences can be seen on magnetic resonance imaging (MRI) during childhood, even in the absence of bone pathology. They can be related to hematopoietic marrow, normal and abnormal bone remodeling. We sought to investigate whether hyper intensity of the bone marrow on MRI of the wrist is age-dependent and to evaluate if this signal follows a consistent age-related pattern. Thirty-one wrist 1.5 T MR images of children (7-18 years) without suspected bone pathology were evaluated for foci of hyperintense bone marrow seen on fluid-sensitive coronal sequences using a scale of 1-3. Correlation of frequency, location and intensity of these foci with age was obtained. Results were analyzed for distribution in single bones and in the following regions: distal forearm, first/second carpal rows, and metacarpal bases. A total of 448 bones were evaluated. Eighty-eight out of 448 (21 out of 31 wrists) showed hyperintense bone marrow seen on fluid-sensitive sequences. The distribution was: radius in 19, ulna in 19, first metacarpal base in 11, scaphoid in 9, lunate in 6, pisiform in 6, and fifth metacarpal base in 1. The involvement of the first and second carpal rows and the metacarpal bases was almost similar (13, 12, and 12 respectively). In the distal forearm, the intensity was similar to or higher than that in the wrist (2.2 vs. 2.0). Frequency decreased with age (100% at 7-9 and 25% at 16-18 years). Foci of hyperintense bone marrow seen on fluid-sensitive sequences can be seen on MRI of the wrist during childhood even without apparent symptoms. It shows a consistent pattern with maturation: frequency and intensity decrease and there is distal-to-proximal resolution. This may be a normal finding that may represent normal bone remodeling or decreasing hematopoietic marrow and should not be confused with pathological bone marrow edema. (orig.)

  5. Factors Influencing Student Performance on the Carpal Bone Test as a Preliminary Evaluation of Anatomical Knowledge Retention

    Science.gov (United States)

    Meyer, Amanda J.; Armson, Anthony; Losco, C. Dominique; Losco, Barrett; Walker, Bruce F.

    2015-01-01

    It has been demonstrated that a positive correlation exists between clinical knowledge and retained concepts in basic sciences. Studies have demonstrated a modest attrition of anatomy knowledge over time, which may be influenced by students' perceived importance of the basic sciences and the learning styles adopted. The aims of this study…

  6. Bone x-ray

    Science.gov (United States)

    ... or broken bone Bone tumors Degenerative bone conditions Osteomyelitis (inflammation of the bone caused by an infection) ... Multiple myeloma Osgood-Schlatter disease Osteogenesis imperfecta Osteomalacia Osteomyelitis Paget disease of the bone Rickets X-ray ...

  7. The relationship between physical factors (Wrist ratio and electrophysiologic factors of median nerve in carpal tunnel syndrome in women

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    Oliaiy Gh

    1997-08-01

    Full Text Available Carpal tunnel syndrome (CTS is considered by researchers because of its high prevalence, and several studies have been done to find the causes and factors which increase the chance for the syndrome. These studies have shown relationships between this syndrome with some physical parameters like wrist dimensions, weight and systemic conditions. There is no investigation on risk factors in CTS in our country. So the main goal of this research is to find and introduce predisposing factors for carpal tunnel syndrome. Methods: Seventy patients and 33 controls 22 to 70 years old were studied. Standard methods for median and ulnar nerve studies were used and questionnaires included physical measurements, history of diseases and personal information were completed for each person. Results: Patients had higher wrist ratio (mean difference, 0.0267, P<0.001, weight (mean difference: 6.098, P<0.001 and body mass index (mean difference: 3.376, P<0.001. Regression analysis showed strong positive relation between wrist ratio and median latencies. The strongest correlation was found between wrist ratio and median minus ulnar distal sensory latencies (Y2=0.4014, P<0.0001. No relation was found between weight and body mass index with median latencies. Seventy-nine percent of patients and 48.5% of controls had wrist ratio of 0.7 or greater (P<0.05. Seventy-two percent of patients with repetetive hand activities and 78% with associated conditions had wrist ratio of 0.7 or greater. Seventy-six percent had wrist ratio less than 0.7. No relationship was found between obesity, diabetes, thyroid disorders, rheumatoid arthritis, taking oral contraceptive, hysterectomy, oophorectomy, menopause and repetetive hand activities with involvement of carpal tunnel syndrome. Discussion: Wrist dimensions seem to be an important predictor for carpal tunnel syndrome also in patients with associated conditions. If individuals with squarer wrists are involved in special conditions

  8. Síndrome do túnel do carpo: aspectos atuais Carpal tunnel syndrome: present approaches

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    JOÃO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Baseado na experiência eletrofisiológica do autor em 668 pacientes e em dados de literatura, foi realizada revisão sobre síndrome do túnel do carpo (STC analisando aspectos clínico-epidemiológicos e de conducão nervosa. O nervo mediano sofre desmielinização nodal ou segmentar por compressão no túnel do carpo, 3-4 cm distal à prega do punho. O complexo sintomátíco inclui dormência e fomigamento noturno nas mãos, frequentemente bilateral e mais comum em mulheres na faixa etária de 40-60 anos. São descritos casos familiares em que a herança poderia determinar ligamento transverso do carpo mais espesso. Fatores antropomórficos podem também representar risco adicional porém com pouca significância estatística. Ressonância magnética pode ser útil em casos selecionados e atípicos. São discutidos aspectos do tratamento conservador e controvérsias do tratamento cirúrgico. Na condução nervosa clássica observa-se aumento de latência distal sensitiva (segmentar e motora do nervo mediano. Métodos adicionais de sensibilização incluem latência palma-punho do mediano (misto, diferença de latência palma-punho mediano/ulnar (misto, diferença de latência mediano/radial e mediano/ulnar (sensitivo, técnica da centimetragem punho-palma com registro no II/III dedos e diferença mediano/ulnar com registro lumbrical/interósseo (motor.A clinical, epidemiological and nerve conduction studies report on carpal tunnel syndrome was done after electrophysiological author's experience on 668 cases and literature review. The median nerve underwent focal (nodal or segmental demyelination after compression on carpal tunnel, 3-4 distal to wrist fold. The symptomatic complex includes nocturnal hands numbness and paraesthesia, mostly bilateral and between 40-60 years old. Familial cases are described and the gene could encode thick transverse carpal ligament. Anthropomorphic findings could also bring about an additional risk, but with low

  9. Invited commentary on: Flexor retinaculum division: does it contribute to the success of carpal tunnel release of Krieger Y et al. International J of Ther and Rehab, March 2011, Vol. 18, no.3, p.139-42

    NARCIS (Netherlands)

    Huisstede, Bionka; Hoogvliet, Peter

    2011-01-01

    Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Open decompression of the median nerve is considered the standard surgical treatment for CTS. This article describes a study to assess and compare the clinical efficacy of operative treatment performed by transverse carpal

  10. Influence of body mass index on median nerve function, carpal canal pressure, and cross-sectional area of the median nerve.

    Science.gov (United States)

    Werner, Robert A; Jacobson, Jon A; Jamadar, David A

    2004-10-01

    Obese individuals have slowed conduction in the median nerve across the wrist, but the mechanism for this is not established. This case-control study of 27 obese subjects and 16 thin subjects was designed to test the hypothesis that obese individuals have higher carpal canal pressures and more median nerve swelling than thin individuals. All subjects were asymptomatic for hand symptoms, and had measurements of median and ulnar sensory nerve conduction in the nondominant hand, ultrasound measurement of the median nerve cross-sectional area proximal to the carpal canal, and carpal canal pressure measurement. There was no difference in age or gender ratio between the obese and thin groups. The median nerve cross-sectional area was equal in the obese and thin groups (9.3 mm2 vs. 9.4 mm2), as was the carpal canal pressure (16.2 mmHg vs. 15.5 mmHg, respectively). There was a strong correlation between median nerve conduction slowing across the wrist and median nerve cross-sectional area at the wrist (r = 0.55, P = 0.002). Obesity does not influence carpal canal pressure or the size of the median nerve at the wrist. However, there is a strong association between slowed median nerve conduction and increased nerve size which suggests endoneurial edema as a metabolic mechanism; the conduction slowing does not appear to be related to mechanical stress.

  11. Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome.

    Science.gov (United States)

    Filius, Anika; Scheltens, Marjan; Bosch, Hans G; van Doorn, Pieter A; Stam, Henk J; Hovius, Steven E R; Amadio, Peter C; Selles, Ruud W

    2015-09-01

    Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross-sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70-71% and specificity of 80-84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel.

  12. Value of F-wave studies on the electrodiagnosis of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Alemdar M

    2015-08-01

    Full Text Available Murat Alemdar Sakarya University Education and Research Hospital, Sakarya, Turkey Background: F waves are late electrophysiological responses to antidromic activation of motor neurons and are used to evaluate the conduction along the whole length of peripheral nerves. We aimed to determine the diagnostic efficacies of minimum median nerve F-wave latency (FWL and median-to-ulnar nerve F-wave latency difference (FWLD on carpal tunnel syndrome (CTS. Materials and methods: The electrophysiological studies consisted of sensory and motor nerve conduction and F-wave studies of the median and ulnar nerves. The best cut-off points of minimum median nerve FWL and FWLD for the diagnosis of CTS were detected for the whole study group and for different height subgroups (Group 1: 150–159 cm, Group 2: 160–169 cm, and Group 3: over 170 cm. The diagnostic efficacies of minimum median nerve FWL and FWLD were calculated for the whole CTS group and for the mild CTS group, separately. Results: The best cut-off point of minimum median nerve FWL on the diagnosis of CTS was determined as 24.60 ms for the whole group. It was 23.90 ms for Group 1, 24.80 ms for Group 2, and 28.40 ms for Group 3. The usage of these stratified cut-off points yielded a higher total diagnostic efficacy rate than single cut-off point usage (79.9% vs 69%, respectively; P=0.02. The best cut-off point of FWLD on the diagnosis of CTS was 0.80 ms for the whole group. It was 0.55 ms for Group 1, 0.30 ms for Group 2, and 0.85 ms for Group 3. Both the single cut-off point usage and the stratified chart usage for FWLD had equal diagnostic efficacy (85.1%. In the mild CTS group, diagnostic efficacy was 55.5% for minimum median nerve FWL and 78.8% for FWLD (P=0.0001. Conclusion: Median-to-ulnar nerve FWLD yields a higher diagnostic efficacy than minimum median nerve FWL on the diagnosis of CTS. However, the sensitivities of both parameters are not satisfactory for the extremities with mild CTS

  13. A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Sung Hye [Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722 (Korea, Republic of); Kwon, Bong Cheol, E-mail: hallymradms@gmail.com [Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Park, Chanyeong [Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Hwang, Su Yeon; Lee, Joon Woo [Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707 (Korea, Republic of); Kim, Sam Soo [Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722 (Korea, Republic of)

    2014-11-15

    Highlights: • The good parameters of both scans in CTS diagnosis were CSA(P1), FA(P1) and FA(P0). • Median nerve signal intensity and flexor retinacular bowing were not significantly different between CTS and controls. • The prestenotic swelling of median nerve of CTS was demonstrated as relatively large CSA and low FA value at P1 level. • Combination of both scans in evaluation of carpal tunnel increased diagnostic performance, and provided merits of both scans. - Abstract: Purpose: To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS). Materials and methods: We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1 cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans. Results: The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P > 0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each. Conclusion: The individual performances of both scans were not significantly different in diagnosing CTS

  14. Sonographic assessment of carpal tunnel syndrome in rheumatoid arthritis: prevalence and correlation with disease activity.

    Science.gov (United States)

    Karadag, Omer; Kalyoncu, Umut; Akdogan, Ali; Karadag, Yesim Sucullu; Bilgen, Sule Apras; Ozbakır, Senay; Filippucci, Emilio; Kiraz, Sedat; Ertenli, Ihsan; Grassi, Walter; Calgüneri, Meral

    2012-08-01

    Carpal tunnel syndrome (CTS) is one of the most frequent extra-articular manifestations of rheumatoid arthritis (RA). High frequency ultrasonography (US) is a sensitive and specific method in diagnosis of CTS. This study is aimed to: firstly assess diameter frequency of CTS in RA with US and compare with a control group; secondly, investigate relationship of CTS with disease activity. One hundred consecutive RA patients (women/men: 78/22) fulfilling ACR 1987 RA criteria and 45 healthy controls (women/control: 34/11) were enrolled into study. Disease activity parameters, RA and CTS patient global assessment and health assessment questionnaire (HAQ-DI) were recorded. Both patient and control group were questioned about secondary causes of CTS, and Katz hand diagram, Boston CTS questionnaire and Phalen ve Tinel tests were applied once for each hand. Wrist joint and carpal tunnel were assessed with US grey scale and power Doppler US, then cross-sectional area of median nerve (CSA) was calculated. Patients with median nerve CSA between 10.0 and 13.0 mm(2) were evaluated with electromyography (EMG). CTS was diagnosed if CSA of median nerve >13.0 mm(2) or CTS was shown with NCS. Although there was no difference between RA patients and controls in age, sex, history of DM (+) and goitre, CTS was more frequent in RA group (respectively, 17.0% vs. 4.4%, P = 0.038). In RA group with CTS, age, history of DM, disease duration, HAQ-DI score, CTS patient global score, Boston symptom severity and functional status scores were elevated compared to without CTS [respectively, 57 (36-73) vs. 50 (24-76), P = 0.041; 35.3% vs. 6.0%, P 0.05). Sensitivity of Katz hand diagram was higher than Tinel and Phalen tests (respectively, 100, 60.0, 66.7%). Boston symptom and functional scores of RA patients with CTS diagnosed by EMG were increased than patients CTS (-) by EMG [respectively, 3.05 (1.90-4.27) vs. 1.55 (1.0-2.90), P = 0.002; 3.25 (1.73-3.82) vs. 1.12 (1.0-2.10), P = 0.008]. CTS

  15. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-01-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  16. Bone graft

    Science.gov (United States)

    ... around the area. The bone graft can be held in place with pins, plates, or screws. Why ... Orthopaedic Surgery, San Francosco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  17. Low Bone Density

    Science.gov (United States)

    ... Information › Bone Density Exam/Testing › Low Bone Density Low Bone Density Low bone density is when your ... compared to people with normal bone density. Detecting Low Bone Density A bone density test will determine ...

  18. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome

    Science.gov (United States)

    Azadeh, Hamid; Dehghani, Mohammad; Zarezadeh, Abolghasem

    2010-01-01

    BACKGROUND: Patients with carpal tunnel syndrome (CTS) often complain of prominent pain in shoulder and arm, also there are patients that have pain in their shoulder and arm which is due to myofascial trigger point (MTP) located in their upper trapezius muscle. Despite the frequency of this observation, few studies have previously sought to establish possible relationship between the CTS and MTP in shoulder area. METHODS: Samples were 160 patients (221 hands) consist of 130 females and 30 males, with suspected diagnosis of CTS, from March 2008 to October 2008. In this study after performing electrodiagnosis searches, another evaluation was performed to find out if there was any sign of myofascial trigger point. The correlation between these two was sought. RESULTS: It was found that all of 36 hands with normal electrodiagnostic findings had myofascial trigger points in their upper trapezius muscle. Out of 185 hands, 130 hands (70%) with electrophysiological evidences of CTS showed myofascial trigger points in their trapezius muscles. Statistical analysis revealed significant (p < 0.001) reverse correlation between the severity of CTS and the presence of MTP. CONCLUSIONS: The findings of this study imply the significant correlation between occurrence of CTS and MTP. It is suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS. PMID:21526092

  19. Efficacy of kinesiotaping in patients with the initial signs of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    I. G. Mikhaylyuk

    2016-01-01

    Full Text Available Background. Carpal tunnel syndrome (CTS is one of the most common tunnel neuropathies. Early symptoms are often limited by periodic and slight discomfort in the area of innervation of a median nerve on the hand, so the patients are not willing to be treated invasively. Thus, a noninvasive therapy, such as kinesiotaping, could be perspective.Objective. Assessment of the efficiency of a kinesiotaping monotheraphy of patients on initial stage of CTS.Materials and methods. We included 120 patients with the initial stage of CTS: 51 men and 69 women aged from 24 till 54 years old. The main group included 70 people, and the control group – 50 patients. The main group was treated within 2 months by kinesiotaping only, control group was observed without any therapeutic intervention.Results. 60 % of the patients from the main group reported beneficial effect of kinesiotaping on clinical symptoms of the CTS.Conclusions. Kinesiotaping monotherapy at initial stages of CTS in our cohort relieves subjective symptoms in the majority of patients. To recommend kinesiotaping as an effective and safe method on initial stages of CTS to patients unwilling to undergo standard invasive treatment methods, a larger multicenter study is needed.

  20. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-08-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment.

  1. Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?

    Science.gov (United States)

    Schmid, A B; Soon, B T C; Wasner, G; Coppieters, M W

    2012-02-01

    Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central pain mechanisms. As previous studies included patients with shoulder/arm symptoms or neck pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the pain during thermal pain testing significantly higher than healthy participants. This was especially apparent for heat pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and arm pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated pain ratings may however be an early indication of central pain mechanisms.

  2. Salvage procedures for degenerative osteoarthritis of the wrist due to advanced carpal collapse.

    Science.gov (United States)

    De Smet, Luc; Degreef, Ilse; Robijns, Filip; Truyen, Jan; Deprez, Patrick

    2006-10-01

    Arthrodesis of the wrist has been considered as the gold standard for osteoarthritis of the wrist. In 1984 Watson and Ballet identified a specific pattern of carpal collapse (scapholunate advanced collapse = SLAC) with progressive osteoarthritis. In order to preserve some motion, other alternative procedures have been proposed: proximal row carpectomy (PRC) and scaphoidectomy combined with a four-corner arthrodesis (4CA). In this cohort of 63 patients, three types of surgical treatment were performed (arthrodesis in 19, PRC in 26 and scaphoidectomy with 4CA in 18). The DASH questionnaire was used to evaluate the residual disability. PRC had a significantly better outcome (DASH=16), while there were no significant differences between full arthrodesis (DASH=45) and four corner arthrodesis (DASH=39). In PRC and in four corner arthrodesis a functional range of motion could be preserved (resepectively 44 degrees and 52 degrees flexion/extension arc). Gripping force remained inferior to the non operated side. There was a significant increase in gripping force in the PRC group, but not in the others. The final gripping force was not significantly different in the three treatment regimes.

  3. Carpal tunnel syndrome: Analysis of online patient information with the EQIP tool.

    Science.gov (United States)

    Frueh, F S; Palma, A F; Raptis, D A; Graf, C P; Giovanoli, P; Calcagni, M

    2015-06-01

    Patients suffering from carpal tunnel syndrome (CTS) actively search for medical information on the Internet. The World Wide Web represents the main source of patient information. The aim of this study was to systematically assess the quality of patient information about CTS in the Internet. A qualitative and quantitative assessment of websites was performed with the modified Ensuring Quality Information for Patients (EQIP) tool that contains 36 standardized items. Five hundred websites with information on CTS treatment options were identified through Google, Bing, Yahoo, Ask.com and AOL. Duplicates and irrelevant websites were excluded. One hundred and ten websites were included. Only five websites addressed more than 20 items; quality scores were not significantly different between the various providing groups. A median of 15 EQIP items was found, with the top website addressing 26 out of 36 items. Major complications such as median nerve injury were reported in 27% of the websites and their treatment in only 3%. This analysis revealed several critical shortcomings in the quality of the information provided to patients suffering from CTS. There is a collective need to provide interactive, informative and educational websites for standard procedures in hand surgery. These websites should be compatible with international quality standards for hand surgery procedures.

  4. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Hamid Azadeh

    2010-01-01

    Full Text Available Background: Patients with carpal tunnel syndrome (CTS often complain of prominent pain in shoulder and arm, also there are patients that have pain in their shoulder and arm which is due to myofascial trigger point (MTP located in their upper trapezius muscle. Despite the frequency of this observation, few studies have previously sought to establish possible relationship between the CTS and MTP in shoulder area. Methods: Samples were 160 patients (221 hands consist of 130 females and 30 males, with suspected diagnosis of CTS, from March 2008 to October 2008. In this study after performing electrodiagnosis searches, another evaluation was performed to find out if there was any sign of myofascial trigger point. The correlation between these two was sought. Results: It was found that all of 36 hands with normal electrodiagnostic findings had myofascial trigger points in their upper trapezius muscle. Out of 185 hands, 130 hands (70% with electrophysiological evidences of CTS showed myofascial trigger points in their trapezius muscles. Statistical analysis revealed significant (p < 0.001 reverse correlation between the severity of CTS and the presence of MTP. Conclusions: The findings of this study imply the significant correlation between occurrence of CTS and MTP. It is suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS.

  5. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome

    Science.gov (United States)

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-01-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment. PMID:27630413

  6. Our results of mini open approach in patients with carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Azad Yıldırım

    2015-12-01

    Full Text Available Objective: In this study, we aimed to evaluate the results of patients underwent surgical release with mini open surgical method due to Carpal tunnel syndrome (CTS and the surgical technique. Methods: 50 wrists of the 42 patients that we could reach after they were applied mini open surgical method between 2009- 2013 were analyzed retrospectively. After surgery, patients were followed for an average 47.4 months. CTS was detected in 26 of the patients in right hand, in 10 of the patients in left hand and in seven of them bilaterally. In 27 Preoperative patients advanced in 21 intermediate and in 2 mild Electromyography (EMG findings compliant with CTS were found. Results: We did not apply a second operation to any of our patients. None of the patients showed any post operative sensitivity on scar tissue and there was no neurovascular damage in any patients during the surgery. The patients returned to their daily activities average on the 10th day after the surgery [range 7-15 days]. In their follow up EMG was not done on a routine basis to the patients. Patients were followed clinically. Conclusion: The advantages of the surgery process we conducted with over pillar mini incision compared to other techniques that there is less pillar region pain and less scar tenderness, shorter return to work and the technique is efficient, cheap and easy to apply.

  7. Diagnostic value of quantitative sensory testing (QST) in carpal tunnel syndrome.

    Science.gov (United States)

    Borg, K; Lindblom, U

    1988-12-01

    The initial sensory symptoms of carpal tunnel syndrome (CTS) are usually intermittent and the clinical neurological examination is often normal. The aim of the present study was to determine the rate of impairment of different somatosensory modalities in CTS by means of the following tests: vibrametry, tactile pulses, von Frey hairs, two-point discrimination (2-PD), graphesthesia and warm and cold perception thresholds. The material consisted of 33 hands with CTS from 22 patients. Each of the first 3 tests was abnormal with elevated thresholds in 17 CTS hands (52%), 2-PD was abnormal in 10 hands (30%), graphesthesia in 8 hands (24%), and warm and cold thresholds in only 5 hands (15%). There was an overlap so that at least one test was abnormal in 27 of the 33 CTS hands (82%). Thus, impairment of sensibility can be demonstrated in a majority of patients with CTS if more than one test is applied. Vibrametry and von Frey hairs are recommended instead of the commonly used 2-PD, since abnormality was more often revealed and since they are equally easy to apply. No individual test was sensitive enough to qualify as a diagnostic criterion when it was applied with the hand in resting position. A significant increase in both sensitivity and specificity can be expected for any test if it is combined with provocation, such as wrist flexion, as has been demonstrated for vibrametry.

  8. Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Makanji, H S; Becker, S J E; Mudgal, C S; Jupiter, J B; Ring, D

    2014-02-01

    This prospective study measured and compared the diagnostic performance characteristics of various clinical signs and physical examination manoeuvres for carpal tunnel syndrome (CTS), including the scratch collapse test. Eighty-eight adult patients that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Attending surgeons documented symptoms and results of standard clinical manoeuvres. The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen's test (67%), Durkan's test (77%), Tinel's test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan's test (18%) and CTS-6 lax (13%). The sensitivity of the scratch collapse test was not superior to other clinical signs and physical examination manoeuvers for CTS, and the specificity of the scratch collapse test was superior to that of Durkan's test and CTS-6 lax. Further studies should seek to limit the influence of a patient's clinical presentation on scratch test performance and assess the scratch test's inter-rater reliability.

  9. Diagnosis of carpal tunnel syndrome: interobserver reliability of the blinded scratch-collapse test.

    Science.gov (United States)

    Blok, Robin D; Becker, Stéphanie J E; Ring, David C

    2014-06-01

    The reliability of the scratch-collapse test for diagnosis of carpal tunnel syndrome (CTS) has not been tested by independent investigators. This study measured the reliability of the scratch-collapse test comparing the treating hand surgeon and blinded evaluators. We performed a prospective observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing. The treating hand surgeon performed the scratch-collapse test. Next, the test was administered by one of the six observers, unaware of the patient's symptoms and the diagnosis made by treating hand surgeon. The kappa statistic (κ) was used to calculate the interrater reliability between the treating hand surgeons and blinded scratchers. The agreement between the blinded observers and the hand surgeons on the scratch-collapse test was substantial 0.63 (95 % CI, 0.34-0.87; p scratch test in our sample was 32 %. In a small study with a spectrum bias favoring electrophysiologically confirmed CTS the reliability was lower than that reported by the inventors of the test, but was still substantial. We propose a larger study of patients with a greater variety of electrodiagnostic test results using fewer observers with more experience.

  10. Upper Limb Neurodynamic Test 1 and symptoms reproduction in carpal tunnel syndrome. A validity study.

    Science.gov (United States)

    Vanti, Carla; Bonfiglioli, Roberta; Calabrese, Monica; Marinelli, Francesco; Guccione, Andrew; Violante, Francesco Saverio; Pillastrini, Paolo

    2011-06-01

    The aim of this study was to estimate the validity of the Upper Limb Neurodynamic Test 1 (ULNT1) for the diagnosis of Carpal Tunnel Syndrome (CTS) with blind comparison to a reference criterion of a compatible clinical presentation and abnormal nerve conduction. 47 subjects with suspected CTS were enrolled. All patients were tested with nerve conduction studies and ULNT1. Considering results as positive in the presence of reproduction of symptoms on affected upper limb, or side-to-side differences in elbow extension, or symptoms modified by lateral neck side-bending, we estimated sensitivity as 91.67%, specificity as 15%, positive likelihood ratio as 1.0784, negative likelihood ratio as 0.5556, and post-test probability for negative test as 40%. Using a new criterion, i.e. the reproduction of symptoms only in the first three digits of the affected hand, we estimated sensitivity as 54.17%, specificity as 70%, positive and negative likelihood ratios as 1.8056 and 0.6548, respectively, and post-test probability for positive test as 68%. Our investigation suggests that the reproduction of the typical current CTS symptoms in the affected hand during ULNT1 testing, improves estimation of the probability of the presence of this condition, even if this test alone cannot be used to diagnose CTS.

  11. Epithelioid Sarcoma of the Forearm Arising from Perineural Sheath of Median Nerve Mimicking Carpal Tunnel Syndrome

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    Hiromasa Fujii

    2009-01-01

    Full Text Available We report here a case of epithelioid sarcoma in the forearm of a 33-year-old male presenting with symptoms and signs of carpal tunnel syndrome originating from the direct involvement of the median nerve. Due to the slow growing of the tumor, the patient noticed the presence of tumor mass in his forearm after several months from the initial onset of the symptoms. Magnetic resonance imaging showed an 8×4 cm mass involving the median nerve in the middle part of the forearm, and histological analysis of the biopsy specimen revealed the diagnosis of epithelioid sarcoma. Radical surgical resection was performed in conjunction with adjuvant chemotherapy. The function of the flexors were restored by the multiple tendon transfers (EIP→FDS; ECRL→FDP; BrR→FPL; EDM→opponens with superficial cutaneous branch of radial nerve transfer to the resected median nerve. The function of the affected hand showed excellent with the DASH disability/symptom score of 22.5, and both the grasp power and sensory of the median nerve area has recovered up to 50% of the normal side. The patient returned to his original vocation and alive with continuous disease free at 3.5-year follow-up since initial treatment.

  12. Etiological factors for developing carpal tunnel syndrome in people who work with computers

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    Magdalena Lewańska

    2013-02-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is the most frequent mononeuropathy of upper extremities. From the early 1990's it has been suggested that intensive work with computers can result in CTS development, however, this relationship has not as yet been proved. The aim of the study was to evaluate occupational and non-occupational risk factors for developing CTS in the population of computer-users. Material and Methods: The study group comprised 60 patients (58 women and 2 men; mean age: 53.8±6.35 years working with computers and suspected of occupational CTS. A survey as well as both median and ulnar nerve conduction examination (NCS were performed in all the subjects. Results: The patients worked with use of computer for 6.43±1.71h per day. The mean latency between the beginning of employment and the occurrence of first CTS symptoms was 12.09±5.94 years. All patients met the clinical and electrophysiological diagnostic criteria of CTS. In the majority of patients etiological factors for developing CTS were non-occupational: obesity, hypothyroidism, oophorectomy, past hysterectomy, hormonal replacement therapy or oral contraceptives, recent menopause, diabetes, tendovaginitis. In 7 computer-users etiological factors were not identified. Conclusion: The results of our study show that CTS is usually generated by different causes not related with using computers at work. Med Pr 2013;64(1:37–45

  13. False Positive Results of Carpal tunnel syndrome in Electro Diagnosis Tests

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    MR Emad

    2010-07-01

    Full Text Available Introduction & Objective: Carpal tunnel syndrome is identified due to compression of median nerve at wrist and develops symptoms such as wrist pain, paresthesia, numbness and the dysfunction of the hands. The gold standard to diagnose, determining prognosis and planning treatment process based on the severity of nerve involvement are electro-diagnosis tests. The purpose of this study was to specify the least and the most false positive results in common electro-diagnosis tests. Materials & Methods: This descriptive study was conducted at Shiraz University of Medical Sciences in 2009. Twelve different electro-diagnosis tests on fifty-five normal cases (110 available hands, which never had experienced the symptoms of this syndrome, were carried out. The data was statistically analyzed by SPSS software, using T test and Cochran's `Q. Results: There were false positive results in many of the performed tests. The most false-positive result was in- difference between median and ulnar motor distal latencies- test with the rate of 15.5% and the lowest false positive result was in- difference between median and ulnar sensory distal latencies of digit 4- test with the rate of 0%. Conclusion: This study revealed that tests which evaluate the differences between median and ulnar or radial nerves sensory distal latency (in the finger 4 and or 1, respectively, had less false positive results, and are more reliable in suspected cases of this syndrome. Also by using several different electro-diagnostic tests, rapid and efficient diagnosis can be achieved.

  14. Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study.

    Science.gov (United States)

    Romeo, Pietro; d'Agostino, M Cristina; Lazzerini, A; Sansone, Valerio C

    2011-10-01

    "Pillar pain" is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density-focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for treating this condition. Our results show that in all of the treated patients, there was a marked improvement: the mean visual analogue scale (VAS) score decreased from 6.18 (±1.02) to 0.44 (±0.63) 120 d after treatment, and redness and swelling of the surgical scar had also decreased significantly.

  15. Pyridoxine metabolism in carpal tunnel syndrome with and without peripheral neuropathy.

    Science.gov (United States)

    Byers, C M; DeLisa, J A; Frankel, D L; Kraft, G H

    1984-11-01

    The role of insufficient pyridoxine as an etiologic factor in the development of carpal tunnel syndrome (CTS) has been reported and has led to the empirical use of pyridoxine to treat CTS. Previous studies have not employed standardized electrodiagnostic criteria to objectively determine the presence of CTS or to rule out peripheral neuropathy (PN). The present study categorized subjects with symptoms suggestive of CTS into four groups by standardized electrodiagnostic criteria: (1) CTS, (2) PN, (3) CTS and PN, (4) normal. At least seven subjects were in each group. Erythrocyte glutamine oxaloacetic acid transaminase (EGOT) activity with and without in vitro enhancement with pyridoxal phosphate was used as a means of identifying subjects with and without pyridoxine metabolic abnormalities. A significant difference in pyridoxine metabolic activity (PMA) was found between groups by both chi square (p less than 0.05) and analysis of variance (p less than 0.05). Further evaluation showed that this difference was associated with the presence or absence of PN (p less than 0.05). There was no difference in PMA when groups were separated on the basis of CTS. Results showed that a PMA abnormality was a factor highly correlated with the presence of PN but not CTS. This finding suggested that the positive response reported previously in subjects with CTS taking supplemental pyridoxine may actually be related to an unrecognized PN, which was compounding the symptomatology.

  16. The Effect of Provocative Tests on Electrodiognosis of Clinical Carpal Tunnel Syndrome

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    MR Emad

    2006-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Nerve conduction study is the most sensitive test for diagnosis of carpal tunnel syndrome (CTS. This test is normal in some patients with mild CTS. Median nerve conduction study evaluation after a provocative test (e.g. wrist flexion may be helpful for diagnosis of mild CTS. This study aimed to determine the effect of wrist flexion on median nerve conduction in patients suspected to CTS and in healthy subjects. Materials & Methods: In this case-controlled study, 20 patients (20 hands with clinical signs of CTS and normal routine electrodiagnosis test results and 20 healthy subjects were investigated. Measured parameters included: median nerve distal sensory latency (DSL, nerve conduction velocity (NCV, compound nerve action potential (CNAP, distal motor latency (DML and compound muscle action potential amplitude (CMAP AMP. The above noted parameters were measured before and after 5 minutes of full wrist flexion. Data were collected by filling out a questionnaire and were analyzed using Paired T-test. Results: Distal Sensory Latency increment and NCV decrement after 5 minutes wrist flexion in the patients group were statistically significant (p<0.05. The same parameters did not show a significant incremental or decremental change in the control group. Conclusion: Median nerve DSL and NCV measurement after 5 minutes wrist flexion may be helpful in determining more sensitive parameters in the electrodiagnosis of CTS.

  17. Diagnostic Value of Ultrasound Compared to Electro Diagnosis in Carpal Tunnel Syndrome

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    Seyed Mansour Rayegani

    2014-10-01

    Full Text Available Introduction: Carpal Tunnel Syndrome (CTS is one of the main causes of disability. The diagnosis of CTS confirm by electrodiagnostic tests. Sonography is an alternative method for diagnosis of CTS that can investigate anatomy and probable pathology. The aim of this study is to investigate the multiple sonographic diagnostic criteria and compare its diagnostic value with electrodiagnosis. Materials and Methods:In this descriptive-cross sectional study, 84 wrists (42 patients with CTS and 42 individuals without any clinical signs in upper limb were investigated. Symptomatic patients underwent clinical examination, standard electrodiagnostic evaluation of upper limb and sonographic investigation of median nerve in forearm and wrist. The control group underwent sonographic investigation. Results: Cross Sectional Area (CSA of Median nerve at distal wrist crease, at the level of Hamate hook and Trapezium, the amount of flexor retinaculum bowing, ratio of CSA at the forearm to distal wrist crease and ratio of CSA at the Pisiform level to distal wrist crease had significant difference in the case group compared to the control group (P-value

  18. Test-retest reliability of transcarpal sensory NCV method for diagnosis of carpal tunnel syndrome

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    Seyed Mostafa Jazayeri

    2015-01-01

    Full Text Available Background: Carpal Tunnel Syndrome (CTS is the most frequent entrapment neuropathy affecting the upper extremity. There are a variety of electrodiagnostic methods available for documenting median neuropathy in CTS. In some studies, determining the sensory NCV across the palm-wrist segment has been introduced as the most sensitive diagnostic procedure for CTS. The aim of this study was to investigate the test-retest reliability of transcarpal median sensory NCV method for the diagnosis of CTS. Materials and Methods: Twenty-three patients with clinical symptoms of CTS were tested two times by two different practitioners in one session and again by the first practitioner after one week. Stimulation of the median nerve was performed in the wrist and palm, with a conduction distance maximum of 7 cm, reliabilities of median nerves sensory nerve action potential latencies with stimulation at wrist and palm (W-SNAP, P-SNAP and its transcarpal NCV were assessed with intraclass correlation coefficient (ICC. Results: Comparison of the obtained values, which were done by two practitioners in one session showed ICC of W-SNAP latency, P-SNAP latency and transcarpal NCV of 0.93, 0.88 and 0.87, respectively and values that were done by one practitioner in two sessions with one-week interval showed ICC of 0.60, 0.50 and 0.47, respectively. Conclusion: Our findings suggest excellent interpractitioner test-retest reliability of transcarpal median sensory NCV method for diagnosing CTS.

  19. Pulsed magnetic field versus ultrasound in the treatment of postnatal carpal tunnel syndrome: A randomized controlled trial in the women of an Egyptian population

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    Dalia M. Kamel

    2017-01-01

    Full Text Available The aim of this study was to compare the effects of pulsed electromagnetic field versus pulsed ultrasound in treating patients with postnatal carpal tunnel syndrome. The study was a randomized, double-blinded trial. Forty postnatal female patients with idiopathic carpal tunnel syndrome were divided randomly into two equal groups. One group received pulsed electromagnetic field, with nerve and tendon gliding exercises for the wrist, three times per week for four weeks. The other group received pulsed ultrasound and the same wrist exercises. Pain level, sensory and motor distal latencies and conduction velocities of the median nerve, functional status scale and hand grip strength were assessed pre- and post-treatment. There was a significant decrease (P  0.05. In conclusion, while the symptoms were alleviated in both groups, pulsed electromagnetic field was more effective than pulsed ultrasound in treating postnatal carpal tunnel syndrome.

  20. Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

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    Barbosa Rafael Inácio

    2012-12-01

    Full Text Available Abstract Background Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration Brazilian Clinical Trials Registry (ReBec - 75ddtf / Universal Trial Number: U1111-1121-5184

  1. Bone marrow transplant

    Science.gov (United States)

    Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical ...

  2. Scaphoid nonunions treated with vascularised bone grafts: MRI assessment

    Energy Technology Data Exchange (ETDEWEB)

    Dailiana, Z.H.; Zachos, V.; Varitimidis, S.; Papanagiotou, P.; Karantanas, A.; Malizos, K.N. E-mail: kmalizos@otenet.gr

    2004-06-01

    Purpose: To assess the value of MR imaging (MRI) with regard to union, graft viability and proximal pole bone marrow status, after use of vascularized bone grafts for treating scaphoid nonunions. Materials and methods: Vascularized bone grafts from the distal radius were used to treat 47 scaphoid nonunions resulting from fractures or enchondromas. Clinical and imaging evaluation was used for the pre- and postoperative assessment of all patients. Apart of conventional radiographs obtained in all cases, 15 patients were also assessed postoperatively with MRI at 3 months. From these 15 patients, eight were assessed preoperatively with MRI whereas nine had serial MRI evaluations at 6 and 12 months. The clinical follow-up time of this subgroup of 15 patients ranged from 6 to 27 months. Results: All patients showed clinical signs of union within 12 weeks form the procedure and at the latest follow-up they experienced complete (10 cases) or almost complete (five cases) relief from pain. Both plain and contrast-enhanced MRI obtained at 3 months showed viability of the bone graft in all cases. At 3 months union was established with plain radiographs in 12 patients at both sides of the graft and in three patients between the graft and proximal pole. At 3 months plain MRI showed nonunion in four patients (two between graft and proximal pole, two between graft and distal pole and one at both sides of the graft) whereas contrast-enhanced MRI revealed only one case of nonunion between graft and proximal pole. Four patients were considered to have osteonecrosis of the proximal pole intraoperatively. Two of them showed necrosis of the proximal pole with preoperative and postoperative plain radiographs and three of them with plain postoperative MRI. Contrast-enhanced MRI at 3 months showed postoperative reversal of necrotic changes in all four scaphoids. MRI also revealed bone marrow oedema of the carpal bones surrounding the scaphoid in 14 cases. Serial MRI at 6 and 12 months

  3. Bone scintigraphy in Erdheim-chester disease: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Siqueira, V.L.; Soares, L.M.M.; Ribeiro, V.P.B.; Coura Filho, G.B.; Sapienza, M.T.; Ono, C.R.; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Fac. de Medicina. Hospital das Clinicas

    2008-07-01

    Full text: Introduction: Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis, of unknown etiology, characterized by infiltration of foamy histiocytes. Clinically, patients usually present with bone pain, and various extraskeletal manifestations. ECD differs from Langerhans cell histiocytosis (LCH) by radiologic and immunohistochemistry features. Case report: A 57-year-old woman presented with a history of intense pain on her left hand, besides eyelid xanthelasmas and xanthoms on frontal area ten years ago. Four years late she presented with pain on hips, legs and feet. Xanthoms spread to perioral area, mento and neck. Radiographs of the hands showed osteolysis of carpal bones bilaterally, osteolysis of fifth left metacarpal bone, osteosclerosis of all metacarpal bones bilaterally, except the fifth, and osteosclerosis of the second and third proximal falanges bilaterally. The legs showed bilateral diaphyseal and metaphyseal osteosclerosis. Bone scintigraphy demonstrated increased uptake on face bone (maxilla), and symmetric intense uptake on elbows, distal radii and ulnae, hands, distal area of femurs, tibias particularly on proximal and distal area, and feet. A tibia biopsy and a biopsy of neck lesion were made. The analysis of histology and immunohistochemistry were consistent with ECD. She has been treated with a-interferon for 1,5 year, and she reports delay in xanthoms progression and bone pain remission. Discussion: ECD is an adult multisystemic xanthogranulomatous infiltrative disease of unknown etiology. It may be confused with LCH, however ECD have distinctive immunohistochemistry and radiologic findings. LCH shows typically lytic bone lesions on axial skeleton, whereas symmetrical long-bone osteosclerosis is the radiologic sign for ECD. LCH stain positive for CD1a and S-100 protein, and the electron microscopy of cytoplasm discloses Biberck granules. ECD stain positive for CD68, negative for CD1a and S-100 protein, shows absent of

  4. Bone mineral content and bone metabolism in young adults with severe periodontitis

    DEFF Research Database (Denmark)

    Wowern von, N.; Westergaard, J.; Kollerup, G.

    2001-01-01

    Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis......Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis...

  5. Development of forelimb bones in indigenous sheep fetuses

    Directory of Open Access Journals (Sweden)

    N. S. Ahmed

    2008-01-01

    Full Text Available The study included detection of the sites of ossification centers and their sequence of appearance in the forelimb bones of indigenous sheep fetuses by using double staining method with younger specimens and radiography or maceration methods with old specimens, as well as, histological study with some ages. The results showed that the primary ossification centers of the forelimb in indigenous sheep fetuses appeared firstly in the diaphyses of radius and ulna, humerus, scapula, metacarpus, phalanges and lastly in the carpal bone at an estimated age of 43, 45, 46, 47, 49 - 56 and 90-118 days old respectively. The results of statistical analysis of the total lengths of scapula, humerus, radius, ulna and metacarpus with the lengths of their ossified parts through the 7th – 15th weeks of fetus age, showed presence of significant differences in the average of these measurements among most of studied weeks. Also there was a significant differences in the average of relative increase in the total length and length of ossified part of diaphysis of studied bones during the 7th week in comparison to the same average in the other studied weeks (8th-15th week of indigenous sheep fetuses age.

  6. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.

    Science.gov (United States)

    Shiri, R; Pourmemari, M H; Falah-Hassani, K; Viikari-Juntura, E

    2015-12-01

    We aimed to estimate the effects of overweight and obesity on carpal tunnel syndrome (CTS), and to assess whether sex modifies the associations. Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate databases from 1953 to February 2015. Fifty-eight studies consisting of 1,379,372 individuals qualified for a meta-analysis. We used a random-effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. Overweight increased the risk of CTS or carpal tunnel release 1.5-fold (pooled confounder-adjusted odds ratio [OR] = 1.47, 95% CI 1.37-1.57, N = 1,279,546) and obesity twofold (adjusted OR = 2.02, 95% CI 1.92-2.13, N = 1,362,207). Each one-unit increase in body mass index increased the risk of CTS by 7.4% (adjusted OR = 1.074, 95% CI 1.071-1.077, N = 1,258,578). Overweight and obesity had stronger effects on carpal tunnel release than CTS. The associations did not differ between men and women, and they were independent of study design. Moreover, the associations were not due to bias or confounding. Excess body mass markedly increases the risk of CTS. As the prevalence of overweight and obesity is increasing globally, overweight-related CTS is expected to increase. Future studies should investigate whether a square-shaped wrist and exposure to physical workload factors potentiate the adverse effect of obesity on the median nerve.

  7. The best cutoff point for median nerve cross sectional area at the level of carpal tunnel inlet.

    Directory of Open Access Journals (Sweden)

    Payam Sarraf

    2014-08-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy. It accounts 90% of all entrapment neuropathies all over the world. Ultrasound is a non-invasive, cost effective and available para-clinical method which could be applied for CTS diagnosis. Cross-sectional area of the median nerve at the level of the inlet is considered as a diagnostic criterion in CTS cases. In this study, thirty-eight patients with electrophysiologically confirmed idiopathic CTS and 22 healthy controls were enrolled. Seventy-one affected nerves and 42 unaffected nerves were evaluated within 14 days after electrophysiological examination. The largest cross-sectional area (CSA was measured at the level of the carpal tunnel inlet and the maximum nerve perimeter was also recorded by means of the software. Mean CSA and perimeter were 14.02 ± 4.5 mm2 and 1.7±0.28m in all patients and 8.2±2.1 mm2, 1.3±0.19 m in controls (P<0.001, P<0.001. Mean CSA and Perimeter were significantly different between patient's groups and control. The best cut off point for CSA of the tunnel inlet was 10.5 mm2 with sensitivity and specificity of 80% and 76% (AUC (Area under the Curve = 0.9, P<0.001. The best cut off point for inlet perimeter was 1.44 m with sensitivity and specificity of 85% and 77 % (AUC=0.87, P<0.001. Our findings showed that median nerve CSA at carpal tunnel inlet could be used as the diagnostic criteria for CTS.

  8. [Bone transplant].

    Science.gov (United States)

    San Julián, M; Valentí, A

    2006-01-01

    We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands.

  9. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review

    Directory of Open Access Journals (Sweden)

    Shi Qiyun

    2011-04-01

    Full Text Available Abstract Background Carpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare the efficacy of surgical treatment of carpal tunnel syndrome with conservative treatment Methods We included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010, MEDLINE (1980 to June 2010, EMBASE (1980 to June 2010, PEDro (searched in June 2010, international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR and 95% confidence intervals for electrophysiological studies and complication were also calculated. Results We assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47 and symptom severity 0.43 (95% CI 0.29, 0.57. There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months ( 0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56. The RR for secondary outcomes of normal

  10. Bone biopsy (image)

    Science.gov (United States)

    A bone biopsy is performed by making a small incision into the skin. A biopsy needle retrieves a sample of bone and it ... examination. The most common reasons for bone lesion biopsy are to distinguish between benign and malignant bone ...

  11. Bone lesion biopsy

    Science.gov (United States)

    Bone biopsy; Biopsy - bone ... needle is gently pushed and twisted into the bone. Once the sample is obtained, the needle is ... sample is sent to a lab for examination. Bone biopsy may also be done under general anesthesia ...

  12. Facts about Broken Bones

    Science.gov (United States)

    ... Room? What Happens in the Operating Room? Broken Bones KidsHealth > For Kids > Broken Bones Print A A ... sticking through the skin . What Happens When a Bone Breaks? It hurts to break a bone! It's ...

  13. Calcium and bones

    Science.gov (United States)

    Bone strength and calcium ... calcium (as well as phosphorus) to make healthy bones. Bones are the main storage site of calcium in ... your body does not absorb enough calcium, your bones can get weak or will not grow properly. ...

  14. Broken Bones (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Broken Bones KidsHealth > For Parents > Broken Bones Print A A ... bone fragments in place. When Will a Broken Bone Heal? Fractures heal at different rates, depending upon ...

  15. Bone densitometry

    DEFF Research Database (Denmark)

    Ravn, Pernille; Alexandersen, P; Møllgaard, A

    1999-01-01

    The bisphosphonates have been introduced as alternatives to hormone replacement therapy (HRT) for the treatment and prevention of postmenopausal osteoporosis. The expected increasing application in at clinical practice demands cost-effective and easily handled methods to monitor the effect on bone...

  16. The association of Raynaud's syndrome with carpal tunnel syndrome: a meta-analysis.

    Science.gov (United States)

    Hartmann, Peter; Mohokum, Melvin; Schlattmann, Peter

    2012-03-01

    Carpal tunnel syndrome (CTS) has traditionally been included among the diseases associated with Raynaud's syndrome (RS). The prevalence of RS in patients suffering from CTS is not well defined. The objective of this paper was to assess the prevalence of RS in patients with CTS-a meta-analysis of published data was performed. The PubMed database of the National Library of Medicine and ISI Web of Knowledge was used for studies dealing with RS and CTS. The studies provided sufficient data to estimate the prevalence of RS in patients of CTS. A forest plot was determined by the revealed prevalence. Statistical analysis was based on methods for a random effects meta-analysis and a finite mixture model for proportions. Publication bias was investigated with the linear regression test (Egger's method). A meta-regression was conducted by the year of publication. Eight eligible studies, contributing data on 675 subjects, were included in this meta-analysis. For CTS, a pooled prevalence of 15.5% and 95% CI (95% CI 0.043, 0.318) were obtained. Statistically publication bias was present (P value 0.143). A mixture model analysis found five latent classes. The meta-regression indicated that the estimated prevalence increased when the year of commencement increased, too. Within the decade (1957-1967), the odds ratio increased from 1 (95% CI 1.065, 1.112) to 2.340 (95% CI 1.886, 2.903). Despite some heterogeneity, there is a possible indication of an association between RS and patients with CTS.

  17. Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent.

    Science.gov (United States)

    Zhang, Wei; Johnston, Jamie A; Ross, Mark A; Sanniec, Kyle; Gleason, Elizabeth A; Dueck, Amylou C; Santello, Marco

    2013-01-01

    Carpal tunnel syndrome (CTS) impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips) or a combination of CTS-affected and non-affected digits ('mixed' grips), we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS-affected and non

  18. Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent.

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    Full Text Available Carpal tunnel syndrome (CTS impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips or a combination of CTS-affected and non-affected digits ('mixed' grips, we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS

  19. Relationship of age, body mass index, wrist and waist circumferences to carpal tunnel syndrome severity.

    Science.gov (United States)

    Komurcu, Hatice Ferhan; Kilic, Selim; Anlar, Omer

    2014-01-01

    Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18-35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36-64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference.

  20. Early diagnosis of carpal tunnel syndrome: comparison of digit 1 with wrist and distoproximal ratio.

    Science.gov (United States)

    Sharma, K R; Rotta, F; Romano, J; Ayyar, D R

    2001-01-01

    Our objective in this study was to compare the sensitivity and specificity of the median sensory nerve conduction velocity (SNCV) from digit 1 to wrist with those of the distoproximal (D/P) ratio of the median SNCV from palm to digit 3/palm to wrist in the diagnosis of mild carpal tunnel syndrome (CTS) by using a receiver operating characteristic (ROC) curve. To achieve this objective, we studied prospectively (January 1997-October 1998) 370 patients referred for CTS. One hundred forty-two patients (38.4%) with moderate to severe CTS and 15 patients (4.1%) with multiple (> or = 3) compressive neuropathies in upper limbs with subclinical peripheral neuropathy were excluded. The remaining 213 patients (302 hands with mild CTS; 167 women; mean age, 50 y +/- 12 y) and 38 controls (71 hands; 25 women; mean age, 47 y +/- 13 y) had median and ulnar nerve conduction studies. ROC curves were constructed for median SNCV digit 1 to wrist and median SNCV D/P ratio from the patients' and controls' data. The median SNCV at or = 1.12, corresponding to an optimal cutoff point on ROC curve, discriminated 67.2% of mild CTS from controls with specificity of 97.2%. Of the 10.3% (31/302) of hands in which digit 1 to wrist was within normal limits at the selected optimal cutoff value ( or = 1.12), and 3.3% (10/302) had a normal electrophysiologic examination. The likelihood ratio (true-positive ratio to false-positive ratio, assessing the discriminative power of a test) of the median SNCV digit 1 to wrist, at an optimal point on ROC curve (63.9), was higher than that of the median SNCV D/P ratio (23.9, chi2 = 36.9, P wrist is more sensitive than the median SNCV D/P ratio in the diagnosis of mild CTS.

  1. Carpal angles as measured on CT and MRI: can we simply translate radiographic measurements?

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Stephanie; Ghumman, Simranjit S.; Moser, Thomas P. [Hopital Notre-Dame (CHUM), Department of Radiology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Ladouceur, Martin [Research Center CHUM, Montreal, QC (Canada)

    2014-12-15

    To determine the reliability of carpal angles measured on CT and MRI compared to radiography and assess if these measurements are interchangeable. Our institutional ethic research committee approved this study. For this retrospective study, two independent observers measured the scapholunate (SL), capitolunate (CL), radiolunate (RL), and radioscaphoid (RS) angles on 21 sets of exams, with each set including a radiograph, CT, and MRI of the same wrist. Inter- and intra-observer agreements were evaluated with the intraclass correlation coefficient (ICC). Linear mixed models and two-way contingency tables were used to determine if the angles measured on cross-sectional modalities were significantly different from those obtained on radiography. Inter-observer agreement was strong (ICC >0.8) for all angles, except for the RL angle measured on MRI (ICC 0.68). Intra-observer agreement was also strong for all angles, except for the CL angle measured on CT (ICC 0.66). SL angles measured on CT and MRI were not statistically different from those measured on radiographs (p = 0.37 and 0.36, respectively), unlike CL, RL, and RS angles (p < 0.05). Accuracy between modalities varied between 76 and 86 % for the SL angle and ranged between 43 and 76 % for the other angles. CL, RL, and RS angles showed large intermodality variability. Therefore, their measurements on CT or MRI could potentially lead to miscategorization. Conversely, our data showing no significant difference between modalities, SL angle could be measured on CT and MRI to assess wrist instability with a lower risk of error. (orig.)

  2. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Seror, P. [Laboratoire d' electromyographie, 146, avenue Ledru-Rollin, Paris 75011 (France)], E-mail: p.seror@wanadoo.fr

    2008-07-15

    We present a review of the international literature concerning sonography for the diagnosis of carpal tunnel syndrome (CTS). Analysis of the results and comparison with electrodiagnostic data provide a sensible albeit personal view on the relevance of sonography and whether it competes or is complementary to electrodiagnosis (EDX). Although EDX is considered as the gold standard for CTS diagnosis, one author chose surgical results to define CTS. The normal and threshold mean values for sonography are particularly variable from one study to another. The standard deviation (S.D.), when compared to mean values, makes normal and abnormal data overlap considerably and produces many false negatives when the specificity is high, and many false positives when the sensitivity is high. In fact, sonography is non-interpretable in only 10 to 15% of the population, and it affirms the median nerve lesion at the wrist in 55% of cases when EDX does it in more than 90% with common tests. Further more the specificity of sonography leads to a false positive diagnosis in 1 case out of 5 versus 1 out of 40 with EDX. The main conclusion is that there is no competition but rather a complementarity between sonography and EDX: sonography is certainly an efficient imaging technique but cannot replace proper EDX performed for upper limb paresthesiae. Namely, sonography can answer only one out of the 8 questions a complete EDX answer: Are sonographic images compatible with a median nerve lesion at the wrist? The answer to this solely question can be obtain with a partial EDX using a single conduction test (motor or sensitive), then duration and cost will be comparable to sonography but will be both more sensitive and specific. Finally, one must kept in mind that the final aim of all examinations in CTS is to determine the cause(s) of upper limb paresthesiae, not simply if there is a median nerve lesion at wrist or not.

  3. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome

    Science.gov (United States)

    Vahdatpour, Babak; Kiyani, Abolghasem; Dehghan, Farnaz

    2016-01-01

    Background: The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS. Materials and Methods: This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student’s t-test, and Chi-square test. Results: All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period. Conclusion: It is recommended to use ESWT as a conservative treatment in patients with CTS. PMID:27563630

  4. A Comparison of Boosting Tree and Gradient Treeboost Methods for Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Gülhan OREKİCİ TEMEL

    2014-10-01

    Full Text Available Objective: Boosting is one of the most successful combining methods. The principal aim of these combining algorithms is to obtain a strong classifier with small estimation error from the combination of weak classifiers. Boosting based on combining tree has many advantages. Data sets can contain mixtures of nominal, ordinal and numerical variables. AdaBoost and Gradient TreeBoost are commonly used boosting procedure. Both methods are a stage wise additive model fitting procedure. Our goal in this study is to explain the both method and to compare the algorithm results on a neurology data set on the purpose of classification. Material and Methods: The data set consists of 4076 incidences in total. The condition of being a patient with Carpal Tunnel Syndrome (CTS or not was considered as the dependent variable. Boosting Tree and Gradient TreeBoost applications were conducted in Statistica 7.0 and Salford Predictive Modeler: TreeNet (R trial version 6.6.0.091. Results: In AdaBoost and Gradient TreeBoost algorithm, multiple trees are grown of the training data. 200 trees are produced for both models. 70 trees in the AdaBoost Algorithm and 196 trees in the Gradient TreeBoost algorithm are chosen as the optimal trees. Conclusion: The sensitivity or specify values in the test data of Gradient TreeBoost are high indicates that they can be used as a successful method in CTS diagnosis. . It is believed that the boosting methods will become very more and more popular in health science due to its easy implementation and high predictive performance.

  5. Amelioration by mecobalamin of subclinical carpal tunnel syndrome involving unaffected limbs in stroke patients.

    Science.gov (United States)

    Sato, Yoshihiro; Honda, Yoshiaki; Iwamoto, Jun; Kanoko, Tomohiro; Satoh, Kei

    2005-04-15

    Our previous study showed that overuse of the nonparetic hand and wrist of the nonparetic side following stroke result in significantly more abnormal on the nonparetic side than on the hemiparetic side in terms of electrophysiologic indices of median nerve function. The purpose of this study was to evaluate the effects of the orally administered mecobalamin, an analogue of vitamin B12, for carpal tunnel syndrome (CTS) in the nonparetic side in patients following stroke. In a randomized open label and prospective study of stroke patients, 67 received of 1500 mug mecobalamin daily for 2 years, and the remaining 68 (untreated group) did not. At baseline, sensory nerve conduction velocity, motor nerve conduction velocity, sensory nerve action potentials (SNAP) at the wrist, palm-to-wrist distal sensory latency, palm-to-wrist SNAP, motor nerve conduction velocity compound motor action potentials, and distal motor latency of median nerve were significantly more abnormal on the nonparetic side than on the hemiparetic side or in controls. Before the treatment 21 patients (31%) of untreated and 20 patients (30%) of treated group met electrophysiologic criteria for CTS. Sensory impairment of the nonparetic side had lessened in the treated group. After 2 years, all electrophysiologic indices of nonparetic side were significantly improved in the treated group compared with those in the untreated group. The improvement from baseline of electrophysiologic parameters in sensory nerve in the treated group was greater than the improvement measured in motor nerve. There were no side effects. Oral mecobalamin treatment is a safe and potentially beneficial therapy for CTS in stroke patients.

  6. Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP).

    Science.gov (United States)

    Zoicas, F; Kleindienst, A; Mayr, B; Buchfelder, M; Megele, R; Schöfl, C

    2016-07-01

    Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly.

  7. Exposure-response relationships between movements and postures of the wrist and carpal tunnel syndrome among male and female house painters

    DEFF Research Database (Denmark)

    Heilskov-Hansen, Thomas; Mikkelsen, Sigurd; Svendsen, Susanne Wulff

    2016-01-01

    OBJECTIVES: To investigate exposure-response relationships between measured movements and postures of the wrist and the incidence of carpal tunnel syndrome (CTS), and any modifications by sex. METHODS: In 2011, we established a historical cohort of 9364 members of the Painters' Union in Denmark. ...

  8. [Outbreak of carpal tunnel syndrome of the upper limbs in automobile seat assemblers: results of exposure evaluation and clinical investigation].

    Science.gov (United States)

    Barbieri, P G; Colombini, D; Rocco, A; Custureri, F; Paderno, G

    1996-01-01

    A group of 59 female workers in the sewing and upholstery departments of a factory manufacturing automobile seats underwent clinical and instrumental tests following reports of several cases of suspected carpal tunnel syndrome. A risk evaluation analysis for disorders attributable to repeated trauma of the upper limbs (WMSDs) was simultaneously carried out using the protocol recommended by the EPM Research Unit in Milan. Evidence was found of a high frequency of elementary actions associated with considerable muscular involvement along with inadequate recovery periods. The clinical investigation revealed an unusually high percentage of carpal tunnel syndromes, often associated with Guyon channel syndrome. This disorder affects males and females equally, is often bilateral, and is not associated with known non-occupational factors. The widespread outbreak of work-related musculo-skeletal disorders reported in the departments in question may have arisen from a combination of significant risk factors relating to the types of activities performed, and the long service of the workers. It is reasonable to assume that failure to adopt technical preventive and organisational measures may have stemmed primarily from a poor evaluation of the relevant occupational risks, and from many years of substandard health surveillance practices.

  9. Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

    Directory of Open Access Journals (Sweden)

    Dimitriou Christos G

    2007-08-01

    Full Text Available Abstract Background Leiomyomas of the deep soft tissue are quite uncommon and occur even more rarely in upper extremity. Case presentation A 32-year old manual laborer man presented with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed but the patient experienced only temporary relief of his symptoms. MRI examination revealed a deep palmary located mass with well-defined margins and ovoid shape. Intraoperatively, the tumor was in continuity with the flexor digitorum superficialis tendon of the middle finger causing substantial compression to median nerve. Histopathological findings of the resected mass were consistent with leiomyoma. After two years the patient was pain-free without signs of tumor recurrence. Conclusion Despite the fact that reports on deep soft tissue leiomyoma are exceptional, this tumor had to be considered as differential diagnosis in painful non-traumatic hand syndromes especially in young patients.

  10. Does sensory relearning improve tactile function after carpal tunnel decompression? A pragmatic, assessor-blinded, randomized clinical trial

    Science.gov (United States)

    Jerosch-Herold, C.; Houghton, J.; Miller, L.; Shepstone, L.

    2016-01-01

    Despite surgery for carpal tunnel syndrome being effective in 80%–90% of cases, chronic numbness and hand disability can occur. The aim of this study was to investigate whether sensory relearning improves tactile discrimination and hand function after decompression. In a multi-centre, pragmatic, randomized, controlled trial, 104 patients were randomized to a sensory relearning (n = 52) or control (n = 52) group. A total of 93 patients completed a 12-week follow-up. Primary outcome was the shape-texture identification test at 6 weeks. Secondary outcomes were touch threshold, touch localization, dexterity and self-reported hand function. No significant group differences were seen for the primary outcome (Shape-Texture Identification) at 6 weeks or 12 weeks. Similarly, no significant group differences were observed on secondary outcomes, with the exception of self-reported hand function. A secondary complier-averaged-causal-effects analysis showed no statistically significant treatment effect on the primary outcome. Sensory relearning for tactile sensory and functional deficits after carpal tunnel decompression is not effective. Level of Evidence: II PMID:27402282

  11. Fixation of trapezial implants in a trapeziometacarpal total joint prosthesis tested in a model of porcine bone.

    Science.gov (United States)

    Hansen, Torben Bæk; Hengst, David; Mortensen, Jesper; Amstrup, Anders Læssøe

    2011-12-01

    High aseptic loosening rates have been reported in total joint prostheses of the carpometacarpal joint of the thumb, particularly in the trapezial component. The primary fixation of new implants may be tested in cadaver bones, but the anatomy of the pig is in many ways similar to that of the human, so we compared the central carpal bone from the forefoot of 6-month-old pigs, which has a saddle joint surface similar to the trapezium, to the trapezium in patients with carpometacarpal osteoarthritis. The mean (SD) bone mineral density of the 13 pig forefoot bones was 0.88 (0.12) g/cm(2) compared with 0.63 (0.16) g/cm(2) in the 31 human trapeziums. The measured size of the porcine bones was slightly larger than that of the human trapeziums. The similarity in form, size, and bone mineral density means that the central bone of the forefoot of 6-month-old pigs may be used for fixation tests in trapezial implants.

  12. 腕管综合征患者开放式松解手术效果的非客观研究%Non objective study of operation effect of carpal tunnel syndrome in patients with open carpal tunnel release

    Institute of Scientific and Technical Information of China (English)

    黄若强; 吕荼; 邱忠朋

    2015-01-01

    目的:采用患者源性的非客观功能评价量表评价腕管综合征患者开放式松解手术的疗效。方法对158例实施开放式腕管松解术腕管综合征患者采用Levine腕管综合征问卷调查表、DASH量表、UEFI量表和SF-36量表对患者手术实施前后的生理、心理和社会功能进行非客观评价。结果所有患者均未发生并发症。 Levine问卷调查表和DASH量表手术前后正中神经外膜松解患者和正中神经外膜未松解患者差值比较,差异无统计学意义(P>0.05),屈肌腱滑膜增生切除患者与屈肌腱滑膜未增生切除患者差值比较,差异无统计学意义(P>0.05)。 Levine问卷调查表的症状和功能评分手术前后差异有统计学意义(P0. 05 ); Between flexor tendon synovial hyperplasia resection pa-tients and flexor tendon synovial hyperplasia patients without resection had no significant differences in data difference ( P>0. 05 ) . Symptoms and function of Levine questionnaire score was statistically significant differences in the scores before and after operation (P<0. 01), suggested that carpal tunnel function improved obviously. Operation of DASH value before and after the difference was statistically significant (P<0. 01), especially the most obvious self-confidence and hand fine operation function improvement ( P<0. 01 ) . UEFI score before and after operation, the difference was statistically significant, suggested that the upper limb function were improved significantly ( P <0. 01). UEFI scale score before and after operation had significant difference (P<0. 01), suggested that the upper limb function improved. SF-36 scale score display operation before and after the 9 aspects were improved significantly (P<0. 05), with an improvement in their health was most obvious. Conclusions Carpal tunnel syndrome patients after open carpal tunnel release surgery can significantly improve symptoms, improve upper limb function, and pro-mote the

  13. Effects of Pain and Disability on Quality of Life in Patients with Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Ayhan Öztürk1

    2013-09-01

    Full Text Available Objective: To evaluate the association between severity of carpal tunnel syndrome (CTS, pain, disability and to assess their effects on quality of life. Methods: CTS patients whose diagnosis were confirmed with nerve conduction studies were classified as “mild”, “moderate”, and “severe”. Pain evaluation was performed by “Pain Quality Assessment Scale (PQAS” in all patients. Short form-36 (SF-36 was used to assess quality of life and “Brief Disability Scale” was used in the evaluation of disability. Results: 93.1% of the patients were women, and 6.9% were men. Mean age was 44.20±8.76 years (range= 29–62. Mean duration of symptoms was 6.67±3.00 months (range=3-12 months. Most common symptom was paresthesia. Electrophysiological evaluations revealed moderate CTS in 43.8%, mild CTS in 44.8%, severe CTS in 6.9% of the patients. There was no significant association between CTS severity and time course subgroup of PQAS (p=0.222. But there was a statistically significant difference in the general pain subgroup and total scores of PQAS between moderate and severe CTS patients (p<0.05. There was a statistically significant difference in the mean scores of Brief Disability Questionnaire between patients with mild and severe CTS (4,46±3,61 and 11,50±4,94, p<0.05, respectively. A statistically significant negative correlation was found between the level of disability and physical function, pain, vitality, social function and mental health domains of SF-36. Conclusion: Quality of life is variably affected in patients with CTS due to the severity of CTS. On this aspect, it is important to diagnose and treat CTS on time to improve the quality of life of patients with CTS in early period, which is the best known and common compression neuropathy of upper extremity in community.

  14. How to make electrodiagnosis of carpal tunnel syndrome with normal distal conductions?

    Science.gov (United States)

    Lee, Wei-Ju; Liao, Yi-Chu; Wei, Shiew-Jue; Tsai, Chi-Wei; Chang, Ming-Hong

    2011-02-01

    The purpose of this study is to investigate which electrodiagnostic techniques are better in clinically diagnosed patients with carpal tunnel syndrome (CTS) and patients with CTS with normal distal conduction study. A total of 230 clinically diagnosed patients with CTS and 100 normal control subjects were enrolled. All subjects were evaluated by eight electrodiagnostic techniques, including conventional conduction studies: median distal sensory latency and distal motor latency; short distance conduction studies across wrist, including wrist-palm sensory conduction time and wrist-palm motor conduction velocity; comparison of median sensory conduction across the wrist with radial or ulnar nerves in the same limb (median-radial sensory latency difference [M-R] or median-ulnar sensory latency difference [M-U]); and comparison of median wrist-palm and palm-index conduction, including distoproximal conduction time difference and distoproximal conduction time ratio. Normal limits were derived by calculating the mean ± 2 standard deviations from the data of the controls. The sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve with 95% confidence interval of each test were calculated. In clinically diagnosed patients with CTS, M-R is the best diagnostic technique with significant difference in area under the receiver operating characteristic curve (0.912) compared with other tests except that of M-U. The sensitivity, specificity, positive predictive value, and negative predictive value of M-R were 84.3%, 98%, 99%, and 73.1%, respectively. Further evaluation of patients with CTS with normal distal latencies also revealed the best diagnostic value of M-R and M-U with significance to other tests in area under the receiver operating characteristic curve. In clinical practice, after conventional median distal sensory latency and distal motor latency studies, the authors suggest performing

  15. Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome

    Science.gov (United States)

    Ren, Yi-Ming; Wang, Xi-Shan; Wei, Zhi-Jian; Fan, Bao-You; Lin, Wei; Zhou, Xian-Hu; Feng, Shi-Qing

    2016-01-01

    Abstract Background: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disease. Either surgical or conservative intervention for CTS patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical efficacy, safety, and cost of surgical versus nonsurgical intervention. Methods: The eligible studies were acquired from PubMed, Medline, Embase, Web of Science, Google, and Cochrane Library. The data were extracted by 2 of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias. Results: Thirteen studies including 9 randomized controlled trials (RCTs) and 4 observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The difference of clinical efficacy was statistically significant between surgical and nonsurgical intervention, and nonsurgical treatment was more effective (OR = 2.35, 95%CI = 1.18–4.67, P = 0.01). Meanwhile, different results were discovered by subgroup analysis. The pooled results of function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care at different follow-up times showed that the differences were not statistically significant between the 2 interventions. The difference of complications and side-effects was statistically significant and conservative treatment achieved better result than surgery (OR = 2.03, 95%CI = 1.28–3.22, P = 0.003). Sensitivity analysis proved the stability of the pooled results. Conclusion: Both surgical and conservative interventions had benefits in CTS. Nonsurgical treatment was more effective and safety than surgical treatment, but there were no significant differences in function improvement, symptom improvement, neurophysiological

  16. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests

    Energy Technology Data Exchange (ETDEWEB)

    Koyuncuoglu, Hasan Rifat [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Kutluhan, Suleyman [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey)]. E-mail: skutluhan@hotmail.com; Yesildag, Ahmet [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Oyar, Orhan [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Guler, Kezban [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Ozden, Ahmet [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey)

    2005-12-15

    The diagnosis of carpal tunnel syndrome (CTS) is mainly based on clinical findings and electrodiagnostic tests (EDT). However, EDT results do not support clinical findings in some cases. It has been recently suggested that ultrasonography (US) can be used to diagnose CTS. In this study, we aimed to investigate whether US has a diagnostic value for CTS in patients with negative EDT findings or not. EDT was performed on 319 wrists with clinical CTS findings in electrophysiology laboratory. Median and ulnar nerve conduction velocities were measured in all cases and electromyography was performed in patient with tenar atrophy and having suspicion involvement of brachial plexus as EDT. Fifty-nine wrists with negative EDT (study group) and 30 wrists from 15 healthy individuals (control group) were examined using US. The mean of cross-sectional areas (CSAs) measurements were found 8.83 {+-} 3.05 mm{sup 2} by tracing method (TM) and 8.51 {+-} 3.13 mm{sup 2} by ellipsoid formula (EF) in study group, and 7.63 {+-} 1.52 mm{sup 2} by TM and 7.66 {+-} 1.42 mm{sup 2} by EF in control group. The differences between study group and control group according to both TM and EF were significant (t-test p = 0.0079, p = 0.0460, respectively). In study group, CSAs were larger than 10.5 mm{sup 2} in 18 (30.51%) and 16 (27.12%) wrists according to TM and EF findings, respectively, and in only one wrist (3.33%) in control group by both TM and EF. The differences of ultrasonographic CTS numbers between study group and control group were significant (p = 0.0024 by TM, p = 0.0086 by EF). We confirmed the usefulness of quantitative US assessment in the diagnosis of CTS in the patients with negative EDT findings. If EDT findings are inadequate to confirm the CTS in the patients with clinical CTS, US studies may be helpful to diagnose.

  17. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Johnsson Ragnar

    2003-05-01

    Full Text Available Abstract Background Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS, with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and determine the properties of the most accurate test. Methods In a population-based study a questionnaire was mailed to a random sample of 3,000 persons. Of 2,466 responders, 262 symptomatic (numbness/tingling in the radial fingers and 125 randomly selected asymptomatic responders underwent clinical and electrophysiologic examinations. A standardized hand diagram was administered to the symptomatic persons. At the clinical examination, the examining surgeon identified 94 symptomatic persons as having clinically certain CTS. Nerve conduction tests were then performed on the symptomatic and the asymptomatic persons by blinded examiners. Analysis with receiver operating characteristic (ROC curves was used to compare the diagnostic accuracy of the nerve conduction tests in distinguishing the persons with clinically certain CTS from the asymptomatic persons. Results No difference was shown in the diagnostic accuracy of median nerve distal motor latency, digit-wrist sensory latency, wrist-palm sensory conduction velocity, and wrist-palm/forearm sensory conduction velocity ratio (area under curve, 0.75–0.76. Median-ulnar digit-wrist sensory latency difference had a significantly higher diagnostic accuracy (area under curve, 0.80. Using the optimal cutoff value of 0.8 ms for abnormal sensory latency difference shown on the ROC curve the sensitivity was 70%, specificity 82%, positive predictive value 19% and negative predictive value 98%. Based on the clinical diagnosis

  18. Dating of cremated bones

    NARCIS (Netherlands)

    Lanting, JN; Aerts-Bijma, AT; van der Plicht, J; Boaretto, E.; Carmi, I.

    2001-01-01

    When dating unburnt bone, bone collagen, the organic fraction of the bone, is used. Collagen does not survive the heat of the cremation pyre, so dating of cremated bone has been considered impossible. Structural carbonate in the mineral fraction of the bone, however, survives the cremation process.

  19. Alteration of proximal conduction velocity at distal nerve injury in carpal tunnel syndrome: demyelinating versus axonal change.

    Science.gov (United States)

    Chang, Ming-Hong; Liu, Lu-Han; Lee, Yi-Chung; Hsieh, Peiyuan F

    2008-06-01

    The objective of this study was to determine the cause of median forearm motor conduction velocity (FMCV) slowing in patients with carpal tunnel syndrome, due to either focal conduction abnormality over wrist or retrograde conduction slowing, and to decide whether the slowing is related to severity of compression or not. Fifty carpal tunnel syndrome patients confirmed by conventional nerve conduction study with abnormal electromyography of the abductor pollicis brevis muscle were group 1, and 100 with normal electromyography, group 2. One hundred volunteers served as controls. In addition to conventional nerve conduction study of median and ulnar nerves, palmar stimulations for median mixed and motor nerves were also performed to calculate wrist-palm mixed nerve conduction time and motor conduction velocity (W-P MCV). For group 1, group 2, and control subjects, respectively, W-P MCV were 19.73+/-7.65 (mean+/-SD), 32.7+/-6.83, and 52.75+/-6.4 m/s, whereas median FMCV were 48.63+/-8.32, 54.42+/-2.11, and 57.86+/-4.24 m/s. There was a significant reduction in the W-P MCV (62.6%, Pulnar FMCV and sensory nerve conduction study results did not, suggesting the reduction of median W-P MCV is not parallel with that of median FMCV in both patients groups. Furthermore, there is a poor correlation of median FMCV and W-P MCV in patient groups, implying conduction blockage of the large myelinating fibers at the wrist, leaving only slower axons to be measured, is not the likely cause of reduction of FMCV. In addition, the reduction of compound muscle action potential amplitude of abductor pollicis brevis muscle, conduction block at wrist and weak correlation of median FMCV and compound muscle action potential amplitude of abductor pollicis brevis exclusively occurred in group 1. Therefore, the retrograde conduction slowing really occurs among patients with carpal tunnel syndrome-markedly in those with abnormal electromyography and mildly in those with only demyelination. This

  20. Cultural adaptation of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome:A Turkish version study

    Institute of Scientific and Technical Information of China (English)

    Ilkerilhanli; Dilek Durmus; Gulhan Orekici

    2015-01-01

    Objective: Cultural adaptations of the questionnaires are important for easy use. We aimed to assess the reliability and validity of the Turkish Version of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome. Methods: To assess test-retest reliability, the Turkish “Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand”questionnaires were answered by patients and controls and were repeated a week later. For testing internal consistency, the Cronbach's alpha test was used. For testing validity, correlations between the subscales of the“Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand” questionnaire were measured in patient groups. One hundred patients with idiopathic Carpal Tunnel Syndrome and 50 healthy participants were included in the study. Results: In test-retest reliability, intraclass correlations of the subscales of the“Michigan Hand Outcomes Questionnaire”were high. Cronbach's alphas were found to be high in all subscales. There was no significant correlation between asthetics and pain scales. We found significant differences between patients and controls regarding all subscales of the“Michigan Hand Outcomes Questionnaire”. Correlations between subscales of the “Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand”questionnaire were significant. We found no difference between one-hand effected and two-hand effected patients, in terms of the “Michigan Hand Outcomes Questionnaire”, “Disabilities of Arm, Shoulder and Hand” questionnaire Function/Symptom and Work average scores. Conclusion: This study showed that the Turkish version of the“Michigan Hand Outcomes Questionnaire”is reliable and valid and can be used in Turkish patients with Carpal Tunnel Syndrome because it is comprehensible and practicable. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B

  1. Smoking and Bone Health

    Science.gov (United States)

    ... supported by your browser. Home Bone Basics Lifestyle Smoking and Bone Health Publication available in: PDF (85 ... late to adopt new habits for healthy bones. Smoking and Osteoporosis Cigarette smoking was first identified as ...

  2. Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle

    Directory of Open Access Journals (Sweden)

    Nermin Tanik

    2016-03-01

    Full Text Available ABSTRACT Carpal tunnel syndrome (CTS is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI and depression using the Beck Depression Inventory (BDI. The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4 questionnaire and a visual analogue scale (VAS. Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

  3. A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release.

    LENUS (Irish Health Repository)

    Theopold, C

    2012-05-01

    We compared the aesthetic outcome of scars after closure of open carpal tunnel incisions with either absorbable 4-0 Vicryl Rapide or non-absorbable 4-0 Novafil. Patients were recruited in a randomized controlled trial and scars were scored at 6 weeks using a modified Patient and Observer Scar Assessment Scale. Scores demonstrated differences only for pain, vascularity and cross-hatching between both groups, though none of these were statistically significant. The dissolving and falling out of Vicryl Rapide was significantly more comfortable than removal of 4-0 Novafil sutures, assessed on a numerical analogue scale. There was no difference in infection rate between both study groups, supporting overall the use of Vicryl Rapide for the closure of palmar hand incisions, in light of the convenience and cost savings associated with absorbable sutures.

  4. Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study

    Directory of Open Access Journals (Sweden)

    Edgard Novaes França Bisneto

    2011-01-01

    Full Text Available OBJECTIVE: To compare the functional results of carpectomy and four-corner fusion surgical procedures for treating osteoarthrosis following carpal trauma. METHODS: In this prospective randomized study, 20 patients underwent proximal row carpectomy or four-corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients. RESULTS: Both proximal row carpectomy and four-corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant. CONCLUSIONS: Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non-union advanced collapse (SLAC/SNAC wrist without degenerative changes in the midcarpal joint.

  5. Advance in Diagnosis for Carpal Tunnel Syndrome (review)%腕管综合征的诊断进展①

    Institute of Scientific and Technical Information of China (English)

    李洋; 朱向阳; 黄怀宇

    2013-01-01

    Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, which include a series of symptoms results from median nerve injury. Electrical physical examination is the gold standard for diagnosis of CTS. More new technology, such as high frequency ultra-sound and magnetic resonance imaging, provides more information for the diagnosis of CTS.%  腕管综合征(CTS)是常见的周围神经病,是正中神经损伤后出现的一组临床症状。目前诊断 CTS 的金标准为电生理检查。高频超声和磁共振等影像学技术为 CTS 的诊断提供了新方法,能有效提高 CTS 诊断的敏感性和特异性。

  6. A wakeboarding injury presented as acute carpal syndrome and median nerve contusion after wrist strangulation: a case report

    Science.gov (United States)

    2009-01-01

    Background We present a case of combined median nerve contusion with immediate loss of sensation after the strangulation with a wakeboarding rope and prolonged referral to our department 72 hours after the injury accompanied by an acute carpal tunnel syndrome with immediate relief of numbness of a significant proportion of the median nerve following surgical decompression. Case presentation The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve. Conclusion In case of acute median neuropathy, urgent surgical intervention with exploration, decompression of both, the median nerve and the superficial branch of the median nerve, accompanied by compartment measurements of the forearm should be performed to regain or re-establish neurological integrity. PMID:19178709

  7. Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index

    Directory of Open Access Journals (Sweden)

    Kuyucu Mutlu

    2009-07-01

    Full Text Available Abstract The purpose of this study is to evaluate prospectively the sensitivities of conventional and new electrophysiological techniques and to investigate their relationship with the body mass index (BMI in a population of patients suspected of having carpal tunnel syndrome (CTS. In this study, 165 hands of 92 consecutive patients (81 female, 11 male with clinical diagnosis of CTS were compared to reference population of 60 hands of 30 healthy subjects (26 female and 4 male. Extensive sensory and motor nerve conduction studies (NCSs were performed in the diagnosis of subtle CTS patients. Also, the patients were divided into subgroups and sensitivities were determined according to BMI. The mean BMI was found to be significantly higher in the CTS than in the control group (p The newer nerve conduction techniques and combining different NCSs tests are more sensitive than single conventional NCS test for the diagnosis of suspected CTS. Meanwhile, CTS is associated with increasing BMI.

  8. The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

    Science.gov (United States)

    Deniz, Orhan; Aygül, Recep; Kotan, Dilcan; Ozdemir, Gökhan; Odabaş, Faruk Omer; Kaya, M Dursun; Ulvi, Hızır

    2012-05-01

    The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

  9. Transverse ultrasound assessment of median nerve deformation and displacement in the human carpal tunnel during wrist movements.

    Science.gov (United States)

    Wang, Yuexiang; Zhao, Chunfeng; Passe, Sandra M; Filius, Anika; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C

    2014-01-01

    The symptoms of carpal tunnel syndrome, a compression neuropathy of the median nerve at the wrist, are aggravated by wrist motion, but the effect of these motions on median nerve motion are unknown. To better understand the biomechanics of the abnormal nerve, it is first necessary to understand normal nerve movement. The purpose of this study was to evaluate the deformation and displacement of the normal median nerve at the proximal carpal tunnel level on transverse ultrasound images during different wrist movements, to have a baseline for comparison with abnormal movements. Dynamic ultrasound images of both wrists of 10 asymptomatic volunteers were obtained during wrist maximal flexion, extension and ulnar deviation. To simplify the analysis, the initial and final shape and position of the median nerve were measured and analyzed. The circularity of the median nerve was significantly increased and the aspect ratio and perimeter were significantly decreased in the final image compared with the first image during wrist flexion with finger extension, wrist flexion with finger flexion and wrist ulnar deviation with finger extension (p nerve displacement vector between finger flexion, wrist flexion with finger extension and wrist ulnar deviation with finger extension (all p's nerve motion in wrist flexion with finger extension (2.36 ± 0.79 normalized units [NU]), wrist flexion with finger flexion (2.46 ± 0.84 NU) and wrist ulnar deviation with finger extension (2.86 ± 0.51 NU) were higher than those in finger flexion (0.82 ± 0.33 NU), wrist extension with finger extension (0.77 ± 0.46 NU) and wrist extension with finger flexion (0.81 ± 0.58 NU) (p ulnar deviation could induce significant transverse displacement and deformation of the median nerve.

  10. Effect of Vitamin B6 on Clinical Symptoms and Electrodiagnostic Results of Patients with Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Mahnaz Talebi

    2013-08-01

    Full Text Available Purpose: Carpal tunnel syndrome (CTS refers to a cluster of signs and symptoms that stems from compression of the median nerve traveling through carpal tunnel. Surgery is a definite treatment for CTS; however, many conservative therapies have been proposed. The present study set out to assess the effect of vitamin B6 in patients with CTS. Methods: Forty patients (67 hands with mild-moderate CTS were initially selected and randomly assigned into two groups as follows: 1 Case group with 20 subjects (32 affected hands receiving vitamin B6 (120 mg/day for 3 months and splinting. 2 Control group with 19 subjects (35 affected hands only received splinting. One subject from the control group dispensed with continuing participation in the research. Daily symptoms and electrodiagnostic (NCV-EMG results were assessed at baseline and after 3 months. Results: Nocturnal awakening frequency due to pain, daily pain, daily pain frequency, daily pain persistence, hand numbness, hand weakness, hand tingling, severity of nocturnal numbness and tingling, nocturnal awakening frequency owing to hand numbness and tingling, and clumsiness in handling objects improved significantly in the vitamin B6-treated patients; even so, only problem with opening a jam bottle and handling phone significantly reduced in the control group. The median nerve sensory latency mean decreased following the treatment; and the median nerve sensory amplitude mean and sensory conduction velocity mean increased. Conclusion: The present study suggests that vitamin B6 treatment improves clinical symptoms and sensory electrodiagnostic results in CTS patients, and thus is recommended for CTS treatment.

  11. Bone development

    DEFF Research Database (Denmark)

    Tatara, M.R.; Tygesen, Malin Plumhoff; Sawa-Wojtanowicz, B.

    2007-01-01

    The objective of this study was to determine the long-term effect of alpha-ketoglutarate (AKG) administration during early neonatal life on skeletal development and function, with emphasis on bone exposed to regular stress and used to serve for systemic changes monitoring, the rib. Shropshire ram...... lambs were randomly assigned to two weight-matched groups at birth. During the first 14 days of life AKG was administered orally to the experimental group (n=12) at the dosage of 0.1 g/kg body weight per day, while the control group (n=11) received an equal dose of the vehicle. Lambs were slaughtered...... has a long-term effect on skeletal development when given early in neonatal life, and that changes in rib properties serve to improve chest mechanics and functioning in young animals. Moreover, neonatal administration of AKG may be considered as an effective factor enhancing proper development...

  12. Carpal tunnel syndrome in association with hand-arm vibration syndrome: a review of claimants seeking compensation in the Mining Industry.

    Science.gov (United States)

    Burke, F D; Lawson, I J; McGeoch, K L; Miles, J N V; Proud, G

    2005-05-01

    Twenty six thousand eight hundred and forty-two miners seeking compensation were clinically assessed for vascular and neurosensory impairment arising from exposure to occupational hand-arm vibration (Hand-Arm Vibration Syndrome). They were also assessed clinically for Carpal Tunnel Syndrome which, if present, would result in additional compensation. Fifteen per cent were assessed as having both HAVS and CTS. Thirty-eight per cent of claimants had nocturnal wakening, 1.3% wasting of abductor pollicis brevis, 15% had a positive Tinel's test and 20% had a positive Phalen's test. The 15% prevalence reported is lower than the rates cited previously in several small population studies of workers exposed to vibration. This paper reports the results of the assessment process and discusses the difficulty of discriminating Carpal Tunnel Syndrome from diffuse neurosensory impairment arising from HAVS.

  13. Is Greulich and Pyle atlas still a good reference for bone age assessment?

    Science.gov (United States)

    Zhang, Aifeng; Tsao, Sinchai; Sayre, James W.; Gertych, Arkadiusz; Liu, Brent J.; Huang, H. K.

    2007-03-01

    The most commonly used method for bone age assessment in clinical practice is the book atlas matching method developed by Greulich and Pyle in the 1950s. Due to changes in both population diversity and nutrition in the United States, this atlas may no longer be a good reference. An updated data set becomes crucial to improve the bone age assessment process. Therefore, a digital hand atlas was built with 1,100 children hand images, along with patient information and radiologists' readings, of normal Caucasian (CAU), African American (BLK), Hispanic (HIS), and Asian (ASI) males (M) and females (F) with ages ranging from 0 - 18 years. This data was collected from Childrens' Hospital Los Angeles. A computer-aided-diagnosis (CAD) method has been developed based on features extracted from phalangeal regions of interest (ROIs) and carpal bone ROIs from this digital hand atlas. Using the data collected along with the Greulich and Pyle Atlas-based readings and CAD results, this paper addresses this question: "Do different ethnicities and gender have different bone growth patterns?" To help with data analysis, a novel web-based visualization tool was developed to demonstrate bone growth diversity amongst differing gender and ethnic groups using data collected from the Digital Atlas. The application effectively demonstrates a discrepancy of bone growth pattern amongst different populations based on race and gender. It also has the capability of helping a radiologist determine the normality of skeletal development of a particular patient by visualizing his or her chronological age, radiologist reading, and CAD assessed bone age relative to the accuracy of the P&G method.

  14. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi

    2010-08-01

    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  15. Orchestration of bone remodeling

    NARCIS (Netherlands)

    Moester, Martiene Johanna Catharina

    2014-01-01

    In healthy individuals, a balance exists between bone formation and resorption. Disruption of this balance can lead to higher or lower bone mass, and disease such as osteoporosis. Treatment for osteoporosis generally inhibits bone resorption, but does not rebuild bone to a healthy strength. More kno

  16. Bone grafts in dentistry

    Directory of Open Access Journals (Sweden)

    Prasanna Kumar

    2013-01-01

    Full Text Available Bone grafts are used as a filler and scaffold to facilitate bone formation and promote wound healing. These grafts are bioresorbable and have no antigen-antibody reaction. These bone grafts act as a mineral reservoir which induces new bone formation.

  17. Bone Marrow Diseases

    Science.gov (United States)

    Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains stem cells. The stem cells can ... the platelets that help with blood clotting. With bone marrow disease, there are problems with the stem ...

  18. The application of carpal tunnel contents of measuring in the clinic%腕管内容物测量在临床中的应用

    Institute of Scientific and Technical Information of China (English)

    孙权; 张道卓; 张宇; 李海航; 田心; 朱悦汀; 杨丽丽; 宋微微; 李艳鑫; 孙世杰

    2012-01-01

    Objective To observe the carpal tunnel contents and describe their relationship. Methods Stainless steel vernier caliper was used to measure carpal tunnel contents, carpal canal morphology, carpal tunnel contents, the transverse carpal ligament thickness of 22 cases ( male 16, female 6 ), 44 specimens of adult cadaveric. Results Carpal tunnel was the fibrous tube, which was slightly flat, cylindrical. Male: internal and external diameter of Stenosis was (25 ±2.6) mm, anteroposterior diameter was ( 10.2 ±1.1) mm. Female: internal and external diameter of stenosis was ( 17 ±2. 5 ) mm, anteroposterior diameter was ( 10. 4 ± 1. 5 ) mm. The transverse carpal ligament of male: ( 25.5 ±4.7 ) mm long, ( 22. 1 ±2.2 ) mm wide, 2.3 mm thick, the lower bound from the distal wrist crease was ( 28.4 ±2.6 ) mm. The first carpal tunnel section of male was ( 189. 7 ± 17. 5 ) mm2 ,the second section was ( 182. 1 ± 13. 7 ) mm2 ,the third section was ( 223.4 ±29. 8 ) mm2. The first section of female was ( 172.4 ± 15. 2 ) mm2, the second section was ( 153. 1 ± 17. 3 ) mm2, the third section was( 178. 1 ±11.6 )mm2. Conclusion The carpal tunnel of male was wide and short, the carpal tunnel of female was narrow, the top half of transverse carpal ligament was thin, lower half was thick, tough and inelastic. Female carpal tunnel is the narrower than men, which was the cause of diseases.%目的 观测腕管内容物并描述其相互间关系,为临床手外科学和显微外科学中的应用提供参考.方法 采用游标卡尺对22具本成人尸体(男16具,女6具),44侧标本成人尸体标本腕管内容物测量,腕管解剖学观察、腕管内容物、腕横韧带的厚度测量等.结果 腕管为纤维性骨管,略呈扁圆柱形,男性:狭窄部内外径(25.0±2.6)mm,前后径(10.2±1.l)mm;女性:狭窄部内外径(17.0±2.5)mm,前后(10.4±1.5)mm.腕横韧带男性:长(25.5±4.7)mm,宽(22.1±2.2)mm,厚2.3 mm,下界距腕远纹(28.4±2.6)mm;女性:长(22.7±3.3)mm

  19. Bone Health and Osteoporosis.

    Science.gov (United States)

    Lupsa, Beatrice C; Insogna, Karl

    2015-09-01

    Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue leading to decreased bone strength and an increased risk of low-energy fractures. Central dual-energy X-ray absorptiometry measurements are the gold standard for determining bone mineral density. Bone loss is an inevitable consequence of the decrease in estrogen levels during and following menopause, but additional risk factors for bone loss can also contribute to osteoporosis in older women. A well-balanced diet, exercise, and smoking cessation are key to maintaining bone health as women age. Pharmacologic agents should be recommended in patients at high risk for fracture.

  20. BONE IN OSTEOPETROSIS

    Directory of Open Access Journals (Sweden)

    Ramkumar

    2014-04-01

    Full Text Available Osteopetrosis, a generalized developmental bone disease due to genetic disturbances, characterized by failure of bone re sorption and continuous bone formation making the bone hard, dense and brittle. Bones of intramembranous ossification and enchondrial ossification are affected genetically and symmetrically. During the process of disease the excess bone formation obliterates the cranial foramina and presses the optic, auditory and facial nerves resulting in defective vision, impaired hearing and facial paralysis. The bone formation in osteopetrosis affects bone marrow function leading to severe anemia and deficient of blood cells. The bone devoid of blood supply due to compression of blood vessels by excess formation of bone are prone to osteomyelitic changes with suppuration and pathological fracture if exposed to infection. Though the condition is chronic progressive, it produces changes leading to fatal condition, it should be studied thoroughly by everyone and hence this article presents a classical case of osteopetrosis with detailed description and discussion for the benefit of readers

  1. Multiscale Modeling of Bone

    Science.gov (United States)

    2014-12-01

    DISEASE Both age and disease can affect the structure of bone, the effects of which are often similar. The most common bone disease is osteoporosis ... Osteoporosis is a disease that results in reduced bone mass and density. This reduction of bone mass and density has a greater impact on trabecular...Bone loss in females is linked to a decrease in estrogen ; the decrease of estrogen associated with menopause increases osteoclast activity [89]. This

  2. Bone cysts: unicameral and aneurysmal bone cyst.

    Science.gov (United States)

    Mascard, E; Gomez-Brouchet, A; Lambot, K

    2015-02-01

    Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.

  3. Wrist small transverse incision treating carpal tunnel syndrome%腕部小横切口治疗腕管综合征

    Institute of Scientific and Technical Information of China (English)

    赵海涛; 胡旭梅

    2016-01-01

    Objective Design and application of small transverse incision for carpal tunnel release surgery, and analyze the treatment of carpal tunnel syndrome curative effect. Methods In palmaris longus muscle feet side distal cross striation 2cm long incision to expose the transverse carpal ligament near the edge and flexor tendon. Resection of edema of the flexor tendon synovial membrane. In the open under the transverse carpal ligament resection. Results Postoperative follow-up for 2 weeks, 32 cases of symptoms completely disappeared, thumb, shown in 3 finger two-point discrimination sense recovered to normal. Postoperative 1-year follow-up, 19 patients with preoperative fish muscle atrophy, muscle atrophy was significantly improved, the thumb opponens function recovered to normal. No cases of carpometacarpe scar pain and ulnar nerve and superficial palmar arch damage and Complications.Conclusion Small incision euthyphoria wrist carpal tunnel release, is a new effective method.%目的:设计及应用小横切口作腕管松解术,并分析其治疗腕管综合征的疗效。方法在掌长肌尺侧,远侧横纹作2cm 长的切口,显露腕横韧带近缘及指屈肌腱。切除水肿的屈肌腱滑膜。在直视下将腕横韧带部分切除。结果术后随访2周,32例的症状完全消失,拇、示、中3指指腹两点辨别觉恢复正常。术后1a 随访,19例术前大鱼肌萎缩者,肌萎缩明显改善,拇指对掌功能恢复正常。无1例产生腕掌部瘢痕痛及尺神经、掌浅弓损伤等并发症。结论腕部小切口直视下行腕管松解术,是一种有效的新方法。

  4. Case-control study on transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after distal radius fracture%腕横韧带切除预防桡骨下端骨折迟发性腕管综合征的病例对照研究

    Institute of Scientific and Technical Information of China (English)

    王彦杰; 王世刚; 苗淑娟; 苏霞

    2011-01-01

    Objective :To investigate the effects of open reduction by palm side for the distal radius fracture and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection for the prevention of delayed carpal tunnel syndrome after operation. Methods:From March 2000 to March 2007,32 patients (8 males and 24 females, ranging in age from 46 to 66 years) with distal radius fracture were treated with open reduction by palm side and T shape plate internal fixation with simultaneous anterior transverse carpal ligament resection; while 30 patients (7 males and 23 females ,ranging in age from 45 to 65 years) only with open reduction by palm side and T shape plate internal fixation. The incidences of delayed carpal tunnel syndrome between the two groups were compared. Results:Among 32 patients treated with open reduction by palm side and T shape plate internal fixation with anterior transverse carpal ligament resection, 3 patients had delayed carpal tunnel syndrome; while in 30 patients treated with open reduction by palm side and T shape plate internal fixation, 10 patients had delayed carpal tunnel syndrome. There was significant statistically difference (P<0.05%). Conclusion:Simultaneous anterior transverse carpal ligament resection can effectively prevent the delayed carpal tunnel syndrome occurrence for the distal radius fracture with open reduction by palm side.%目的:探讨桡骨下端骨折采用掌侧切口切开复位"T"形钢板内固定并I期行腕横韧带切除对术后发生迟发性腕管综合征的预防作用.方法:自2000年3月至2007年3月,桡骨下端骨折患者采用两种方法治疗.采用切开复位"T"形钢板内固定并I期行腕横韧带切除治疗32例,男8例,女24例;年龄46~66岁;B3型骨折21例,C1型骨折6例,C2型骨折4例,C3型骨折1例.采用单纯骨折切开复位"T"形钢板内固定治疗30例,男7例,女23例;年龄45~65岁;B3型骨折13例,C1型骨折9例,C2型骨折6例,C3型骨折2

  5. Clinical characteristics, neurophysiological grade and outcome of patients with carpal tunnel syndrome A retrospective study

    Institute of Scientific and Technical Information of China (English)

    Jingxia Dang

    2007-01-01

    BACKGROUND: Carpal tunnel syndrome (CTS) is diagnosed mainly according to clinical symptoms, physical sign and neurodiagnostic laboratory examination. The therapeutic effect of conservative management and surgical operation in treating CTS need to be further observed and evaluated. OBJECTIVE: To analyze the clinical characteristics, neurophysiological grade and outcome in patients with CTS.DESIGN: Retrospective case-analysis.SETTING: Department of Neurology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University. PARTICIPANTS: Totally 161 patients with suspected CTS from National Neuroscience Institute of Singapore referred to the Neurodiagnostic Laboratory for the confirmatory testing between January and September 2002. The involved patients, 137 male and 24 female, were aged 21-85 years. METHODS:①The condition of diabetes mellitus complicated by abnormal thyroid function was observed.②The effect on predominant hand, and paraesthesia were observed.③Neuroelectrophysiological studies were performed and the results were graded into mild, moderate and severe CTS according to the American Association of Electrodiagnostic Medicine (AAEM) criteria.④Conservative management and surgical intervention were followed up 3 months later, and symptoms and physical sign basically disappeared, and function was basically recovered, which indicated that disease condition improved.MAIN OUTCOME MEASURES:①Condition of CTS complicated by metabolic disease;②Effects on predominant hand and paraesthesia;③Electrophysiological grading; ④Prognosis.RESULTS: Totally 161 patients participated in the final analysis.①Condition of CTS complicated by metabolic disease: Among 161 patients, 17.4% (28/161) were documented to have diabetes mellitus and 7(4.3%) had hypothyroidism.②Effects on predominant hand and paraesthesia: Dominant hand involvement was present in 134 patients (83.2%) and more than 75% had onset of symptoms in the dominant hand. Sensory symptoms like

  6. Regulation of Bone Metabolism.

    Science.gov (United States)

    Shahi, Maryam; Peymani, Amir; Sahmani, Mehdi

    2017-04-01

    Bone is formed through the processes of endochondral and intramembranous ossification. In endochondral ossification primary mesenchymal cells differentiate to chondrocytes and then are progressively substituted by bone, while in intramembranous ossification mesenchymal stem cells (MSCs) differentiate directly into osteoblasts to form bone. The steps of osteogenic proliferation, differentiation, and bone homeostasis are controlled by various markers and signaling pathways. Bone needs to be remodeled to maintain integrity with osteoblasts, which are bone-forming cells, and osteoclasts, which are bone-degrading cells.In this review we considered the major factors and signaling pathways in bone formation; these include fibroblast growth factors (FGFs), bone morphogenetic proteins (BMPs), wingless-type (Wnt) genes, runt-related transcription factor 2 (RUNX2) and osteoblast-specific transcription factor (osterix or OSX).

  7. Regulation of Bone Metabolism

    Science.gov (United States)

    Shahi, Maryam; Peymani, Amir; Sahmani, Mehdi

    2017-01-01

    Bone is formed through the processes of endochondral and intramembranous ossification. In endochondral ossification primary mesenchymal cells differentiate to chondrocytes and then are progressively substituted by bone, while in intramembranous ossification mesenchymal stem cells (MSCs) differentiate directly into osteoblasts to form bone. The steps of osteogenic proliferation, differentiation, and bone homeostasis are controlled by various markers and signaling pathways. Bone needs to be remodeled to maintain integrity with osteoblasts, which are bone-forming cells, and osteoclasts, which are bone-degrading cells.In this review we considered the major factors and signaling pathways in bone formation; these include fibroblast growth factors (FGFs), bone morphogenetic proteins (BMPs), wingless-type (Wnt) genes, runt-related transcription factor 2 (RUNX2) and osteoblast-specific transcription factor (osterix or OSX). PMID:28367467

  8. Carpal instability reparation and reconstruction%腕关节不稳的修复与重建

    Institute of Scientific and Technical Information of China (English)

    邱南海; 张文龙

    2010-01-01

    背景:腕关节不稳是常见的腕关节损伤并发症,临床上可明确各期腕关节不稳的诊断,然而对腕关节不稳各期的修复重建以及晚期腕关节不稳假体置换的问题仍存在争议.目的:通过文献检索和总结,探讨腕关节不稳的机制、诊断和修复重建的方法.方法;应用计算机检索万方数据库和Pubmed数据库1972-01,2009-12的相关文献,检索词分别为"腕关节不稳定;腕关节损伤;修复重建"和"carpal instability;carpal injury;reparation and reconstruction",限定文章语言种类为中文和英文.纳入34篇所述内容与腕关节不稳定的发病机制、分类、腕关节不稳定诊断以及腕关节不稳定治疗相关的文章.结果与结论:腕关节不稳可通过患者的一般表现、X射线表现、其他影像学表现以及关节镜表现等明确诊断.腕关节不稳的治疗和修复重建可根据损伤的类型、程度以及有无退化性改变选择治疗方法,早期通过关节镜的修复重建具有手术损伤小,患者痛苦少,住院时间短,康复期短,功能恢复快的特点;晚期可通过关节融合、关节成形以及腕关节假体置换等方法可达到治疗腕不稳的目的.

  9. Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial

    Directory of Open Access Journals (Sweden)

    Onur Armagan

    2014-08-01

    Full Text Available OBJECTIVE: The aim of this placebo-controlled study was to evaluate the effects of pulsed and continuous ultrasound treatments combined with splint therapy on patients with mild and moderate idiopathic carpal tunnel syndrome. METHODS: The study included 46 carpal tunnel syndrome patients who were randomly divided into 3 groups. The first group (n = 15 received a 0 W/cm2 ultrasound treatment (placebo; the second group (n = 16 received a 1.0 W/cm2 continuous ultrasound treatment and the third group (n = 15 received a 1.0 W/cm2 1:4 pulsed ultrasound treatment 5 days a week for a total of 15 sessions. All patients also wore night splints during treatment period. Pre-treatment and post-treatment Visual Analogue Scale, Symptom Severity Scale and Functional Status Scale scores, median nerve motor conduction velocity and distal latency and sensory conduction velocities of the median nerve in the 2nd finger and palm were compared. Clinicaltrials.gov: NCT02054247. RESULTS: There were significant improvements in all groups in terms of the post-treatment Functional Status Scale score (p<0.05 for all groups, Symptom Severity Scale score (first group: p<0.05, second group: p<0.01, third group: p<0.001 and Visual Analogue Scale score (first and third groups: p<0.01, second group: p<0.001. Sensory conduction velocities improved in the second and third groups (p<0.01. Distal latency in the 2nd finger showed improvement only in the third group (p<0.01 and action potential latency in the palm improved only in the second group (p<0.05. CONCLUSION: The results of this study suggest that splinting therapy combined with placebo and pulsed or continuous ultrasound have similar effects on clinical improvement. Patients treated with continuous and pulsed ultrasound showed electrophysiological improvement; however, the results were not superior to those of the placebo.

  10. Surgical treatment of synovial hyperplasia carpal tunnel syndrome%滑膜增生型腕管综合征的手术治疗

    Institute of Scientific and Technical Information of China (English)

    李建强; 姜保国; 陈建海; 付中国; 王天兵

    2014-01-01

    Background Carpal tunnel syndrome is the most common compressive peripheral neuropathy,which is a couple of clinical syndromes caused by the oppression of the median nerve in the carpal tunnel.The tough of the transverse carpal ligament and thickness of its edge are the major factors in the oppression of the median nerve.Under normal circumstances,there is a large amount of tendon synovial in the carpal tunnel,which plays a role of nutrition and lubrication to the nerve. However,the tendon synovial hyperplasia,or even congestion and edema can cause or aggravate the oppression of the median nerve.Also,it will cause an inflammatory stimulate to the nerve.The major clinical manifestations of carpal tunnel syndrome are numbness and pain of three and a half fingers of the radial side.Usually,the pain radiates to the hand and forearm,accompanied with dysfunction of thumb opposition,thenar muscle atrophy and decreased grip and pinch strength.But in the synovial hyperplasia carpal tunnel syndrome,because of increased congestion at night and reflux disorder,there will be a significant night pain and numbness,which sometimes even makes the patients awake at a fixed time at night.These are the typical symptoms of synovial hyperplasia carpal tunnel syndrome. When the patients wake up,many will activate the fingers and wrists to relieve the pain,which promotes the synovial reflux in the carpal tunnel and reduces the pressure of carpal tunnel.As such reasons,there will be a phenomenon that clinical manifestations in the resting state do not fully meet the electrophysiological examination after activity.Patients who were diagnosed as synovial hyperplasia carpal tunnel syndrome were admitted to our hospital.We performed transverse carpal ligament release,carpal tunnel decompression,synovial tissue removal and median nerve release.The purpose of this study is to describe clinical characteristics of synovial hyperplasia carpal tunnel syndrome and analyzes the outcome of treatment

  11. The utility of ultrasonographic bone age determination in detecting growth disturbances; a comparative study with the conventional radiographic technique

    Energy Technology Data Exchange (ETDEWEB)

    Hajalioghli, Parisa; Tarzamni, Mohammad Kazem; Arami, Sara [Tabriz University of Medical Sciences, Department of Radiology, Imam Reza Teaching Hospital, Tabriz (Iran, Islamic Republic of); Fouladi, Daniel Fadaei [Tabriz University of Medical Sciences, Neurosciences Research Center, Tabriz (Iran, Islamic Republic of); Tabriz University of Medical Sciences, Imam Reza Teaching Hospital, Neurosciences Research Center, Tabriz (Iran, Islamic Republic of); Ghojazadeh, Morteza [Tabriz University of Medical Sciences, Department of Physiology, School of Medicine, Tabriz (Iran, Islamic Republic of)

    2015-09-15

    To test whether the conventional radiographic technique in determining bone age abnormalities can be replaced by ultrasonography. A total of 54 Caucasian subjects up to 7 years of age with clinically suspected growth problems underwent left hand and wrist radiographic and ultrasonographic bone age estimations with the use of the Greulich-Pyle atlas. The ultrasonographic scans targeted the ossification centers in the radius and ulna distal epiphysis, carpal bones, epiphyses of the first and third metacarpals, and epiphysis of the middle phalanx, as described in previous reports. The degree of agreement between the two sets of data, as well as the accuracy of the ultrasonographic method in detecting radiographically suggested bone age abnormities, was examined. The mean chronological age, radiographic bone age, and ultrasonographic bone age (all in months) were 41.96 ± 22.25, 26.68 ± 14.08, and 26.71 ± 13.50 in 28 boys and 43.62 ± 24.63, 30.12 ± 17.69, and 31.27 ± 18.06 in 26 girls, respectively. According to the Bland-Altman plot there was high agreement between the results of the two methods with only three outliers. The deviations in bone age from the chronological age taken by the two techniques had the same sign in all patients. Supposing radiography to be the method of reference, the sensitivity, specificity, positive predictive value, and negative predictive value of sonography in detecting growth abnormalities were all 100 % in males and 90.9, 100, 100, and 93.8 %, respectively, in females. The conventional radiographic technique for determining bone age abnormalities could be replaced by ultrasonography. (orig.)

  12. Bilateral carpal valgus deformity in hand-reared cheetah cubs (Acinonyx jubatus).

    Science.gov (United States)

    Bell, Katherine M; van Zyl, Malan; Ugarte, Claudia E; Hartman, Angela

    2011-01-01

    Four hand-reared cheetah cubs (Acinonyx jubatus) exhibited progressively severe bilateral valgus deformity of the carpi (CV) during the weaning period. Radiographs of the thoracic limbs suggested normal bone ossification, and serum chemistry was unremarkable. All affected cubs developed CV shortly after the onset of gastroenteritis, which was treated medically, and included use of a prescription diet. A sudden decrease in growth rate was associated with gastrointestinal disease. Before gastroenteritis and CV, affected cubs had higher growth rates than unaffected cubs, despite similar mean daily energy intake. Return to normal thoracic limb conformation was consequent to dietary manipulation (including a reduction in energy intake and vitamin and mineral supplementation), as well as decreased growth rates and recovery from gastroenteritis. The cause of the CV is likely to have been multi-factorial with potentially complex physiological interactions involved.

  13. What Is Bone Cancer?

    Science.gov (United States)

    ... start in bone, muscle, fibrous tissue, blood vessels, fat tissue, as well as some other tissues. They can develop anywhere in the body. There are several different types of bone tumors. Their names are based on ...

  14. Osteochondroma (Bone Tumor)

    Science.gov (United States)

    ... to be the most common benign bone tumor, accounting for 35% to 40% of all benign bone ... imaging scans. Doctors may also request computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to ...

  15. What causes bone loss?

    Science.gov (United States)

    ... bone biology. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier; 2016:chap 29. Maes C, Kronenberg HM. Bone development and remodeling. In: Jameson JL, ...

  16. Bone mineral density test

    Science.gov (United States)

    BMD test; Bone density test; Bone densitometry; DEXA scan; DXA; Dual-energy x-ray absorptiometry; p-DEXA; Osteoporosis-BMD ... need to undress. This scan is the best test to predict your risk of fractures. Peripheral DEXA ( ...

  17. A longitudinal study of industrial and clerical workers: incidence of carpal tunnel syndrome and assessment of risk factors.

    Science.gov (United States)

    Gell, Nancy; Werner, Robert A; Franzblau, Alfred; Ulin, Sheryl S; Armstrong, Thomas J

    2005-03-01

    This study followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome (CTS). The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS. This prospective study followed 432 industrial and clerical workers over 5.4 years. Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening. On the basis of logistic regression, significant predictors for CTS include baseline median-ulnar peak latency difference, a history of wrist/hand/finger tendonitis, a history of numbness, tingling, burning, and/or pain in the hand, and work above the action level of the peak force and hand activity level threshold limit value. This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS.

  18. Acupuncture-Evoked Response in Somatosensory and Prefrontal Cortices Predicts Immediate Pain Reduction in Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Yumi Maeda

    2013-01-01

    Full Text Available The linkage between brain response to acupuncture and subsequent analgesia remains poorly understood. Our aim was to evaluate this linkage in chronic pain patients with carpal tunnel syndrome (CTS. Brain response to electroacupuncture (EA was evaluated with functional MRI. Subjects were randomized to 3 groups: (1 EA applied at local acupoints on the affected wrist (PC-7 to TW-5, (2 EA at distal acupoints (contralateral ankle, SP-6 to LV-4, and (3 sham EA at nonacupoint locations on the affected wrist. Symptom ratings were evaluated prior to and following the scan. Subjects in the local and distal groups reported reduced pain. Verum EA produced greater reduction of paresthesia compared to sham. Compared to sham EA, local EA produced greater activation in insula and S2 and greater deactivation in ipsilateral S1, while distal EA produced greater activation in S2 and deactivation in posterior cingulate cortex. Brain response to distal EA in prefrontal cortex (PFC and brain response to verum EA in S1, SMA, and PFC were correlated with pain reduction following stimulation. Thus, while greater activation to verum acupuncture in these regions may predict subsequent analgesia, PFC activation may specifically mediate reduced pain when stimulating distal acupoints.

  19. Associations of cardiovascular risk factors, carotid intima-media thickness and manifest atherosclerotic vascular disease with carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Liira Helena

    2011-04-01

    Full Text Available Abstract Background The role of atherosclerosis in carpal tunnel syndrome (CTS has not previously been addressed in population studies. The aim of this study was to investigate the associations of cardiovascular risk factors, carotid artery intima-media thickness (IMT, and clinical atherosclerotic diseases with CTS. Methods In this cross sectional study, the target population consisted of subjects aged 30 or over who had participated in the national Finnish Health Survey in 2000-2001. Of the 7977 eligible subjects, 6254 (78.4% were included in our study. Carotid IMT was measured in a sub-sample of subjects aged 45 to 74 (N = 1353. Results Obesity (adjusted odds ratio (OR 2.4, 95% confidence interval (CI 1.1-5.4, high LDL cholesterol (OR 3.8, 95% CI 1.6-9.1 for >190 vs. 200 vs. Conclusions Our findings suggest an association between CTS and cardiovascular risk factors in young people, and carotid IMT and clinical atherosclerotic vascular disease in older people. CTS may either be a manifestation of atherosclerosis, or both conditions may share similar risk factors.

  20. Motor nerve conduction velocity and function in carpal tunnel syndrome following neural mobilization: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Manu Goyal

    2016-01-01

    Full Text Available Introduction: Carpal tunnel syndrome (CTS is the most common nerve entrapment syndrome in the upper extremity leading to the functional disability. The consequence of the entrapment is the poor health of the nerve (conduction, mobility, and blood flow. Purpose of the Study: The aim of the study is to evaluate the effect of neural mobilization on the motor nerve conduction velocity and function in the CTS patients. Methods: Thirty CTS patients (only females were scrutinized on the basis of the inclusion and exclusion criteria. They were randomized into two groups A (n = 15 and B (n = 15 using simple random sampling. Group A patients were treated with the conventional physiotherapy regimen and Group B were provided neural mobilization. Results: The data analysis was done using SPSS version 22. The t-test reveals that there was statistically significant improvement in posttreatment values of Group B for numeric pain rating scale, symptom severity scale, function status scale, motor nerve conduction latency, and velocity at P≤ 0.05. Conclusions: Neural mobilization in the CTS patients improves the motor nerve conduction and functional status. It may be incorporated in the physiotherapy treatment protocol of CTS patients.

  1. Association between the catechol-o-methyltransferase val158met polymorphism with susceptibility and severity of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Erkol İnal E

    2015-12-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy of the upper extremity. In this study, we aimed to clarify the relationships between the catechol-O-methyltransferase (COMT gene Val158Met (rs4680 polymorphism and development, functional and clinical status of CTS. Ninety-five women with electro diagnostically confirmed CTS and 95 healthy controls were enrolled in the study. The functional and clinical status of the patients was measured by the Turkish version of the Boston Questionnaire and intensity of pain related to the past 2 weeks was evaluated on a visual analog scale (VAS. The Val158Met polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP, method. We divided patients according to the genotypes of the Val158Met polymorphism as Val/Val, Val/Met and Met/Met. There were not any significant differences in terms of Val158Met polymorphisms between patients and healthy controls (p >0.05. We also did not find any relationships between the Val158Met polymorphism and CTS (p >0.05. In conclusion, although we did not find any relationships between CTS and the Val158Met polymorphism, we could not generalize this result to the general population. Future studies are warranted to conclude precise associations.

  2. Carpal tunnel syndrome: a case-control study evaluating its relationship with body mass index and hand and wrist measurements.

    Science.gov (United States)

    Farmer, J E; Davis, T R C

    2008-08-01

    This case-control study investigated the associations between the body mass index (BMI), hand and wrist measurements and carpal tunnel syndrome (CTS). The hands and wrists of 50 patients with CTS and 50 age- and sex-matched controls were measured. The right and left wrist indices (wrist depth/wrist width) were significantly greater in CTS patients (mean = 0.71. SD = 0.04) than in the controls (mean = 0.69 SD = 0.04). The hand index (hand length/palm width) and BMI were not significantly different in the two groups. The hand, but not the wrist, index was found to correlate with the BMI. These results provide some support for a causative association between wrist morphometry, as measured by the wrist index, and CTS, but this difference is too small to be of diagnostic value in clinical or epidemiological practice. The results could also suggest that the previously reported association between CTS and the hand index may be secondary to differences in the BMI.

  3. Effect of body mass index on ulnar nerve conduction velocity, ulnar neuropathy at the elbow, and carpal tunnel syndrome.

    Science.gov (United States)

    Landau, Mark E; Barner, Kristen C; Campbell, William W

    2005-09-01

    Both high and low body mass index (BMI) have been reported as risk factors for ulnar neuropathy at the elbow (UNE), and a high BMI as a risk factor for carpal tunnel syndrome (CTS). To determine whether the extremes of BMI are risk factors for UNE or CTS, and whether BMI affects calculation of median and ulnar motor nerve conduction velocity (NCV), we retrospectively analyzed the electrodiagnostic records of control patients, UNE patients, and CTS patients. The BMI was calculated for 50 patients with a sole diagnosis of UNE and compared to the BMI of 50 patients with CTS and 50 control subjects. The mean BMIs were 25.9 +/- 4.4, 30.1 +/- 5.5, and 28.3 +/- 5.6 for the UNE, CTS, and controls, respectively. By one-way analysis of variance, the difference in BMI between the UNE patients and the normal patients was significant (P ulnar motor NCV across the elbow but not with forearm NCV. Across-elbow (AE) ulnar motor NCV may be falsely increased in patients with a high BMI, probably due to distance measurement factors. Not only do relatively slender individuals have comparatively slower AE ulnar NCVs, they are also at increased risk for developing UNE. Patients with a high BMI are at increased risk for CTS.

  4. Androgens and bone.

    Science.gov (United States)

    Vanderschueren, Dirk; Vandenput, Liesbeth; Boonen, Steven; Lindberg, Marie K; Bouillon, Roger; Ohlsson, Claes

    2004-06-01

    Loss of estrogens or androgens increases the rate of bone remodeling by removing restraining effects on osteoblastogenesis and osteoclastogenesis, and also causes a focal imbalance between resorption and formation by prolonging the lifespan of osteoclasts and shortening the lifespan of osteoblasts. Conversely, androgens, as well as estrogens, maintain cancellous bone mass and integrity, regardless of age or sex. Although androgens, via the androgen receptor (AR), and estrogens, via the estrogen receptors (ERs), can exert these effects, their relative contribution remains uncertain. Recent studies suggest that androgen action on cancellous bone depends on (local) aromatization of androgens into estrogens. However, at least in rodents, androgen action on cancellous bone can be directly mediated via AR activation, even in the absence of ERs. Androgens also increase cortical bone size via stimulation of both longitudinal and radial growth. First, androgens, like estrogens, have a biphasic effect on endochondral bone formation: at the start of puberty, sex steroids stimulate endochondral bone formation, whereas they induce epiphyseal closure at the end of puberty. Androgen action on the growth plate is, however, clearly mediated via aromatization in estrogens and interaction with ERalpha. Androgens increase radial growth, whereas estrogens decrease periosteal bone formation. This effect of androgens may be important because bone strength in males seems to be determined by relatively higher periosteal bone formation and, therefore, greater bone dimensions, relative to muscle mass at older age. Experiments in mice again suggest that both the AR and ERalpha pathways are involved in androgen action on radial bone growth. ERbeta may mediate growth-limiting effects of estrogens in the female but does not seem to be involved in the regulation of bone size in males. In conclusion, androgens may protect men against osteoporosis via maintenance of cancellous bone mass and

  5. Gracile bone dysplasias

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, Kazimierz [Department of Medical Imaging, The Children' s Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW (Australia); Masel, John [Department of Radiology, Royal Children' s Hospital, Brisbane (Australia); Sillence, David O. [Department of Paediatrics and Child Health, The University of Sydney (Australia); Arbuckle, Susan [Department of Anatomical Pathology, The Children' s Hospital at Westmead, NSW (Australia); Juttnerova, Vera [Oddeleni Lekarske Genetiky, Hradec Kralove (Czech Republic)

    2002-09-01

    Gracile bone dysplasias constitute a group of disorders characterised by extremely slender bones with or without fractures. We report four newborns, two of whom showed multiple fractures. Two babies had osteocraniostenosis and one had features of oligohydramnios sequence. The diagnosis in the fourth newborn, which showed thin long bones and clavicles and extremely thin, poorly ossified ribs, is uncertain. Exact diagnosis of a gracile bone dysplasia is important for genetic counselling and medico-legal reasons. (orig.)

  6. 肘管、腕管的超声解剖及其临床应用%Study on the anatomy and clinical implication of cubital and carpal tunnel with ultrasound

    Institute of Scientific and Technical Information of China (English)

    郭瑞军; 于亚东; 邵新中; 王明花; 田德虎; 张文云; 张经歧; 张晓丽

    2000-01-01

    目的 探讨高频超声对肘管、腕管综合征的诊断价值.方法 /应用高频超声观察30例正常人的肘管及腕管的超声解剖并对20例肘管综合征、10例腕管综合征患者术前行超声检查.结果 高频超声不仅能清晰显示构成肘管及腕管的骨质、软组织及其内容物,而且能够明确肘管和腕管综合征的病因以及尺神经和正中神经的形态学变化.结论 高频超声在肘管、腕管综合征的诊断及鉴别诊断中具有重要价值.%Objective To evaluate the diagnostic value of high frequency ultrasound in cubital and carpal tunnel syndrome. Methods High frequency ultrasonography of normal cubital and carpal tunnel were performed in 30 healthy volunteers. Then sonorgraphic examination was carried out in 20 patients with cubital tunnel syndrome and 10 patients with carpal tunnel syndrome before operation. Results Not only the structure of cubital and carpal tunnel cauld be showed clearly, but also the cause of the cubital and carpal tunnel syndrome could be distinct. Conclusion High frequency ultrasound is of high diagnostic value in cubital and carpal tunnel syndrome.

  7. Enzymatic maceration of bone

    DEFF Research Database (Denmark)

    Uhre, Marie-Louise; Eriksen, Anne Marie; Simonsen, Kim Pilkjær;

    2015-01-01

    the bones. The DNA analysis showed that DNA was preserved on all the pieces of bones which were examined. Finally, the investigation suggests that enzyme maceration could be gentler on the bones, as the edges appeared less frayed. The enzyme maceration was also a quicker method; it took three hours compared...

  8. Oxytocin and bone

    Science.gov (United States)

    Sun, Li; Zaidi, Mone; Zallone, Alberta

    2014-01-01

    One of the most meaningful results recently achieved in bone research has been to reveal that the pituitary hormones have profound effect on bone, so that the pituitary-bone axis has become one of the major topics in skeletal physiology. Here, we discuss the relevant evidence about the posterior pituitary hormone oxytocin (OT), previously thought to exclusively regulate parturition and breastfeeding, which has recently been established to directly regulate bone mass. Both osteoblasts and osteoclasts express OT receptors (OTR), whose stimulation enhances bone mass. Consistent with this, mice deficient in OT or OTR display profoundly impaired bone formation. In contrast, bone resorption remains unaffected in OT deficiency because, even while OT stimulates the genesis of osteoclasts, it inhibits their resorptive function. Furthermore, in addition to its origin from the pituitary, OT is also produced by bone marrow osteoblasts acting as paracrine-autocrine regulator of bone formation modulated by estrogens. In turn, the power of estrogen to increase bone mass is OTR-dependent. Therefore, OTR−/− mice injected with 17β-estradiol do not show any effects on bone formation parameters, while the same treatment increases bone mass in wild-type mice. These findings together provide evidence for an anabolic action of OT in regulating bone mass and suggest that bone marrow OT may enhance the bone-forming action of estrogen through an autocrine circuit. This established new physiological role for OT in the maintenance of skeletal integrity further suggests the potential use of this hormone for the treatment of osteoporosis. PMID:25209411

  9. Bone regeneration with cultured human bone grafts

    Energy Technology Data Exchange (ETDEWEB)

    Yoshikawa, T.; Nakajima, H. [Nara Medical Univ., Kashihara City (Japan). Dept. of Pathology; Nara Medical Univ., Kashihara City (Japan). Dept. of Orthopedic Surgery; Ohgushi, H.; Ueda, Y.; Takakura, Y. [Nara Medical Univ., Kashihara City (Japan). Dept. of Orthopedic Surgery; Uemura, T.; Tateishi, T. [National Inst. for Advanced Interdisciplinary Research (NAIR), Ibaraki (Japan). Tsukuba Research Center; Enomoto, Y.; Ichijima, K. [Nara Medical Univ., Kashihara City (Japan). Dept. of Pathology

    2001-07-01

    From 73 year old female patient, 3 ml of bone marrow was collected from the ilium. The marrow was cultured to concentrate and expand the marrow mesenchymal cells on a culture dish. The cultured cells were then subculturedeither on another culture dish or in porous areas of hydroxyapatite ceramics in the presence of dexamethasone and beta-glycerophosphate (osteo genic medium). The subculturedtissues on the dishes were analyzed by scanning electron microscopy (SEM), and subculturedtissues in the ceramics were implanted intraperitoneally into athymic nude mice. Vigorous growth of spindle-shaped cells and a marked formation of bone matrix beneath the cell layers was observed on the subculture dishes by SEM. The intraperitoneally implanted ceramics with cultured tissues revealed thick layer of lamellar bone together with active osteoblasts lining in many pore areas of the ceramics after 8 weeks. The in vitro bone formations on the culture dishes and in vivo bone formation in porous ceramics were detected. These results indicate that we can assemble an in vitro bone/ceramic construct, and due to the porous framework of the ceramic, the construct has osteogenic potential similar to that of autologous cancellous bone. A significant benefit of this method is that the construct can be made with only a small amount of aspirated marrow cells from aged patients with little host morbidity. (orig.)

  10. Central sensitization does not identify patients with carpal tunnel syndrome who are likely to achieve short-term success with physical therapy.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Cleland, Joshua A; Ortega-Santiago, Ricardo; de-la-Llave-Rincon, Ana Isabel; Martínez-Perez, Almudena; Pareja, Juan A

    2010-11-01

    The aim of the current study was to identify whether hyperexcitability of the central nervous system is a prognostic factor for individuals with carpal tunnel syndrome (CTS) likely to experience rapid and clinical self-reported improvement following a physical therapy program including soft tissue mobilization and nerve slider neurodynamic interventions. Women presenting with clinical and electrophysiological findings of CTS were involved in a prospective single-arm trial. Participants underwent a standardized examination and then a physical therapy session. The physical therapy sessions included both soft tissue mobilization directed at the anatomical sites of potential median nerve entrapment and a passive nerve slider neurodynamic technique targeted to the median nerve. Pressure pain thresholds (PPT) over the median, radial and ulnar nerves, C5-C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle were assessed bilaterally. Additionally, thermal detection and pain thresholds were measured over the carpal tunnel and thenar eminence bilaterally to evaluate central nervous system excitability. Subjects were classified as responders (having achieved a successful outcome) or non-responders based on self-perceived recovery. Variables were entered into a stepwise logistic regression model to determine the most accurate variables for determining prognosis. Data from 72 women were included in the analysis, of which 35 experienced a successful outcome (48.6%). Three variables including PPT over the C5-C6 joint affected side 66 points were identified. If 2 out of 3 variables were present (LR + 14.8), the likelihood of success increased from 48.6 to 93.3%. We identified 3 factors that may be associated with a rapid clinical response to both soft tissue mobilization and nerve slider neurodynamic techniques targeted to the median nerve in women presenting with CTS. Our results support that widespread central sensitization may not be present in women with CTS who

  11. Comparison of High Resolution Ultrasonography and Nerve Conduction Study in the Diagnosis of Carpal Tunnel Syndrome: Diagnostic Value of Median Nerve Cross-Sectional Area

    Directory of Open Access Journals (Sweden)

    A. Mohammadi

    2009-11-01

    Full Text Available Background/Objective: Carpal tunnel syndrome (CTS is a common peripheral entrapment neuropathy. This study was performed to evaluate whether high-resolution ultrasonography may be an alternative diagnostic method for nerve conduction study (NCS in the diagnosis of carpal tunnel syndrome. "nPatients and Methods: 132 wrists of 82 patients and 152 wrists of controls were enrolled in the study. The cross sectional area of the median nerve was measured at the carpal tunnel inlet and outlet in all patients and controls. All patients had a nerve conduction study. Then comparison between ultrasonography and NCS was performed. Combination of clinical diagnosis and NCS was used as the gold standard. "nResults: The mean cross-sectional area (CSA of the median nerve at the tunnel inlet was 11.4±1.7 mm2 for the patient group and 5.78 ±0.9 mm2 for the control group (P<0.001. The mean cross-sectional area at the tunnel outlet was 9.9±1.2 mm2 for the patient group and 4.7±0.7 mm2 for the control group (P<0.001. The best cut-off value of CSA at the tunnel inlet and the outlet was 7.5 mm2. "nConclusion: In patients with clinical diagnosis of CTS we confirmed that the diagnostic value of ultrasonography is similar to NCS and sonography may be used in primary evaluation of CTS.

  12. Bone scintiscanning updated.

    Science.gov (United States)

    Lentle, B C; Russell, A S; Percy, J S; Scott, J R; Jackson, F I

    1976-03-01

    Use of modern materials and methods has given bone scintiscanning a larger role in clinical medicine, The safety and ready availability of newer agents have led to its greater use in investigating both benign and malignant disease of bone and joint. Present evidence suggests that abnormal accumulation of 99mTc-polyphosphate and its analogues results from ionic deposition at crystal surfaces in immature bone, this process being facilitated by an increase in bone vascularity. There is, also, a component of matrix localization. These factors are in keeping with the concept that abnormal scintiscan sites represent areas of increased osteoblastic activity, although this may be an oversimplification. Increasing evidence shows that the bone scintiscan is more sensitive than conventional radiography in detecting focal disease of bone, and its ability to reflect the immediate status of bone further complements radiographic findings. The main limitation of this method relates to nonspecificity of the results obtained.

  13. BONES WITH BIOCERAMICS

    Directory of Open Access Journals (Sweden)

    Wijianto Wijianto

    2017-01-01

    Full Text Available This paper discuss about ceramics in application as bone implant. Bioceramics for instance Hydroxyapatite, usually is abbreviated with HA or HAp, is a mineral that is very good physical properties as bone replacement in human body. To produce Hydroxyapatite, coating process is used which have good potential as they can exploit the biocompatible and bone bonding properties of the ceramic. There are many advantages and disadvantages of bioceramics as bone implant. Advantages of hydroxyapatite as bone implant are rapidly integrated into the human body, and is most interesting property that will bond to bone forming indistinguishable unions. On contrary, disadvantages of hydroxyapatite as bone implant are poor mechanical properties (in particular fatigue properties mean that hydroxyapatite cannot be used in bulk form for load bearing applications such as orthopaedics and poor adhesion between the calcium phosphate coating and the material implant will occur.

  14. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

    OpenAIRE

    Ke, Ming-Jen; Chen, Liang-Cheng; Chou, Yu-Ching; Li, Tsung-Ying; Chu, Heng-Yi; Tsai, Chia-Kuang; Wu, Yung-Tsan

    2016-01-01

    Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 co...

  15. Treatment of carpal tunnel syndrome with atgesia%感觉过敏型腕管综合征的治疗

    Institute of Scientific and Technical Information of China (English)

    顾玉东; 史其林; 陈德松; 王涛; 张丽银

    2008-01-01

    Objective To report the treatment of 7 cases of carpal tunnel syndrome(CTS)with algesia.Methods One hundred and twenty eight cases of carpal tunnel syndrome within the period of March 2002 and March 2005 were retrospectively analyzed.There were 7 cases(4 female and 3 male)had algesia,4 cases were treated with endoscopic management of carpal tunnel release (ECTR) and 3 cases were treated with open management of carpal tunnel release(OCTR).These 7 cases were followed-up 1-4years(average 1.5 years)postoperatively.Results Two ECTR cases and 2 OCTR cases had bad therapeutic effect and the others had good effect.Both 2 bad-effect ECTR cases feel special pain when insert the catheter.Only inject Triamcinolone Acetonide-A within epineurium after completely release in the goodeffect OCTR ease.Conclusion CTS with algesia is a special type of CTS,the key to treat it is to protect epineurium.%目的 报道7例感觉过敏型腕管综合征的诊治特点.方法 收集与分析2002年3月至2005年3月间128例腕管综合征中感觉过敏型7例的病情及治疗特点.其中女性4例、男性3例.4例应用内镜治疗,3例切开治疗,经1~4年随访,平均随访时间1.5年.结果 内镜治疗中2例疗效差,均在术中插入扩张导管时出现异常疼痛,另外2例基本满意.3例切开治疗中,2例疗效差,1例基本满意.3例基本满意中,2例内镜插入导管时均未出现疼痛,另1例为单纯切断腕横韧带,并在神经外膜下注射激素.结论 感觉过敏型腕管综合征是一组特殊病例,保护神经外膜是治疗关键.

  16. Wide field of view computed tomography and mid carpal instability: The value of the sagittal radius–lunate–capitate axis – Preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Repse, Stephen E., E-mail: stephrep@gmail.com [Department of Diagnostic Imaging, Monash Health, VIC (Australia); Koulouris, George, E-mail: GeorgeK@melbourneradiology.com.au [Melbourne Radiology Clinic, Ground Floor, 3-6/100 Victoria Parade, East Melbourne, VIC (Australia); Centre for Orthopaedic Research, School of Surgery, University of Western Australia, Nedlands, WA (Australia); Troupis, John M., E-mail: john.troupis@gmail.com [Department of Diagnostic Imaging & Monash Cardiovascular Research Centre, Monash Health and Department of Biomedical Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, VIC (Australia)

    2015-05-15

    Highlights: • Unique insight into the assessment of mid carpal instability. • 4D CT using sagittal reconstructions along the radius–lunate–capitate axis. • 4D CT observations of vacuum phenomenon, trigger lunate and capitate subluxation. • Earlier recognition of mid carpal instability. - Abstract: Purpose: Dynamic four dimensional (4D) computed tomography (CT) has recently emerged as a practical method for evaluating complex functional abnormality of joints. We retrospectively analysed 4D CT studies undertaken as part of the clinical management of hand and wrist symptoms. We present our initial experience of 4D CT in the assessment of functional abnormalities of the wrist in a group of patients with mid carpal instability (MCI), specifically carpal instability non-dissociative. We aim to highlight unique features in assessment of the radius–lunate–capitate (RLC) axis which allows insight and understanding of abnormalities in function, not just morphology, which may be contributing to symptoms. Materials and methods: Wide field of view multi-detector CT scanner (320 slices, 0.5 mm detector thickness) was used to acquire bilateral continuous motion assessment in hand flexion and extension. A maximum z-axis coverage of 16 cm was available for each acquisition, and a large field of view (FOV) was used. Due to the volume acquisition during motion, reconstructions at multiple time points were undertaken. Dynamic and anatomically targeted multi-planar-reconstructions (MPRs) were then used to establish the kinematic functionality of the joint. Results: Our initial cohort of 20 patients was reviewed. Three findings were identified which were present either in isolation or in combination. These are vacuum phenomenon, triggering of the lunate and capitate subluxation. We provide 4D CT representations of each and highlight features considered of clinical importance and their significance. We also briefly discuss how the current classifications of dynamic wrist

  17. Diabetes, Biochemical Markers of Bone Turnover, Diabetes Control, and Bone

    OpenAIRE

    Starup-Linde, Jakob

    2013-01-01

    Diabetes mellitus is known to have late complications including micro vascular and macro vascular disease. This review focuses on another possible area of complication regarding diabetes; bone. Diabetes may affect bone via bone structure, bone density, and biochemical markers of bone turnover. The aim of the present review is to examine in vivo from humans on biochemical markers of bone turnover in diabetics compared to non-diabetics. Furthermore, the effect of glycemic control on bone marker...

  18. Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study.

    Science.gov (United States)

    Gíslason, M K; Stansfield, B; Bransby-Zachary, M; Hems, T; Nash, D H

    2012-11-01

    A finite element model of the wrist was developed to simulate mechanical changes that occur after surgery of the wrist. After partial arthrodesis, the wrist will experience altered force transmission during loading. Three different types of partial arthrodesis were investigated - radiolunate, radioscaphoid, and radioscapholunate - and compared with the healthy untreated wrist. The results showed that the compressive forces on the radiocarpal joint decreased compared with the untreated wrist with both radiolunate and radioscaphoid fusions. The load transmission through the midcarpal joints varied depending on arthrodesis type. The forces in the extrinsic ligaments decreased with the fusion, most noticeably in the dorsal radiotriquetral ligament, but increased in the dorsal scaphotriquetral ligament. From the results of the study it can be concluded that the radioscapholunate fusion shows the most biomechanically similar behaviour out of the three fusion types compared with the healthy wrist. The modelling described in this paper may be a useful approach to pre-operative planning in wrist surgery.

  19. Meta-analysis of limited mini incision release and traditional open carpal tunnel release for treatment of carpal tunnel syndrome%有限小切口松解与常规切开松解修复腕管综合征的Meta分析

    Institute of Scientific and Technical Information of China (English)

    艾科热木•吾普尔; 加莎热特•杰力勒; 艾合买提江•玉素甫; 阿不来提•阿不拉; 阿布都黑力力•买买提艾力; 刘亚飞; 阿依娜孜; 黄勇; 杨朋斐

    2014-01-01

    BACKGROUND:Since 1991, many physicians try to combine the smal open-incision along the wrist crease with traditional carpal tunnel release that is simple and safe to reduce tissue damage and recurrence rate. But what kind of techniques is superior has been controversial. OBJECTIVE:To compare the efficacy and safety of limited mini incision (non-endoscopic) carpal tunnel release with traditional open carpal tunnel release for carpal tunnel syndrome. METHODS:Based on Cochrane Systematic Review, we searched through the MEDLINE (1966-01/2010-03), EMBASE (1966-01/2014-05), Cochrane Library (2014-05) and CBM disc (1979-01/2013-12), and relevant seven Chinese and English orthopedic journals by hand. Then, we colected al the randomized control trials related to carpal tunnel syndrome. The quality of trials was criticaly assessed. The Revman5.2.2 that provided by Cochrane Colaboration was used for data management and analysis on the evidence of the difference in the efficacy and safety of limited mini incision carpal tunnel release versus traditional open carpal tunnel release. RESULTS AND CONCLUSION: Totaly seven randomized controled trials were included by total retrieve and screening. The results of meta-analysis showed no significant differences in the scar tenderness, pilar pain, subjective satisfaction and recovery time between groups of limited mini incision carpal tunnel release and traditional open carpal tunnel release (P > 0.05). The rate of complications and operation time in group of limited mini incision carpal tunnel release were lower than those in group of traditional open carpal tunnel release (P   目的:对非内窥镜的有限小切口松解和传统腕管切开松解治疗腕管综合征的疗效进行系统评价。  方法:按照 Cochrane系统评价的方法,计算机检索MEDLINE(1966年1月至2010年3月)、EMBASE(1966年1月至2014年5月)、Cochrane图书馆(2014年5月)及中国生物医学文献数据库(1979年1月至2013年12

  20. Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation.

    Science.gov (United States)

    Zhang, Wei; Johnston, Jamie A; Ross, Mark A; Smith, Anthony A; Coakley, Brandon J; Gleason, Elizabeth A; Dueck, Amylou C; Santello, Marco

    2011-01-01

    The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS), a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g) for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

  1. Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation.

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    Full Text Available The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS, a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

  2. Efficacy of splinting and oral steroids in the treatment of carpal tunnel syndrome: A prospective randomized clinical and electrophysiological study

    Directory of Open Access Journals (Sweden)

    Mishra Sanjay

    2006-01-01

    Full Text Available Objective: To study the efficacy of splinting and oral steroids in the management of carpal tunnel syndrome (CTS. Design: Prospective, randomized, open-label, clinical and electrophysiological study with 3-month follow-up. Materials and Methods: Forty patients with CTS were randomly divided into splint group (N-20, wearing splint in neutral position for 4 weeks; and steroid group (N-20, who received oral prednisolone 20 mg/day for 2 weeks followed by 10 mg/day for 2 weeks. Clinical and electrophysiological evaluations were done at baseline and at 1-month and 3-month follow-up. Independent ′t′ test and paired ′t′ test were used for statistical analysis. Outcome Measures: Primary outcome measure was the symptom severity score and functional status score. Secondary outcome measures were median nerve sensory and motor distal latency and conduction velocity. Results: At the end of 3 months, statistically significant improvement was seen in symptom severity score and functional status score in both groups ( P P =0.001 at 3 months in steroid group, while insignificant improvement ( P =0.139 was observed in splint group. On comparing the clinical and electrophysiological improvement between the two groups, except for the functional status score, there was no significant difference at 3-month follow-up. Improvement in functional status score was significantly more in steroid group ( P =0.03. Conclusion : There was significant improvement in both groups, clinically as well as electrophysiologically, at 3 months. On comparing the efficacy of the two treatment methods, except for the functional status score, there was no significant difference between the two groups.

  3. Ultrasound assessment on selected peripheral nerve pathologies. Part I: Entrapment neuropathies of the upper limb - excluding carpal tunnel syndrome.

    Science.gov (United States)

    Kowalska, Berta; Sudoł-Szopińska, Iwona

    2012-09-01

    Ultrasound (US) is one of the methods for imaging entrapment neuropathies, post-traumatic changes to nerves, nerve tumors and postoperative complications to nerves. This type of examination is becoming more and more popular, not only for economic reasons, but also due to its value in making accurate diagnosis. It provides a very precise assessment of peripheral nerve trunk pathology - both in terms of morphology and localization. During examination there are several options available to the specialist: the making of a dynamic assessment, observation of pain radiation through the application of precise palpation and the comparison of resultant images with the contra lateral limb. Entrapment neuropathies of the upper limb are discussed in this study, with the omission of median nerve neuropathy at the level of the carpal canal, as extensive literature on this subject exists. The following pathologies are presented: pronator teres muscle syndrome, anterior interosseus nerve neuropathy, ulnar nerve groove syndrome and cubital tunnel syndrome, Guyon's canal syndrome, radial nerve neuropathy, posterior interosseous nerve neuropathy, Wartenberg's disease, suprascapular nerve neuropathy and thoracic outlet syndrome. Peripheral nerve examination technique has been presented in previous articles presenting information about peripheral nerve anatomy [Journal of Ultrasonography 2012; 12 (49): 120-163 - Normal and sonographic anatomy of selected peripheral nerves. Part I: Sonohistology and general principles of examination, following the example of the median nerve; Part II: Peripheral nerves of the upper limb; Part III: Peripheral nerves of the lower limb]. In this article potential compression sites of particular nerves are discussed, taking into account pathomechanisms of damage, including predisposing anatomical variants (accessory muscles). The parameters of ultrasound assessment have been established - echogenicity and echostructure, thickness (edema and related increase

  4. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    Directory of Open Access Journals (Sweden)

    Melani Carla

    2008-10-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare. Incidence rates of in-hospital cases of CTS were estimated based on 1 codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence on regional databases; 2 demographic general population data for each region. We compared (using the χscore test age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs for married/unmarried men and women. Results Age-standardized incidence rates (per 100,000 person-years of in-hospital cases of CTS were 166 in women and 44 in men (106 overall. Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60 in women, and 1.42 (95% CI, 1.40–1.45 in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts. Conclusion This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  5. Primary somatosensory/motor cortical thickness distinguishes paresthesia-dominant from pain-dominant carpal tunnel syndrome.

    Science.gov (United States)

    Maeda, Yumi; Kettner, Norman; Kim, Jieun; Kim, Hyungjun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Libby, Alexandra; Mezzacappa, Pia; Mawla, Ishtiaq; Morse, Leslie R; Audette, Joseph; Napadow, Vitaly

    2016-05-01

    Paresthesia-dominant and pain-dominant subgroups have been noted in carpal tunnel syndrome (CTS), a peripheral neuropathic disorder characterized by altered primary somatosensory/motor (S1/M1) physiology. We aimed to investigate whether brain morphometry dissociates these subgroups. Subjects with CTS were evaluated with nerve conduction studies, whereas symptom severity ratings were used to allocate subjects into paresthesia-dominant (CTS-paresthesia), pain-dominant (CTS-pain), and pain/paresthesia nondominant (not included in further analysis) subgroups. Structural brain magnetic resonance imaging data were acquired at 3T using a multiecho MPRAGE T1-weighted pulse sequence, and gray matter cortical thickness was calculated across the entire brain using validated, automated methods. CTS-paresthesia subjects demonstrated reduced median sensory nerve conduction velocity (P = 0.05) compared with CTS-pain subjects. In addition, cortical thickness in precentral and postcentral gyri (S1/M1 hand area) contralateral to the more affected hand was significantly reduced in CTS-paresthesia subgroup compared with CTS-pain subgroup. Moreover, in CTS-paresthesia subjects, precentral cortical thickness was negatively correlated with paresthesia severity (r(34) = -0.40, P = 0.016) and positively correlated with median nerve sensory velocity (r(36) = 0.51, P = 0.001), but not with pain severity. Conversely, in CTS-pain subjects, contralesional S1 (r(9) = 0.62, P = 0.042) and M1 (r(9) = 0.61, P = 0.046) cortical thickness were correlated with pain severity, but not median nerve velocity or paresthesia severity. This double dissociation in somatotopically specific S1/M1 areas suggests a neuroanatomical substrate for symptom-based CTS subgroups. Such fine-grained subgrouping of CTS may lead to improved personalized therapeutic approaches, based on superior characterization of the linkage between peripheral and central neuroplasticity.

  6. Bone building with bortezomib

    Science.gov (United States)

    Roodman, G. David

    2008-01-01

    In this issue of the JCI, Mukherjee et al. report that bortezomib, a clinically available proteasome inhibitor active against myeloma, induces the differentiation of mesenchymal stem/progenitor cells (MSCs) — rather than mature osteoprogenitor cells — into osteoblasts, resulting in new bone formation (see the related article beginning on page 491). These results were observed when MSCs were implanted subcutaneously in mice or were used to treat a mouse model of postmenopausal bone loss. Others have reported that immunomodulatory drugs (e.g., thalidomide and lenalidomide), which are active against myeloma, also block the activity of bone-resorbing osteoclasts. These results reflect the utility of targeting endogenous MSCs for the purpose of tissue repair and suggest that combining different classes of agents that are antineoplastic and also inhibit bone destruction and increase bone formation should be very beneficial for myeloma patients suffering from severe bone disease. PMID:18219395

  7. Adrenal gland and bone.

    Science.gov (United States)

    Hardy, Rowan; Cooper, Mark S

    2010-11-01

    The adrenal gland synthesizes steroid hormones from the adrenal cortex and catecholamines from the adrenal medulla. Both cortisol and adrenal androgens can have powerful effects on bone. The overproduction of cortisol in Cushing's disease leads to a dramatic reduction in bone density and an increase risk of fracture. Overproduction of adrenal androgens in congenital adrenal hyperplasia (CAH) leads to marked changes in bone growth and development with early growth acceleration but ultimately a significant reduction in final adult height. The role of more physiological levels of glucocorticoids and androgens on bone metabolism is less clear. Cortisol levels measured in elderly individuals show a weak correlation with measures of bone density and change in bone density over time with a high cortisol level associated with lower bone density and more rapid bone loss. Cortisol levels and the dynamics of cortisol secretion change with age which could also explain some age related changes in bone physiology. It is also now clear that adrenal steroids can be metabolized within bone tissue itself. Local synthesis of cortisol within bone from its inactive precursor cortisone has been demonstrated and the amount of cortisol produced within osteoblasts appears to increase with age. With regard to adrenal androgens there is a dramatic reduction in levels with aging and several studies have examined the impact that restoration of these levels back to those seen in younger individuals has on bone health. Most of these studies show small positive effects in women, not men, but the skeletal sites where benefits are seen varies from study to study.

  8. Bone scanning in otolaryngology.

    Science.gov (United States)

    Noyek, A M

    1979-09-01

    Modern radionuclide bone scanning has introduced a new concept in physiologic and anatomic diagnostic imaging to general medicine. As otolaryngologists must diagnose and treat disease in relation to the bony and/or cartilaginous supporting structures of the neurocranium and upper airway, this modality should be included in the otolaryngologist's diagnostic armamentarium. It is the purpose of this manuscript to study the specific applications of bone scanning to our specialty at this time, based on clinical experience over the past three years. This thesis describes the development of bone scanning in general (history of nuclear medicine and nuclear physics; history of bone scanning in particular). General concepts in nuclear medicine are then presented; these include a discussion of nuclear semantics, principles of radioactive emmissions, the properties 99mTc as a radionuclide, and the tracer principle. On the basis of these general concepts, specific concepts in bone scanning are then brought forth. The physiology of bone and the action of the bone scan agents is presented. Further discussion considers the availability and production of the bone scan agent, patient factors, the gamma camera, the triphasic bone scan and the ultimate diagnostic principle of the bone scan. Clinical applications of bone scanning in otolaryngology are then presented in three sections. Proven areas of application include the evaluation of malignant tumors of the head and neck, the diagnosis of temporomandibular joint disorders, the diagnosis of facial fractures, the evaluation of osteomyelitis, nuclear medicine imaging of the larynx, and the assessment of systemic disease. Areas of adjunctive or supplementary value are also noted, such as diagnostic imaging of meningioma. Finally, areas of marginal value in the application of bone scanning are described.

  9. Neuroconduccion of the medium nerve in the carpal tunnel in data-entry personnel of two companies of telecommunications. Medellín. October-November 2005

    Directory of Open Access Journals (Sweden)

    Luis F. De Subiría

    2008-02-01

    Full Text Available Objetive: This study was carried out in order to know the comportment of the median nerve’s impulse speed at the carpal tunnel associated to the exposure time to the fingers’ repetitive motion risk factor. Methodology: This study was applied to data-entry personnel at two companies in the city of Medellin, Colombia, during October and November of 2005. Age, gender, labour exposure time, dominant hand and pathological antecedents associated to the carpal tunnel syndrome variables were investigated. Clinical test and a median nerve conduction test were applied to the workers. Discussion: 55 data-entry workers were evaluated, for a total of 110 hands. The survey included ages between 19 and 40 years old and an average age of 28; 86% of the studied subjects were women; 91% of surveyed subjects declared themselves as right-handed and 60% had a normal weight. Subjects had worked between 12 and 180 months as data-entry personnel with an average time of 83 months, working 48 hours a week. No relevant statistical link was found between labour exposure time and median nerve conduction. Results suggest that doing repetitive movements at work as the only risk factor is not a cause of nerve conduction disorder in the median nerve.

  10. The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial.

    Science.gov (United States)

    Ke, Ming-Jen; Chen, Liang-Cheng; Chou, Yu-Ching; Li, Tsung-Ying; Chu, Heng-Yi; Tsai, Chia-Kuang; Wu, Yung-Tsan

    2016-12-02

    Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

  11. Correlation between Female Sex Hormones and Electrodiagnostic Parameters and Clinical Function in Post-menopausal Women with Idiopathic Carpal Tunnel Syndrome

    Science.gov (United States)

    Mohammadi, Azam; Naseri, Mahshid; Namazi, Hamid; Ashraf, Mohammad Javad

    2016-01-01

    Objectives To investigate the role of sex-hormonal changes in idiopathic carpal tunnel syndrome (CTS) among post-menopausal women through measuring estrogen receptor (ER) expression in their transverse carpal ligament (TCL) and serum estrogen level, as well as determine the correlation between these factors and electrodiagnostic parameters and Boston score. Methods Biopsy samples of TCL were collected from 12 postmenopausal women who had undergone surgery for severe idiopathic CTS; control specimens were collected from 10 postmenopausal women without CTS who had undergone surgery for the other hand pathologies. To determine the distributions of ER in TCL, histological and immunohistochemical examinations were performed. Serum estrogen level was also measured. Electrodiagnosis and Boston questionnaire were used for CTS severity and determination of the patients' function. Results ER expression in TCL and serum estrogen level were not significantly different in the case group compared to the control group (P = 0.79 and P = 0.88, respectively). Also, there was no correlation between ER expression or serum estrogen level and electrodiagnostic parameters or Boston score. Conclusions Sex hormones cannot still be considered as the etiology of idiopathic CTS in postmenopausal women. The role of other factors such as wrist ratio and narrower outlet in females compared to the males should be considered along with hormonal changes. PMID:27617242

  12. An evaluation of radial and ulnar artery flow characteristics in diabetic patients with carpal tunnel syndrome and the diagnostic value of ultrasonography in these patients

    Directory of Open Access Journals (Sweden)

    Ahmet Boyacı

    2014-06-01

    Full Text Available Objectives: This study aimed to research the value of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS in patients with diabetes mellitus (DM and to examine the flow characteristics of the radial and ulnar arteries in diabetic patients with CTS. Methods: A total of 23 diabetic hands diagnosed with CTS from electrophysiological evaluation (DM-CTS, 47 asymptomatic diabetic hands (DM and 50 healthy hands (C as the control group were evaluated with high resolution ultrasonography. The median nerve was measured in the cross-sectional area (CSA, flattening ratio (FR and at the level of the carpal tunnel inlet [proximal (p] and the wrist crease [distal (d]. The radial and ulnar arteries were evaluated with both hands in a neutral position. Results: In the DM-CTS group, the CSA-p and CSA-d values were statistically signficantly greater compared to the DM and C groups (p0.05. The radial artery diameter was determined to be statistically significantly greater in the DM-CTS group than the C group (p<0.05. Conclusion: The median nerve CSA is significantly greater in diabetic CTS patients compared to patients with diabetes only and healthy controls. In the evaluation of CTS in diabetic patients, CSA measured with ultrasonography may be a diagnostic tool. J Clin Exp Invest 2014; 5 (2: 179-185

  13. Hypercalciuric Bone Disease

    Science.gov (United States)

    Favus, Murray J.

    2008-09-01

    Hypercalciuria plays an important causal role in many patients with calcium oxalate (CaOx) stones. The source of the hypercalciuria includes increased intestinal Ca absorption and decreased renal tubule Ca reabsorption. In CaOx stone formers with idiopathic hypercalciuria (IH), Ca metabolic balance studies have revealed negative Ca balance and persistent hypercalciuria in the fasting state and during low dietary Ca intake. Bone resorption may also contribute to the high urine Ca excretion and increase the risk of bone loss. Indeed, low bone mass by DEXA scanning has been discovered in many IH patients. Thiazide diuretic agents reduce urine Ca excretion and may increase bone mineral density (BMD), thereby reducing fracture risk. Dietary Ca restriction that has been used unsuccessfully in the treatment of CaOx nephrolithiasis in the past may enhance negative Ca balance and accelerate bone loss. DEXA scans may demonstrate low BMD at the spine, hip, or forearm, with no predictable pattern. The unique pattern of bone histologic changes in IH differs from other causes of low DEXA bone density including postmenopausal osteoporosis, male hypogonadal osteoporosis, and glucocorticoid-induced osteoporosis. Hypercalciuria appears to play an important pathologic role in the development of low bone mass, and therefore correction of urine Ca losses should be a primary target for treatment of the bone disease accompanying IH.

  14. Glutamate signalling in bone.

    Directory of Open Access Journals (Sweden)

    Karen eBrakspear

    2012-08-01

    Full Text Available Mechanical loading plays a key role in the physiology of bone, allowing bone to functionally adapt to its environment, however characterisation of the signalling events linking load to bone formation is incomplete. A screen for genes associated with mechanical load-induced bone formation identified the glutamate transporter GLAST, implicating the excitatory amino acid, glutamate, in the mechanoresponse. When an osteogenic load (10N, 10Hz was externally applied to the rat ulna, GLAST (EAAT1 mRNA, was significantly down-regulated in osteocytes in the loaded limb. Functional components from each stage of the glutamate signalling pathway have since been identified within bone, including proteins necessary for calcium-mediated glutamate exocytosis, receptors, transporters and signal propagation. Activation of ionotropic glutamate receptors has been shown to regulate the phenotype of osteoblasts and osteoclasts in vitro and bone mass in vivo. Furthermore, glutamatergic nerves have been identified in the vicinity of bone cells expressing glutamate receptors in vivo. However, it is not yet known how a glutamate signalling event is initiated in bone or its physiological significance. This review will examine the role of the glutamate signalling pathway in bone, with emphasis on the functions of glutamate transporters in osteoblasts.

  15. Blood: bone equilibrium

    Energy Technology Data Exchange (ETDEWEB)

    Neuman, M.W.

    1982-01-01

    The conundrum of blood undersaturation with respect to bone mineralization and its supersaturation with respect to bone's homeostatic function has acquired a new equation. On the supply side, Ca/sup 2 +/ is pumped in across bone cells to provide the needed Ca/sup 2 +/ x P/sub i/ for brushite precipitation. On the demand side, blood is in equilibrium with bone fluid, which is in equilibrium with a mineral more soluble than apatite. The function of potassium in this equation is yet to be found.

  16. Olecranon bone graft: revisited.

    Science.gov (United States)

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan

    2010-09-01

    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  17. 不同手术方法治疗腕管综合征的临床疗效分析%Clinical effects of different surgical methods in the treatment of carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    陈浩宇; 王朝辉; 罗桦杰

    2012-01-01

    Objective To discuss the clinical effects and safety of treating carpal tunnel syndrome with two different surgical methods. Methods Fifty-eight patients with carpal tunnel syndrome were randomly divided into two groups. Group A (n=28) was treated by minimally invasive double small incision carpal tunnel release operation, and group B (n=30) was treated by endoscopic carpal tunnel release operation, and the patients were followed up for 14-36 months, then the clinical effects and safety of the two methods were analysed and evaluated. Results The excellent rate was 96.43% in group A and 96.67% in group B, snowing no statistically significant difference between the two groups (P>0.05). Group B got less postoperative complications and shorter time to return to work than group A (P<0.05). Conclusion The minimally invasive double small incision carpal tunnel release operation and the endoscopic carpal tunnel release operation are both effective in the treatment of carpal tunnel syndrome, but the latter is safer.%目的 探讨两种不同手术方法治疗腕管综合征的临床疗效和安全性.方法 对58例腕管综合征患者随机分为微创双小切口腕管松解术组(A组,28例)和内镜下腕管松解术组(B组,30例),随访14~36个月,主要观察术后并发症(包括瘢痕痛、手墩柱部痛、返支损伤及RSD)、恢复工作时间,并采用Kelly评定法评价临床疗效.结果 A组优良率为96.43%,B组优良率为96.67%,差异无统计学意义(P>0.05),B组的术后并发症及术后恢复工作时间优于A组(P<0 05).结论 微创双小切口腕管松解术及内镜下腕管松解术治疗腕管综合征都有效,但内镜下腕管松解的手术治疗方法更为安全.

  18. The acrophysis: a unifying concept for understanding enchondral bone growth and its disorders. II. Abnormal growth

    Energy Technology Data Exchange (ETDEWEB)

    Oestreich, Alan E. [Department of Radiology, Cincinnati Children' s Hospital Medical Center, 3333 Burnet Avenue, OH 45229-3039, Cincinnati (United States)

    2004-03-01

    In order to discuss and illustrate the effects common to normal and abnormal enchondral bone at the physes and at all other growth plates of the developing child, the term ''acrophysis'' was proposed. Acrophyses include the growth plates of secondary growth centers including carpals and tarsals and apophyses, and the growth plates at the nonphyseal ends of small tubular bones. Abnormalities at acrophyseal sites are analogous to those at the physeal growth plates and their metaphyses. For example, changes relating to the zone of provisional calcification (ZPC) are often important to the demonstration of such similarities. Lead lines were an early example of the concept of analogy from abnormality due to physeal and to acrophyseal disturbance. The ZPC is a key factor in understanding patterns of rickets and its healing. Examples (including hypothyroidism, scurvy and other osteoporosis, Ollier disease, achondroplasia, and osteopetrosis, as well as the family of frostbite, Kashin-Beck disease, and rat bite fever) illustrate the acrophysis principle and in turn their manifestations are explained by that principle. (orig.)

  19. Developmental characteristics of various types of hand bones of Poland's syndrome%Poland综合征手部不同类型骨骼的发育特征

    Institute of Scientific and Technical Information of China (English)

    吴冯胜; 田文; 赵俊会; 马炜; 郭阳; 殷耀斌

    2016-01-01

    Objective To explore development status in different types of the hand bone and its developmental characteristics with Poland syndrome.Methods There were 32 cases with Poland's syndrome who accepted bilateral hand X-ray examination in Department of Hand Surgery,Beijing Jishuitan Hospital from February 2013 to August 2014.There were 24 male and 8 female patients aged from 1.0 to 15.0 years with median age of 2.4 years.Right hand deformity was 23 cases and left hand deformity was 9 cases.According to Tanner-Whitehouse skeletal age scoring system,20 bones (radius and ulna,7 carpal bones,11 metacarpal and phalangeal bones) selected from the affected and contralateral limb respectively,were evaluated.Besides,hand deformity of the cases was classified into 5 types based on relevant literature.Each bone was given an individual age using the references of Greulich-Pyle chart.The average of all individual ages was taken as gross bone age,the average of individual ages of radius and ulna was taken as bone age of long bones,the average of individual ages of carpal bone was taken as bone age of carpal bones,and the average of individual age of metacarpal and phalangeal bones was taken as bone age of short bones.The delay of bone age was evaluated by correlation test,while the curve of cubic equation was used for analyzing the variance of skeletal development with age.Results The delay of long bone age of patients with Poland's syndrome in this study were 0-1.9 years ((0.5 ±0.5) years),0-2.2 years ((0.7 ±0.5)years) for carpal bone,0.5-2.0 years((0.6 ±0.4) years)for short bone and 0.1-1.7 years((0.6 ±0.4)years) for gross bone.Twelve cases in type Ⅱ hand deformity,15 cases in type Ⅲ and 5 cases in type Ⅳ.The delay of bone ages,including long bone age,carpal bone age,short bone age and gross bone age,was not related with gender and side(all P > 0.05),but related with degree of deformity(F =3.663-12.971,P =0.000-0.038).Conclusion Compared with normal upper limb,the bone

  20. Diagnostic value of 64-slice CT examination and multi-planar reconstruction of carpal fractures%64层螺旋CT及多平面重建对腕骨骨折的诊断价值

    Institute of Scientific and Technical Information of China (English)

    王聚宝; 奚甘平; 张建福

    2014-01-01

    To investigate the value of 64-slice CT examination and multi -planar reconstruction technique in the diagno-sis of carpal fractures .Methods:A retrospective analysis of 31 patients imaging data with carpal fracture diagnosed by 64-slice CT exam-ination and multi-planar reconstruction , by comparing with conventional X -ray radiography examination .Results:31 patients in routine X-ray examination revealed 19 carpal fractures , CT and multi-planar reconstruction examination revealed 39 .There was significant difference ( P <0.05) for carpal fracture detection between the two examination .Conclusion:Compared to the conventional X -ray ex-amination, the 64-slice CT examination and multi -planar reconstruction might have important clinical significance in the diagnosis of carpal fractures .%目的:探讨64层螺旋CT及多平面重建技术在腕骨骨折诊断中的价值。方法:回顾分析31例经64层螺旋CT及多平面重建检查确诊腕骨骨折患者的影像学资料,并与常规X线摄影检查结果相对比。结果:31例患者中常规X线检查发现腕骨骨折19处,CT及多平面重建检查发现39处。两者对腕骨骨折的检出有明显差别(P<0.05)。结论:与常规X线检查相比较,64层螺旋CT及多平面重建对确诊腕骨骨折及骨折部位、类型的显示有重要的临床价值。