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Sample records for carpal tunnel surgery

  1. Is one-stop surgery for carpal tunnel syndrome safe?

    DEFF Research Database (Denmark)

    Jørgensen, Louise Møller; Piil, Karin; Bashir, Asma

    2017-01-01

    OBJECTIVES: The aim of this study was to evaluate one-stop surgery (OSS) for carpal tunnel syndrome (CTS) regarding symptom relief and patient satisfaction. OSS in our setting means only one visit to the hospital for surgery and no hospital appointments for preassessment or follow-up. We hypothes...

  2. Outcome of open carpal tunnel release surgery

    International Nuclear Information System (INIS)

    Khan, A.A.; Ali, H.; Muhammad, G.; Gul, N.; Zardan, K.K.; Mushtaq, M.; Ali, S.; Bhatti, S.N.; Ali, K.; Rashid, B.; Saboor, A.

    2015-01-01

    Background: Carpel tunnel syndrome is a common compression neuropathy of the median nerve causing pain, numbness and functional dysfunction of the hand. Among the available treatments, surgical release of the nerve is the most effective and acceptable treatment option. The aim of this study was to see the outcomes of surgical release of carpel tunnel using open technique. Method: This descriptive case series was conducted at the Department of neurosurgery, Ayub Teaching Hospital Abbottabad from April 2013 to March 2014. One hundred consecutive patients with carpel tunnel syndrome were included who underwent open carpel tunnel release surgery. They were followed up at 1, 3 and 6 months. Residual pain, numbness and functional improvement of the hand were the main outcome measures. Results: Out of 100 patients, 19 were males. The age ranged from 32 to 50 years with a mean of 39.29±3.99 years. The duration of symptoms was from 5 to 24 months. In the entire series patient functional outcome and satisfaction was 82 percentage at 1 month, 94 percentage at 3 months and 97 percentage at 6 months. 18 percentage patient had residual pain at 1 month post-operative follow-up, 6percentage at 3 months and 3 percentage at 6 month follow-up. Conclusion: Open carpel tunnel release surgery is an effective procedure for compression neuropathy of the median nerve. It should be offered to all patients with moderate to severe pain and functional disability related to carpel tunnel syndrome. (author)

  3. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... a passing cramp? It could be carpal tunnel syndrome. The carpal tunnel is a narrow passageway of ... three times more likely to have carpal tunnel syndrome than men. Early diagnosis and treatment are important ...

  4. 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

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

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    Adham do Amaral e Castro

    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 studiedthree 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. Temporal trend of carpal tunnel release surgery: a population-based time series analysis.

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    Naif Fnais

    Full Text Available BACKGROUND: Carpal tunnel release (CTR is among the most common hand surgeries, although little is known about its pattern. In this study, we aimed to investigate temporal trends, age and gender variation and current practice patterns in CTR surgeries. METHODS: We conducted a population-based time series analysis among over 13 million residents of Ontario, who underwent operative management for carpal tunnel syndrome (CTS from April 1, 1992 to March 31, 2010 using administrative claims data. RESULTS: The primary analysis revealed a fairly stable procedure rate of approximately 10 patients per 10,000 population per year receiving CTRs without any significant, consistent temporal trend (p = 0.94. Secondary analyses revealed different trends in procedure rates according to age. The annual procedure rate among those age >75 years increased from 22 per 10,000 population at the beginning of the study period to over 26 patients per 10,000 population (p<0.01 by the end of the study period. CTR surgical procedures were approximately two-fold more common among females relative to males (64.9% vs. 35.1 respectively; p<0.01. Lastly, CTR procedures are increasingly being conducted in the outpatient setting while procedures in the inpatient setting have been declining steadily - the proportion of procedures performed in the outpatient setting increased from 13% to over 30% by 2010 (p<0.01. CONCLUSION: Overall, CTR surgical-procedures are conducted at a rate of approximately 10 patients per 10,000 population annually with significant variation with respect to age and gender. CTR surgical procedures in ambulatory-care facilities may soon outpace procedure rates in the in-hospital setting.

  7. Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial.

    Science.gov (United States)

    Fernández-de-Las-Peñas, C; Cleland, J; Palacios-Ceña, M; Fuensalida-Novo, S; Alonso-Blanco, C; Pareja, J A; Alburquerque-Sendín, F

    2017-08-01

    People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p < 0.01) and higher decrease of pain intensity at 3 month follow-up (p < 0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes. Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity. The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome. © 2017 European Pain Federation - EFIC®.

  8. High-resolution sonography in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Solbiati, L.; De Pra, L.; Rizzatto, G.; Derchi, L.E.

    1986-01-01

    Carpal tunnel syndrome, caused by the compression on the median nerve under the transverse carpal ligament, has multiple causes and clinical presentations. One hundred eighteen patients with carpal tunnel sydrome underwent high-resolution US which demonstrated unpalpable cystic masses in 25 patients (lobulated stalked synovial cysts in 19 and retrotendinous cysts in six, all confirmed at surgery), and diffuse thickening and decreased echogenicity of the tendon sheaths in 87 patients, suggesting tenosynovitis (confirmed at surgery in 64). In six patients simple encasement of muscle bellies in the carpal tunnel was shown. US can delineate the cause of carpal tunnel syndrome, suggest the need for surgery, and aid the surgeon in locating the lesion to be removed

  9. Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

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    Nazım Karalezli

    2013-01-01

    Full Text Available Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1 the transverse carpal ligament and the distal forearm fascia intact, (2 only the transverse carpal ligament incised, (3 the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.

  10. Management of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Mooar, Pekka A; Doherty, William J; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

    2018-03-15

    The American Academy of Orthopaedic Surgeons (AAOS) has developed Appropriate Use Criteria (AUC) for Management of Carpal Tunnel Syndrome. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. To provide the evidence foundation for this AUC, the AAOS Evidence-Based Medicine Unit provided the writing panel and voting panel with the 2016 AAOS Clinical Practice Guideline titled Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. The Management of Carpal Tunnel Syndrome AUC clinical patient scenarios were derived from indications typical of patients with suspected carpal tunnel syndrome in clinical practice, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of treatments. The 135 patient scenarios and 6 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

  11. 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.

  12. Enhanced MRI in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Hayakawa, Katsuhiko; Nakane, Takashi; Kobayashi, Shigeru; Asai, Takahiro; Wada, Kunio; Yoshizawa, Hidezo

    1998-01-01

    In this study, we performed contrast-enhanced MRI in patients with idiopathic carpal tunnel syndrome and examined the morphologic change in the carpal tunnel. In the transverse section of the opening of carpal tunnel where scaphoid and pisiform bones are figured out, we measured and examined 4 items, viz. the soft carpal tunnel volume, flat rate of median nerve, position of median nerve and thickness of palmer ligaments composing the base of carpal tunnel, with an image analyzer attached to the MRI apparatus. Whereas the average carpal tunnel volume in 12 hands of normal controls was 166.8 mm 2 , that in 74 hands of carpal tunnel syndrome was 207.2 mm 2 , a significant increase compared with the normal controls. The flat rate of median nerve was 46% in the controls, but that was 37.5% in the carpal tunnel syndrome, a significant flattening was noted. We connected the peaks of the scaphoid node and pisiform bone with a line and named it standard line. When we observed the position of median nerve in the carpal tunnel, the nerve in 9 of 12 hands, 75%, lay below the standard line in the controls, but the nerve in 65 of 74 hands, 87.8%, lay above the standard line in the carpal tunnel syndrome, clearly showing that the median nerve had shifted to the palmar side. Regarding these morphologic changes of the carpal tunnel, the internal pressure of the carpal tunnel is considered to be raised with swelling of the soft tissues mainly composing the inside of carpal tunnel, thus the area of cross section of carpal tunnel to be increased, the median nerve to be shifted to the palmar side and the median nerve to be compressed by the transverse carpal ligament at that time. Although we can observe these morphological changes readily in MRI images, these images show only the results of carpal tunnel syndrome after all, and do not specify the direct causes. However, we believe that these facts are important factors in the manifestation of idiopathic carpal tunnel syndrome. (author)

  13. MR imaging of the carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Elias, D.; Lind, J.; Blair, S.; Light, T.; Wisniewski, R.; Moncado, R.

    1987-01-01

    MR is an ideal noninvasive means to image the structures forming the carpal tunnel in both normal and pathologic conditions. The carpal tunnel syndrome is a frequently encountered entity caused by compression of the median nerve as it passes through the carpal tunnel. This may result from a variety of conditions including edema from acute chronic trauma, rheumatoid tenosynovitis, degenerative joint disease or soft-tissue masses. This exhibit demonstrates the optimal MR imaging techniques to display the structures of the carpal tunnel. The normal anatomy is reviewed and variations in normal anatomy that may predispose to disease are included. Examples of the morphologic changes demonstrated in 20 patients diagnosed with carpal tunnel syndrome are displayed. The exhibit also reviews the findings in 20 postoperative cases

  14. The potential complications of open carpal tunnel release surgery to the ulnar neurovascular bundle and its branches: A cadaveric study.

    Science.gov (United States)

    Boughton, O; Adds, P J; Jayasinghe, J A P

    2010-07-01

    This study investigated the ulnar artery and the ulnar nerve and its branches in the palm to assess how frequently they may be at risk of damage during open carpal tunnel release surgery. Twenty-one formalin-embalmed cadaveric hands were dissected, and the proximity of the ulnar neurovascular bundle to two different lines of incision, the 3rd and 4th interdigital web space axis and the ring finger axis, was assessed and compared. It was found that an incision in the latter (ring finger) axis put the ulnar artery at risk in 12 of 21 specimens, whereas an incision in the former axis (3rd/4th interdigital web space) put the ulnar artery at risk in only two specimens. In 15 hands at least one structure (the ulnar artery or a branch of the ulnar nerve) was at risk in the ring finger axis compared to only seven hands in the axis of the 3rd/4th interdigital web space. We conclude that the ulnar artery and branches of the ulnar nerve are at increased risk of damage with an incision in the axis of the ring finger. The importance of using a blunt dissection technique under direct vision during surgery to identify and preserve these structures and median nerve branches is emphasized. (c) 2010 Wiley-Liss, Inc.

  15. Conservative therapeutic management of carpal tunnel syndrome

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    Roberto Sérgio Martins

    Full Text Available ABSTRACT Carpal tunnel syndrome is the most prevalent nerve compression and can be clinically or surgically treated. In most cases, the first therapeutic alternative is conservative treatment but there is still much controversy regarding the most effective modality of this treatment. In this study, we critically evaluated the options of conservative treatment for carpal tunnel syndrome, aiming to guide the reader through the conventional options used in this therapy.

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

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    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

  17. 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%.

  18. Acute carpal tunnel syndrome in a patient with haemophilia.

    Science.gov (United States)

    Mayne, Alistair Ivan William; Howard, Anthony; Kent, Matthew; Banks, Joanne

    2012-07-03

    Acute carpal tunnel syndrome (CTS) is a rare surgical condition usually resulting from wrist trauma. We present the case of a young haemophilic man who developed acute CTS following trivial injury. The patient was initially managed conservatively but symptom progression resulted in carpal tunnel decompression. A literature review and management approach are presented. This is an important complication of haemophilia to be aware of as prompt conservative management can obviate the need for surgery. This case is useful in (a) highlighting the importance of considering a patient's medical history when formulating differential diagnoses and (b) outlining a management approach to this condition.

  19. Education, night splinting and exercise versus usual care on recovery and conversion to surgery for people awaiting carpal tunnel surgery : A protocol for a randomised controlled trial

    NARCIS (Netherlands)

    Lewis, Karina J.; Ross, Leo; Coppieters, Michel W.; Vicenzino, Bill; Schmid, Annina B.

    2016-01-01

    Introduction Carpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in public health systems create delays in accessing treatment for this

  20. [Occupational carpal tunnel syndrome: 27 cases].

    Science.gov (United States)

    Slimane, Neila Ben; Elleuch, Mohamed; Gharbi, Ezzedine; Babay, Habib; Hamdoun, Moncef

    2010-09-01

    Carpal tunnel syndrome is the most frequent of tunnel syndromes in the field of the professional sphere. It is related to repetitive movements of flexion-extension of the wrist and fingers or to a support on the heel of the hands. To determine the posts in a risk and to specify the modalities of guaranteed reimbursement of professional carpal tunnel syndrome. A retrospective and descriptive study of 27 medical files of employees indemnified for professional carpal tunnel syndrome registered in the medical control services of the social security office in charge of medical insurance of Tunis and Sousse during a period of 10 years (1995-2004). There were 24 women and 3 men with the average age of 40 years all occupying posts in a risk. Their average time of service is 15 years. Tow-thirds of them work in the clothing and textile industry. The attack is bilateral in 13 cases. Nightly acroparaesthesia rules the clinical rate (44.44% of cases). Motor disorders are noted in the quarter of cases. The electromyogram had confirmed diagnosis in all of cases. The previous state study put in evidence the antecedent of carpal tunnel syndrome in 5 cases and diabetes in one case. Twenty-one patients had profit of permanent partial incapacity with a rate varying from 3 to 25%. Five had got a transfer of working place and one stayed in the same post with a half-time work. The professional origin of carpal tunnel syndrome must be called up in front of an activity in a risk. The reparation is done according to picture 82 of occupational diseases.

  1. Endoscopic release for carpal tunnel syndrome.

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    Vasiliadis, Haris S; Georgoulas, Petros; Shrier, Ian; Salanti, Georgia; Scholten, Rob J P M

    2014-01-31

    (95% CI 62% to 19%). ECTR more frequently resulted in transient nerve problems (ie, neurapraxia, numbness, and paraesthesiae), while OCTR had more wound problems (ie, infection, hypertrophic scarring, and scar tenderness). ECTR was safer than OCTR when the total number of complications were assessed (20 studies, RR 0.60, 95% CI 0.40 to 90) representing a relative drop in the probability by 40% (95% CI 60% to 10%).Rates of recurrence of symptoms and the need for repeated surgery were comparable between ECTR and OCTR groups.The overall risk of bias in studies that contribute data to these results is rather high; fewer than 25% of the included studies had adequate allocation concealment, generation of allocation sequence or blinding of the outcome assessor.The quality of evidence in this review may be considered as generally low. Five of the studies were presented only as abstracts, with insufficient information to judge their risk of bias. In selection bias, attrition bias or other bias (baseline differences and financial conflict of interest) we could not reach a safe judgement regarding a high or low risk of bias. Blinding of participants is impossible due to the nature of interventions.We identified three further potentially eligible studies upon updating searches just prior to publication. These compared ECTR with OCTR (two studies) or mini-open carpal tunnel release (one study) and will be fully assessed when we update the review. In this review, with support from low quality evidence only, OCTR and ECTR for carpal tunnel release are about as effective as each other in relieving symptoms and improving functional status, although there may be a functionally significant benefit of ECTR over OCTR in improvement in grip strength. ECTR appears to be associated with fewer minor complications compared to OCTR, but we found no difference in the rates of major complications. Return to work is faster after endoscopic release, by eight days on average. Conclusions from this

  2. EXTRACORPOREAL SHOCKWAVE THERAPY FOR POST BURN CARPAL TUNNEL SYNDROME

    OpenAIRE

    Hesham Galal Mahran; Ashraf Hassan Mohammed; Shimaa Nabil Aboelazm

    2015-01-01

    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 e...

  3. Alternative diagnostic technique for carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Hayakawa, Katsuhiko; Nakane, Takashi; Kobayashi, Shigeru; Shibata, Kunio

    2002-01-01

    Compressive and entrapment neuropathies are common clinical syndromes characterized by neurologic deficits due to mechanical or dynamic compression of peripheral nerves. However, the definitive diagnosis based on clinical symptoms alone is difficult in many cases, and the electrophysiological diagnostic method is solely used as a supplementary diagnostic method at present. As a new diagnostic method for entrapment neuropathy, the present study investigated the usefulness of gadolinium-enhanced MRI in carpal tunnel syndrome. On enhanced MRI of idiopathic carpal tunnel syndrome, contrast-enhancement in the median nerve was found in 30 of 34 hands (88.2%). Enhanced MRI allows to visualize intraneural edema in the nerve easily on the naked eye. Therefore, this technique supplied useful information for making definitive diagnosis and is promising as a non-invasive diagnostic method for entrapment neuropathy. (author)

  4. Alternative diagnostic technique for carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, Katsuhiko; Nakane, Takashi [Aiko Orthopaedic Hospital, Nagoya (Japan); Kobayashi, Shigeru; Shibata, Kunio [Fujita Health Univ., Toyoake, Aichi (Japan). School of Medicine

    2002-10-01

    Compressive and entrapment neuropathies are common clinical syndromes characterized by neurologic deficits due to mechanical or dynamic compression of peripheral nerves. However, the definitive diagnosis based on clinical symptoms alone is difficult in many cases, and the electrophysiological diagnostic method is solely used as a supplementary diagnostic method at present. As a new diagnostic method for entrapment neuropathy, the present study investigated the usefulness of gadolinium-enhanced MRI in carpal tunnel syndrome. On enhanced MRI of idiopathic carpal tunnel syndrome, contrast-enhancement in the median nerve was found in 30 of 34 hands (88.2%). Enhanced MRI allows to visualize intraneural edema in the nerve easily on the naked eye. Therefore, this technique supplied useful information for making definitive diagnosis and is promising as a non-invasive diagnostic method for entrapment neuropathy. (author)

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

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    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.

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

    Science.gov (United States)

    Botchu, Rajesh; Khan, Aman; Jeyapalan, Kanagaratnam

    2012-01-01

    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.

  7. Dextrose-induced subsynovial connective tissue fibrosis in the rabbit carpal tunnel: A potential model to study carpal tunnel syndrome?

    NARCIS (Netherlands)

    Oh, S.; Ettema, A.M.; Zhao, C.; Zobitz, M.E.; Wold, L.E.; An, K.N.; Amadio, P.C.

    2008-01-01

    In this pilot study, hypertonic dextrose solution was used to induce fibrosis of the subsynovial connective tissue (SSCT) and create an animal model of potential use in the study of carpal tunnel syndrome (CTS). The SSCT of the carpal tunnel in 15 New Zealand white rabbits were injected with 0.05 ml

  8. The carpal tunnel syndrome in children.

    Science.gov (United States)

    Leti Acciaro, A; Pilla, F; Faldini, C; Adani, R

    2017-12-21

    Carpal tunnel syndrome (CTS) in children represents a complex challenge for the hand surgeon because of its rarity, poor patient cooperation, frequently associated malformation syndromes and mental retard, atypical symptoms and nuanced and poor sensitivity of instrumental tests. The most frequently associated causes with the CTS in children are rare congenital malformations and diseases, requiring an overall assessment of the young patient and a high degree of suspicion for the potentially associated canalicular syndrome. On the other hand, the associated syndromes may be the main ally for a diagnosis that starts from the knowledge of the literature and the surgeon's suspicion by observing the child wailing. Early diagnosis and decompression treatment is mandatory. The authors report a case series of 26 children and analyze the etiology and diagnostic algorithms. Patient assessment was based on complete clinical examination and medical history collection of these young patients with the involvement of the family and educators. In all 26 patients treated, along an average period of 23 months (minimum 12, maximum 30), no signs of recurrence or persistence of median nerve disturbances were recorded. In conclusion, we believe that anamnesis, a careful physical examination and analysis of instrumental examinations, should be accompanied by a thorough knowledge of rare diseases in the context of congenital malformations. The carpal tunnel syndrome, while well known and treated by each orthopedic surgeon, reveals a mysterious aspect in the context of the "fabulous" world of childhood illnesses, even more difficult than rare congenital diseases.

  9. Validation of the Boston Carpal Tunnel Questionnaire in Russia

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    D. G. Yusupova

    2018-01-01

    Full Text Available International scales and questionnaires have become widespread in Russian neurology. Validation is a procedure of top priority necessary before applying this kind of diagnostic instrument in Russian-speaking population. In this article, validation of the Boston Carpal Tunnel Questionnaire (BCTQ intended for patients with this disease is described. Use of validated Russian version would allow to objectively evaluate severity of clinical manifestations of carpal tunnel syndrome and follow patient dynamics. We present the official BCTQ version recommended for use in Russia, as well as data that showed high sensitivity and reliability of this instrument for clinical evaluation of carpal tunnel syndrome.

  10. [Socio professional impact of surgical release of carpal tunnel syndrome].

    Science.gov (United States)

    Kraiem, Aouatef Mahfoudh; Hnia, Hajer; Bouzgarrou, Lamia; Henchi, Mohamed Adnène; Khalfallah, Taoufik

    2016-01-01

    The objective was studying the socio-professional impact of release surgery for carpal tunnel syndrom (CTS). We conducted a cross-sectional study of patients operated for work-related CTS; data were collected in the Occupational Health Department at the University Hospital Tahar Sfar in Mahdia, Tunisia over a period of 8 years, from 1 January 2006 to December 2013. Data collection was performed using a survey form focusing on participants' socio-professional and medical characteristics and on their professional future. We used Karasek's questionnaire to study psychosocial constraints at work. The duration of a work stoppage following release surgery for CTS was significantly related to the existence of musculoskeletal disorders other than CTS, to a statement that the carpal tunnel syndrome was work related and to job seniority. As regards the professional future of operated employees, 50.7% remained in the same position, 15.3% were given customized workstation and 33.8% were offered a different position within the same company. The professional future of these employees was related to their occupational qualifications and to the type of sensory and/or motor impairment of median nerve detected during EMG test. A number of nonlesional factors determines the duration of the work stoppage, while the professional future of patients operated for CTS essentially depends on their professional qualifications and on EMG data. Certainly much broader studies would allow to refine these results.

  11. Flexor pollicis longus tenosynovitis in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Manfield, Laura; Thomas, Mark; Lee, Se Won

    2014-06-01

    Carpal tunnel syndrome is typically diagnosed from history and physical examination then confirmed with electrodiagnosis. Electrodiagnosis provides only limited anatomic information and evaluation of space-occupying lesions. The authors present two cases in which demonstrated flexor pollicis longus tenosynovitis coexistent with carpal tunnel syndrome was diagnosed with ultrasonography. Ultrasonography is an effective modality that enhances the investigation of diseases in the soft tissues of the wrist and the hand. It can be useful in directing specific treatment by increasing diagnostic accuracy.

  12. The comparison between limited open carpal tunnel release using direct vision and tunneling technique and standard open carpal tunnel release: a randomized controlled trial study.

    Science.gov (United States)

    Suppaphol, Sorasak; Worathanarat, Patarawan; Kawinwongkovit, Viroj; Pittayawutwinit, Preecha

    2012-04-01

    To compare the operative outcome of carpal tunnel release between limited open carpal tunnel release using direct vision and tunneling technique (group A) with standard open carpal tunnel release (group B). Twenty-eight patients were enrolled in the present study. A single blind randomized control trial study was conducted to compare the postoperative results between group A and B. The study parameters were Levine's symptom severity and functional score, grip and pinch strength, and average two-point discrimination. The postoperative results between two groups were comparable with no statistical significance. Only grip strength at three months follow up was significantly greater in group A than in group B. The limited open carpal tunnel release in the present study is effective comparable to the standard open carpal tunnel release. The others advantage of this technique are better cosmesis and improvement in grip strength at the three months postoperative period.

  13. The Effect of Carpal Tunnel Release on Typing Performance.

    Science.gov (United States)

    Zumsteg, Justin W; Crump, Matthew J C; Logan, Gordon D; Weikert, Douglas R; Lee, Donald H

    2017-01-01

    To describe the effect of carpal tunnel release (CTR) on typing performance. We prospectively studied 27 patients undergoing open CTR. Patient demographics and clinical characteristics including nerve conduction studies, electromyography results, and duration of symptoms were collected. Before surgery and at 8 time points after surgery, ranging from 1 to 12 weeks, typing performance for an approximately 500-character paragraph was assessed via an on-line platform. The Michigan Hand Questionnaire (MHQ) and the Boston Carpal Tunnel Questionnaire functional component (BCTQ-F) and symptom severity component (BCTQ-S) component were completed before surgery and at 1, 3, 6, and 12 weeks after surgery. We used repeated-measures analyses of variance and follow-up dependent-samples t tests to analyze change in typing performance across sessions, and linear regressions to assess relationships between typing performance and demographic and outcome measures. We compared typing speed with the MHQ, BCTQ-F, and BCTQ-S using the Pearson correlation test. Average typing speed decreased significantly from 49.7 ± 2.7 words per minute (wpm) before surgery to 45.2 ± 3.1 wpm at 8 to 10 days after surgery. Mean typing speed for the group exceeded the preoperative value between weeks 2 and 3, with continued improvement to 53.5 ± 3.5 wpm at 12 weeks after surgery. No clinical or demographic variables were associated with the rate of recovery or the magnitude of improvement after CTR. The MHQ, BCTQ-F, and BCTQ-S each demonstrated significant improvement from preoperative values over the 12-week period. The MHQ and BCTQ-F scores correlated well with typing speed. On average, typing speed returned to preoperative levels between 2 and 3 weeks after CTR and typing speed showed improvement beyond preoperative levels after surgery. The MHQ and BCTQ-F correlate well with typing speed after CTR. Prognostic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc

  14. [Carpal tunnel syndrome and steel industry].

    Science.gov (United States)

    Caciari, T; Rosati, M V; Casale, T; Sancini, A; Giubilati, R; De Sio, S; Suppi, A; Tomei, G; Santoro, L; Scala, B; Nardone, N; Tomei, F

    2013-01-01

    The carpal tunnel syndrome (CTS) is a common working pathology. The CTS diagnosis is not so easy because neurophysiological investigations are necessary. The purpose of this study is to evaluate the working risks and the presence of CTS signs using a focused anamnestic and clinical procedure. We evaluated the working risks of CTS in a population of 65 male workers of a steel industry (average age 25.1 and seniority 2.82), performing 5 different tasks. The Borg Scale was used to evaluate the subjective muscle effort. Diurnal paresthesia (V1FG), nocturnal paresthesia (V1FN), hypersensitivity (V1IS), hypostenia (V1IT) were considered. We identified three main working risks repetitiveness of single actions, static and prolonged posture of the truck, muscle effort. 21.5% of the workers showed at least one of the three symptoms;13.8% showed one or more symptoms; the clinical objectivity was observed in 18.5%. A relation between V1FG, V1FN, clinical objective linked to the workers age of the task 1 (p =0.035) is showed. To prevent CTS, the use of the Borg Scale associated with identification of the risks and with the anamenstic-clinical investigation is useful to discriminate people at risk of CTS.

  15. Electrodiagnostic Testing and Treatment for Carpal Tunnel Syndrome in Canada.

    Science.gov (United States)

    Li Pi Shan, Rodney; Nicolle, Michael; Chan, Ming; Ashworth, Nigel; White, Chris; Winston, Paul; Dukelow, Sean

    2016-01-01

    1) Assess which electrodiagnostic studies Canadian clinicians use to aid in the diagnosis of carpal tunnel syndrome (CTS). 2) Assess whether Canadian clinicians follow the American Association of Neuromuscular & Electrodiagnostic Medicine/American Academy of Neurology/American Academy of Physical Medicine and Rehabilitation Practice Parameter for Electrodiagnostic Studies in CTS. 3) Assess how Canadian clinicians manage CTS once a diagnosis has been established. In this prospective observational study, an electronic survey was sent to all members of the Canadian Neuromuscular Group (CNMG) and the Canadian Association of Physical Medicine and Rehabilitation (CAPM&R) Neuromuscular Special Interest Group. Questions addressed which electrodiagnostic tests were being routinely used for the diagnosis of carpal tunnel syndrome. Management recommendations for CTS was also explored. Of the 70 individuals who completed the survey, fourteen different nerve conduction study techniques were reported. Overall, 36/70 (51%) of participants followed the AANEM/AAN/AAPM&R Practice Parameter. The standard followed by the fewest of our respondents with 64% compliance (45/70) was the use of a standard distance of 13 to 14 cm with respect to the median sensory nerve conduction study. Regarding management, 99% would recommend splinting in the case of mild CTS. In moderate CTS, splinting was recommended by 91% of clinicians and 68% would also consider referral for surgery. In severe CTS, most recommended surgery (93%). There is considerable variability in terms of which electrodiagnostic tests Canadian clinicians perform for CTS. Canadian clinicians are encouraged to adhere to the AANEM/AAN/AAPM&R Practice Parameter for Electrodiagnostic Studies in CTS.

  16. 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.

  17. [Carpal tunnel syndrome in children. About 10 clinical cases].

    Science.gov (United States)

    Leduc, A; Perrot, P; Truffandier, M V; Bellier-Waast, F; Duteille, F

    2014-06-01

    The carpal tunnel syndrome is a common peripheral neuropathy in adults but is rare in children. We report a series of 10 carpal tunnel syndromes in children. We have supported five children, two males and three females, with a bilateral carpal tunnel syndrome. We studied the clinical history (history, symptoms, stage of disease), therapeutic management and remote development. Three children were diagnosed with a mucopolysaccharidosis, the fourth with VATER association. For the last child, it was a form considered idiopathic. Two children were referred for night pains, the others for under-utilization of their first three fingers, two of which had a thenar atrophy. Four children underwent an electromyogram for diagnostic confirmation. We realized open surgical treatment at one time, by section of the carpal ligament. The average age of our patients was 4years. The average decline in the surgical study was 19 months. Postoperatively, we noted, in all patients, complete regression of the painful symptoms, a sensory improvement and recovery of the opposition of the thumb. The scarcity of carpal tunnel syndrome in children and the atypical symptoms may cause diagnostic delay, with serious consequences. We keep vigilant and ready to access to additional tests (electromyogram). For our team, the therapeutic approach is a systematic open surgical treatment. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. The etiology of idiopathic carpal tunnel syndrome. Evaluation from the viewpoint of magnetic resonance imaging

    International Nuclear Information System (INIS)

    Ikeda, Jun

    2003-01-01

    The etiology of idiopathic carpal tunnel syndrome has not been clarified. A cross sectional area of carpal tunnel, flexor tendons, median nerve, and thickness of transverse carpal ligament were evaluated by MRI. Twenty-six patients who were electrophysiologically diagnosed with idiopathic carpal tunnel syndrome were tested by MRI. All patients were females; the mean age was sixty-four years old. The cross sectional area of carpal tunnel, the median nerve area, the area of the flexor tendons and its synovium in carpal tunnel, and thickness of the transverse carpal ligament were calculated. The following are of a seuere type carpal tunnel syndrome: Mean area of the flexor tendons and its synovium in carpal tunnel, 110.5±25.5 mm 2 (control group; 79.3±13.8 mm 2 ); ratio of flexor tendons and its synovium area to carpal tunnel area, 51.6±8.8% (control; 40.5±2.3%); and thickness of the transverse carpal ligament, 3.3±0.4 mm (control; 2.4±0.4 mm). These mean areas in severe carpal tunnel syndrome were significantly greater than those in mild type (p<0.05 or p<0.01). From the viewpoint of this result, it is possible that tenosynovitis is strongly to the etiology of idiopathic carpal tunnel syndrome. In other words, synovium edema causes chronic high pressure environment in carpal tunnel. Moreover, we classified these MRI findings into the following subgroups: enlargement of cross sectional area of flexor tendon and its synovia (n=8; 25.8%), thickened transverse carpal ligament (n=11; 35.5%), and combined type (n=7; 22.6%). This classification by MRI imaging was related to a clinical course and electro-physiologic severity. The present study suggests that to evaluate the cross sectional, area of an MRI image is useful for diagnosis and cure of idiopathic carpal tunnel syndrome. (author)

  19. Comparison of symptoms, physical examination and electromyography findings, with the results of surgery of carpal tunnel release, in patients treated between January 2007 and December 2008, at the Hospital Calderon Guardia

    International Nuclear Information System (INIS)

    Chavarria Alvarado, Manuel

    2010-01-01

    A comparison of the preoperative findings was performed in patients with the diagnosis of carpal tunnel syndrome, with functional outcomes and postoperative residual pain, using the scale Patient Rate Wrist Evaluation (PRWE). All patients have had clinical history, physical examination and electromyography studies. They were operated by minimally invasive open surgery. The information was collected in an Excel table and patients have located via telephone. 100% of the evaluated patients have engaged in activities that involve trauma or repetitive wrist movements. The physical sign with predicative positive value for suspect of carpal tunnel syndrome has been the Phalen, present in over 70% of cases. The amount of physical signs present preoperatively and postoperative results were found without correlation. The mixed lesion, both sensory and motor has been the most found in electrodiagnostic studies. Patients whose studies have been negative, postoperative results have showed less favorable. Only 69% of patients operated in the orthopedic service of the Hospital Rafael Angel Calderon Guardia (HCG), have had favorable postoperative results. (author) [es

  20. Does a carpal tunnel syndrome predict an underlying disease?

    NARCIS (Netherlands)

    M.C. de Rijk (Maarten); F.H. Vermeij (Frederique); M. Suntjens (Maartje); P.A. van Doorn (Pieter)

    2007-01-01

    textabstractCarpal tunnel syndrome (CTS) may be the presenting symptom of an underlying disease such as diabetes mellitus, hypothyroidism or connective tissue disease (CTD). It was investigated whether additional blood tests (glucose level, thyroid-stimulating hormone level and erythrocyte

  1. Percutaneous Ultrasound-Guided Carpal Tunnel Release: Study Upon Clinical Efficacy and Safety

    Energy Technology Data Exchange (ETDEWEB)

    Petrover, David, E-mail: dpetrover@yahoo.fr; Silvera, Jonathan, E-mail: silvera.jonathan@gmail.com [Imagerie Médicale Paris Centre Bachaumont-clinique Blomet RamsayGDS, Department of Interventional Radiology (France); Baere, Thierry De, E-mail: Debaere@igr.fr [Gustave Roussy Institute (France); Vigan, Marie, E-mail: marie.vigan@gmail.com [Association pour la recherche en chirurgie de l’épaule et du coude, clinique Drouot (France); Hakimé, Antoine, E-mail: thakime@yahoo.com [Imagerie Médicale Paris Centre Bachaumont-clinique Blomet RamsayGDS, Department of Interventional Radiology (France)

    2017-04-15

    ObjectivesTo evaluate the feasibility and 6 months clinical result of sectioning of the transverse carpal ligament (TCL) and median nerve decompression after ultra-minimally invasive, ultrasound-guided percutaneous carpal tunnel release (PCTR) surgery.MethodsConsecutive patients with carpal tunnel syndrome were enrolled in this descriptive, open-label study. The procedure was performed in the interventional radiology room. Magnetic resonance imaging was performed at baseline and 1 month. The Boston Carpal Tunnel Questionnaire was administered at baseline, 1, and 6 months.Results129 patients were enrolled. Significant decreases in mean symptom severity scores (3.3 ± 0.7 at baseline, 1.7 ± 0.4 at Month 1, 1.3 ± 0.3 at Month 6) and mean functional status scores (2.6 ± 1.1 at baseline, 1.6 ± 0.4 at Month 1, 1.3 ± 0.5 at Month 6) were noted. Magnetic resonance imaging showed a complete section of all TCL and nerve decompression in 100% of patients. No complications were identified.ConclusionsUltrasound-guided PCTR was used successfully to section the TCL, decompress the median nerve, and reduce self-reported symptoms.

  2. Percutaneous Ultrasound-Guided Carpal Tunnel Release: Study Upon Clinical Efficacy and Safety

    International Nuclear Information System (INIS)

    Petrover, David; Silvera, Jonathan; Baere, Thierry De; Vigan, Marie; Hakimé, Antoine

    2017-01-01

    ObjectivesTo evaluate the feasibility and 6 months clinical result of sectioning of the transverse carpal ligament (TCL) and median nerve decompression after ultra-minimally invasive, ultrasound-guided percutaneous carpal tunnel release (PCTR) surgery.MethodsConsecutive patients with carpal tunnel syndrome were enrolled in this descriptive, open-label study. The procedure was performed in the interventional radiology room. Magnetic resonance imaging was performed at baseline and 1 month. The Boston Carpal Tunnel Questionnaire was administered at baseline, 1, and 6 months.Results129 patients were enrolled. Significant decreases in mean symptom severity scores (3.3 ± 0.7 at baseline, 1.7 ± 0.4 at Month 1, 1.3 ± 0.3 at Month 6) and mean functional status scores (2.6 ± 1.1 at baseline, 1.6 ± 0.4 at Month 1, 1.3 ± 0.5 at Month 6) were noted. Magnetic resonance imaging showed a complete section of all TCL and nerve decompression in 100% of patients. No complications were identified.ConclusionsUltrasound-guided PCTR was used successfully to section the TCL, decompress the median nerve, and reduce self-reported symptoms.

  3. 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.

  4. A new technique of single portal endoscopic carpal tunnel release.

    Science.gov (United States)

    Ip, Wing-Yuk Josephine; Sweed, Tamer Ahmed; Fung, Kwok Keung Boris; Tipoe, George L; Pun, Tze Shing

    2012-03-01

    Since the first description of endoscopic carpal tunnel release (ECTR) in 1987 by Okutsu many endoscopic techniques have been developed, but the majority of the literature on ECTR has dealt with the Chow and Agee techniques. ECTR is indicated for carpal tunnel syndrome that is not responding to conservative treatment for 6 months. This new technique of ECTR is a single-portal technique using instruments originally designed for endoscopic cubital tunnel release, with no disposable instruments used. It also has the advantage of performing the release with the median nerve protected under direct vision. Ten cases were operated with this technique after performing the procedure on 8 hands of 4 fresh frozen cadavers. There were no neurovascular or tendon injuries with this technique and patients were satisfied with the results.

  5. Supraretinacular endoscopic carpal tunnel release: surgical technique with prospective case series.

    Science.gov (United States)

    Ecker, J; Perera, N; Ebert, J

    2015-02-01

    Current techniques for endoscopic carpal tunnel release use an infraretinacular approach, inserting the endoscope deep to the flexor retinaculum. We present a supraretinacular endoscopic carpal tunnel release technique in which a dissecting endoscope is inserted superficial to the flexor retinaculum, which improves vision and the ability to dissect and manipulate the median nerve and tendons during surgery. The motor branch of the median nerve and connections between the median and ulnar nerve can be identified and dissected. Because the endoscope is inserted superficial to the flexor retinaculum, the median nerve is not compressed before division of the retinaculum and, as a result, we have observed no cases of the transient median nerve deficits that have been reported using infraretinacular endoscopic techniques. © The Author(s) 2014.

  6. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis,

    Directory of Open Access Journals (Sweden)

    Michel Chammas

    2014-10-01

    Full Text Available Carpal tunnel syndrome (CTS is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Elec-troneuromyographic examination may be recommended before the operation or in cases of occupational illnesses.

  7. Incidence of Carpal Tunnel Syndrome in the US Military Population

    OpenAIRE

    Wolf, Jennifer Moriatis; Mountcastle, Sally; Owens, Brett D.

    2009-01-01

    Carpal tunnel syndrome (CTS) is a common disease. Its epidemiology has been evaluated previously, mostly in regional populations or in working groups, with an incidence between 1.5 and 3.5 per 1,000 person-years. We studied this diagnosis in the US military population, with the hypothesis that this young population would have a lower incidence of CTS than previously reported in general populations. The Defense Medical Epidemiology Database notes all medical encounters for all US military pers...

  8. Postoperative Pain Management after Carpal Tunnel Syndrome Surgical Treatment: Comparing Practice with Guidelines.

    Science.gov (United States)

    Utrobičić, Ivan; Utrobičić, Frane; Prološčić, Ivona; Utrobičić, Toni; Jerić, Milka; Jeličić Kadić, Antonia; Puljak, Livia

    2017-09-01

    The management of postoperative pain after carpal tunnel syndrome surgical treatment at a tertiary hospital was analyzed and compared with the guidelines for perioperative pain management. This retrospective study included 579 patients operated on for carpal tunnel syndrome at the Split University Hospital Center in Split, Croatia. The following key data were collected from patient medical records: age, gender, type and dosage of premedication, type and dosage of anesthesia, type and dosage of postoperative analgesia per each postoperative day. The procedures related to perioperative pain were analyzed and compared with the current guidelines for perioperative acute pain management. Study results showed that 99.6% of patients with carpal tunnel syndrome were operated under local anesthesia, of which 2.9% also received sedation. Analgesics were prescribed to 45% of patients after surgery, and according to patient charts, 39% of patients actually received postoperative analgesic(s). Generally, postoperative pain was treated on the fi rst postoperative day, mostly with nonsteroidal anti-inflammatory drugs. Only two patients received weak opioids for postoperative pain. Many recommendations from the guidelines for perioperative acute pain management were not followed. In conclusion, the guidelines should be followed and appropriate interventions used to improve postoperative pain management.

  9. Time course and predictors of median nerve conduction after carpal tunnel release.

    Science.gov (United States)

    Rotman, Mitchell B; Enkvetchakul, Bobby V; Megerian, J Thomas; Gozani, Shai N

    2004-05-01

    To identify predictors of outcome and of electrophysiologic recovery in patients with carpal tunnel syndrome (CTS) treated by endoscopic carpal tunnel release using a nerve conduction testing system (NC-Stat; NEUROMetrix, Inc, Waltham, MA). Validity of the automated nerve conduction testing system was shown by comparing presurgical distal motor latencies (DMLs) against a reference obtained by referral to an electromyography laboratory. The DML was evaluated in 48 patients with CTS. Measurements were obtained within 1 hour of surgery and at 2 weeks, 6 weeks, 3 months, and 6 months after carpal tunnel release. Presurgical and postsurgical DMLs were then compared and correlated with variables and possible predictors of outcome including age, body mass index, gender, and presurgical DMLs. The automated nerve conduction testing system DMLs matched those of reference electromyography/nerve conduction study values with high correlation. Sensitivity of the automated nerve conduction testing system when compared with a standardized CTS case definition was 89%, with a specificity of 95%. A significant correlation was found between the DML before release and the DML 1 hour after release. Moreover, maximal postsurgical DML improvement was highly dependent on the presurgical DML, with no improvement shown for the 6-ms group. Among the clinical variables of age, gender, and body mass index only age was mildly predictive of postrelease DML changes at 6 months. No other correlations between clinical variables and postsurgical DMLs were significant. In addition the predictive value of age was lost when combined with the presurgical DML in a multivariate analysis. Postsurgical changes in the median nerve DML were highly dependent on the prerelease latency. The sensitivity and specificity of a nerve conduction monitoring system in detecting and aiding in the diagnosis of CTS is useful in the long-term management of patients with CTS and can aid in determining the level of improvement

  10. Preferences in Sleep Position Correlate With Nighttime Paresthesias in Healthy People Without Carpal Tunnel Syndrome.

    Science.gov (United States)

    Roth Bettlach, Carrie L; Hasak, Jessica M; Krauss, Emily M; Yu, Jenny L; Skolnick, Gary B; Bodway, Greta N; Kahn, Lorna C; Mackinnon, Susan E

    2017-10-01

    Carpal tunnel syndrome has been associated with sleep position preferences. The aim of this study is to assess self-reported nocturnal paresthesias and sleeping position in participants with and without carpal tunnel syndrome diagnosis to further clinical knowledge for preventive and therapeutic interventions. A cross-sectional survey study of 396 participants was performed in young adults, healthy volunteers, and a patient population. Participants were surveyed on risk factors for carpal tunnel syndrome, nocturnal paresthesias, and sleep preferences. Binary logistic regression analysis was performed comparing participants with rare and frequent nocturnal paresthesias. Subanalyses for participants without carpal tunnel syndrome under and over 21 years of age were performed on all factors significantly associated with subclinical compression neuropathy in the overall population. Thirty-three percent of the study population experienced nocturnal paresthesias at least weekly. Increased body mass index ( P < .001) and sleeping with the wrist flexed ( P = .030) were associated with a higher frequency of nocturnal paresthesias. Side sleeping was associated with less frequent nocturnal symptoms ( P = .003). In participants without carpal tunnel syndrome, subgroup analysis illustrated a relationship between nocturnal paresthesias and wrist position. In participants with carpal tunnel syndrome, sleeping on the side had a significantly reduced frequency of nocturnal paresthesias. This study illustrates nocturnal paresthesias in people without history of carpal tunnel syndrome including people younger than previously reported. In healthy patients with upper extremity subclinical compression neuropathy, sleep position modification may be a useful intervention to reduce the frequency of nocturnal symptoms prior to developing carpal tunnel syndrome.

  11. 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....

  12. 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.

  13. Effects of hypertonic dextrose injections in the rabbit carpal tunnel.

    Science.gov (United States)

    Yoshii, Yuichi; Zhao, Chunfeng; Schmelzer, James D; Low, Phillip A; An, Kai-Nan; Amadio, Peter C

    2011-07-01

    This study investigated the effects of different doses of hypertonic dextrose injection on the carpal tunnel subsynovial connective tissue (SSCT) and median nerve in a rabbit model. Thirty-eight New Zealand white rabbits weighing 4.0-4.5 kg were used. One forepaw carpal tunnel was randomly injected with one of five different treatments: saline-single injection; saline-two injections 1 week apart; 10% dextrose-single injection; 20% dextrose-single injection; or 10% dextrose-two injections 1 week apart. Animals were sacrificed at 12 weeks after the initial injection and were evaluated by electrophysiology (EP), SSCT mechanical testing and histology. There were significant increases in the energy absorption of the SSCT in the 10% dextrose-double injection group compared to the saline injection groups. SSCT stiffness was also significantly increased in the 10% dextrose-double injection group compared to the other groups. There was a significant increase in the thickness of the SSCT in the 10% dextrose-double injection group compared to the saline-single injection group and a significant decrease in the nerve short-long diameter ratio in the 10% dextrose-double injection group compared to the saline-single injection group. There were no changes in EP among the groups. SSCT fibrosis is present for up to 12 weeks after dextrose injection; multiple injections have bigger effects, including what appears to be a secondary change in nerve flattening. This model may be useful to study the effects of external fibrosis on nerve morphology and physiology, such as occurs clinically in carpal tunnel syndrome. Copyright © 2011 Orthopaedic Research Society.

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

    Directory of Open Access Journals (Sweden)

    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

  15. Which surgery should be offered for carpal tunnel syndrome in a patient who was previously treated for recurrence on the contralateral side? Preliminary study of 13 patients with the Canaletto® implant.

    Science.gov (United States)

    Illuminati, I; Seigle-Murandi, F; Gouzou, S; Fabacher, T; Facca, S; Hidalgo Diaz, J J; Liverneaux, P

    2017-12-01

    There are no published studies on the management of carpal tunnel syndrome (CTS) patients who have already been operated for recurrent CTS on the contralateral side. The aim of this study was to evaluate 13 patients with CTS who underwent primary release using a Canaletto ® implant. The 13 patients had all been operated for recurrent CTS previously. On the contralateral side, they all had subjective signs, and two of them already had complications. All were operated with the Canaletto ® implant according to Duché's technique, in a mean of 20minutes. After a mean 19.3-month follow-up, paresthesia, pain, and QuickDASH scores were significantly improved, even in one patient who underwent revision at another facility. This preliminary study suggests that use of a Canaletto ® implant as first-line treatment for CTS in patients who already underwent revision surgery on the other side is a simple and safe technique, without worsening of symptoms. These findings should be assessed with a prospective randomized controlled trial. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  16. Clinical Study on Five Cases of Carpal tunnel syndrome

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    Kim Il Hwan

    2001-12-01

    Full Text Available Objections : The purpose of the study was to evaluate the effectiveness of treating the carpal tunnel syndrome by using both the Herbal Acupuncture and herbal medicine therapy on five cases. Methods : For the Herbal Acupuncture, Jungseonguhhyl No. 1 and Hwanglyunhaedoktang were used. For the herbal medicine, Dangguihwalhyul-tang was used. The patients were treated once in every two days; the result was evaluated after ten treatments. Patients' conditions were monitored through their testimony, phalen's test, nerve conduction study and electromyography. Results : In all five cases, the patients showed improvement; in four cases, the patients no longer had most of the clinical symptoms. Based on the result of the nerve conduction study, for the four cases in which the patients no longer displayed most of the clinical symptoms, their nerve conduction rate improved; for the remaining one case, the patient's nerve conduction rate deteriorated. Conclusions : The results of this study demonstrate that combining the Herbal Acupuncture and herbal medicine therapy can have noticeable effects in treating the carpal tunnel syndrome; developing more variety of the herbal acupuncture would lead to even better treatment results.

  17. Mini transverse versus longitudinal incision in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Korkmaz, M.; Cepoglu, M.C.

    2013-01-01

    Objective: To evaluate the effectiveness of mini-transverse compared with mini-longitudinal incision for carpal tunnel release (CTR) with reference to postoperative functional capacity, symptom severity and complication rate. Study Design: Analytical study. Place and Duration of Study: Cumhuriyet University Medical Faculty, Department of Orthopaedics, Tokat State Hospital, Department of Orthopaedics and Medical Park Tokat Hospital, Department of Neurosurgery, from January 2007 to January 2009. Methodology: This study included 93 hands of 79 patients with carpal tunnel syndrome (CTS), which were operated between 2007 and 2009. Patients were divided according to incision types into Group-1 (undergoing mini-longitudinal incision) and Group-2 (undergoing mini-transverse incision). Patients were evaluated initially and at 3 weeks after treatment according to symptom severity and functional status of Boston Questionnaire (BQ). Demographic and clinical data were analyzed and compared statistically between two groups. Results: Statistically significant differences were observed in BQ symptom and functional scores between the pre- and postoperative period (p < 0.0001). BQ symptom and functional scores at postoperative period were better in Group-1 than Group-2 (p = 0.044 and p = 0.023 respectively). The scar hypersensitivity (p = 0.258) and tenderness (p = 1.00) associated with the incision sites were not statistically different. Conclusion: Longitudinal incision is more effective on symptom and functional conditions than transverse incision. However, there was less scar formation with transverse incision. (author)

  18. Electrophysiologic Findings and Pain in Carpal Tunnel Syndrome

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    Hava Dönmez Keklikoğlu

    2009-12-01

    Full Text Available OBJECTIVE: Carpal tunnel syndrome (CTS is defined as median nerve entrapment within the carpal tunnel at the wrist. Pain and paresthesia are the most common presenting symptoms of the patients. In this study, our aim was to identify the association between intensity of presenting symptoms and electrophysiologic findings in patients referred to the electrophysiology laboratory with prediagnosis of CTS. METHODS: Sixty-two consecutive patients who were referred to the electrophysiology laboratory with the diagnosis of CTS were enrolled in the study. The intensity of pain was determined by visual analog scale, the findings of Tinel-Phalen tests were assessed, and clinico-demographic findings were recorded. Nerve conduction studies were performed bilaterally in median and ulnar nerves. The severity of CTS was determined with electrophysiologic evaluation, and the association between electrophysiologic findings and symptoms were analyzed statistically. RESULTS: Sixty-two (57 female, 5 male patients were examined in the study. CTS was bilateral in 53 patients and unilateral in 9 patients (total 115 hands. Mean pain score was 5.78 ± 3.50. In 28 hands with a clinical diagnosis of CTS, no electrophysiologic CTS findings were found, whereas in 32 hands mild, in 41 hands moderate and in 14 hands severe findings were obtained. CONCLUSION: According to our study, there was no statistically significant association between severity of symptoms and severity of electrophysiologic findings in CTS

  19. Carpal tunnel syndrome and the "double crush" hypothesis: a review and implications for chiropractic

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    Russell Brent S

    2008-04-01

    Full Text Available Abstract Upton and McComas claimed that most patients with carpal tunnel syndrome not only have compressive lesions at the wrist, but also show evidence of damage to cervical nerve roots. This "double crush" hypothesis has gained some popularity among chiropractors because it seems to provide a rationale for adjusting the cervical spine in treating carpal tunnel syndrome. Here I examine use of the concept by chiropractors, summarize findings from the literature, and critique several studies aimed at supporting or refuting the hypothesis. Although the hypothesis also has been applied to nerve compressions other than those leading to carpal tunnel syndrome, this discussion mainly examines the original application – "double crush" involving both cervical spinal nerve roots and the carpal tunnel. I consider several categories: experiments to create double crush syndrome in animals, case reports, literature reviews, and alternatives to the original hypothesis. A significant percentage of patients with carpal tunnel syndrome also have neck pain or cervical nerve root compression, but the relationship has not been definitively explained. The original hypothesis remains controversial and is probably not valid, at least for sensory disturbances, in carpal tunnel syndrome. However, even if the original hypothesis is importantly flawed, evaluation of multiple sites still may be valuable. The chiropractic profession should develop theoretical models to relate cervical dysfunction to carpal tunnel syndrome, and might incorporate some alternatives to the original hypothesis. I intend this review as a starting point for practitioners, educators, and students wishing to advance chiropractic concepts in this area.

  20. Trigger wrist and carpal tunnel syndrome caused by hand intramuscular intrasynovial angiofibrolipoma: A rare case report

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    Turan C Dulgeroglu

    2016-08-01

    Full Text Available Trigger wrist is a clinical entity characterized by triggering or the crackling of the wrist. Here, a case is reported of intrasynovial angiofibrolipoma that caused trigger wrist and carpal tunnel syndrome. This is the only case report where trigger wrist and carpal tunnel syndrome caused by the intrasynovial angiofibrolipoma were developed simultaneously. it is believed that that adhesive tenosynovitis developing in the tendons may have contributed to the triggering and carpal tunnel syndrome in the wrist as a result of inflammation occuring as a consequence of intrasynovial angiofibrolipoma. [Hand Microsurg 2016; 5(2.000: 107-109

  1. A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon: A case report.

    Science.gov (United States)

    Lu, Hui; Chen, Qiang; Shen, Hui

    2017-03-01

    Gouty tophi is a rare cause of CTS. We first report a unique case of repeated CTS with gouty tophi in flexor tendon. In the previous literature, the symptoms cases of CTS were gradually increased. We report a 44-year-old male porter presented with mass on his left distal forearm combined a repeated carpal tunnel syndrome for 5 years. He felt numbness in fingers and his left palmar. The CTS symptoms had been eased through rest and dugs medication. It recurred twice. Monosodium urate crystal deposits were found in surgery. Histologic findings confirmed the diagnosis of gout. We removed partial of gouty tophus and retained the integrity of the tendon. Two years after the surgery, the patient had not experienced any symptom recurrence. Early diagnosis and control of gout are necessary to avoid irreversible complications. The surgery combined with decreasing trioxypurine treatment can improve the treatment outcome of gouty tophus.

  2. A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon

    Science.gov (United States)

    Lu, Hui; Chen, Qiang; Shen, Hui

    2017-01-01

    Abstract Rationale: Gouty tophi is a rare cause of CTS. We first report a unique case of repeated CTS with gouty tophi in flexor tendon. In the previous literature, the symptoms cases of CTS were gradually increased. Patient concerns: We report a 44-year-old male porter presented with mass on his left distal forearm combined a repeated carpal tunnel syndrome for 5 years. He felt numbness in fingers and his left palmar. The CTS symptoms had been eased through rest and dugs medication. It recurred twice. Diagnoses: Monosodium urate crystal deposits were found in surgery. Histologic findings confirmed the diagnosis of gout. Interventions: We removed partial of gouty tophus and retained the integrity of the tendon. Outcomes: Two years after the surgery, the patient had not experienced any symptom recurrence. Lessons: Early diagnosis and control of gout are necessary to avoid irreversible complications. The surgery combined with decreasing trioxypurine treatment can improve the treatment outcome of gouty tophus. PMID:28248892

  3. Impact of cell therapy in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Mena Perez, Rafael; Fernandez Delgado, Norma; Garmendia Garcia, Fermin

    2012-01-01

    We present a small series of patients with carpal tunnel syndrome who underwent implantation of autologous mononuclear cells from peripheral blood to assess the feasibility and safety of these in the sixth month after that procedure. We included 6 patients treated at the Department of Orthopedic in The Enrique Cabrera General Teaching Hospital. The improvement in symptoms began one week after the procedure. Pain and cramping were the first to disappear, the improvement increased one month after and it was maintained until the sixth month of evaluation. The clinical-neurological manifestations improved in 80.3 % of patients, as well as in the study of motor and sensory conduction. There was no reaction to the implant. The improvement of the clinical manifestations and conduction studies support the mediation of stem cells in inflammatory action, revascularization and remyelination of the median nerve, which is expressed in the positive responses obtained

  4. Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome

    NARCIS (Netherlands)

    Makanji, H. S.; Becker, S. J. E.; Mudgal, C. S.; Jupiter, J. B.; Ring, D.

    2014-01-01

    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

  5. 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.

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

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    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.

  7. Magnetic resonance imaging evaluation of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Hachisuka, Hiroki; Kimori, Kenji; Tsuge, Kenya; Murakami, Tsuneji

    2006-01-01

    In many reports, the severity of carpal tunnel syndrome (CTS) is evaluated by subjective symptoms and nerve conduction findings of the median nerve. However, nerve conduction studies are complicated and the patients occasionally experience pain. In this report, we quantified a morphological change in the median nerve by using MRI, and reviewed a new noninvasive method of CTS evaluation. The survey was carried out on 55 idiopathic CTS patients (45 females and 10 males). The affected areas were 33 right hands and 22 left hands. The average age of the patients was 59 years. We used Philips Gyroscan Intera 1.5 Tesla MRI. T2 weighted axial image of the carpal canal sliced by width of 1 mm was used to measure a minimum axis/maximum axis (median nerve compression rate; MNCR). Simultaneously, we measured the nerve conduction velocity and terminal latency of the motor and sensory nerves; we evaluated the thumb motor disturbance by Hamada's classification and sensory disturbance by Semmes-Weinstein test. The statistical correlations between these items and MNCR were analyzed. MNCR had a significant correlation with all items, particularly with motor nerve conduction velocity and latency, and Hamada's classification. There have been some trials regarding the application of MRI findings for CTS evaluation. In these reports, they measured the cross section of the median nerve or brightness of the median nerve, flexor tendon, or intrinsic muscle. However, it is difficult to measure an MRI cross section or brightness in common practice. MNCR has a statistical correlation with the nerve conduction study, is easy to measure, and noninvasive. MNCR is useful as an objective evaluation method of CTS severity. (author)

  8. Combined Kinesiotaoe and Therapeutic Ultrasound in the Treatment of Carpal Tunnel Syndrome

    International Nuclear Information System (INIS)

    Mohamed, O.G.; Elhafez, H.M.; Alshatoury, H.A.; Refaat, R.

    2016-01-01

    Background : Carpal tunnel syndrome is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Hand is an Accepted November 2016 . important part of body to perform the complex daily living activities. Purpose: To find out effect of combined kinesiotape and therapeutic ultrasound in the treatment of carpal tunnel syndrome. Material and Methods :Thirty Carpal Tunnel Syndrome female patients with positive electro diagnostic findings (MMDL >4.2 ms) participated in this study, their ages ranged between 40 and 50 years. Design of study :They were divided randomly into two equal groups. Group (A) received kinesiotape applicatio n on the affected wrist for 3 days, then day off and then another three days each week for 4 weeks combined with a program of 12 sessions of continuous ultrasound, 3 sessions per week for 5 minute persession in addition nerve and tendon gliding exercise . While, Group (B) received a program of 12 sessions of continuous ultrasound, 3 sessions per week for 5 minute per session in addition tendon and nerve gliding exercise. The treatment program continued for 4 weeks. Boston carpal tunnel questionnaire and median motor distallatency, visual analogue scale and hand grip dynamometer were performed before and after the treatment program for all patients of the two groups. Results : The obtained results showed a highly statistically significant (P< 0.0001) improvement in both groups (A and B) concerning Boston carpal tunnel questionnaire , visual analogue scale and hand grip dynamometer but there was significant improvement in group (A) only concerning median motor distal latency. The improvement was highly significant (P< 0.0001) in group (A) when compared with group (B). Conclusion: It could be concluded that the use of combined kinesiotape and therapeutic ultrasound in the treatment of carpal tunnel syndrome appeared to be effective. Yet the combined effect of kinesiotape with

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

    International Nuclear Information System (INIS)

    Yao, Lawrence; Gai, Neville

    2009-01-01

    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 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 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 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.)

  10. Ergonomic positioning or equipment for treating carpal tunnel syndrome.

    Science.gov (United States)

    O'Connor, Denise; Page, Matthew J; Marshall, Shawn C; Massy-Westropp, Nicola

    2012-01-18

    Non-surgical treatment, including ergonomic positioning or equipment, are sometimes offered to people experiencing mild to moderate symptoms from carpal tunnel syndrome (CTS). The effectiveness and duration of benefit from ergonomic positioning or equipment interventions for treating CTS are unknown. To assess the effects of ergonomic positioning or equipment compared with no treatment, a placebo or another non-surgical intervention in people with CTS. We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 2, in The Cochrane Library), MEDLINE (1966 to June 2011), EMBASE (1980 to June 2011), CINAHL Plus (1937 to June 2011), and AMED (1985 to June 2011). We also reviewed the reference lists of randomised or quasi-randomised trials identified from the electronic search. Randomised or quasi-randomised controlled trials comparing ergonomic positioning or equipment with no treatment, placebo or another non-surgical intervention in people with CTS. Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias of included studies. We calculated risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for the primary and secondary outcomes. We pooled results of clinically and statistically homogeneous trials, where possible, to provide estimates of the effect of ergonomic positioning or equipment. We included two trials (105 participants) comparing ergonomic versus placebo keyboards. Neither trial assessed the primary outcome (short-term overall improvement) or adverse effects of interventions. In one small trial (25 participants) an ergonomic keyboard significantly reduced pain after 12 weeks (MD -2.40; 95% CI -4.45 to -0.35) but not six weeks (MD -0.20; 95% CI -1.51 to 1.11). In this same study, there was no difference between ergonomic and standard keyboards in hand function at six or 12 weeks or palm

  11. Usefulness of magnetic resonance imaging in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Morita, Akimasa; Fujisawa, Kouzou; Tsujii, Masaya; Hirata, Hitoshi; Uchida, Atsumasa

    2005-01-01

    Electrodiagnostic studies are highly sensitive and specific for the diagnosis of carpal tunnel syndrome (CTS). However, conduction velocities do not correlate with symptom severity or treatment outcomes. Magnetic resonance imaging (MRI) revealed tenosynovial thickening within the carpal tunnel as the most constant finding in CTS; it is encountered in more than 95% of the patients. The purpose of the present study is to analyze the relationship between subjective symptoms and MRI findings, and to identify clinical evaluations that reflect subjective symptom severity. The subject group comprised 48 females with CTS. Patients were divided into 4 groups based on their symptom duration (A: lesser than 3 months, B: 4 to 6 months, C: 7 to 12 months, D: more than 13 months). All patients were preoperatively assessed for subjective symptom severity by using a Likert scale, sensory conduction velocity (SCV), and compound muscle action potential (CMAP). In addition, all patients underwent MRI examination for the evaluation of flexor tenosynovial thickening represented by palmar bowing of the flexor retinaculum (PBFR). Fourteen healthy females with comparable demographics served as the controls. Relationships were estimated using Spearman rank score or Mann-Whitney's U test. Regarding subjective symptoms, pain severity decreased significantly in the order A>B>C; it did not decrease significantly in D. Paresthesia did not show any significant difference among the groups. PBFR was significantly higher in all the groups as compared to the control, and similar to pain severity, it decreased significantly in the order A>B>C; it did not decrease significantly in D. Statistical analysis established a close correlation between pain severity and PBFR. However, pain severity did not show any correlation with either electrophysiology or functional status. In contrast to electrophysiology or objective functional status assessment, flexor tenosynovial thickening shows a close correlation

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

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    Margriet H M van Doesburg

    Full Text Available 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.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.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.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.

  13. Comparison of symptoms, physical examination and electromyography findings, with the results of surgery of carpal tunnel release, in patients treated between January 2007 and December 2008, at the Hospital Calderon Guardia; Comparacion de la sintomatologia, exploracion fisica y hallazgos electromiograficos, con los resultados de la cirugia de liberacion de tunel carpal, en pacientes tratados entre enero 2007 y diciembre 2008, en el Hospital Calderon Guardia

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    Chavarria Alvarado, Manuel

    2010-07-01

    A comparison of the preoperative findings was performed in patients with the diagnosis of carpal tunnel syndrome, with functional outcomes and postoperative residual pain, using the scale Patient Rate Wrist Evaluation (PRWE). All patients have had clinical history, physical examination and electromyography studies. They were operated by minimally invasive open surgery. The information was collected in an Excel table and patients have located via telephone. 100% of the evaluated patients have engaged in activities that involve trauma or repetitive wrist movements. The physical sign with predicative positive value for suspect of carpal tunnel syndrome has been the Phalen, present in over 70% of cases. The amount of physical signs present preoperatively and postoperative results were found without correlation. The mixed lesion, both sensory and motor has been the most found in electrodiagnostic studies. Patients whose studies have been negative, postoperative results have showed less favorable. Only 69% of patients operated in the orthopedic service of the Hospital Rafael Angel Calderon Guardia (HCG), have had favorable postoperative results. (author) [Spanish] Una comparacion de los hallazgos preoperatorios fue realizada en los pacientes con diagnostico del sindrome del tunel carpal, con los resultados funcionales y dolor residual en el posoperatorio, utilizando la escala Patient Rate Wrist Evaluation (PRWE). Todos los pacientes han tenido historia clinica, examen fisico y estudios electromiograficos. Ellos fueron intervenidos mediante cirugia abierta minimamente invasiva. La informacion fue recolectada en una tabla de excel y los pacientes fueron localizados via telefonica. El 100% de los pacientes evaluados se han dedicado a realizar actividades que implican trauma o movimientos repetitivos de las munecas. El signo fisico con valor predictivo positivo para la sospecha de sindrome de tunel carpal ha sido el Phalen, presente en mas del 70% de los casos. La cantidad

  14. Importance of Recognizing Carpal Tunnel Syndrome for Neurosurgeons: A Review.

    Science.gov (United States)

    Yunoki, Masatoshi; Kanda, Takahiro; Suzuki, Kenta; Uneda, Atsuhito; Hirashita, Koji; Yoshino, Kimihiro

    2017-04-15

    Idiopathic carpal tunnel syndrome (CTS) is a common complaint, reflecting entrapment neuropathy of the upper extremity. CTS produces symptoms similar to those of other conditions, such as cervical spondylosis or ischemic or neoplastic intracranial disease. Because of these overlaps, patients with CTS are often referred to a neurosurgeon. Surgical treatment of CTS was started recently in our department. Through this experience, we realized that neurosurgeons should have an increased awareness of this condition so they can knowledgeably assess patients with a differential diagnosis that includes CTS and cervical spinal and cerebral disease. We conducted a literature review to gain the information needed to summarize current knowledge on the clinical, pathogenetic, and therapeutic aspects of CTS. Because the optimal diagnostic criteria for this disease are still undetermined, its diagnosis is based on the patient's history and physical examination, which should be confirmed by nerve conduction studies and imaging modalities such as magnetic resonance imaging and ultrasonography. Treatment methods include observation, medication, splinting, steroid injections, and surgical intervention. Understanding the clinical features and pathogenesis of CTS, as well as the therapeutic options available to treat it, is important for neurosurgeons if they are to provide the correct management of patients with this disease.

  15. Hypothyroidism and carpal tunnel syndrome: a meta-analysis.

    Science.gov (United States)

    Shiri, Rahman

    2014-12-01

    This study aimed to assess the magnitude of the association between hypothyroidism and carpal tunnel syndrome (CTS). Eighteen studies were included in a random-effects meta-analysis. A meta-analysis of the studies that did not control their estimates for any confounder showed an association between a thyroid disease (hypo- or hyperthyroidism) and CTS (N = 9,573, effect size [ES] = 1.32 (95% confidence interval [CI], 1.04-1.68) and between hypothyroidism and CTS (N = 64,531, ES = 2.15 [95% CI, 1.64-2.83]). When a meta-analysis limited to the studies that controlled their estimates for some potential confounders, the association between a thyroid disease and CTS disappeared (N = 4,799, ES = 1.17 [95% CI, 0.71-1.92], I(2) = 0%), and the effect size for hypothyroidism largely attenuated (N = 71,133, ES = 1.44 [95% CI, 1.27-1.63], I(2) = 0%). Moreover, there was evidence of publication bias. This meta-analysis found only a modest association between hypothyroidism and CTS. Confounding and publication bias may still account for part of the remaining excess risk. © 2014 Wiley Periodicals, Inc.

  16. Carpal tunnel syndrome in the Turkish steel industry.

    Science.gov (United States)

    Gedizlioglu, Muhtesem; Arpaci, Esra; Cevher, Demet; Ce, Pinar; Kulan, Can Ahmet; Colak, Ilhan; Duzgun, Baran

    2008-05-01

    Certain occupations are reported to be associated with a high risk for carpal tunnel syndrome (CTS). In this study, we investigated the development of CTS in iron-steel industry workers. Subjects were recruited from a factory of 650 workers and assessed by means of history, physical examination and electrophysiological testing. Seventy-nine subjects from the factory and 53 healthy controls with occupations unrelated to heavy physical work were assessed. None of the worker group had electrophysiological evidence of CTS. One subject in the control group has electrophysiological evidence of CTS. In the worker group, all sensory nerve conduction velocities and ulnar nerve action potential amplitudes in both hands and distal motor latencies were statistically different. In our study, among a group of heavy labourers, no cases of CTS were detected. However, all electrophysiologic parameters of workers were different from controls. Our results point to a diffuse, but subclinical injury of peripheral nerves under heavy physical work conditions, instead of a local effect such as CTS.

  17. Kinesiotaping as an alternative treatment method for carpal tunnel syndrome.

    Science.gov (United States)

    Geler Külcü, Duygu; Bursali, Canan; Aktaş, İlknur; Bozkurt Alp, Selin; Ünlü Özkan, Feyza; Akpinar, Pınar

    2016-06-23

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment choices are not always satisfactory. The aim of this study was to investigate the effect of kinesiotaping (KT) on pain level, grip strength, and functional status compared with that of placebo KT and orthotic device (OD) in patients with CTS. In this randomized, placebo-controlled study, participants were allocated into one of three groups: an experimental KT group (Group 1), a placebo KT group (Group 2), and an OD group (Group 3). Visual analogue scale (VAS) and Douleur Neuropathique 4 (DN4) scores, dynamometric grip strength measures, and the Boston CTS questionnaire (BQ) were the outcome measures. All groups significantly improved in terms of VAS scores (P < 0.05), DN4 scores (P < 0.05), and BQ scores (P < 0.05). Grip strength improved in Group 3 (P = 0.001). There was a significant difference among the groups with respect to BQ scores (P < 0.05). KT application for the treatment of CTS should be an alternative treatment choice.

  18. [Clinical auxiliary diagnosis value of high frequency ultrasonographic measurements of the thickness of transverse carpal ligaments in carpal tunnel syndrome patients].

    Science.gov (United States)

    Xu, L; Chen, F M; Wang, L; Zhang, P X; Jiang, X R

    2016-04-18

    To evaluate the meaning and value of high-frequency ultrasound in the diagnosis of carpal tunnel syndrome (CTS). 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-frequency 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 direct 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 hamate 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) analyzed. 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-index finger sensory nerve conduction velocity (SCV), wrist-middle finger SCV showed a negative correlation. High frequency ultrasound measurements of thickness of transverse carpal ligaments is a valuable method for the diagnosis of CTS.

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

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    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

  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

    2016-09-06

    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. 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. 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). 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. Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch/Trial2.aspx

  1. Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: Preliminary Clinical Results.

    Science.gov (United States)

    Henning, P Troy; Yang, Lynda; Awan, Tariq; Lueders, Daniel; Pourcho, Adam M

    2018-04-02

    Ultrasound-guided carpal tunnel release was performed on 14 patients (18 wrists) using dynamic expansion of the transverse safe zone. Our patient population included able-bodied patients and those with impairments. The first 8 cases (12 wrists) underwent the procedure in an operating room, the remainder in an outpatient setting. No complications occurred, and all patients were able to immediately resume use of their hands without therapy. Improvements in the Quick Form of the Disabilities of the Arm, Shoulder, and Hand Index and Boston Carpal Tunnel Questionnaire at 3 months were comparable to results reported with mini-open and endoscopic release. Our results show that ultrasound-guided carpal tunnel release can be safely and effectively performed in an outpatient setting. © 2018 by the American Institute of Ultrasound in Medicine.

  2. Computer use and carpal tunnel syndrome: A meta-analysis.

    Science.gov (United States)

    Shiri, Rahman; Falah-Hassani, Kobra

    2015-02-15

    Studies have reported contradictory results on the role of keyboard or mouse use in carpal tunnel syndrome (CTS). This meta-analysis aimed to assess whether computer use causes CTS. Literature searches were conducted in several databases until May 2014. Twelve studies qualified for a random-effects meta-analysis. Heterogeneity and publication bias were assessed. In a meta-analysis of six studies (N=4964) that compared computer workers with the general population or other occupational populations, computer/typewriter use (pooled odds ratio (OR)=0.72, 95% confidence interval (CI) 0.58-0.90), computer/typewriter use ≥1 vs. computer/typewriter use ≥4 vs. computer/typewriter use (pooled OR=1.34, 95% CI 1.08-1.65), mouse use (OR=1.93, 95% CI 1.43-2.61), frequent computer use (OR=1.89, 95% CI 1.15-3.09), frequent mouse use (OR=1.84, 95% CI 1.18-2.87) and with years of computer work (OR=1.92, 95% CI 1.17-3.17 for long vs. short). There was no evidence of publication bias for both types of studies. Studies that compared computer workers with the general population or several occupational groups did not control their estimates for occupational risk factors. Thus, office workers with no or little computer use are a more appropriate comparison group than the general population or several occupational groups. This meta-analysis suggests that excessive computer use, particularly mouse usage might be a minor occupational risk factor for CTS. Further prospective studies among office workers with objectively assessed keyboard and mouse use, and CTS symptoms or signs confirmed by a nerve conduction study are needed. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Incidence of carpal tunnel syndrome in the US military population.

    Science.gov (United States)

    Wolf, Jennifer Moriatis; Mountcastle, Sally; Owens, Brett D

    2009-09-01

    Carpal tunnel syndrome (CTS) is a common disease. Its epidemiology has been evaluated previously, mostly in regional populations or in working groups, with an incidence between 1.5 and 3.5 per 1,000 person-years. We studied this diagnosis in the US military population, with the hypothesis that this young population would have a lower incidence of CTS than previously reported in general populations. The Defense Medical Epidemiology Database notes all medical encounters for all US military personnel and maintains the number of all personnel on active duty each year. We queried the database using the International Classification of Diseases, ninth revision, code 354.0 (CTS) and analyzed the personnel presenting for initial visits for the years 1998-2006. Multivariate Poisson analysis was performed, controlling for rank, gender, age, and race. The raw incidence of CTS in the US military was 3.98 per 1,000 person-years, in a population of 12,298,088 person-years. Females had a significantly higher incidence of CTS than males, with an adjusted incidence rate ratio of 3.29. CTS incidence increased by age, with the age group > or = 40 years having a significantly higher incidence. Additionally, military rank was found to be an independent risk factor for CTS, with rates higher in senior officer and enlisted groups. This suggests that occupational requirements have an effect on CTS within the military. We showed a comparable incidence of CTS between the US military and general population, with a significantly higher female cohort with a diagnosis of CTS. Increased age and advanced rank were risk factors for CTS.

  4. 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.

  5. Thrombosed persistent median artery causing carpal tunnel syndrome associated with bifurcated median nerve: A case report

    International Nuclear Information System (INIS)

    Salter, M.; Sinha, N. R.; Szmigielski, W.

    2011-01-01

    Background: Carpal tunnel syndrome is a sporadically occurring abnormality due to compression of median nerve. It is exceedingly rare for it to be caused by thrombosis of persistent median artery. Case Report: A forty two year old female was referred for ultrasound examination due to ongoing wrist pain, not relived by pain killers and mild paraesthesia on the radial side of the hand. High resolution ultrasound and Doppler revealed a thrombosed persistent median artery and associated bifurcated median nerve. The thrombus resolved on treatment with anticoagulants. Conclusions: Ultrasound examination of the wrist when done for patients with carpal tunnel syndrome should preferably include looking for persistent median artery and its patency. (authors)

  6. Carpal Tunnel Syndrome in Aberrant Muscle Syndrome: A Case Report and Review of the Literature.

    Science.gov (United States)

    Steele, Jessica; Coombs, Christopher

    2018-06-01

    Aberrant Muscle Syndrome (AMS) is a rare congenital hand difference that is characterised by unilateral non-progressive muscular hyperplasia. The aetiology of aberrant muscle syndrome is not known, but a recently published case has shown a somatic PIK3CA activating mutation in a patient with AMS. Carpal tunnel syndrome (CTS) in children is rare. The most common causes are the mucopolysaccaridoses but space-occupying lesions have also been reported to cause CTS in children. We report the first case of CTS in a child with AMS successfully treated with open carpal tunnel release and excision of aberrant muscles.

  7. High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

    Directory of Open Access Journals (Sweden)

    Katarzyna Kapuścińska

    2015-09-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2 with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2 , max. 31 mm2 . Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%. Increased nerve vascularity on the transverse section was present in 50 patients (80.65%. Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

  8. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

    OpenAIRE

    Melani Carla; Fateh-Moghadam Pirous; dell'Omo Marco; de Giacomi Giovanna; Bena Antonella; Cooke Robin MT; Curti Stefania; Baldasseroni Alberto; Mattioli Stefano; Biocca Marco; Buiatti Eva; Campo Giuseppe; Zanardi Francesca; Violante Francesco S

    2008-01-01

    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 estima...

  9. Diagnosis of carpal tunnel syndrome: interobserver reliability of the blinded scratch-collapse test

    NARCIS (Netherlands)

    Blok, Robin D.; Becker, Stéphanie J. E.; Ring, David C.

    2014-01-01

    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

  10. Pathological changes in the subsynovial connective tissue increase with self-reported carpal tunnel syndrome symptoms.

    Science.gov (United States)

    Tat, Jimmy; Wilson, Katherine E; Keir, Peter J

    2015-05-01

    Fibrosis and thickening of the subysnovial connective tissue are the most common pathological findings in carpal tunnel syndrome. The relationship between subsynovial connective tissue characteristics and self-reported carpal tunnel syndrome symptoms was assessed. Symptoms were characterized using the Boston Carpal Tunnel Questionnaire and Katz hand diagram in twenty-two participants (11 with symptoms, 11 with no symptoms). Using ultrasound, the thickness of the subsynovial connective tissue was measured using a thickness ratio (subsynovial thickness/tendon thickness) and gliding function was assessed using a shear strain index ((Displacement(tendon)-Displacement(subsynovial))/Displacement(tendon)x 100). For gliding function, participants performed 10 repeated flexion-extension cycles of the middle finger at a rate of one cycle per second. Participants with symptoms had a 38.5% greater thickness ratio and 39.2% greater shear strain index compared to participants without symptoms (p<0.05). Ultrasound detected differences the SSCT in symptomatic group that was characterized by low self-reported symptom severity scores. This study found ultrasound useful for measuring structural and functional changes in the SSCT that could provide insight in the early pathophysiology associated with carpal tunnel syndrome symptoms. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Carpal tunnel sonography by the rheumatologist versus nerve conduction study by the neurologist

    NARCIS (Netherlands)

    Swen, WAA; Jacobs, JWG; Bussemaker, FEAM; de Waard, J; Bijlsma, JWJ

    Objective. To determine the value of sonogaphy (SG) performed by the rheumatologist to diagnose carpal tunnel syndrome (CTS). Methods. Sixty-three patients with clinical signs of CTS according to the neurologist. based on patient history and clinical examination, were studied. In the 6 weeks prior

  12. Increased pain sensitivity is not associated with electrodiagnostic findings in women with carpal tunnel syndrome.

    Science.gov (United States)

    de la Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César; Laguarta-Val, Sofia; Alonso-Blanco, Cristina; Martínez-Perez, Almudena; Arendt-Nielsen, Lars; Pareja, Juan A

    2011-01-01

    To determine the differences in widespread pressure pain and thermal hypersensitivity in women with minimal, moderate, and severe carpal tunnel syndrome (CTS) and healthy controls. A total of 72 women with CTS (19 with minimal, 18 with moderate, and 35 with severe) and 19 healthy age-matched women participated. Pressure pain thresholds were bilaterally assessed over the median, ulnar, and radial nerves, the C5 to C6 zygapophyseal joint, the carpal tunnel, and the tibialis anterior muscle. In addition, warm and cold detection thresholds and heat and cold pain thresholds were bilaterally assessed over the carpal tunnel and the thenar eminence. All outcome parameters were assessed by an assessor blinded to the participant's condition. No significant differences in pain parameters among patients with minimal, moderate, and severe CTS were found. The results showed that PPT were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, C5 to C6 zygapophyseal joint, and the tibialis anterior muscle in patients with minimal, moderate, or severe CTS as compared with healthy controls (all, P<0.001). In addition, patients with CTS also showed lower heat pain threshold and reduced cold pain threshold compared with controls (P<0.001). No significant sensory differences between minimal, moderate, or severe CTS were found. The similar widespread pressure and thermal hypersensitivity in patients with minimal, moderate, or severe CTS and pain intensity suggests that increased pain sensitivity is not related to electrodiagnostic findings.

  13. Progression of carpal tunnel syndrome according to electrodiagnostic testing in nonoperatively treated patients

    NARCIS (Netherlands)

    van Suchtelen, Mark; Becker, Stéphanie J. E.; Gruber, Jillian S.; Ring, David

    2014-01-01

    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. This retrospective study analyzed sixty-two adult

  14. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy : A prospective study

    NARCIS (Netherlands)

    Meems, M.; Truijens, S. E. M.; Spek, V.; Visser, L. H.; Pop, V. J. M.

    2015-01-01

    Objective To investigate the prevalence, severity and relation to fluid retention of self-reported pregnancy-related carpal tunnel syndrome (CTS) symptoms in a large sample of pregnant women. Design A prospective longitudinal cohort study. Setting Dutch women who became pregnant between January 2013

  15. Carpal tunnel syndrome. Risk factors and preventive strategies for the dental hygienist.

    Science.gov (United States)

    Gerwatowski, L J; McFall, D B; Stach, D J

    1992-02-01

    Carpal tunnel syndrome (CTS) is well recognized as an occupational risk for dental hygienists. The contributing risk factors fall primarily into two categories: medical and occupational. The purposes of this paper are to examine the factors that predispose one to CTS in order to increase awareness among dental hygienists, and to offer preventive strategies that can be incorporated into daily practice.

  16. 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.

  17. Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome-A Systematic Review.

    Science.gov (United States)

    Huisstede, Bionka M; van den Brink, Janneke; Randsdorp, Manon S; Geelen, Sven J; Koes, Bart W

    2017-05-31

    To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016. Two reviewers independently applied the inclusion criteria to select potential studies. Two reviewers independently extracted the data and assessed the methodologic quality. A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found. Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Comparative Anatomy of the Subsynovial Connective Tissue in the Carpal Tunnel of the Rat, Rabbit, Dog, Baboon, and Human

    OpenAIRE

    Ettema, Anke M.; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C.

    2006-01-01

    The tenosynovium in the human carpal tunnel is connected to the flexor tendons and the median nerve by the subsynovial connective tissue (SSCT). The most common histological finding in carpal tunnel syndrome (CTS), a compression neuropathy of the median nerve, is noninflammatory fibrosis of the SSCT. The relationship, if any, between the fibrosis and nerve pathology is unknown, although some have speculated that a change in the SSCT volume or stiffness might be the source of the compression. ...

  1. Z-Elongation of the transverse carpal ligament vs. complete resection for the treatment of carpal tunnel syndrome.

    Science.gov (United States)

    Castro-Menéndez, M; Pagazaurtundúa-Gómez, S; Pena-Paz, S; Huici-Izco, R; Rodríguez-Casas, N; Montero-Viéites, A

    Carpal tunnel syndrome is treated successfully by surgical release of the transverse carpal ligament (TCL). However, persistent weakness of grip and pain over the thenar and hypothenar ends of this ligament, and "pillar pain", are reported to be common complications. In order to reduce these complications, different ligament reconstruction or lengthening techniques have been proposed. The purpose of this study is compare effectiveness and complications of TCL z-lengthening technique with complete TCL section. A prospective, randomised, intervention trial was conducted on 80 patients. The patients were divided into 2 groups: 1) complete release of TCL; 2) z-lengthening of TCL according to a modified Simonetta technique. Grip strength, pillar pain and clinical and functional assessment were carried out using the Levine et al. questionnaire. No significant differences were observed (p>.05) in the postoperative reviews between the two groups as regards grip strength loss and pillar pain. There were significant differences between preoperative and postoperative mean Levine scores, but there was no difference in the mean scores of the two procedures at any time. In conclusion, according to the results, TCL z-lengthening is more effective than simple division, but there is no identifiable benefit in z-lengthening for avoiding complications. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Evaluation of Radiographic Instability of the Trapeziometacarpal Joint in Women With Carpal Tunnel Syndrome.

    Science.gov (United States)

    Kim, Jeong Hwan; Gong, Hyun Sik; Kim, Youn Ho; Rhee, Seung Hwan; Kim, Jihyoung; Baek, Goo Hyun

    2015-07-01

    To determine whether median nerve dysfunction measured by electrophysiologic studies in carpal tunnel syndrome (CTS) is associated with thumb trapeziometacarpal (TMC) joint instability. We evaluated 71 women with CTS and 31 asymptomatic control women. Patients with generalized laxity or TMC joint osteoarthritis were excluded. We classified the electrophysiologic severity of CTS based on nerve conduction time and amplitude and assessed radiographic instability of the TMC joint based on TMC joint stress radiographs. We compared subluxation ratio between patients with CTS and controls and performed correlation analysis of the relationship between the electrophysiologic grade and subluxation ratio. Thirty-one patients were categorized into the mild CTS subgroup and 41 into the severe CTS subgroup. There was no significant difference in subluxation ratio between the control group and CTS patients or between the control group and CTS subgroup patients. Furthermore, there was no significant correlation between electrophysiologic grade and subluxation ratio. This study demonstrated that patients with CTS did not have greater radiographic TMC joint instability compared with controls, and suggests that TMC joint stability is not affected by impaired median nerve function. Further studies could investigate how to better evaluate proprioceptive function of TMC joint and whether other nerves have effects on TMC joint motor/proprioceptive function, to elucidate the relationship between neuromuscular control of the TMC joint, its stability, and its progression to osteoarthritis. Diagnostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. A randomized, controlled trial of magnetic therapy for carpal tunnel syndrome.

    Science.gov (United States)

    Baute, Vanessa; Keskinyan, Vahakn S; Sweeney, Erica R; Bowden, Kayla D; Gordon, Allison; Hutchens, Janet; Cartwright, Michael S

    2018-03-07

    Magnet therapy has been proposed as a treatment for neurologic conditions. In this this trial we assessed the feasibility and efficacy of a magnet inserted into a wristband for carpal tunnel syndrome (CTS). Twenty-two patients with mild to moderate CTS were randomized to wear a high-dose or low-dose "sham" magnetic wristband for 6 weeks. The primary outcome was the Symptom Severity Scale (SSS) of the Boston Carpal Tunnel Questionnaire. Secondary measures were nerve conduction studies (NCS), median nerve ultrasound, and compliance. Compliance for both groups was >90%. Improvements in the mean SSS, NCS, and median nerve ultrasound did not reach statistical significance. Magnet therapy via wristband is well-tolerated. Further investigations in larger populations are needed to determine efficacy. Muscle Nerve, 2018. © 2018 Wiley Periodicals, Inc.

  4. 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.

  5. Carpal tunnel syndrome: a complication of arteriovenous fistula in hemodialysis patients.

    Science.gov (United States)

    Kumar, S.; Trivedi, H. L.; Smith, E. K.

    1975-01-01

    Symptoms of compression of the median nerve in the carpal tunnel developed in two patients in whom an arteriovenous fistula was created to alleviate chronic renal failure through hemodialysis. Anatomic changes in the wrist area due to the fistula are probably important in the development of this syndrome, and pre-existing uremic peripheral polyneuropathy may also be important in the early development of local symptoms of nerve damage. Images FIG. 1 PMID:1201544

  6. The diagnostic efficacy of clinical findings and electrophysiological studies in carpal tunnel syndrome

    OpenAIRE

    Buyukkoyuncu Pekel, Nilufer; Nar Senol, Pelin; Yildiz, Demet; Kilic, Ahmet Kasim; Kamaci Sener, Deniz; Seferoglu, Meral; Gunes, Aygul

    2017-01-01

    Objective. The aim of the study was to examine the relation between clinical findings, neurological examination and electrophysiological studies in diagnosing carpal tunnel syndrome (CTS) and share our institutional experience in patients with CTS. Methods. Patients presenting with complaints of pain, paresthesia, and weakness in hands who diagnosed CTS between 2014 and 2015 were examined retrospectively. Demographic characteristics, clinical and neurological examination findings and electrod...

  7. [Etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype wrist movements].

    Science.gov (United States)

    Lewańska, Magdalena; Walusiak-Skorupa, Jolanta

    2014-01-01

    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. 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. 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. 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.

  8. 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

  9. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel.

    Science.gov (United States)

    Evers, Stefanie; Thoreson, Andrew R; Smith, Jay; Zhao, Chunfeng; Geske, Jennifer R; Amadio, Peter C

    2018-01-01

    The aim of this study was to assess alterations in median nerve (MN) biomechanics within the carpal tunnel resulting from ultrasound-guided hydrodissection in a cadaveric model. Twelve fresh frozen human cadaver hands were used. MN gliding resistance was measured at baseline and posthydrodissection, by pulling the nerve proximally and then returning it to the origin. Six specimens were treated with hydrodissection, and 6 were used as controls. In the hydrodissection group there was a significant reduction in mean peak gliding resistance of 92.9 ± 34.8 mN between baseline and immediately posthydrodissection (21.4% ± 10.5%; P = 0.001). No significant reduction between baseline and the second cycle occurred in the control group: 9.6 ± 29.8 mN (0.4% ± 5.3%; P = 0.467). Hydrodissection can decrease the gliding resistance of the MN within the carpal tunnel, at least in wrists unaffected by carpal tunnel syndrome. A clinical trial of hydrodissection seems justified. Muscle Nerve 57: 25-32, 2018. © 2017 Wiley Periodicals, Inc.

  10. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial.

    Science.gov (United States)

    Michalsen, Andreas; Bock, Silke; Lüdtke, Rainer; Rampp, Thomas; Baecker, Marcus; Bachmann, Jürgen; Langhorst, Jost; Musial, Frauke; Dobos, Gustav J

    2009-06-01

    We investigated the effectiveness of cupping, a traditional method of treating musculoskeletal pain, in patients with carpal tunnel syndrome (CTS) in an open randomized trial. n = 52 outpatients (58.5 +/- 8.0 years) with neurologically confirmed CTS were randomly assigned to either a verum (n = 26) or a control group (n = 26). Verum patients were treated with a single application of wet cupping, and control patients with a single local application of heat within the region overlying the trapezius muscle. Patients were followed up on day 7 after treatment. The primary outcome, severity of CTS symptoms (VAS), was reduced from 61.5 +/- 20.5 to 24.6 +/- 22.7 mm at day 7 in the cupping group and from 67.1 +/- 20.2 to 51.7 +/- 23.9 mm in the control group [group difference -24.5mm (95%CI -36.1; -2.9, P cupping therapy may be effective in relieving the pain and other symptoms related to CTS. The efficacy of cupping in the long-term management of CTS and related mechanisms remains to be clarified. The results of a randomized trial on the clinical effects of traditional cupping therapy in patients with carpal tunnel syndrome are presented. Cupping of segmentally related shoulder zones appears to alleviate the symptoms of carpal tunnel syndrome.

  11. Consumer health information on the Internet about carpal tunnel syndrome: indicators of accuracy.

    Science.gov (United States)

    Frické, Martin; Fallis, Don; Jones, Marci; Luszko, Gianna M

    2005-02-01

    To identify indicators of accuracy for consumer health information on the Internet. Several popular search engines were used to find websites on carpal tunnel syndrome. The accuracy and completeness of these sites were determined by orthopedic surgeons. It also was noted whether proposed indicators of accuracy were present. The correlation between proposed indicators of accuracy and the actual accuracy of the sites was calculated. A total of 116 websites and 29 candidate indicators were examined. A high Google toolbar rating of the main page of a site, many inlinks to the main page of a site, and an unbiased presentation of information on carpal tunnel syndrome were considered genuine indicators of accuracy. Many proposed indicators taken from published guidelines did not indicate accuracy (e.g., the author or sponsor having medical credentials). There are genuine indicators of the accuracy of health information on the Internet. Determining these indicators, and informing providers and consumers of health information about them, would be useful for public health care. Published guidelines have proposed many indicators that are obvious to unaided observation by the consumer. However, indicators that make use of the invisible link structure of the Internet are more reliable guides to accurate information on carpal tunnel syndrome.

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

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    Yan Chen

    2016-01-01

    Full Text Available 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 optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside reflection 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 significantly among cases, with the measured laser reflection coefficient ranging from 1.8% to 54%. The reflection coefficient 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.

  13. Percutaneous carpal tunnel release compared with mini-open release using ultrasonographic guidance for both techniques.

    Science.gov (United States)

    Nakamichi, Ken-ichi; Tachibana, Shintaro; Yamamoto, Seizo; Ida, Masayoshi

    2010-03-01

    To compare the outcomes of percutaneous carpal tunnel release (PCTR) and mini-open carpal tunnel release (mini-OCTR) using ultrasonographic guidance for both techniques. We included 74 hands of 65 women with idiopathic carpal tunnel syndrome (age, 52-71 y; mean, 58 y). Thirty-five hands of 29 women had the PCTR (release with a device consisting of an angled blade, guide, and holder, along a line midway between the median nerve and ulnar artery (safe line) under ultrasonography (incision, 4 mm), and 39 hands of 36 women had the mini-OCTR (release along the safe line, distally under direct vision (incision, 1-1.5 cm) and proximally under ultrasonography, using a device consisting of a basket punch and outer tube. Assessments at 3, 6, 13, 26, 52, and 104 weeks showed no significant differences in neurologic recovery between the groups (p > .05). The PCTR group had significantly less pain, greater grip and key-pinch strengths, and better satisfaction scores at 3 and 6 weeks (p < .05), and less scar sensitivity at 3, 6, and 13 weeks (p < .05). There were no complications. The PCTR provides the same neurologic recovery as does the mini-OCTR. The former leads to less postoperative morbidity and earlier functional return and achievement of satisfaction. Therapeutic III. Copyright 2010. Published by Elsevier Inc.

  14. "Hand surgeons probably don't starve": Patient's perceptions of physician reimbursements for performing an open carpal tunnel release.

    Science.gov (United States)

    Kokko, Kyle P; Lipman, Adam J; Sapienza, Anthony; Capo, John T; Barfield, William R; Paksima, Nader

    2015-12-01

    The purpose of this study is to evaluate patient's perceptions of physician reimbursement for the most commonly performed surgery on the hand, a carpal tunnel release (CTR). Anonymous physician reimbursement surveys were given to patients and non-patients in the waiting rooms of orthopaedic hand physicians' offices and certified hand therapist's offices. The survey consisted of 13 questions. Respondents were asked (1) what they thought a surgeon should be paid to perform a carpal tunnel release, (2) to estimate how much Medicare reimburses the surgeon, and (3) about how health care dollars should be divided among the surgeon, the anesthesiologist, and the hospital or surgery center. Descriptive subject data included age, gender, income, educational background, and insurance type. Patients thought that hand surgeons should receive $5030 for performing a CTR and the percentage of health care funds should be distributed primarily to the hand surgeon (56 %), followed by the anesthesiologist (23 %) and then the hospital/surgery center (21 %). They estimated that Medicare reimburses the hand surgeon $2685 for a CTR. Most patients (86 %) stated that Medicare reimbursement was "lower" or "much lower" than what it should be. Respondents believed that hand surgeons should be reimbursed greater than 12 times the Medicare reimbursement rate of approximately $412 and that the physicians (surgeons and anesthesiologist) should command most of the health care funds allocated to this treatment. This study highlights the discrepancy between patient's perceptions and actual physician reimbursement as it relates to federal health care. Efforts should be made to educate patients on this discrepancy.

  15. Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome

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    Eleftheriou Andreas

    2012-08-01

    Full Text Available Abstract Background Contradictory reports have been published regarding the association of Carpal Tunnel Syndrome (CTS and the use of computer keyboard. Previous studies did not take into account the cumulative exposure to keyboard strokes among computer workers. The aim of the present study was to investigate the association between cumulative keyboard use (keyboard strokes and CTS. Methods Employees (461 from a Governmental data entry & processing unit agreed to participate (response rate: 84.1 % in a cross-sectional study. Α questionnaire was distributed to the participants to obtain information on socio-demographics and risk factors for CTS. The participants were examined for signs and symptoms related to CTS and were asked if they had previous history or surgery for CTS. The cumulative amount of the keyboard strokes per worker per year was calculated by the use of payroll’s registry. Two case definitions for CTS were used. The first included subjects with personal history/surgery for CTS while the second included subjects that belonged to the first case definition plus those participants were identified through clinical examination. Results Multivariate analysis used for both case definitions, indicated that those employees with high cumulative exposure to keyboard strokes were at increased risk of CTS (case definition A: OR = 2.23;95 % CI = 1.09-4.52 and case definition B: OR = 2.41; 95%CI = 1.36-4.25. A dose response pattern between cumulative exposure to keyboard strokes and CTS has been revealed (p  Conclusions The present study indicated a possible association between cumulative exposure to keyboard strokes and development of CTS. Cumulative exposure to key-board strokes would be taken into account as an exposure indicator regarding exposure assessment of computer workers. Further research is needed in order to test the results of the current study and assess causality between cumulative keyboard strokes and

  16. 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. © Georg Thieme Verlag KG Stuttgart · New York.

  17. 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

  18. Ultrasound Evaluation of Patients with Moderate and Severe Carpal Tunnel Syndrome

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    Ali Moghtaderi

    2012-01-01

    Full Text Available The objective of this study is to determine cut-off points for the crosssectional areas of the median nerve proximal and distal to carpal tunnel in moderate and severe Carpal Tunnel Syndrome (CTS and compare the results of our study with those available in the literature. Forty-three patients with upper limb pain other than CTS and 36 patients with idiopathic CTS enrolled into the study. The diagnosis and categorization of CTS were based on electrophysiologic criteria of the American Academy of Neurology. Median nerve cross-sectional areas were measured. Arithmetic mean values and standard deviation of each variable were measured. Student t-test and chi-squared test were applied to compare continuous and dichotomous variables between CTS and non-CTS control groups. Ultimately the diagnostic performances of the test characteristics including sensitivity, specificity, positive and negative predictive values were measured. Mean cross-sectional area of the nerve is higher in moderate than severe CTS proximal and distal to carpal tunnel. We accepted cut-off points of 11.5 mm2 and 13.5 mm2 for cross-sectional areas of the proximal and distal portions of carpal canal respectively. The sensitivity, specificity, positive and negative predictive values for the proximal inlet are 83%, 90.7%, 65.5% and 55.7%; and for the distal outlet are 36.1%, 93%, 81.2% and 63.4% respectively. We suggest that ultrasound is a good diagnostic modality for patients referred to tertiary care centers which categorized as moderate CTS.

  19. Can Impairment Interfere with Performance by Women with Carpal Tunnel Syndrome According to International Classification of Function?

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    Somayeh Kavousipor

    2015-03-01

    Full Text Available Background: Carpal tunnel syndrome is the most prevalent compression neuropathy of upper extremity which, two of the most important risk factors of that are the female sex and manual works. In the model of international classification of function, disability and health, disease is an impairment, results in functional limitation. The goal of this study is to compare hand function of participants between various severities of carpal tunnel syndrome. Methods: In a cross-sectional study, during 6 months period of time, 30 housekeeper women with carpal tunnel syndrome, with the mean age of 47.03 years, were selected through simple sampling. They were assessed for hand function, by Purdue peg board test and Boston questionnaire, after that a professional practitioner had performed Nerve Conductive Velocity (NCV test and identified the severity of their diseases. Then the data were analyzed with SPSS software, by Kruskal-Wallis test. Results: The mean of Purdue peg board test and Boston questionnaire scores in various clusters of carpal tunnel syndrome severity, were not different (P>0.05. Conclusion: In this research, severity of electrodiagnostic findings of participants, with carpal tunnel syndrome, is not related to their performance and functional limitations.

  20. Early response of local steroid injection versus mini incision technique in treatment of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Awan, A.S.; Khan, A.; Afridi, S.A.; Khan, R.S.

    2015-01-01

    Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the post-operative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. Methods: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups. Fifty-eight Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. Results: In this study mean age of the patients was 32.8 ± 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. Conclusion: The difference in pain after 1 month of the intervention was not statistically significant. (author)

  1. Altered brain morphometry in carpal tunnel syndrome is associated with median nerve pathology☆☆☆

    Science.gov (United States)

    Maeda, Yumi; Kettner, Norman; Sheehan, James; Kim, Jieun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Mezzacappa, Pia; Morse, Leslie R.; Audette, Joseph; Napadow, Vitaly

    2013-01-01

    Objective Carpal tunnel syndrome (CTS) is a common median nerve entrapment neuropathy characterized by pain, paresthesias, diminished peripheral nerve conduction velocity (NCV) and maladaptive functional brain neuroplasticity. We evaluated structural reorganization in brain gray matter (GM) and white matter (WM) and whether such plasticity is linked to altered median nerve function in CTS. Methods We performed NCV testing, T1-weighted structural MRI, and diffusion tensor imaging (DTI) in 28 CTS and 28 age-matched healthy controls (HC). Voxel-based morphometry (VBM) contrasted regional GM volume for CTS versus HC. Significant clusters were correlated with clinical metrics and served as seeds to define associated WM tracts using DTI data and probabilistic tractography. Within these WM tracts, fractional anisotropy (FA), axial (AD) and radial (RD) diffusivity were evaluated for group differences and correlations with clinical metrics. Results For CTS subjects, GM volume was significantly reduced in contralesional S1 (hand-area), pulvinar and frontal pole. GM volume in contralesional S1 correlated with median NCV. NCV was also correlated with RD and was negatively correlated with FA within U-fiber cortico-cortical association tracts identified from the contralesional S1 VBM seed. Conclusions Our study identified clear morphometric changes in the CTS brain. This central morphometric change is likely secondary to peripheral nerve pathology and altered somatosensory afference. Enhanced axonal coherence and myelination within cortico-cortical tracts connecting primary somatosensory and motor areas may accompany peripheral nerve deafferentation. As structural plasticity was correlated with NCV and not symptomatology, the former may be a better determinant of appropriate clinical intervention for CTS, including surgery. PMID:23799199

  2. The value of high-resolution sonography and MR imaging in the diagnosis and follow-up of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Buchberger, W.; Judmaier, W.; Birbamer, G.; Hasenoehrl, K.; Schmidauer, C.

    1993-01-01

    120 wrists of 105 patients with carpal tunnel syndrome were studied preoperatively by high-resolution sonography. Follow-up examinations after carpal tunnel release were performed in 72 wrists. In addition, 40 wrists were examined preoperatively, and 20 wrists were examined postoperatively by MR imaging. Based on quantitative analysis of the cross-sectional area and shape of the median nerve and of the palmar bowing of the flexor retinaculum, sonography established the diagnosis in 95% of cases. MR was superior in the evaluation of mild degrees of median nerve compression, and in the detection of possible causes of the carpal tunnel syndrome, such as synovitis of the flexor tendon sheaths or ganglionic cysts. In postoperative follow-up, sonographic demonstration of a normally flattened median nerve was an excellent indicator of the successful carpal tunnel release. In 10 patients with persistent or recurrent symptoms after carpal tunnel release, the underlying pathology could be exactly demonstrated by MR. (orig.) [de

  3. Treatment of carpal tunnel syndrome with polarized polychromatic noncoherent light (Bioptron light): a preliminary, prospective, open clinical trial.

    Science.gov (United States)

    Stasinopoulos, D; Stasinopoulos, I; Johnson, M I

    2005-04-01

    Our aim was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of idiopathic carpal tunnel syndrome. Carpal tunnel syndrome is the most common compression neuropathy, but no satisfactory conservative treatment is available at present. An uncontrolled experimental study was conducted in patients who visited our clinic from mid-2001 to mid-2002. A total of 25 patients (22 women and three men) with unilateral idiopathic carpal tunnel syndrome, mild to moderate nocturnal pain, and paraesthesia lasting >3 months participated in the study. The average age of the patients was 47.4 years and the average duration of patients' symptoms was 5.2 months. Polarized polychromatic noncoherent light (Bioptron light) was administered perpendicular to the carpal tunnel area. The irradiation time for each session was 6 min at an operating distance of 5-10 cm from the carpal tunnel area, three times weekly for 4 weeks. Outcome measures used were the participants' global assessments of nocturnal pain and paraesthesia, respectively, at 4 weeks and 6 months. At 4 weeks, two patients (8%) had no change in nocturnal pain, six (24%) were in slightly less nocturnal pain, 12 (48%) were much better in regard to nocturnal pain and five (20%) were pain-free. At 6 months, three patients (12%) were slightly better in regard to nocturnal pain, 13 (52%) were much better regarding nocturnal pain, and nine patients (36%) were pain-free. At 4 weeks, four patients (16%) had no change in paraesthesia, five (20%) were slightly better, 13 patients (52%) were much better, and three patients (12%) were without paraesthesia. At 6 months, two patients (8%) had no change in paraesthesia, two (8%) were slightly better, 14 (56%) were much better, and seven (28%) were without paraesthesia. Nocturnal pain and paraesthesia associated with idiopathic carpal tunnel syndrome improved during polarized polychromatic noncoherent light (Bioptron light) treatment. Controlled

  4. Diagnostic utility of F waves in clinically diagnosed patients of carpal tunnel syndrome.

    Science.gov (United States)

    Joshi, Anand G; Gargate, Ashwini R

    2013-01-01

    Sensory nerve conduction velocity (SNCV) of median nerve measured across the carpal tunnel, difference between distal sensory latencies (DSLs) of median and ulnar nerves and difference between distal motor latencies (DMLs) of median and ulnar nerves are commonly used nerve conduction parameters for diagnosis of carpal tunnel syndrome (CTS). These are having high degree of sensitivity and specificity. Study of median nerve F-wave minimal latency (FWML) and difference between F-wave minimal latencies (FWMLs) of median and ulnar nerves have also been reported to be useful parameters for diagnosis of CTS. However, there is controversy regarding superiority of F-wave study for diagnosis of CTS. So the aim of present study was to compare sensitivity and specificity of median FWML and difference between FWMLs of median and ulnar nerves with that of above mentioned electrophysiological parameters and to find out which parameters are having more sensitivity and specificity, for early diagnosis of CTS. Median and ulnar nerves sensory and motor conduction, median and ulnar nerves F-wave studies were carried out bilaterally in 125 clinically diagnosed patients of carpal tunnel syndrome. These parameters were also studied in 45 age matched controls. Difference between DSLs of median and ulnar nerves, median SNCV and difference between DMLs of median and ulnar nerves were having highest sensitivity and specificity while median FWML and difference between FWMLs of median and ulnar nerves was having lowest sensitivity and specificity for diagnosis of CTS. So in conclusion F-wave study is not superior parameter for diagnosis of CTS.

  5. Identification of Subgroups of Women with Carpal Tunnel Syndrome with Central Sensitization.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Fernández-Muñoz, Juan J; Navarro-Pardo, Esperanza; da-Silva-Pocinho, Ricardo F; Ambite-Quesada, Silvia; Pareja, Juan A

    2016-09-01

    Identification of subjects with different sensitization mechanisms can help to identify better therapeutic strategies for carpal tunnel syndrome (CTS). The aim of the current study was to identify subgroups of women with CTS with different levels of sensitization. A total of 223 women with CTS were recruited. Self-reported variables included pain intensity, function, disability, and depression. Pressure pain thresholds (PPT) were assessed bilaterally over median, ulnar, and radial nerves, C5-C6 joint, carpal tunnel, and tibialis anterior to assess widespread pressure pain hyperalgesia. Heat (HPT) and cold (CPT) pain thresholds were also bilaterally assessed over the carpal tunnel and the thenar eminence to determine thermal pain hyperalgesia. Pinch grip force between the thumb and the remaining fingers was calculated to determine motor assessment. Subgroups were determined according to the status on a previous clinical prediction rule: PPT over the affected C5-C6 joint 66 points. The ANOVA showed that women within group 1 (positive rule, n = 60) exhibited bilateral widespread pressure hyperalgesia (P < 0.001) and bilateral thermal thresholds (P < 0.001) than those within group 2 (negative rule, n = 162). Women in group 1 also exhibited higher depression than those in group 2 (P = 0.023). No differences in self-reported variables were observed. This study showed that a clinical prediction rule originally developed for identifying women with CTS who are likely to respond favorably to manual physical therapy was able to identify women exhibiting higher widespread pressure hyper-sensitivity and thermal hyperalgesia. This subgroup of women with CTS exhibiting higher sensitization may need specific therapeutic programs. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Frequency of Metabolic Syndrome and Its Components in Patients with Carpal Tunnel Syndrome

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    Iftikhar, S.; Javed, M. A.; Kasuri, M. N.

    2016-01-01

    Objective: To determine the frequency of metabolic syndrome and its components in patients with carpal tunnel syndrome. Study Design: Case-series. Place and Duration of Study: Department of Neurology, Mayo Hospital, Lahore, from January to June 2012. Methodology: Seventy-five (64 females and 11 males) patients with clinically diagnosed and electrodiagnostically confirmed carpal tunnel syndrome were inducted. Their waist circumference, blood pressure, fasting blood glucose, fasting triglycerides and high density lipoprotein cholesterol levels were recorded. Patients were categorized having metabolic syndrome according to Adult Treatment Panel III criteria, if any 3 were present out of hypertension, elevated fasting triglycerides, reduced high density lipoprotein cholesterol, elevated fasting blood glucose, and elevated waist circumference. Result: Mean age of the patients was 42.04±9.31 years, mean waist circumference was 95.32±9.03 cm, mean systolic blood pressure was 134.13±13.72 mmHg, mean diastolic blood pressure was 89.13±8.83 mmHg, mean fasting blood glucose was 94.35±21.81 mg/dl, mean fasting triglycerides was 177.48±48.69 mg/dl, and mean high density lipoprotein cholesterol was 41.95±11.17 mg/dl. Metabolic syndrome was found in 54 (72 percentage) patients including 9 (16.7 percentage) males and 45 (83.3 percentage) females. Out of 75 patients, 54 (72 percentage) had elevated waist circumference, 52 (69.3 percentage) had elevated blood pressure, 19 (25.3 percentage) had elevated fasting blood glucose, 53 (70.6 percentage) had elevated fasting triglycerides and 54 (72 percentage) had reduced high density lipoprotein cholesterol. Highest frequency of metabolic syndrome was found in age range of 40 - 49 years in both genders. Conclusion: Metabolic syndrome is frequently found in the patients with carpal tunnel syndrome. (author)

  7. A program plan addressing carpal tunnel syndrome: the utility of King's goal attainment theory.

    Science.gov (United States)

    Norgan, G H; Ettipio, A M; Lasome, C E

    1995-08-01

    1. Today's nurse is prepared to address the needs of groups of individuals who share common characteristics or risks (aggregates). Program planning skills and ability to use nursing theory can enhance the nurse's effectiveness in addressing the needs of such aggregates. 2. Carpal tunnel syndrome and other repetitive stress injuries are very costly to industry, both in terms of monetary loss and lost work hours. Such injuries can be reduced in the workplace through careful observation and communication of trends by the nurse. 3. The systems perspective of King's goal attainment theory guided the nurse in problem solving and facilitating the development of a workplace capable of responding to trends as they occur.

  8. Intraneural blood flow analysis during an intraoperative Phalen's test in carpal tunnel syndrome.

    Science.gov (United States)

    Yayama, Takafumi; Kobayashi, Shigeru; Awara, Kousuke; Takeno, Kenichi; Miyazaki, Tsuyoshi; Kubota, Masafumi; Negoro, Kohei; Baba, Hisatoshi

    2010-08-01

    Phalen's test has been one of the most significant of clinical signs when making a clinical diagnosis of idiopathic carpal tunnel syndrome (CTS). However, it is unknown whether intraneural blood flow changes during Phalen's test in patients with CTS. In this study, an intraoperative Phalen's test was conducted in patients with CTS to observe the changes in intraneural blood flow using a laser Doppler flow meter. During Phalen's test, intraneural blood flow showed a sharp decrease, which lasted for 1 min. Intraneural blood flow decreased by 56.7%-100% (average, 78.0%) in the median nerve relative to the blood flow before the test. At 1 min after completing the test, intraneural blood flow returned to the baseline value. After carpal tunnel release, there was no marked decrease in intraneural blood flow. This study demonstrated that the blood flow in the median nerve is reduced when Phalen's test is performed in vivo. Copyright 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Efficacy of high frequency ultrasound in postoperative evaluation of carpal tunnel syndrome treatment

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    Katarzyna Kapuścińska

    2016-03-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leave because of work-related hand overload. The main treatment is operation. Aim: The aim of the study is to assess the usefulness of high frequency ultrasound in the postoperative evaluation of CTS treatment efficacy. Material and methods: Sixty-two patients (50 women and 12 men aged 28–70, mean age 55.2 underwent surgical treatment of CTS. Ultrasound examinations of the wrist in all carpal tunnel sufferers were performed 3 months after the procedure with the use of a high frequency broadband linear array transducer (6–18 MHz, using 18 MHz band of MyLab 70/Esaote. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging for postoperative evaluation of CTS treatment efficacy. Results: Among all 62 patients, 3 months after surgical median nerve decompression: in 40 patients, CTS symptoms subsided completely, and sonographic evaluation did not show median nerve entrapment signs; in 9 patients, CTS symptoms persisted or exacerbated, and ultrasound proved nerve compression revealing preserved flexor retinaculum fibers; in 13 patients, scar tissue symptoms occurred, and in 5 of them CTS did not subside completely (although ultrasound showed no signs of compression. Conclusions: Ultrasound imaging with the use of a high frequency transducer is a valuable diagnostic tool for postoperative assessment of CTS treatment efficacy.

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

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    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.

  11. Work-related carpal tunnel syndrome treatment: a cross-sectional study among 106 patients

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    M. Aouatef

    2017-08-01

    Full Text Available The objective is to assess the influence of sociodemographic, professional and clinical variables on the choice of treatment of work-related carpal tunnel syndrome (CTS. An exhaustive and trans-sectional study was conducted over a period of eight years, from 1st January 2006 to 31 December 2013 in the Department of Occupational Medicine at University Hospital of Mahdia, Tunisia. The study population was represented by patients with work-related carpal tunnel syndrome. Data collection was based on a questionnaire sheet, describing social, occupational and medical characteristics of patients. The study population was characterized by a large female dominance, representing 95.3% with an average age of 42±7.8 years. Patients medically treated represented 38.7% and 61.3% had had surgical treatment. After binary logistic regression, surgical indication of CTS was significantly correlated to diabetes (p=0.017, other musculoskeletal disorders (p=0.02, functional signs of CTS (acrocyanosis p=0.05; muscle weakness p=0.015; radiating pain p=0.01; painful discomfort of the hand, the forearm or arm p=0.027 and to the atrophy of thenar muscles (p=0.018. According to this study, the choice of therapy for occupational CTS depends only on clinical data. More detailed studies will be needed to refine these results.

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

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    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.)

  13. Meta-analysis: association between wrist posture and carpal tunnel syndrome among workers.

    Science.gov (United States)

    You, Doohee; Smith, Allan H; Rempel, David

    2014-03-01

    Carpal tunnel syndrome (CTS) is a common work-related peripheral neuropathy. In addition to grip force and repetitive hand exertions, wrist posture (hyperextension and hyperflexion) may be a risk factor for CTS among workers. However, findings of studies evaluating the relationship between wrist posture and CTS are inconsistent. The purpose of this paper was to conduct a meta-analysis of existing studies to evaluate the evidence of the relationship between wrist posture at work and risk of CTS. PubMed and Google Scholar were searched to identify relevant studies published between 1980 and 2012. The following search terms were used: "work related", "carpal tunnel syndrome", "wrist posture", and "epidemiology". The studies defined wrist posture as the deviation of the wrist in extension or flexion from a neutral wrist posture. Relative risk (RR) of individual studies for postural risk was pooled to evaluate the overall risk of wrist posture on CTS. Nine studies met the inclusion criteria. All were cross-sectional or case-control designs and relied on self-report or observer's estimates for wrist posture assessment. The pooled RR of work-related CTS increased with increasing hours of exposure to wrist deviation or extension/flexion [RR = 2.01; 95% confidence interval (CI): 1.646-2.43; p Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

  14. Efficacy of paraffin wax bath for carpal tunnel syndrome: a randomized comparative study

    Science.gov (United States)

    Ordahan, Banu; Karahan, Ali Yavuz

    2017-12-01

    Carpal tunnel syndrome (CTS) is the most frequently diagnosed neuropathy of upper extremity entrapment neuropathies. We aimed to investigate the effectiveness of paraffin therapy in patients with CTS. Seventy patients diagnosed with mild or moderate CTS were randomly divided into two groups as splint treatment (during the night and day time as much as possible for 3 weeks) alone and splint (during the night and day time as much as possible for 3 weeks) + paraffin treatment (five consecutive days a week for 3 weeks). Clinical and electrophysiological assessments were performed before and 3 weeks after treatment. The patients were assessed by using visual analog scale (VAS) for pain, electroneuromyography (ENMG), and Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). The significant improvement was found in VAS scores in both groups when compared with pretreatment values ( p 0.05), whereas a significant improvement was noted in the BCTQ symptom severity scale score in the splint group ( p 0.05), and the difference in these parameters between the groups was statistically significant ( p Paraffin treatment with splint increases the recovery in functional and electrophysiological parameters.

  15. The effect of polarized polychromatic noncoherent light (bioptron) therapy on patients with carpal tunnel syndrome.

    Science.gov (United States)

    Raeissadat, Seyed Ahmad; Rayegani, Seyed Mansoor; Rezaei, Sajad; Sedighipour, Leyla; Bahrami, Mohammad Hasan; Eliaspour, Dariush; Karimzadeh, Afshin

    2014-01-01

    To study the effects of Polarized Polychromatic Noncoherent Light (Bioptron) therapy on patients with carpal tunnel syndrome (CTS). This study was designed as a randomized clinical trial. Forty four patients with mild or moderate CTS (confirmed by clinical and electrodiagnostic studies) were assigned randomly into two groups (intervention and control goups). At the beginning of the study, both groups received wrist splinting for 8 weeks. Bioptron light was applied for the intervention group (eight sessions, for 3/weeks). Bioptron was applied perpendicularly to the wrist from a 10 centimeter sdistance. Pain severity and electrodiagnostic measurements were compared from before to 8 weeks after initiating each treatment. Eight weeks after starting the treatments, the mean of pain severity based on Visual Analogue Scale (VAS) scores decreased significantly in both groups. Median Sensory Nerve Action Potential (SNAP) latency decreased significantly in both groups. However, other electrophysiological findings (median Compound Motor Action Potential (CMAP) latency and amplitude, also SNAP amplitude) did not change after the therapy in both groups. There was no meaningful difference between two groups regarding the changes in the pain severity. Bioptron with the above mentioned parameters led to therapeutic effects equal to splinting alone in patients with carpal tunnel syndrome. However, applying Bioptron with different therapeutic protocols and light parameters other than used in this study, perhaps longer duration of therapy and long term assessment may reveal different results favoring Bioptron therapy.

  16. 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

  17. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial

    NARCIS (Netherlands)

    Schrijver, H.M.; Gerritsen, A.A.M.; Strijers, R.L.; Uitdehaag, B.M.J.; Scholten, R.J.P.M.; de Vet, H.C.W.; Bouter, L.M.

    2005-01-01

    The reported relationships between nerve conduction studies (NCS) and outcome measures in carpal tunnel syndrome (CTS) are weak to moderate. However, selection of patients may have confounded nonrandomized studies. NCS have potentially great value in selecting patients for a specific treatment and

  18. Surgical Treatment of Carpal Tunnel Syndrome through a Minimal Incision on the Distal Wrist Crease: An Anatomical and Clinical Study

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    Hye Mi Yoo

    2015-05-01

    Full Text Available BackgroundAn anatomical analysis of the transverse carpal ligament (TCL and the surrounding structures might help in identifying effective measures to minimize complications. Here, we present a surgical technique based on an anatomical study that was successfully applied in clinical settings.MethodsUsing 13 hands from 8 formalin-fixed cadavers, we measured the TCL length and thickness, correlation between the distal wrist crease and the proximal end of the TCL, and distance between the distal end of the TCL and the palmar arch; the TCL cross sections and the thickest parts were also examined. Clinically, fasciotomy was performed on the relevant parts of 15 hands from 13 patients by making a minimally invasive incision on the distal wrist crease. Postoperatively, a two-point discrimination check was conducted in which the sensations of the first, second, and third fingertips and the palmar cutaneous branch injuries were monitored (average duration, 7 months.ResultsIn the 13 cadaveric hands, the distal wrist crease and the proximal end of the TCL were placed in the same location. The average length of the TCL and the distance from the distal TCL to the superficial palmar arch were 35.30±2.59 mm and 9.50±2.13 mm, respectively. The thickest part of the TCL was a region 25 mm distal to the distal wrist crease (average thickness, 4.00±0.57 mm. The 13 surgeries performed in the clinical settings yielded satisfactory results.ConclusionsThis peri-TCL anatomical study confirmed the safety of fasciotomy with a minimally invasive incision of the distal wrist crease. The clinical application of the technique indicated that the minimally invasive incision of the distal wrist crease was efficacious in the treatment of the carpal tunnel syndrome.

  19. The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study.

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    Alexander Marschall

    Full Text Available To investigate the prognostic value of B-mode and Power Doppler (PD ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS.Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months and long-term (15-36 months follow-up. At baseline, the cross-sectional area (CSA of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0-3. Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ and the DASH Questionnaire, as well as visual analogue scales for the patient's assessment of pain (painVAS and physician's global assessment (physVAS. The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models.Short-term and long-term follow-up data were available for 111 (82.2% and 105 (77.8% patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists. Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05, but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes.Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings.

  20. Intradermal therapy (mesotherapy) for the treatment of acute pain in carpal tunnel syndrome: a preliminary study.

    Science.gov (United States)

    Conforti, Giorgio; Capone, Loredana; Corra, Stefano

    2014-01-01

    The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy). In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence. The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment. With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS.

  1. Effect of finger motion on transverse median nerve movement in the carpal tunnel.

    Science.gov (United States)

    Kang, Hyo Jung; Yoon, Joon Shik

    2016-10-01

    We used ultrasonography (US) to investigate the effects of finger motion on movement of the median nerve in patients with carpal tunnel syndrome (CTS) and the correlation between these US parameters and CTS severity. Ultrasonographic measures were performed in 23 control wrists and 22 CTS wrists in women. During first through third finger flexion and grip motion, median nerve movements were obtained using US and a tracing program. Nerve movements during third finger flexion in the dorsopalmar axis and grip motion in both axes, and during second finger flexion in the radioulnar axis, differed significantly between the control and CTS groups. US parameters correlated negatively with cross-sectional area. This study shows that transverse median nerve movements decreased during grip using US and correlated negatively with CTS severity. Muscle Nerve, 2016 Muscle Nerve 54: -, 2016 Muscle Nerve 54: 738-742, 2016. © 2016 Wiley Periodicals, Inc.

  2. Infrared thermography based on artificial intelligence as a screening method for carpal tunnel syndrome diagnosis.

    Science.gov (United States)

    Jesensek Papez, B; Palfy, M; Mertik, M; Turk, Z

    2009-01-01

    This study further evaluated a computer-based infrared thermography (IRT) system, which employs artificial neural networks for the diagnosis of carpal tunnel syndrome (CTS) using a large database of 502 thermal images of the dorsal and palmar side of 132 healthy and 119 pathological hands. It confirmed the hypothesis that the dorsal side of the hand is of greater importance than the palmar side when diagnosing CTS thermographically. Using this method it was possible correctly to classify 72.2% of all hands (healthy and pathological) based on dorsal images and > 80% of hands when only severely affected and healthy hands were considered. Compared with the gold standard electromyographic diagnosis of CTS, IRT cannot be recommended as an adequate diagnostic tool when exact severity level diagnosis is required, however we conclude that IRT could be used as a screening tool for severe cases in populations with high ergonomic risk factors of CTS.

  3. The Prevalence of Carpal Tunnel Syndrome in Latino Poultry Processing Workers and Other Latino Manual Workers

    Science.gov (United States)

    Cartwright, Michael S.; Walker, Francis O.; Blocker, Jill N.; Schulz, Mark R.; Arcury, Thomas A.; Grzywacz, Joseph G.; Mora, Dana; Chen, Haiying; Marín, Antonio J.; Quandt, Sara A.

    2011-01-01

    Objective To determine the prevalence of carpal tunnel syndrome (CTS) in Latino poultry processing workers. Methods Symptoms and nerve conduction studies were used to prospectively assess 287 Latino poultry processing workers and 226 Latinos in other manual labor occupations. Results The prevalence of CTS was higher in poultry processing (8.7%) compared to non-poultry manual workers (4.0%, p poultry workers was 2.51 (95% CI of 1.80 to 3.50) compared to non-poultry workers. Within the poultry workers, those who performed packing, sanitation, and chilling had a trend toward less CTS than those who performed tasks requiring more repetitive and strenuous hand movements. Discussion Latino poultry processing workers have a high prevalence of CTS, which likely results from the repetitive and strenuous nature of the work. PMID:22258161

  4. Two-point discrimination and kinesthetic sense disorders in productive age individuals with carpal tunnel syndrome.

    Science.gov (United States)

    Wolny, Tomasz; Saulicz, Edward; Linek, Paweł; Myśliwiec, Andrzej

    2016-06-16

    The aim of this study was to evaluate two-point discrimination (2PD) sense and kinesthetic sense dysfunctions in carpal tunnel syndrome (CTS) patients compared with a healthy group. The 2PD sense, muscle force, and kinesthetic differentiation (KD) of strength; the range of motion in radiocarpal articulation; and KD of motion were assessed. The 2PD sense assessment showed significantly higher values in all the examined fingers in the CTS group than in those in the healthy group (p<0.01). There was a significant difference in the percentage value of error in KD of pincer and cylindrical grip (p<0.01) as well as in KD of flexion and extension movement in the radiocarpal articulation (p<0.01) between the studied groups. There are significant differences in the 2PD sense and KD of strength and movement between CTS patients compared with healthy individuals.

  5. Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome.

    Science.gov (United States)

    Araújo, Rogério Gayer Machado de; Kouyoumdjian, João Aris

    2007-09-01

    Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU) in electrodiagnosis of carpal tunnel syndrome (CTS). Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands). Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands). PMU was obtained at the usual temperature, >32 degrees C, and after wrist/hand cooling to PMU and mixed ulnar palmar latency in patients versus controls. We concluded that cooling significantly modifies the PMU. We propose that the latencies of compressed nerve overreact to cooling and that this response could be a useful tool for incipient CTS electrodiagnosis. There was a significant latency overreaction of the ulnar nerve to cooling in CTS patients. We hypothesize that subclinical ulnar nerve compression is associated with CTS.

  6. Association Between Cardiovascular Risk Factors and Carpal Tunnel Syndrome in Pooled Occupational Cohorts.

    Science.gov (United States)

    Hegmann, Kurt T; Thiese, Matthew Steven; Kapellusch, Jay; Merryweather, Andrew S; Bao, Stephen; Silverstein, Barbara; Wood, Eric M; Kendall, Richard; Wertsch, Jacqueline; Foster, James; Garg, Arun; Drury, David L

    2016-01-01

    The aim of the study was to ascertain if cardiovascular (CVD) risk factors are carpal tunnel syndrome (CTS) risk factors. Analysis of pooled baseline data from two large prospective cohort studies (n = 1824) assessed the relationships between a modified Framingham Heart Study CVD risk score both CTS and abnormal nerve conduction study prevalence. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratio and 95% confidence intervals were calculated for individual risk scores. There was a strong relationship between CVD risk score and both CTS and abnormal nerve conduction study after adjustment for confounders, with odds ratios as high as 4.16 and 7.35, respectively. Dose responses were also observed. In this workplace population, there is a strong association between CVD risk scores and both CTS and abnormal nerve conduction study that persisted after controlling for confounders. These data suggest a potentially modifiable disease mechanism.

  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. [The risk of the carpal tunnel syndrome in some work activities].

    Science.gov (United States)

    Baldasseroni, A; Tartaglia, R; Carnevale, F

    1995-01-01

    The aim of the study was to generate hypotheses on what could be the ISTAT (National Institute of Statistics) job classes with a major risk of carpal tunnel syndrome in order to plan more specific analytic epidemiology studies and apply more correct ergonomic solutions. A case-control cross-sectional survey without matching was carried out. The source of data were the computerized medical records of a large regional hospital: 833 carpal tunnel syndrome cases (mean age 48, SD 9.33) and 3222 controls (mean age 43.5, SD 13.22) hospitalized for other diseases, were selected. The odds ratio (OR) and 95% confidence limits, controlled for age and gender by a logistic linear regression model, were calculated as measures of association for the comparison between non-exposed managerial/administrative staff and industrial workers. The analysis showed a statistically significant risk for some ISTAT job classes, in particular class 53 (spinners, weavers, dyers and similar jobs) (OR = 2.65; C.L. 1.52-4.62) class 54 (knitters, tailors, hatmakers, upholsterers and similar jobs) (OR = 1.69; C.L. 1.06-2.71), 55 (tanners, shoemakers, leather manufacture workers and similar jobs) (OR = 2.74; C.L. 1.66-4.53) and group 742 (Hotel and restaurant cooks) (OR = 2.99; C.L. 1.45-6.13). Job classes 45 (carpenters, welders and similar jobs). 62 (electricians, electrotechnicians, radio engineers and similar jobs), 63 (gasfitters, plumbers, heating engineers and similar jobs) and 85 (porters and other jobs involving manual handling of loads) showed ORs higher than 2 but without statistical significance. The results are valid for planning further studies, especially in the textile and shoe and leather manufacturing sectors.

  9. Translation and Validation of the Persian Version the Boston Carpal Tunnel Syndrome Questionnaire.

    Science.gov (United States)

    Hassankhani, Golnaz Ghayyem; Moradi, Ali; Birjandinejad, Ali; Vahedi, Ehsan; Kachooei, Amir R; Ebrahimzadeh, Mohammad H

    2018-01-01

    Carpal tunnel syndrome (CTS) is recognized as the most common type of neuropathies. Questionnaires are the method of choice for evaluating patients with CTS. Boston Carpal Tunnel Syndrome (BCTS) is one of the most famous questionnaires that evaluate the functional and symptomatic aspects of CTS. This study was performed to evaluate the validity and reliability of the Persian version of BCTS questionnaire. First, both parts of the original questionnaire (Symptom Severity Scale and Functional Status Scale) were translated into Persian by two expert translators. The translated questionnaire was revised after merging and confirmed by an orthopedic hand surgeon. The confirmed questionnaire was interpreted back into the original language (English) to check for any possible content inequality between the original questionnaire and its final translated version. The final Persian questionnaire was answered by 10 patients suffering from CTS to elucidate its comprehensibility; afterwards, it was filled by 142 participants along with the Persian version of the Quick-DASH questionnaire. After 2 to 6 days, the translated questionnaire was refilled by some of the previous patients who had not received any substantial medical treatment during that period. Among all 142 patients, 13.4 % were male and 86.6 % were female. The reliability of the questionnaire was tested using Cronbach's alpha and Intraclass correlation coefficient (ICC). Cronbach's alpha was 0.859 for symptom severity scale (SSS) and 0.878 for functional status scale (FSS). Also, ICCs were calculated as 0.538 for SSS and 0.773 for FSS. In addition, construct validity of SSS and FSS against QuickDASH were 0.641 and 0.701, respectively. Based on our results, the Persian version of the BCTQ is valid and reliable. Level of evidence: II.

  10. 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.

  11. Effectiveness of PELOID therapy in carpal tunnel syndrome: A randomized controlled single blind study

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    Metin Ökmen, Burcu; Kasapoğlu Aksoy, Meliha; Güneş, Aygül; Eröksüz, Riza; Altan, Lale

    2017-08-01

    Carpal tunnel syndrome(CTS) is the most common neuromuscular cause of upper extremity disability. We aimed to investigate the effectiveness of peloid therapy in patients with CTS. This randomized, controlled, single-blind study enrolled 70 patients between the ages of 30 to 65 who had a diagnosis of either mild, mild-to-moderate, or moderate CTS. The patients were randomized into two groups using random number table. In the first group, (Group 1)( n = 35), patients were given splint (every night for 6 weeks) + peloid treatment(five consecutive days a week for 2 weeks) and in the second group, (Group 2)( n = 28), patients received splint treatment(every night for 6 weeks) alone. The patients were assessed by using visual analog scale(VAS) for pain, electroneuromyography(ENMG), the Boston Carpal Tunnel Syndrome Questionnaire(BCTSQ), hand grip strength(HGS), finger grip strength(FGS), and Short Form-12(SF-12). The data were obtained before treatment(W0), immediately after treatment(W2), and one month after treatment(W6). Both in Group 1 and 2, there was a statistically significant improvement in all the evaluation parameters at W2 and W6 when compared to W0( p < 0.05). Comparison of the groups with each other revealed significantly better results for VAS, BCTSQ, mSNCV, SF-12 in Group 1 than in Group 2 at W2( p < 0.05). There was also a statistically significant difference in favor of Group 1 for VAS, BCTSQ, FGS and MCS at W6 when compared to W0 ( p < 0.05). The results of our study demonstrated that in patients with CTS; peloid + splint treatment was more effective than splint treatment alone in pain, functionality and life quality both at after treatment(W2) and one month after treatment (W6). We may suggest peloid as a supplementary therapeutic agent in CTS.

  12. DASH (disabilities of the arm, shoulder, and hand) evaluation of QOL for carpal tunnel syndrome

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    Morita, Akimasa; Kawamoto, Masataka; Fujisawa, Kouzou; Tsujii, Masaya; Hirata, Hitoshi

    2006-01-01

    The questionnaire on the disabilities of the arm, shoulder, and hand is a region-specific, self-administered outcome instrument that is developed as a measure of self-rate upper extremity disability and symptoms. Last year, the Japanese version of disabilities of the arm, shoulder and hand (DASH) was cross-culturally adapted. The main purpose of this study is to analyze the relationship between DASH and clinical assessment (findings of MRI and electrodiagnostic parameters). The subjects comprised 41 patients (6 males and 35 females) with carpal tunnel syndrome (CTS), except for cases with other upper extremity disorders. These subjects prospectively completed DASH 1 (disability module), DASH 2 (symptom module), and DASH (disability and symptom module) before the release of the open carpal tunnel. The patients were divided into 3 groups based on the symptom duration (A: shorter than 3 months, B: 4-11 months, C: longer than 12 months). All patients were preoperatively assessed with regard to sensory conduction velocity (SCV) and compound muscle action potential (CMAP). In addition, all patients underwent MRI in order to evaluate the flexor tenosynovial swelling represented by palmar bowing of the flexor retinaculum (PBFR). The relationships were estimated using the Spearman rank score, unpaired t tests, and Bonferroni tests. DASH 2 scores indicated greater responsiveness than DASH 1, which reflected the character of CTS. DASH 1 scores were higher in patients who were affected in their dominant hand than in those whose nondominant hand was affected. The DASH scores decreased significantly in groups A and B, with the exception of C. However, DASH did not show any correlation either with the parameters, age, or MRI assessment. DASH can be used for the research of preoperative outcomes related to CTS. It also has the advantage of being useful in assessing and comparing the outcome for various other hand disorders. (author)

  13. Impact of distal median neuropathy on handwriting performance for patients with carpal tunnel syndrome in office and administrative support occupations.

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    Kuo, Li-Chieh; Hsu, Hsiao-Man; Wu, Po-Ting; Lin, Sheng-Che; Hsu, Hsiu-Yun; Jou, I-Ming

    2014-06-01

    This study investigates the handwriting performance of patients with carpal tunnel syndrome (CTS) and healthy controls in office and administrative support occupations, adopting both biomechanical and functional perspectives. This work also explores how surgical intervention altered the performance of the CTS patients. Fourteen CTS patients and 14 control subjects were recruited to complete a self-reported survey and participate in sensory tests, hand strength, dexterity and handwriting tasks using a custom force acquisition pen along with motion capture technology. Based on the results of these, the sensory measurements, along with functional and biomechanical parameters, were used to determine the differences between the groups and also reveal any improvements that occurred in the CTS group after surgical intervention. The CTS patients showed significantly poorer hand sensibility and dexterity than the controls, as well as excessive force exertion of the digits and pen tip, and less efficient force adjustment ability during handwriting. After surgery and sensory recovery, the hand dexterity and pen tip force of the CTS patients improved significantly. The force adjustment abilities of the digits also increased, but these changes were not statistically significant. This study provides the objective measurements and novel apparatus that can be used to determine impairments in the handwriting abilities of office or administrative workers with CTS. The results can also help clinicians or patients to better understand the sensory-related deficits in sensorimotor control of the hand related to CTS, and thus develop and implement more suitable training or adaptive protocols.

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

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    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.

  15. High-resolution MR imaging of the carpal tunnel and the wrist. Application of a 5-cm surface coil

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    Maurer, J.; Bleschkowski, A.; Tempka, A.; Felix, R. [Medical Faculty of the Humboldt Univ., Berlin (Germany). Dept. of Radiology

    2000-07-01

    In order to make a comparative analysis of transversal tomograms obtained by high-resolution MR imaging with frozen cross-sections of an anatomical forearm specimen, twenty-two healthy volunteers were also examined using the same coil system to test for a range of possible clinical applications and for the depiction of morphological and morphometrical values of normal anatomy in vivo. MR images of the carpal tunnel of 22 healthy volunteers were obtained with a 1.5-T whole-body system with a 5-cm surface coil. Measurements were recorded with a field-of-view between 50x50 mm{sup 2} and 60x60 mm{sup 2} in a 256x256 pixel matrix for the T1 sequence. A slice thickness of 2 mm was used. The images were acquired using a T1-weighted SE sequence (TR/TE 500/38 ms) and a T2-weighted SE sequence (TR/TE 2000/70 ms). Additionally, a formalin-fixed anatomical forearm specimen was imaged for anatomic correlation. The imaged transversal cross-section levels in the specimen were subsequently freeze-sectioned. The anatomical structures of the MR findings were identified and compared with the macroscopical sections of the specimen. Based on the good depiction of details at this coil system with a pixel size in T1 of 0.195x0.195 mm, high-resolution MR imaging enabled identification of the interior structures of the carpal tunnel, as well as delineation of connective tissue. The clinical value of high-resolution MR includes the diagnosis of carpal tunnel syndrome and inflammatory disorders of the wrist. Our results support the feasibility of high-resolution MR imaging of the carpal tunnel and the wrist using small surface coils.

  16. High-resolution MR imaging of the carpal tunnel and the wrist. Application of a 5-cm surface coil

    International Nuclear Information System (INIS)

    Maurer, J.; Bleschkowski, A.; Tempka, A.; Felix, R.

    2000-01-01

    In order to make a comparative analysis of transversal tomograms obtained by high-resolution MR imaging with frozen cross-sections of an anatomical forearm specimen, twenty-two healthy volunteers were also examined using the same coil system to test for a range of possible clinical applications and for the depiction of morphological and morphometrical values of normal anatomy in vivo. MR images of the carpal tunnel of 22 healthy volunteers were obtained with a 1.5-T whole-body system with a 5-cm surface coil. Measurements were recorded with a field-of-view between 50x50 mm 2 and 60x60 mm 2 in a 256x256 pixel matrix for the T1 sequence. A slice thickness of 2 mm was used. The images were acquired using a T1-weighted SE sequence (TR/TE 500/38 ms) and a T2-weighted SE sequence (TR/TE 2000/70 ms). Additionally, a formalin-fixed anatomical forearm specimen was imaged for anatomic correlation. The imaged transversal cross-section levels in the specimen were subsequently freeze-sectioned. The anatomical structures of the MR findings were identified and compared with the macroscopical sections of the specimen. Based on the good depiction of details at this coil system with a pixel size in T1 of 0.195x0.195 mm, high-resolution MR imaging enabled identification of the interior structures of the carpal tunnel, as well as delineation of connective tissue. The clinical value of high-resolution MR includes the diagnosis of carpal tunnel syndrome and inflammatory disorders of the wrist. Our results support the feasibility of high-resolution MR imaging of the carpal tunnel and the wrist using small surface coils

  17. 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.

  18. Efficacy of Manual Therapy Including Neurodynamic Techniques for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial.

    Science.gov (United States)

    Wolny, Tomasz; Saulicz, Edward; Linek, Paweł; Shacklock, Michael; Myśliwiec, Andrzej

    2017-05-01

    The purpose of this randomized trial was to compare the efficacy of manual therapy, including the use of neurodynamic techniques, with electrophysical modalities on patients with mild and moderate carpal tunnel syndrome (CTS). The study included 140 CTS patients who were randomly assigned to the manual therapy (MT) group, which included the use of neurodynamic techniques, functional massage, and carpal bone mobilizations techniques, or to the electrophysical modalities (EM) group, which included laser and ultrasound therapy. Nerve conduction, pain severity, symptom severity, and functional status measured by the Boston Carpal Tunnel Questionnaire were assessed before and after treatment. Therapy was conducted twice weekly and both groups received 20 therapy sessions. A baseline assessment revealed group differences in sensory conduction of the median nerve (P < .01) but not in motor conduction (P = .82). Four weeks after the last treatment procedure, nerve conduction was examined again. In the MT group, median nerve sensory conduction velocity increased by 34% and motor conduction velocity by 6% (in both cases, P < .01). There was no change in median nerve sensory and motor conduction velocities in the EM. Distal motor latency was decreased (P < .01) in both groups. A baseline assessment revealed no group differences in pain severity, symptom severity, or functional status. Immediately after therapy, analysis of variance revealed group differences in pain severity (P < .01), with a reduction in pain in both groups (MT: 290%, P < .01; EM: 47%, P < .01). There were group differences in symptom severity (P < .01) and function (P < .01) on the Boston Carpal Tunnel Questionnaire. Both groups had an improvement in functional status (MT: 47%, P < .01; EM: 9%, P < .01) and a reduction in subjective CTS symptoms (MT: 67%, P < .01; EM: 15%, P < .01). Both therapies had a positive effect on nerve conduction, pain reduction, functional status, and subjective symptoms in

  19. Usefulness of ultrasound assessment of median nerve mobility in carpal tunnel syndrome.

    Science.gov (United States)

    Park, Gi-Young; Kwon, Dong Rak; Seok, Jung Im; Park, Dong-Soon; Cho, Hee Kyung

    2018-01-01

    Background Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy of the upper extremity. Recently, dynamic ultrasound (US) imaging has shown differences in median nerve mobility between the affected and unaffected sides in CTS. Purpose The present study was performed to compare the median nerve mobility between patients with CTS and healthy individuals, and to correlate median nerve mobility with the severity of CTS. Material and Methods A total of 101 patients (128 wrists) with CTS and 43 healthy individuals (70 wrists) were evaluated. Electrodiagnostic studies were initially conducted to determine the neurophysiological grading scale (NGS). The cross-sectional area (CSA) of the median nerve and the grade of median nerve mobility were measured using US. Results The mean grade of median nerve mobility in the CTS group (1.9) was significantly lower than that in the control group (2.6; P mobility and distal motor latency of the median nerve (r = -0.218, P = 0.015), NGS (r = -0.207, P = 0.020) and CSA of the median nerve (r = -0.196, P = 0.028). Conclusion The grade of median nerve mobility was negatively correlated with the severity of CTS. US assessment of median nerve mobility may be useful in diagnosing and determining the severity of CTS.

  20. 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.

  1. A prospective study of carpal tunnel syndrome: workplace and individual risk factors

    Science.gov (United States)

    Burt, Susan; Deddens, James A; Crombie, Ken; Jin, Yan; Wurzelbacher, Steve; Ramsey, Jessica

    2015-01-01

    Objectives To quantify the risk for carpal tunnel syndrome (CTS) from workplace physical factors, particularly hand activity level and forceful exertion, while taking into account individual factors including age, gender, body mass index (BMI), and pre-existing medical conditions. Methods Three healthcare and manufacturing workplaces were selected for inclusion on the basis of range of exposure to hand activity level and forceful exertion represented by their jobs. Each study participants job tasks were observed and evaluated ’ onsite and videotaped for further analysis, including frequency and duration of exertion and postural deviation. Individual health assessment entailed electrodiagnostic testing of median and ulnar nerves, physical examination and questionnaires at baseline with annual follow-up for 2 years. Results The incidence of dominant hand CTS during the study was 5.11 per 100 person-years (29 cases). Adjusted HRs for dominant hand CTS were as follows: working with forceful exertion ≥20% but job strain. Conclusions Workplace and individual risk factors both contribute to the risk for CTS. Time spent in forceful exertion can be a greater risk for CTS than obesity if the job exposure is high. Preventive workplace efforts should target forceful exertions. PMID:23788614

  2. Predictive factors associated with severity of carpal tunnel syndrome in multiethnic Asian patients

    International Nuclear Information System (INIS)

    Sulaiman, W.A.W.; Sumon, S.H.; Kee, H.F.; Lim, S.M.S.; Said, S.M.

    2017-01-01

    Carpal tunnel syndrome (CTS) is the commonest entrapment neuropathy referred for electro diagnostic evaluation. The objective of this study is to evaluate the risk factors associated with CTS and their relationship with the severity in nerve conduction abnormality. Methodology: This study was based on the retrospective data analysis of patients who were electro-physiologically diagnosed as CTS in a tertiary neurophysiology service. Patients were divided into 2 groups; non-severe and severe CTS. Factors, which include age, gender, ethnicity, laterality of CTS, symptoms and diabetes mellitus were analyzed separately and compared with severity of CTS based on NCS. Results: We analyzed 144 patients with age ranging from 18 to 76 years. Patients with bilateral CTS were 4 times more likely at risk to developed severe CTS while diabetes mellitus patients are 2.5 times more likely. There was no significant association found between age, gender, ethnicity and symptomatic patients with the CTS severity. Conclusion: This study shows that patients with bilateral CTS and diabetes mellitus are at higher risk in developing severe CTS. Therefore, early screening with NCS is recommended in these groups of patients. (author)

  3. Infrared thermography based on artificial intelligence for carpal tunnel syndrome diagnosis.

    Science.gov (United States)

    Jesensek Papez, B; Palfy, M; Turk, Z

    2008-01-01

    Thermography for the measurement of surface temperatures is well known in industry, although is not established in medicine despite its safety, lack of pain and invasiveness, easy reproducibility, and low running costs. Promising results have been achieved in nerve entrapment syndromes, although thermography has never represented a real alternative to electromyography. Here an attempt is described to improve the diagnosis of carpal tunnel syndrome with thermography using a computer-based system employing artificial neural networks to analyse the images. Method reliability was tested on 112 images (depicting the dorsal and palmar sides of 26 healthy and 30 pathological hands), with the hand divided into 12 segments and compared relative to a reference. Palmar segments appeared to have no beneficial influence on classification outcome, whereas dorsal segments gave improved outcome with classification success rates near to or over 80%, and finger segments influenced by the median nerve appeared to be of greatest importance. These are preliminary results from a limited number of images and further research will be undertaken as our image database grows.

  4. Psychosocial Risk Factors and the Association With Carpal Tunnel Syndrome: A Systematic Review.

    Science.gov (United States)

    Mansfield, Michael; Thacker, Michael; Sandford, Fiona

    2017-10-01

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Research has shown that associative factors for CTS include occupational and biomechanical elements, gender, and age. To date, no systematic review has been undertaken to determine specifically whether there are any psychosocial risk factors in developing CTS. The objective is to determine whether psychosocial factors are associated with and/or predict the development of CTS. A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE, and CINAHL from inception to May 30, 2017. Quantitative studies must have investigated a minimum of 1 or more psychosocial factors-cognitive, affective, behavioral, vocational, or interpersonal processes (eg, social support)-and include a point or risk estimate. One reviewer conducted the search and 2 reviewers independently assessed eligibility and completed methodological quality assessment using a modified Downs and Black checklist. Data were analyzed narratively. Six moderate- to high-quality studies were included in the final review. Five studies reported a positive association between psychosocial factors and CTS, where psychosocial factors were more in those who reported CTS. One study reported no positive or negative association with CTS development. Four studies reported a negative association between psychosocial factors and CTS, where psychosocial factors were less in those who reported CTS. There is limited evidence for a positive association between psychosocial factors and CTS. However, this was not a consistent finding across all included studies. Further research is indicated in standardizing CTS diagnostic criteria and investigating other working environments.

  5. 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

  6. Carpal tunnel syndrome assessment with diffusion tensor imaging. Value of fractional anisotropy and apparent diffusion coefficient

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    Klauser, A.S.; Kremser, C. [Medical University of Innsbruck, Department of Radiology, Innsbruck (Austria); Abd Ellah, M. [Medical University of Innsbruck, Department of Radiology, Innsbruck (Austria); Assiut University, Department of Diagnostic Radiology, South Egypt Cancer Institute, Assiut (Egypt); Taljanovic, M. [University of Arizona, College of Medicine, Banner- University Medical Center, Department of Medical Imaging, Tucson (United States); Schmidle, G.; Gabl, M. [Medical University of Innsbruck, Department for Trauma Surgery, Innsbruck (Austria); Cartes-Zumelzu, F.; Steiger, R.; Gizewski, E.R. [Medical University of Innsbruck, Department of Neuroradiology, Neuroimaging core facility, Innsbruck (Austria)

    2018-03-15

    To quantitatively assess carpal tunnel syndrome (CTS) with DTI by evaluating two approaches to determine cut-off values. In forty patients with CTS diagnosis confirmed by nerve conduction studies (NCs) and 14 healthy subjects (mean age 58.54 and 57.8 years), cross-sectional area (CSA), apparent diffusion coefficient (ADC) and fractional anisotropy (FA) at single and multiple levels with intraobserver agreement were evaluated. Maximum and mean CSA and FA showed significant differences between healthy subjects and patients (12.85 mm{sup 2} vs. 28.18 mm{sup 2}, p < 0.001, and 0.613 vs. 0.524, p=0.007, respectively) (10.12 mm{sup 2} vs. 19.9 mm{sup 2}, p<0.001 and 0.617 vs. 0.54, p=0.003, respectively), but not maximum and mean ADC (p > 0.05). For cut-off values, mean and maximum CSA showed the same sensitivity and specificity (93.3 %). However, mean FA showed better sensitivity than maximum FA (82.6 % vs. 73.9 %), but lower specificity (66.7 % vs. 80 %), and significant correlation for maximum CSA, 97 % (p < 0.01), with good correlation for maximum ADC and FA, 84.5 % (p < 0.01) and 62 % (p=0.056), respectively. CSA and FA showed significant differences between healthy subjects and patients. Single measurement at maximum CSA is suitable for FA determination. (orig.)

  7. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory.

    Science.gov (United States)

    Roquelaure, Y; Mariel, J; Dano, C; Fanello, S; Penneau-Fontbonne, D

    2001-01-01

    The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand.

  8. Etiological factors for developing carpal tunnel syndrome in people who work with computers

    Directory of Open Access Journals (Sweden)

    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

  9. Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome.

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    Benjamin Soon

    Full Text Available Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms. Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047, intensity (p = 0.044 and area (p = 0.012 of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006. Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.

  10. Body mass index as predictor of carpal tunnel syndrome among garment workers

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    Lie T Merijanti S.

    2009-12-01

    Full Text Available Of the nerve entrapment syndromes the most well-known is the carpal tunnel syndrome (CTS involving the median nerve. In the field of occupational medicine this condition is categorized as an occupational disease, for which industrial workers may claim compensation if the CTS occurs as a consequence of their job. However, although several occupational risk factors have been suggested as causing the development of CTS, a definitive role of work activities as the central cause of CTS is unclear. The aim of the present study was to evaluate both non-occupational and occupational factors associated with CTS in garment home-industry workers. A cross-sectional study was performed from April to June 2008 in the garment home industry in North Jakarta. A total of 99 workers, consisting of 45 males and 54 females were included in this study. Historical data were obtained from a self-administered detailed questionnaire, while anthropometric and provocative median nerve test variables were measured directly. The results showed that body mass index (BMI was a significant predictor of CTS in male workers (p=0.031, while the risk of CTS was three-fold higher in female workers using hormonal contraceptives (Prevalence Ratio/PR = 3.3 ; 95% Confidence of Interval/CI = 1.0 – 10.5. In conclusion it appears that BMI and hormonal contraceptive use were CTS predictors.

  11. Body mass index as predictor of carpal tunnel syndrome among garment workers

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    Lie T. Merijanti

    2016-02-01

    Full Text Available Of the nerve entrapment syndromes the most well-known is the carpal tunnel syndrome (CTS involving the median nerve. In the field of occupational medicine this condition is categorized as an occupational disease, for which industrial workers may claim compensation if the CTS occurs as a consequence of their job. However, although several occupational risk factors have been suggested as causing the development of CTS, a definitive role of work activities as the central cause of CTS is unclear. The aim of the present study was to evaluate both non-occupational and occupational factors associated with CTS in garment home-industry workers. A cross-sectional study was performed from April to June 2008 in the garment home industry in North Jakarta. A total of 99 workers, consisting of 45 males and 54 females were included in this study. Historical data were obtained from a self-administered detailed questionnaire, while anthropometric and provocative median nerve test variables were measured directly. The results showed that body mass index (BMI was a significant predictor of CTS in male workers (p=0.031, while the risk of CTS was three-fold higher in female workers using hormonal contraceptives (Prevalence Ratio/PR = 3.3 ; 95% Confidence of Interval/CI = 1.0 – 10.5. In conclusion it appears that BMI and hormonal contraceptive use were CTS predictors.

  12. Attributable risk of carpal tunnel syndrome according to industry and occupation in a general population.

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    Roquelaure, Yves; Ha, Catherine; Nicolas, Guillaume; Pélier-Cady, Marie-Christine; Mariot, Camille; Descatha, Alexis; Leclerc, Annette; Raimbeau, Guy; Goldberg, Marcel; Imbernon, Ellen

    2008-09-15

    An epidemiologic surveillance network for carpal tunnel syndrome (CTS) was set up in the general population of a French region to assess the proportion of CTS cases attributable to work in high-risk industries and occupations. Cases of CTS occurring among patients ages 20-59 years living in the Maine and Loire region were included prospectively from 2002 to 2004. Medical and occupation history was gathered by mailed questionnaire for 815 women and 320 men. Age-adjusted relative risks of CTS and the attributable risk fractions of CTS among exposed persons (AFEs) were computed in relation to industry sectors and occupation categories. Twenty-one industry sectors and 8 occupational categories for women and 10 sectors and 6 occupational categories for men were characterized by a significant excess risk of CTS. High AFE values were observed in the manufacturing (42-93% for both sexes), construction (66% for men), and personal service industries (66% for women) and in the trade and commerce sectors (49% for women). High AFE values were observed in lower-grade white-collar occupations for women (43-67%) and blue-collar occupations for men (60-74%) and women (48-88%). The attributable proportions of CTS cases among workers employed in industry sectors and occupation categories identified at high risk of CTS varied between 36% and 93%.

  13. Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers.

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    Evanoff, Bradley; Gardner, Bethany T; Strickland, Jaime R; Buckner-Petty, Skye; Franzblau, Alfred; Dale, Ann Marie

    2016-05-01

    The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown. We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours. Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims. Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment. © 2016 Wiley Periodicals, Inc.

  14. Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design.

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    Conlon, Craig; Asch, Steven; Hanson, Mark; Avins, Andrew; Levitan, Barbara; Roth, Carol; Robbins, Michael; Dworsky, Michael; Seabury, Seth; Nuckols, Teryl

    2016-01-01

    Little is known about quality of care for occupational health disorders, although it may affect worker health and workers' compensation costs. Carpal tunnel syndrome (CTS) is a common work-associated condition that causes substantial disability. To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs. Prospective observational study of 477 individuals with new workers' compensation claims for CTS without acute trauma who were treated at 30 occupational health clinics from 2011 to 2013 and followed for 18 months. Timing of key clinical events, adherence to 45 quality measures, changes in scores on the Boston Carpal Tunnel Questionnaire and 12-item Short Form Health Survey Version 2 (SF-12v2), and costs associated with medical care and disability. Two hundred sixty-seven subjects (56%) received a diagnosis of CTS and had claims filed around the first visit to occupational health, 104 (22%) received a diagnosis before that visit and claim, and 98 (21%) received a diagnosis or had claims filed after that visit. One hundred seventy-eight (37%) subjects had time off work, which started around the time of surgery in 147 (83%) cases and lasted a median of 41 days (interquartile range = 42 days). The timing of diagnosis varied, but time off work was generally short and related to surgery. If associations of quality of care with key medical, economic, and quality-of-life outcomes are identified for work-associated CTS, systematic efforts to evaluate and improve quality of medical care for this condition are warranted.

  15. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status

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    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.

  16. Incidence rates of in-hospital carpal tunnel syndrome in the general population and possible associations with marital status.

    Science.gov (United States)

    Mattioli, Stefano; Baldasseroni, Alberto; Curti, Stefania; Cooke, Robin M T; Bena, Antonella; de Giacomi, Giovanna; dell'Omo, Marco; Fateh-Moghadam, Pirous; Melani, Carla; Biocca, Marco; Buiatti, Eva; Campo, Giuseppe; Zanardi, Francesca; Violante, Francesco S

    2008-10-28

    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. 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 chiscore 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. 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). 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.

  17. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

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    Giorgio Pajardi

    2014-01-01

    Full Text Available We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS, scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n=60 served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n=60 received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation. Patients in Group C (n=60 received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05. Moreover, patients in Group B had a significantly lower number of positive Phalen’s tests at 3 months compared with the other study groups (P<0.05. We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.

  18. 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.

  19. Ultrasound-Guided Carpal Tunnel Release Using Dynamic Expansion of the Transverse Safe Zone in a Patient With Postpolio Syndrome: A Case Report.

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    Henning, Troy; Lueders, Daniel; Chang, Kate; Yang, Lynda

    2018-03-06

    The prevalence of carpal tunnel syndrome (CTS) in patients with postpolio syndrome occurs at a rate of 22%. Irrespective of those with CTS, 74% of postpolio patients weight bear through their arms for ambulation or transfers. As open carpal tunnel release is performed along the weight-bearing region of the wrist, their functional independence may be altered while recovering. This case demonstrates that ultrasound-guided carpal tunnel release was successfully performed in a patient with postpolio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  20. Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release.

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    Roh, Young Hak; Koh, Young Do; Kim, Jong Oh; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

    2018-04-01

    Health literacy is the ability to obtain, process, and understand health information needed to make appropriate health decisions. The proper comprehension by patients regarding a given disease, its treatment, and the physician's instructions plays an important role in shared decision-making. Studies have disagreed over the degree to which differences in health literacy affect patients' preferences for shared decision-making; we therefore sought to evaluate this in the context of shared decision-making about carpal tunnel release. (1) Do patients with limited health literacy have different preferences of shared decision-making for carpal tunnel release than those with greater levels of health literacy? (2) How do patients with limited health literacy retrospectively perceive their role in shared decision-making after carpal tunnel release? Over a 32-month period, one surgeon surgically treated 149 patients for carpal tunnel syndrome. Patients were eligible if they had cognitive and language function to provide informed consent and complete a self-reported questionnaire and were not eligible if they had nerve entrapment other than carpal tunnel release or had workers compensation issues; based on those, 140 (94%) were approached for study. Of those, seven (5%) were lost to followup before 6 months, leaving 133 for analysis here. Their mean age was 55 years (range, 31-76 years), and 83% (111 of 133) were women. Thirty-three percent (44 of 133) of patients had less than a high school education. Health literacy was measured according to the Newest Vital Sign during the initial visit, and a score of ≤ 3 was considered limited health literacy. Forty-four percent of patients had limited health literacy. The Control Preferences Scale was used for patients to indicate their preferred role in surgical decision-making preoperatively and to assess their perceived level of involvement postoperatively. Bivariate and multivariable analyses were performed to determine whether

  1. 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

  2. Does a Directive to an Internet Site Enhance the Doctor-Patient Interaction? A Prospective Randomized Study for Patients with Carpal Tunnel Syndrome.

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    Aung, Khin-Kyemon; Wu, Wei Kang; Tokumi, Andrew; Kuo, Phoebe; Day, Charles S

    2015-07-01

    Sixty-two percent of patients would like their doctor to recommend a specific web site to find health information, but only 3% of patients receive such recommendations. We investigated whether providing patients with an Internet web-site link recommended by their physician would improve patient knowledge and satisfaction. Our hypothesis was that directing patients to a reliable web site would improve both. Sixty patients with a new diagnosis of carpal tunnel syndrome were prospectively randomized into two groups. Twenty-three patients in the control group had a traditional physician office visit and received standard care for carpal tunnel syndrome. Thirty-seven patients in the treatment group received a handout that directed them to the American Society for Surgery of the Hand (ASSH) web page on carpal tunnel syndrome in addition to the standard care provided in the office visit. Patients later completed a ten-question true-or-false knowledge questionnaire and a six-item satisfaction survey. Differences in scores were analyzed using two-sample t tests. Less than half (48%) of the patients who were given the Internet directive reported that they had visited the recommended web site. The mean scores on the knowledge assessment (6.84 of 10 for the treatment group and 6.96 of 10 for the control group) and the satisfaction survey (4.49 of 5 for the treatment group and 4.43 of 5 for the control group) were similar for both groups. The mean score for knowledge was similar for the patients who had used the ASSH web site and for those who had not (6.89 and 6.97 respectively). Moreover, compared with patients who had not used the Internet at all to learn about carpal tunnel syndrome, patients who used the Internet scored 6.6% better (mean score, 7.14 for those who used the Internet compared with 6.70 for those who had not; p > 0.05). Regardless of Internet usage, most patients scored well on the knowledge assessment and reported a high level of satisfaction. Whether the

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

    International Nuclear Information System (INIS)

    Wang, Chien-Kuo; Jou, I-Ming; Huang, Han-Wei; Chen, Pei-Yin; Tsai, Hong-Ming; Liu, Yi-Sheng; Lin, Chou-Ching K.

    2012-01-01

    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 (×10 −3 mm 2 /s) for the control group and 0.42 ± 0.04 and 1.50 ± 0.15 (×10 −3 mm 2 /s) for the CTS group, respectively. The linear correlations of FA and ADC versus electrophysiological indicators of CTS were significant (R 2 ranged from 0.09 to 0.36), indicating FA and ADC from DTI had significant correlation with the existence and severity of CTS.

  4. Triggering of Carpal Tunnel Syndrome Symptoms in Patients Using Urban Public Transportation.

    Science.gov (United States)

    de Saboya Lenzi, Luiz Guilherme; Fernandes, Carlos Henrique; Myiamoto Meirelles, Lia; Baptista Gomes Dos Santos, João; Faloppa, Flávio; Raduan Neto, Jorge

    2016-09-01

    Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy found in clinical practice. Recent studies evaluated which external factors could be involved in the CTS symptoms, including prolonged exposure to vibration, especially in the upper limb. This study investigated signs and symptoms in patients with CTS after using urban transport on (1) both upper limbs, (2) how long before these symptoms appear, and (3) the hands position or body reaction during the act of pressing the safety bars. Methods: The study was conducted from July 2012 to April 2013. A total of 205 (178 women and 27 men) patients were evaluated. CTS was diagnosed in 285 hands. All participants answered a questionnaire formulated by the authors. The questionnaire was applied by researchers who were single-blinded and not involved in the research. Results: Most of the participants (87%) were women, but there was no statistical significance in age between groups (women = 51.24 ± 8.47 years, men = 51.10 ± 6.52 years, P > .05). The symptoms appeared significantly in the first 15 minutes after boarding when compared with patients who had no symptoms during the journey. There was no difference between hands position along the journey and the onset of symptoms. Conclusions: The onset of symptoms in patients with CTS using urban public transportation most commonly occurred in the first 15 minutes after boarding. Public transport vibration seems to be, at least in part, directly related to the development of symptoms. Questionnaires for the assessment of paresthesia symptoms during the use of public transport may be useful for CTS diagnosis.

  5. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures

    Science.gov (United States)

    Mondelli, Mauro; Farioli, Andrea; Mattioli, Stefano; Aretini, Alessandro; Ginanneschi, Federica; Greco, Giuseppe; Curti, Stefania

    2016-01-01

    Objective To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS) severity scales. Methods We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios were calculated separately by gender. Results We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively) and males (AUC 0.91 and 0.82, respectively). Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively) and males (AUC 0.84 and 0.76, respectively). The results of waist-hip-height ratio AUC were similar. Conclusions Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study. PMID:27768728

  6. Severity of Carpal Tunnel Syndrome and Diagnostic Accuracy of Hand and Body Anthropometric Measures.

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    Mauro Mondelli

    Full Text Available To study the diagnostic properties of hand/wrist and body measures according to validated clinical and electrophysiological carpal tunnel syndrome (CTS severity scales.We performed a prospective case-control study. For each case, two controls were enrolled. Two five-stage clinical and electrophysiological scales were used to evaluate CTS severity. Anthropometric measurements were collected and obesity indicators and hand/wrist ratios were calculated. Area under the receiver operating characteristic curves (AUC, sensitivity, specificity, and likelihood ratios were calculated separately by gender.We consecutively enrolled 370 cases and 747 controls. The wrist-palm ratio, waist-hip-height ratio and waist-stature ratio showed the highest proportion of cases with abnormal values in the severe stages of CTS for clinical and electrophysiological severity scales in both genders. Accuracy tended to increase with CTS severity for females and males. In severe stage, most of the indexes presented moderate accuracy in both genders. Among subjects with severe CTS, the wrist-palm ratio presented the highest AUC for hand measures in the clinical and electrophysiological severity scales both in females (AUC 0.83 and 0.76, respectively and males (AUC 0.91 and 0.82, respectively. Among subjects with severe CTS, the waist-stature ratio showed the highest AUC for body measures in the clinical and electrophysiological severity scales both in females (AUC 0.78 and 0.77, respectively and males (AUC 0.84 and 0.76, respectively. The results of waist-hip-height ratio AUC were similar.Wrist-palm ratio, waist-hip-height ratio and waist-stature ratio could contribute to support the diagnostic hypothesis of severe CTS that however has to be confirmed by nerve conduction study.

  7. Diagnosis and treatment of hand-arm vibration syndrome and its relationship to carpal tunnel syndrome.

    Science.gov (United States)

    Falkiner, Sonja

    2003-07-01

    Hand-arm vibration syndrome (HAVS) is a condition associated with the use of vibrating tools that occurs mainly in men. It consists primarily of 'occupational' Raynaud disease and digital polyneuropathy. Carpal tunnel syndrome (CTS) is also associated with hand transmitted vibration exposure and can coexist with HAVS. This article examines recent papers on causation, diagnosis, relationship to CTS and treatment. A Medline search was conducted, as was a search of UK, USA and Australian government occupational health and safety websites. Published papers that were single case studies or of poor design were not included. There are no 'gold standard' diagnostic tests for HAVS. It can mimic CTS in temperate climates and can occur with CTS. This is the diagnostic challenge when a male worker presents with apparent CTS symptoms. If he has worked with vibrating tools for many years, a diagnosis of HAVS or co-diagnosis of HAVS should be considered before a diagnosis of pure CTS is made. Nonwork risk factors for HAVS are predisposition, smoking, and exposure to vibration outside work. Cessation of exposure (and smoking) and redeployment is a critical part of treatment due to the dose response relationship of HAVS. This contrasts with adequately treated CTS, where the vast majority of workers can return to pre-injury duties. In severe cases, calcium antagonists are also used, but treatment is often ineffective. Few workplaces in Australia manage vibration risk or conduct screening to identify workers with early HAVS who should be redeployed. Local doctors have an important opportunity to diagnose HAVS and to make recommendations to the workplace on redeployment as part of treatment before symptoms become irreversible.

  8. Sensory-Motor Index is Useful Parameter in Electroneurographical Diagnosis of Carpal Tunnel Syndrome

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    Zoran Perić

    2006-08-01

    Full Text Available It was performed electroneurographic (ENG studies with surface electrodes and examined nervus medianus (NM in 60 patients (38 females, average age of 50,28 years (X+/-SD=50,28+/-11, with clinical diagnosis of carpal tunnel syndrome (CTS and at least one border or discrete abnormal value of conventional electrophysiological tests. It was also examined 57 healthy individuals (33 females as control group, average age of 45,65 years (X+/-SD=45,65+/-9,68. The sensitivity and specificity of sensory-motor index (SMI, terminal latency index(TLI and residual latency (RL were calculated and compared. SMI is determinate by using following formula: distal distance (DD (in cm/distal motor latency (DML (in ms + sensory conduction velocity (SCV (in m/s/motor conduction velocity (MCV (in m/s of NM. SCV of NM was measured by antidromic technique in segment wrist-index finger and MCV of NM in forearm segment above wrist. SMI mean value of control group was 3,45 (X+/-SD=3,45+/-0,45 with lower limit of normal value 2,82 and in patients with CTS 2,13 (X+/-SD=2,13 +/-0,37. The sensitivity of SMI in patients with CTS was 98,51%. SMI is useful parameter in electroneurographical diagnosis of CTS and it's determination is easy and fast and specially important in cases with border or discrete abnormal values of other NM electrophysiological parameters, when SMI values can indicate incipient phase of CTS evolution. In rare cases (about 1% of CTS with selective NM motor axons affection, SMI may have normal value (false negative result, but DML is always prolonged in this cases. SMI is not dependent on age and DD values in patients with CTS and control subjects.

  9. Prevalent involvement of thenar motor fibres in vineyard workers with carpal tunnel syndrome.

    Science.gov (United States)

    Mondelli, M; Baldasseroni, A; Aretini, A; Ginanneschi, F; Padua, L

    2010-08-01

    Carpal tunnel syndrome (CTS) has a high prevalence in agricultural workers, especially those engaged in vineyards. We postulated that vineyard CTS was electrophysiologically different from CTS of other subjects. We performed a retrospective cross-sectional electrophysiological study of two cohorts of consecutive patients with CTS, the first consisting of vineyard workers and the second, of other unselected types of workers, housewives and pensioners. Thirty-three vineyard workers (mean age 46.8years, 42% women) and 205 patients with other occupations (mean age 53.7years; 66% women) were enrolled. All patients underwent sensory and motor neurography of the median and ulnar nerves. Differences in demographic and electrophysiological findings between groups were calculated and multiple linear regression analysis was performed to eliminate the influence of potential confounding factors (age, sex, BMI, clinical severity of CTS) on the results of univariate difference analysis. Univariate analysis showed that DML was longer and compound muscle action potential amplitude of the median nerve, recorded from the abductor pollicis brevis muscle, was smaller in vineyard workers than in the other CTS patients. These differences remained significant after adjusting the results for confounding factors. The vineyard workers showed a different pattern of CTS than the other patients: thenar motor fibres were more affected, presumably due to chronic compression on the thenar branch. This suggests an association between "common" CTS and thenar mononeuropathy. Occupational physiologists should clarify the mechanisms of neuromuscular engagement in particular jobs and ergonomists design suitable working tools, because many "individual" risk factors are difficult to change, but workplace-related risk factors can be modified. Copyright 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  10. Carpal tunnel syndrome among laboratory technicians in relation to personal and ergonomic factors at work.

    Science.gov (United States)

    El-Helaly, Mohamed; Balkhy, Hanan H; Vallenius, Laura

    2017-11-25

    Work-related carpal tunnel syndrome (CTS) has been reported in different occupations, including laboratory technicians, so this study was carried out to determine the prevalence and the associated personal and ergonomic factors for CTS among laboratory technicians. A cross-sectional study was conducted among 279 laboratory technicians at King Fahd Hospital, Saudi Arabia, who filled in a self-administered questionnaire, including questions regarding their demographic criteria, occupational history, job tasks, workplace tools, ergonomic factors at work, and symptoms suggestive of CTS. Physical examinations and electrodiagnostic studies were carried out for those who had symptoms suggestive of CTS to confirm the diagnosis. Univariate and multivariate analysis were performed for both personal and physical factors in association with confirmed CTS among laboratory technicians. The prevalence of CTS among the laboratory technicians was 9.7% (27/279). The following were the statistically significant risk factors for CTS among them: gender (all cases of CTS were female, P=0.00), arm/hand exertion (OR: 7.96; 95% CI: 1.84-34.33), pipetting (OR: 7.27; 95% CI: 3.15-16.78), repetitive tasks (OR: 4.60; 95% CI: 1.39-15.70), using unadjustable chairs or desks (OR: 3.35; 95% CI: 1.23-9.15), and working with a biosafety cabinet (OR: 2.49; 95% CI: 1.11-5.59). CTS cases had significant longer work duration (17.9 ± 5.6 years) than CTS non-case (11.5 ± 7.4 yeas) with low OR (1.108). This study demonstrates some personal and ergonomic factors associated with CTS among the laboratory technicians, including female gender, arm/hand exertion, pipetting, repetitive tasks, working with a biosafety cabinet, and an unadjusted workstation.

  11. Personal risk factors for carpal tunnel syndrome in female visual display unit workers.

    Science.gov (United States)

    Riccò, Matteo; Cattani, Silvia; Signorelli, Carlo

    2016-11-18

    Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome, which since the beginning of the seventies has been linked to the keyboard and visual display unit (VDU). The objective of this study was to investigate the prevalence and personal factors associated with CTS in female VDU workers in Italy. Participants in this study were female adult subjects, working ≥ 20 h/week (N = 631, mean age 38.14±7.81 years, mean working age 12.9±7.24 years). Signs and symptoms were collected during compulsory occupational medical surveillance. The binary logistic regression was used to estimate adjusted odds ratios for the factors of interest. Diagnosis of CTS was reported in 48 cases (7.6%, 11 of them or 1.7% after a surgical correction) for the incidence of 5.94/1000 person-years. In general, signs and symptoms of CTS were associated with the following demographic factors: previous trauma of upper limb (adjusted odds ratio (ORa) = 8.093, 95% confidence interval (CI): 2.347-27.904), history (> 5 years) of oral contraceptives therapy/hormone replacement therapy (ORa = 3.77, 95% CI: 1.701-8.354) and cervical spine signs/symptoms (ORa = 4.565, 95% CI: 2.281-9.136). The prevalence of CTS was similar to the estimates for the general population of Italy. Among personal risk factors, hormone therapy, previous trauma of the upper limb and signs/symptoms of the cervical spine appeared to be associated with a higher risk of CTS syndrome. Eventually, the results reinforce interpretation of CTS in VDU workers as a work-related musculoskeletal disorder rather than a classical occupational disease. Int J Occup Med Environ Health 2016;29(6):927-936. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  12. Personal risk factors for carpal tunnel syndrome in female visual display unit workers

    Directory of Open Access Journals (Sweden)

    Matteo Riccò

    2016-12-01

    Full Text Available Objectives: Carpal tunnel syndrome (CTS is the most common nerve entrapment syndrome, which since the beginning of the seventies has been linked to the keyboard and visual display unit (VDU. The objective of this study was to investigate the prevalence and personal factors associated with CTS in female VDU workers in Italy. Material and Methods: Participants in this study were female adult subjects, working ≥ 20 h/week (N = 631, mean age 38.14±7.81 years, mean working age 12.9±7.24 years. Signs and symptoms were collected during compulsory occupational medical surveillance. The binary logistic regression was used to estimate adjusted odds ratios for the factors of interest. Results: Diagnosis of CTS was reported in 48 cases (7.6%, 11 of them or 1.7% after a surgical correction for the incidence of 5.94/1000 person-years. In general, signs and symptoms of CTS were associated with the following demographic factors: previous trauma of upper limb (adjusted odds ratio (ORa = 8.093, 95% confidence interval (CI: 2.347–27.904, history (> 5 years of oral contraceptives therapy/hormone replacement therapy (ORa = 3.77, 95% CI: 1.701–8.354 and cervical spine signs/symptoms (ORa = 4.565, 95% CI: 2.281–9.136. Conclusions: The prevalence of CTS was similar to the estimates for the general population of Italy. Among personal risk factors, hormone therapy, previous trauma of the upper limb and signs/symptoms of the cervical spine appeared to be associated with a higher risk of CTS syndrome. Eventually, the results reinforce interpretation of CTS in VDU workers as a work-related musculoskeletal disorder rather than a classical occupational disease. Int J Occup Med Environ Health 2016;29(6:927–936

  13. Evaluation of median nerve T2 signal changes in patients with surgically treated carpal tunnel syndrome.

    Science.gov (United States)

    Samanci, Yavuz; Karagöz, Yeşim; Yaman, Mehmet; Atçı, İbrahim Burak; Emre, Ufuk; Kılıçkesmez, Nuri Özgür; Çelik, Suat Erol

    2016-11-01

    To determine the accuracy of median nerve T2 evaluation and its relation with Boston Questionnaire (BQ) and nerve conduction studies (NCSs) in pre-operative and post-operative carpal tunnel syndrome (CTS) patients in comparison with healthy volunteers. Twenty-three CTS patients and 24 healthy volunteers underwent NCSs, median nerve T2 evaluation and self-administered BQ. Pre-operative and 1st year post-operative median nerve T2 values and cross-sectional areas (CSAs) were compared both within pre-operative and post-operative CTS groups, and with healthy volunteers. The relationship between MRI findings and BQ and NCSs was analyzed. The ROC curve analysis was used for determining the accuracy. The comparison of pre-operative and post-operative T2 values and CSAs revealed statistically significant improvements in the post-operative patient group (pT2 values at all levels and BQ values, and positive and negative correlations were also found regarding T2 values and NCS findings in CTS patients. The receiver operating characteristic curve analysis for defined cut-off levels of median nerve T2 values in hands with severe CTS yielded excellent accuracy at all levels. However, this accuracy could not be demonstrated in hands with mild CTS. This study is the first to analyze T2 values in both pre-operative and post-operative CTS patients. The presence of increased T2 values in CTS patients compared to controls and excellent accuracy in hands with severe CTS indicates T2 signal changes related to CTS pathophysiology and possible utilization of T2 signal evaluation in hands with severe CTS. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. ASYMMETRY OF SOMATOSENSORY CORTICAL PLASTICITY IN PATIENT WITH BILATERAL CARPAL TUNNEL SYNDROME

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    Hikmat Hadoush

    2017-09-01

    Full Text Available Background: Following peripheral nerve lesion, the adult somatosensory system showedcortical reorganizational abilities.Previous studies identified the digits' somatotopy map changes and somatosensory cortical plasticity in response to the Carpal Tunnel Syndrome (CTS that affected the dominant hand only. Objective: Answering the remained question is that what the extent of the cortical plasticity would be in left and right somatosensory cortices in response to CTS affecting the right and left hands simultaneously. Methods: Cortical representations activated by tactile stimulation of median nerve (index and ulnar nerve (little of both dominant and non-dominant hands were evaluated by Magnetoencephalography (MEG systemfor healthy participants and patient with bilateral moderate CTS. index – little fingers'somatotopy map and inter-digit cortical distance was then mapped and calculated for each participant on the real MRI data and the 3D brain surface image. Results: in healthy participants, index – little inter-digit somatosensory cortical distance of right hand (dominant was significantly larger than the index – little inter-digitsomatosensory cortical distance of left hand (11.2±2.1mm vs.7.0±2.9mm, P = 0.006. However, in patient with bilateral CTS, the index – little inter-digit somatosensory cortical distance of righthand (dominant was significantly smaller than the index – little inter-digit somatosensory cortical distance of left hand (5.8mm vs. 7.4mm. Conclusion: our data could be interpreted as the hand use – dependency served more median nerve – cortical territory from the ulnar nerve invasion in the right somatotopy map (left hand than the left somatotopy map of the right hand.

  15. Sonography and electrodiagnosis in carpal tunnel syndrome diagnosis, an analysis of the literature

    International Nuclear Information System (INIS)

    Seror, P.

    2008-01-01

    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

  16. Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity

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    Firosh Khan

    2017-01-01

    Full Text Available Aim: Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and is one of the most common requests for electrodiagnosis. We aimed to note the relationship of subjective symptom severity of CTS, with objective electrophysiological severity and psychological status of patients. Patients and Methods: One hundred and forty-four consecutive patients of CTS referred to neurophysiology laboratory of a tertiary care hospital over 1 year were prospectively studied. Boston CTS Assessment Questionnaire (BCTSAQ and visual analog scale (VAS were used to assess subjective symptom severity. Psychological status was assessed by Hospital Anxiety and Depression Scale (HADS. Electrophysiological severity of CTS was estimated by median motor distal latency and median to ulnar peak sensory latency difference across the wrist. Each parameter in both hands was scored from 0 to 3 depending on the severity grade, and a composite electrophysiological severity score (CEPSS was calculated for each patient by summing up the scores in both hands. Statistical analysis was done by Spearman's rank correlation test. Results: There was significant correlation of BCTSAQ with VAS (P = 0.001, HADS anxiety score (P < 0.001, and HADS depression score (P = 0.01. CEPSS had no significant correlation with VAS (P = 0.103, HADS anxiety score (P = 0.211, or HADS depression score (P = 0.55. CEPSS had a borderline correlation with BCTSAQ (P = 0.048. Conclusions: While the subjective symptoms of CTS are well correlated with psychological factors, their correlation with objective electrophysiological severity is weak. Hence, prompt treatment of psychological comorbidity is important in symptomatic management of CTS; decision about surgical intervention should be based on electrophysiological severity rather than symptom severity.

  17. Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients.

    Science.gov (United States)

    Gomes, Irênio; Becker, Jefferson; Ehlers, João Arthur; Kapczinski, Flávio; Nora, Daniel Bocchese

    2004-09-01

    To describe the demographic characteristics of gender, age, and presence of repetitive movements, intake of alcohol and non-steroid anti-inflammatories (NSAI), medical specialties that referred patients to nerve conduction studies and electromyography (NCS-EMG), school attainment, and seasonal distribution in patients with a neurophysiological diagnosis of carpal tunnel syndrome (CTS) in the State of Rio Grande do Sul, Brazil. A series of 1039 patients (1549 hands) with neurophysiologically defined CTS was studied. Patients were referred for NCS-EMG in 3 universities and 2 private services, from August 2001 to January 2003. All patients completed a questionnaire containing demographic information. The diagnosis of CTS was established following a pre-established protocol, with defined diagnostic criteria. Around one fourth of patients had already performed NCS-EMG; the greatest frequency of CTS was observed in women (5.6:1) and in patients above the age of 40. Most patients reported performing repetitive movements in their daily routine (69.7%); 12.9% reported use of NSAI and 14.9% regular intake of alcoholic beverages. A greater frequency of CTS was observed in the months of July and August, when compared to the other months of the year. Around 2/3 of the study population had completed at least secondary school. Most requests of nerve conduction studies did not provide a diagnostic hypothesis (59.9%) and neurophysiologic studies were requested mostly by traumatology/orthopedics (71.1%). We have concluded that, in our environment, CTS shows some demographical characteristics that are similar to what the literature describes. Also, we have found that most of our sample concluded at least secondary school, and was referred to neurophysiologic studies by orthopedists. To be pointed out is the seasonal distribution of CTS, which demonstrates a significant association with winter months.

  18. Cultural adaptation of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome: A Turkish version study

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    Ilker Ilhanli

    2015-03-01

    Full Text Available 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

  19. The importance of the recovery treatment in increasing the quality of the lives of the patients with the carpal tunnel syndrome

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    Sinziana Calina Silisteanu

    2016-09-01

    Full Text Available The hand is a very important segment in gestures, functionality and the achievement of ADL. The Carpal tunnel syndrome was described for the first time by Paget in 1854 , being a very frequent health condition of the extremity in the upper limb caused by the compression of the median nerve at the level of the fibre bone tunnel at the level of the hand wrist. The incidence of the Carpal tunnel syndrome is approximately 0.125% - 1% /year, having a prevalence of 5-15%. Among the patients diagnosed with the Carpal tunnel syndrome, 80% are over 40 years old, the women being more affected than the men. The Carpal tunnel syndrome is a disability issue with social and economic consequences, being a burden for the society. The recovery is conservative and it consists of immobilisation by orthesis at the hand level, crio-therapy, kinetic therapy, electric therapy (laser, ultrasound, low and average frequency electrical power or by surgical intervention. This study tries to point out if it is possible to influence the quality of life and the individuals' level of functional independence by applying therapeutic protocols specific to this health condition. The patients diagnosed with the Carpal tunnel syndrome received a complex treatment which included electric therapy (of low and average frequency, TENS, laser and ultrasound, massage for the upper limb and kinetic therapy, with a length of 15 days, then the patients were called for the checkup 30 days later. It is important to set clear objectives for the recovery programmes and to create optimised treatment schemes. They confirm the hypothesis based on which the research was conducted. Therefore, any health condition for this segment may influence the quality of patients' life, with involvement in the achievement of the daily activities and the social professional insertion.

  20. Which nerve conduction parameters can predict spontaneous electromyographic activity in carpal tunnel syndrome?

    Science.gov (United States)

    Chang, Chia-Wei; Lee, Wei-Ju; Liao, Yi-Chu; Chang, Ming-Hong

    2013-11-01

    We investigate electrodiagnostic markers to determine which parameters are the best predictors of spontaneous electromyographic (EMG) activity in carpal tunnel syndrome (CTS). We enrolled 229 patients with clinically proven and nerve conduction study (NCS)-proven CTS, as well as 100 normal control subjects. All subjects were evaluated using electrodiagnostic techniques, including median distal sensory latencies (DSLs), sensory nerve action potentials (SNAPs), distal motor latencies (DMLs), compound muscle action potentials (CMAPs), forearm median nerve conduction velocities (FMCVs) and wrist-palm motor conduction velocities (W-P MCVs). All CTS patients underwent EMG examination of the abductor pollicis brevis (APB) muscle, and the presence or absence of spontaneous EMG activities was recorded. Normal limits were determined by calculating the means ± 2 standard deviations from the control data. Associations between parameters from the NCS and EMG findings were investigated. In patients with clinically diagnosed CTS, abnormal median CMAP amplitudes were the best predictors of spontaneous activity during EMG examination (p95% (positive predictive rate >95%). If the median CMAP amplitude was higher than the normal limit (>4.9 mV), the rate of no spontaneous EMG activity was >94% (negative predictive rate >94%). An abnormal SNAP amplitude was the second best predictor of spontaneous EMG activity (p<0.001; OR 4.13; 95% CI 2.16-7.90), and an abnormal FMCV was the third best predictor (p=0.01; OR 2.10; 95% CI 1.20-3.67). No other nerve conduction parameters had significant power to predict spontaneous activity upon EMG examination. The CMAP amplitudes of the APB are the most powerful predictors of the occurrence of spontaneous EMG activity. Low CMAP amplitudes are strongly associated with spontaneous activity, whereas high CMAP amplitude are less associated with spontaneous activity, implying that needle EMG examination should be recommended for the detection of

  1. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests

    International Nuclear Information System (INIS)

    Koyuncuoglu, Hasan Rifat; Kutluhan, Suleyman; Yesildag, Ahmet; Oyar, Orhan; Guler, Kezban; Ozden, Ahmet

    2005-01-01

    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 2 by tracing method (TM) and 8.51 ± 3.13 mm 2 by ellipsoid formula (EF) in study group, and 7.63 ± 1.52 mm 2 by TM and 7.66 ± 1.42 mm 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 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

  2. Prevalence of Mucopolysaccharidosis Types I, II, and VI in the Pediatric and Adult Population with Carpal Tunnel Syndrome (CTS). Retrospective and Prospective Analysis of Patients Treated for CTS

    DEFF Research Database (Denmark)

    Nørmark, Mette Borch; Kjaer, Nanna; Lund, Allan Meldgaard

    2017-01-01

    BACKGROUND: We wanted to investigate whether the prevalence of mucopolysaccharidoses (MPS) I, II, and VI was higher than expected in a selected cohort of patients with carpal tunnel syndrome (CTS). CTS is a common finding in patients with MPS, and therefore we screened patients who had undergone ...

  3. Blood Flow Changes in Subsynovial Connective Tissue on Contrast-Enhanced Ultrasonography in Patients With Carpal Tunnel Syndrome Before and After Surgical Decompression.

    Science.gov (United States)

    Motomiya, Makoto; Funakoshi, Tadanao; Ishizaka, Kinya; Nishida, Mutsumi; Matsui, Yuichiro; Iwasaki, Norimasa

    2017-11-24

    Although qualitative alteration of the subsynovial connective tissue in the carpal tunnel is considered to be one of the most important factors in the pathophysiologic mechanisms of carpal tunnel syndrome (CTS), little information is available about the microcirculation in the subsynovial connective tissue in patients with CTS. The aims of this study were to use contrast-enhanced ultrasonography (US) to evaluate blood flow in the subsynovial connective tissue proximal to the carpal tunnel in patients with CTS before and after carpal tunnel release. The study included 15 volunteers and 12 patients with CTS. The blood flow in the subsynovial connective tissue and the median nerve was evaluated preoperatively and at 1, 2, and 3 months postoperatively using contrast-enhanced US. The blood flow in the subsynovial connective tissue was higher in the patients with CTS than in the volunteers. In the patients with CTS, there was a significant correlation between the blood flow in the subsynovial connective tissue and the median nerve (P = .01). The blood flow in both the subsynovial connective tissue and the median nerve increased markedly after carpal tunnel release. Our results suggest that increased blood flow in the subsynovial connective tissue may play a role in the alteration of the microcirculation within the median nerve related to the pathophysiologic mechanisms of CTS. The increase in the blood flow in the subsynovial connective tissue during the early postoperative period may contribute to the changes in intraneural circulation, and these changes may lead to neural recovery. © 2017 by the American Institute of Ultrasound in Medicine.

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

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    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.

  5. Pain, depression and sleep disorders in patients with diabetic and nondiabetic carpal tunnel syndrome: a vicious cycle

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    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.

  6. 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.

  7. Activation in the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system in women with carpal tunnel syndrome.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Díaz-Rodríguez, Lourdes; Salom-Moreno, Jaime; Galiano-Castillo, Noelia; Valverde-Herreros, Lis; Martínez-Martín, Javier; Pareja, Juan A

    2014-08-01

    The aim of this study is to investigate the differences in salivary cortisol (hypothalamic-pituitary-adrenocortical [HPA] axis), α-amylase activity (sympathetic nervous system [SNS]), and immunoglobulin A (IgA; immune system) concentrations between women with carpal tunnel syndrome (CTS) and healthy women. A cross-sectional study. Activation of HPA, SNS, and immune system in CTS has not been clearly determined. One hundred two women (age: 45 ± 7 years) with electrodiagnostic and clinical diagnosis of CTS and 102 matched healthy women. The intensity of the pain was assessed with a Numerical Pain Rating Scale (0-10), and disability was determined with Boston Carpal Tunnel Questionnaire. Salivary cortisol concentration, α-amylase activity, salivary flow rate, and IgA concentration were collected from nonstimulated saliva. Women with CTS exhibited lower salivary flow rate (P  0.2) were found between groups as a total. Women with severe CTS exhibited lower salivary flow rate (P < 0.001), higher α-amylase activity (P = 0.002), and higher cortisol concentration (P = 0.03) than healthy women and than those with minimal/moderate CTS (P < 0.05). Within women with CTS, significant positive associations between α-amylase activity and the intensity of pain were found: the highest the level of pain, the higher the α-amylase activity, i.e., higher SNS activation. These results suggest that women with severe CTS exhibit changes in activation in the HPA axis and SNS but not in the humoral immune system. Activation of the SNS was associated with the intensity of pain. Future studies are needed to elucidate the direction of this relationship. Wiley Periodicals, Inc.

  8. Epidemiological survey of patients with a carpal tunnel syndrome referred to Sina Hospital in Hamedan during 2014-2016

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    Masoud Ghiasian

    2017-11-01

    Full Text Available Background: Carpal tunnel syndrome is a common mono-neuropathy with various causes. This study aimed at evaluating the epidemiology of patients with the carpal tunnel syndrome referred to Sina Hospital in Hamedan City, Iran. Materials and Methods: In this descriptive-cross sectional study, 300 patients (600 hands suffering from paresthesia, pain and weakness of the first to third finger were studied. Diagnosis and severity of the disease was evaluated according to history, examination and electro-diagnostic studies. Afterall the data were collected. Results: This study was conducted on 230 (76.7% females and 70 (23.3% males with the mean ages of 47.3±17.4 and 49.1±20.2 years, respectively (P=0.224. Sixteen of them were left-handed and the rest were right-handed. Also, 113 of the patients had risk factors such as diabetes with the prevalence of 18.1% and hypothyroidism with 6.4% as the most common ones. The most common occupations were carpet weaving and milking with prevalence rates of 19.4% and 13.3%, respectively. In electro-diagnostic findings, 57% of the patients had moderate involvement and 16.6% had severe involvement. The Phalen and Tinel test was positive in 32.2% of the patients and negative in 32.2% of the cases. There was a relationship between the severity of involvement and probability of a positive Phalen and Tinel test. Conclusion: Considering that 76% of the cases were women and among jobs, after housekeeping, carpet weaving and milking are the most common ones, paying more attention to these people and designing the proper work tools (especially carpet weaving and milking tools as well as training of the housewives are recommended to prevent this syndrome.

  9. Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study

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    Farioli, Andrea; Curti, Stefania; Bonfiglioli, Roberta; Baldasseroni, Alberto; Spatari, Giovanna; Mattioli, Stefano; Violante, Francesco Saverio

    2018-01-01

    Abstract Objectives We aimed at assessing whether differences among males and females in carpal tunnel syndrome (CTS) epidemiology might be attributable to segregation with respect to occupational biomechanical exposures or differential access to care by sex. Methods We analysed surgically treated cases of CTS occurring among non-manual workers in Tuscany between 1997 and 2000. We conducted a Monte Carlo simulation to estimate the difference in occupational biomechanical exposures between males and females necessary to explain the observed incidence rate ratios. We also accounted for the sex-specific probability of receiving surgery after the diagnosis of CTS, as women were reported to be more likely to undergo surgery in a subset of our study population. We quantified the hypothetical biomechanical overload through the hand activity level (HAL) metric proposed by the American Conference of Governmental Industrial Hygienists. To quantify the effect of HAL on CTS risk, we assumed a prior distribution based on findings from two large cohort studies of industrial workers. Results After adjustment for the probability of receiving surgery, women showed a 4-fold incidence of CTS as compared with men. To explain this association among non-manual workers, women should have an average value of HAL at least 5 points higher. Conclusions Our analysis does not support the hypothesis that the difference in CTS incidence between males and females is entirely attributable to occupational risk factors or to differential access to surgery. The causal pathway between sex and CTS might include more determinants such as hormonal factors, anthropometric characteristics, and non-occupational exposure to biomechanical overload (e.g. household tasks). PMID:29579135

  10. Establishing and validating the fluorescent amyloid ligand h-FTAA (heptamer formyl thiophene acetic acid) to identify transthyretin amyloid deposits in carpal tunnel syndrome.

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    Hahn, Katharina; Nilsson, K Peter R; Hammarström, Per; Urban, Peter; Meliss, Rolf Rüdiger; Behrens, Hans-Michael; Krüger, Sandra; Röcken, Christoph

    2017-06-01

    Transthyretin-derived (ATTR) amyloidosis is a frequent finding in carpal tunnel syndrome. We tested the following hypotheses: the novel fluorescent amyloid ligand heptameric formic thiophene acetic acid (h-FTAA) has a superior sensitivity for the detection of amyloid compared with Congo red-staining; Amyloid load correlates with patient gender and/or patient age. We retrieved 208 resection specimens obtained from 184 patients with ATTR amyloid in the carpal tunnel. Serial sections were stained with Congo red, h-FTAA and an antibody directed against transthyretin (TTR). Stained sections were digitalized and forwarded to computational analyses. The amount of amyloid was correlated with patient demographics. Amyloid stained intensely with h-FTAA and an anti-TTR-antibody. Congo red-staining combined with fluorescence microscopy was significantly less sensitive than h-FTAA-fluorescence and TTR-immunostaining: the highest percentage area was found in TTR-immunostained sections, followed by h-FTAA and Congo red. The Pearson correlation coefficient was .8 (Congo red vs. h-FTAA) and .9 (TTR vs. h-FTAA). Amyloid load correlated with patient gender, anatomical site and patient age. h-FTAA is a highly sensitive method to detect even small amounts of ATTR amyloid in the carpal tunnel. The staining protocol is easy and h-FTAA may be a much more sensitive procedure to detect amyloid at an earlier stage.

  11. Treatment of Carpal Tunnel Syndrome in pregnancy with Polarized Polychromatic Non-coherent Light (Bioptron Light): A Preliminary, Prospective, Open Clinical Trial.

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    Dimitrios, Stasinopoulos; Stasinopoulos, Loannis

    2017-12-31

    The aim of this trial was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of Carpal Tunnel Syndrome (CTS) in pregnancy. An uncontrolled experimental study was conducted in pregnant patients with CTS who visited our clinic from January 2006 to January 2010. Bioptron light (480-3400 nm; 95% polarization; 40 mW/cm 2 ; and 2.4 J/cm 2 ) was administered perpendicular to the carpal tunnel area. The irradiation time for each session was 6 min at an operating distance of 5-10 cm from the carpal tunnel area, twice each day, five days per week for 2 weeks. Pain and paraesthesia using a visual analogue scale (VAS) and finger pinch strength were evaluated at the end of treatment (week 2) and 1-month (week 6) after the end of treatment. The Student'sttest was used and p values Bioptron light is a reliable, safe, and effective treatment option in pregnant patients with CTS. Controlled clinical trials are needed to establish the absolute and relative effectiveness of this intervention.

  12. Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial

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    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.

  13. Personal and occupational risk factors for carpal tunnel syndrome in meat processing industry workers in Northern Italy.

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    Riccò, Matteo; Signorelli, Carlo

    2017-03-24

    Carpal tunnel syndrome (CTS) is a musculoskeletal condition that often impairs the fitness to work. Our aim is to retrospectively evaluate the association between physical exposures in meat processing industry in Northern Italy and the CTS, taking into account non-occupational factors. A cross-sectional study was performed to include 434 workers (236 males, 198 females, 37.0±10.6 years old, working age: 12.6±10.8 years) from meat processing industries. Signs and symptoms were collected at the compulsory occupational medical surveillance. Occupational risk factors were assessed through a questionnaire and direct assessment by investigators. Adjusted odds ratios (ORadj) for factors of interest were estimated through binary logistic regression. Diagnosis of the CTS was reported for 61 out of 434 subjects (14.1%) for an incidence of 11.3/1000 person- years. In general, signs and symptoms for the CTS were associated with the following demographic factors: smoking history (OR = 1.909, 95% confidence interval (CI): 1.107-3.293), previous traumas of the upper limb (OR = 3.533, 95% CI: 1.743-7.165), hypothyroidism status (OR = 7.897, 95% CI: 2.917-21.38) and, in the case of female participants only, previous pregnancies (OR = 2.807, 95% CI: 1.200-6.566) as well as a personal history of oral contraceptive therapy and/or steroidal replacement therapy (OR = 11.57, 95% CI: 4.689-28.56). The carpal tunnel syndrome cases were associated with the following occupational factors (> 4 h/day): forceful hand exertion (ORadj = 3.548, 95% CI: 1.379-9.131), repeated trauma of the hand (ORadj = 3.602, 95% CI: 1.248- 10.395), repeated movements of the wrist (ORadj = 2.561, 95% CI: 1.100-5.960). Increasing levels of hand activity and force were associated with the increased CTS prevalence among participants. Recommendations have to be provided in order to reduce occupational exposure to these risk factors and improve medical surveillance. Med Pr 2017;68(2):199-209. This work is available

  14. Personal and occupational risk factors for carpal tunnel syndrome in meat processing industry workers in Northern Italy

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    Matteo Riccò

    2017-04-01

    Full Text Available Background: Carpal tunnel syndrome (CTS is a musculoskeletal condition that often impairs the fitness to work. Our aim is to retrospectively evaluate the association between physical exposures in meat processing industry in Northern Italy and the CTS, taking into account non-occupational factors. Material and Methods: A cross-sectional study was performed to include 434 workers (236 males, 198 females, 37.0±10.6 years old, working age: 12.6±10.8 years from meat processing industries. Signs and symptoms were collected at the compulsory occupational medical surveillance. Occupational risk factors were assessed through a questionnaire and direct assessment by investigators. Adjusted odds ratios (ORadj for factors of interest were estimated through binary logistic regression. Results: Diagnosis of the CTS was reported for 61 out of 434 subjects (14.1% for an incidence of 11.3/1000 person- years. In general, signs and symptoms for the CTS were associated with the following demographic factors: smoking history (OR = 1.909, 95% confidence interval (CI: 1.107–3.293, previous traumas of the upper limb (OR = 3.533, 95% CI: 1.743–7.165, hypothyroidism status (OR = 7.897, 95% CI: 2.917–21.38 and, in the case of female participants only, previous pregnancies (OR = 2.807, 95% CI: 1.200–6.566 as well as a personal history of oral contraceptive therapy and/or steroidal replacement therapy (OR = 11.57, 95% CI: 4.689–28.56. The carpal tunnel syndrome cases were associated with the following occupational factors (> 4 h/day: forceful hand exertion (ORadj = 3.548, 95% CI: 1.379–9.131, repeated trauma of the hand (ORadj = 3.602, 95% CI: 1.248– 10.395, repeated movements of the wrist (ORadj = 2.561, 95% CI: 1.100–5.960. Conclusions: Increasing levels of hand activity and force were associated with the increased CTS prevalence among participants. Recommendations have to be provided in order to reduce occupational exposure to these risk factors and

  15. The effectiveness of the low-power laser and kinesiotaping in the treatment of carpal tunnel syndrome, a pilot study.

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    Güner, A; Altan, L; Kasapoğlu Aksoy, M

    2018-05-01

    In mild and moderate cases of carpal tunnel syndrome (CTS), the conservative approach is suggested. The purpose of this study is to assess and compare the effect of low-power laser versus the combination of low-power laser and kinesiotaping on pain, muscle strength, functionality, and electrophysiologic parameters in the patients with CTS. The study was planned as single-blind, prospective, randomized control. 64 hands diagnosed with CTS were included in the study. The patients were randomly divided into three groups by closed envelope method. Low-power laser therapy was applied to Group 1 (21 hands), kinesiotaping and low-power laser therapy in group 2 (22 hands), sham laser therapy in Group 3 (21 hands). All patients were assessed by visual numeric pain scale (VNS), hand grip strength (HGS), finger pinch strength (FPS), the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), before treatment, after treatment (3rd week), and after (12th week) 3 months the treatment with the same physician. Motor and sensory nerve conduction studies were performed with electroneuromyography (ENMG) before the treatment (0th week) and at the end of the 12th week. Comparison of the group 1 with the group 3 showed significantly better improvement in the former in VNS, BCTSQ at 3rd week and 12th week compared to 0th week, and in FPS and HGS at 3rd week. Comparison of the group 2 with the group 3 showed significantly better improvement in the former VNS, BCTSQ, FPS and HGS at 3rd and 12th week compared to 0th week. When Group 1 and Group 2 were compared there was no statistically significant difference in any parameters in the 3rd week, but there was a statistically significant difference in favor of group 2 in FPS and HGS parameters at the 12th week. We have found that the kinesiotaping method applied with low-power laser treatment does not provide any additional benefit to the low-power laser treatment in the short term, however, in the long term, the increase in the HGS and FPS has

  16. Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies.

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    Descatha, A; Dale, A-M; Franzblau, A; Coomes, J; Evanoff, B

    2010-02-01

    We evaluated the utility of physical examination manoeuvres in the prediction of carpal tunnel syndrome (CTS) in a population-based research study. We studied a cohort of 1108 newly employed workers in several industries. Each worker completed a symptom questionnaire, a structured physical examination and nerve conduction study. For each hand, our CTS case definition required both median nerve conduction abnormality and symptoms classified as "classic" or "probable" on a hand diagram. We calculated the positive predictive values and likelihood ratios for physical examination manoeuvres in subjects with and without symptoms. The prevalence of CTS in our cohort was 1.2% for the right hand and 1.0% for the left hand. The likelihood ratios of a positive test for physical provocative tests ranged from 2.0 to 3.3, and those of a negative test from 0.3 to 0.9. The post-test probability of positive testing was study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first-level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings.

  17. An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal, India.

    Science.gov (United States)

    Gangopadhyay, Somnath; Chakrabarty, Sabarni; Sarkar, Krishnendu; Dev, Samrat; Das, Tamal; Banerjee, Sunetra

    2015-01-01

    Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery. The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS). The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS. Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group. Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS.

  18. Associations of cardiovascular risk factors, carotid intima-media thickness and manifest atherosclerotic vascular disease with carpal tunnel syndrome

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    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.

  19. Prevalence and Work-Relatedness of Carpal Tunnel Syndrome in the Working Population, United States, 2010 National Health Interview Survey

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    Luckhaupt, Sara E.; Dahlhamer, James M.; Ward, Brian W.; Sweeney, Marie H.; Sestito, John P.; Calvert, Geoffrey M.

    2015-01-01

    Background Patterns of prevalence and work-relatedness of carpal tunnel syndrome (CTS) among workers offer clues about risk factors and targets for prevention. Methods Data from an occupational health supplement to the 2010 National Health Interview Survey were used to estimate the prevalence of self-reported clinician-diagnosed CTS overall and by demographic characteristics. The proportion of these cases self-reported to have been attributed to work by clinicians was also examined overall and by demographic characteristics. In addition, the distribution of industry and occupation (I&O) categories to which work-related cases of CTS were attributed was compared to the distribution of I&O categories of employment among current/recent workers. Results Data were available for 27,157 adults, including 17,524 current/recent workers. The overall lifetime prevalence of clinician-diagnosed CTS among current/recent workers was 6.7%. The 12-month prevalence was 3.1%, representing approximately 4.8 million workers with current CTS; 67.1% of these cases were attributed to work by clinicians, with overrepresentation of certain I&O categories. Conclusions CTS affected almost 5 million U.S. workers in 2010, with prevalence varying by demographic characteristics and I&O. PMID:22495886

  20. An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal, India

    Science.gov (United States)

    Gangopadhyay, Somnath; Chakrabarty, Sabarni; Sarkar, Krishnendu; Dev, Samrat; Das, Tamal; Banerjee, Sunetra

    2015-01-01

    Background: Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery. Objectives: The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS). Methods: The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS. Results: Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group. Conclusions: Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS. PMID:25658674

  1. Association between the catechol-o-methyltransferase val158met polymorphism with susceptibility and severity of carpal tunnel syndrome

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    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. Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome

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    Kapellusch, Jay M.; Garg, Arun; Bao, Stephen S.; Silverstein, Barbara A.; Burt, Susan E.; Dale, Ann Marie; Evanoff, Bradley A.; Gerr, Frederic E.; Harris-Adamson, Carisa; Hegmann, Kurt T.; Merlino, Linda A.; Rempel, David M.

    2015-01-01

    Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure–response relationships for MSDs. The pooling process is difficult and time-consuming, and small methodological differences could lead to different exposure–response relationships. A subcommittee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed. PMID:23697792

  3. Pattern of severity on the basis of elecro-diagonostic studies in patients with carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Akhlaque, U.; Waheed, A.; Ali, W.L.; Afzal, S.

    2014-01-01

    To study the pattern of severity in patients with Carpal Tunnel Syndrome (CTS) presented at electro-diagnostic clinic at Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi. Study Design: Cross-sectional descriptive study. Place and Duration of study: Elctro-diagnostic Department of Armed Forces Institute of rehabilitation Medicine (AFIRM), Rawalpindi for 6 months from 1st July 2012 to 31st Dec 2012. Subjects and Methods: One hundred and fifty hands from 96 patients, both male and female were sampled according to inclusion criteria by non-probability purposive sampling. Never conduction studies (both motor and sensory studies) were performed using Xeltec electrodiagnostic machine. In patients with normal standard testing but with positive clinical features comparison testing was performed. Results were interpreted and graded according to severity. Results: Out of total 150 hands, 38 hands (25.3%) had minimal CTS, (20.7%) had mild, 56 (37.3%) had moderate, while 21 (14%) severe CTS. Four 2.7%) patients had extensive lesion. Out of all 96 patients 54 (56.25%) had bilateral disease and rest 42 (43.75%) had unilateral disease. Conclusion: The study showed that the most frequent grade at the time of presentation to electro diagnostic clinic is moderate followed by minimal. Since in a large fraction of symptomatic population standard tests were normal, comparison testing is important for early diagnosis. (author)

  4. [The cross-sectional area of the median nerve by sonography in the diagnosis of carpal tunnel syndrome].

    Science.gov (United States)

    Sabag-Ruiz, Enrique; Higuera-Lugo, Cirilo Omar; Ornelas-Aguirre, José Manuel; Gómez-Alcalá, Alejandro V

    2009-01-01

    To measure the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) level by sonography (S) in a Mexican population. A comparative cross-sectional design study with a nonprobabilistic sampling with 50 women and 50 men in good health were submitted for measuring MNCSA at the level of the CT. Other variables like sex; side and degree of daily hand activity were also studied. The analysis was made by descriptive statistics, and Mann-Whitney U or Kruskal-Wallis tests. The mean MNCSA was 0.063 +/- 0.015 cm(2), in women; in men it was 0.072 +/- 0.018 cm(2); the difference was significant (p right side and 0.060 cm(2) in the left (90th percentile for both hands of 0.084 cm(2)); in men, it was of 0.070 cm(2) in the right hand and of 0.069 cm(2) in the left (90th percentile for both hands of 0.097 cm(2)). The difference between women and men was significant in each side, but not between right and left hands (p = 0.21). There was no correlation between age and MNCSA on either side, or with hand activity. A MNCSA value of 0.1 cm(2) for men and 0.09 cm(2) for women is proposed as a standard parameter for the Mexican population.

  5. A comparison of data sources for the surveillance of work-related carpal tunnel syndrome in Massachusetts.

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    Davis, Letitia; Wellman, Helen; Hart, James; Cleary, Robert; Gardstein, Betsey M; Sciuchetti, Paul

    2004-09-01

    This study examined whether a state surveillance system for work-related carpal tunnel syndrome (WR-CTS) based on workers' compensation claims (Sentinel Event Notification System for Occupational Risks, SENSOR) and the Annual Survey of Occupational Injuries and Illnesses (SOII) identified the same industries, occupations, sources of injury, and populations for intervention. Trends in counts, rates, and female/male ratios of WR-CTS during 1994-1997, and age distributions were compared across three data sources: SENSOR, Massachusetts SOII, and National SOII. SENSOR and National SOII data on WR-CTS were compared by industry, occupation, and injury source. Due to small sample size and subsequent gaps in available information, state SOII data on WR-CTS were of little use in identifying specific industries and occupations for intervention. SENSOR and National SOII data on the frequency of WR-CTS cases identified many similar occupations and industries, and both surveillance systems pointed to computer use as a risk factor for WR-CTS. Some high rate industries identified by SENSOR were not identified using National SOII rates even when national findings were restricted to take into account the distribution of the Massachusetts workforce. Use of national SOII data on rates of WR-CTS for identifying state industry priorities for WR-CTS prevention should be undertaken with caution. Options for improving state SOII data and use of other state data systems should be pursued.

  6. Modeling the cost-benefit of nerve conduction studies in pre-employment screening for carpal tunnel syndrome.

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    Evanoff, Bradley; Kymes, Steve

    2010-06-01

    The aim of this study was to evaluate the costs associated with pre-employment nerve conduction testing as a screening tool for carpal tunnel syndrome (CTS) in the workplace. We used a Markov decision analysis model to compare the costs associated with a strategy of screening all prospective employees for CTS and not hiring those with abnormal nerve conduction, versus a strategy of not screening for CTS. The variables included in our model included employee turnover rate, the incidence of CTS, the prevalence of median nerve conduction abnormalities, the relative risk of developing CTS conferred by abnormal nerve conduction screening, the costs of pre-employment screening, and the worker's compensation costs to the employer for each case of CTS. In our base case, total employer costs for CTS from the perspective of the employer (cost of screening plus costs for workers' compensation associated with CTS) were higher when screening was used. Median costs per employee position over five years were US$503 for the screening strategy versus US$200 for a no-screening strategy. A sensitivity analysis showed that a strategy of screening was cost-beneficial from the perspective of the employer only under a few circumstances. Using Monte Carlo simulation varying all parameters, we found a 30% probability that screening would be cost-beneficial. A strategy of pre-employment screening for CTS should be carefully evaluated for yield and social consequences before being implemented. Our model suggests such screening is not appropriate for most employers.

  7. 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.

  8. Determining the effectiveness of various treatment modalities in carpal tunnel syndrome by ultrasonography and comparing ultrasonographic findings with other outcomes.

    Science.gov (United States)

    Soyupek, Feray; Yesildag, Ahmet; Kutluhan, Suleyman; Askin, Ayhan; Ozden, Ahmet; Uslusoy, Gokcen Ay; Demirci, Seden

    2012-10-01

    Firstly, we aimed to determine the effectiveness of various treatment modalities using ultrasonography (US), and secondly, we aimed to assess the correlations between the ultrasonographic findings and electrophysiological tests, symptom severity, functional status and physical findings. 74 hands of 47 patients with carpal tunnel syndrome (CTS) were randomly treated by applying wrist splinting alone in the neutral position (23 hands), phonophoresis with corticosteroid (PCS) (28 hands) and phonophoresis with non-steroid anti-inflamatory drug (PNSAI) (23 hands). The cross-sectional area (CSA) of the median nerve (MN) was determined by ultrasound on the initial and at the 3 months after treatment. MN conduction studies were performed on the initial visit and 3 months after treatment. The patients completed the Boston symptom severity questionnaire. For clinical evaluation, we used Phalen's and Tinel's signs. We could find reduction in CSA of MN in PCS group (P 0.05) and also between ultrasonographic parameters and BQ scores (P > 0.05). Although there was some improvement in clinical parameters, ultrasonographic parameters did not change in P-NSAI group. The most effective treatment modality was P-CS according to ultrasonographic and other findings. Although there were inverse correlations between the CSA of MN and sensory and motor MN conduction velocity, no relationship was found between symptom severity, functional status and US findings or electrophysiological studies.

  9. Topiramate-induced Neuropathy Mimicking Carpal Tunnel Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Jigar S. Gandhi

    2018-01-01

    Full Text Available Carpel tunnel syndrome (CTS is a condition in which median nerve compression results in paresthesias and pain in thewrist and hand. We are going to report a rare case of topiramate-induced neuropathy which clinically resembles CTS.Discontinuation of topiramate resulted in spontaneous resolution of numbness, paresthesia and pain in a few days. Highclinical suspicion is advised in patients who are on topiramate and present with signs of compressive neuropathy.

  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. Association Between Manual Loading and Newly Developed Carpal Tunnel Syndrome in Subjects With Physical Disabilities: A Follow-Up Study.

    Science.gov (United States)

    Lin, Yen-Nung; Chiu, Chun-Chieh; Huang, Shih-Wei; Hsu, Wen-Yen; Liou, Tsan-Hon; Chen, Yi-Wen; Chang, Kwang-Hwa

    2017-10-01

    To identify the association between body composition and newly developed carpal tunnel syndrome (CTS) and to search for the best probabilistic cutoff value of associated factors to predict subjects with physical disabilities developing new CTS. Longitudinal. University-affiliated medical center. Subjects with physical disabilities (N=47; mean age ± SD, 42.1±7.7y). Not applicable. Median and ulnar sensory nerve conduction velocity (SNCV) were measured at the initial and follow-up tests (interval >2y). Total and regional body composition were measured with dual-energy x-ray absorptiometry at the initial test. Leg lean tissue percentage was calculated to delineate each participant's manual loading degree during locomotion. Leg lean tissue percentage is the lean tissue mass of both legs divided by body weight. Based on median SNCV changes, we divided all participants into 3 groups: subjects with bilateral CTS (median SNCV value normative ulnar SNCV value >37.8m/s) in the initial test (n=10), subjects with newly developed CTS in the follow-up test (n=8), and subjects without additional CTS in the follow-up test (n=27). Eight of 35 subjects not having bilateral CTS initially developed new CTS (8.8% per year; mean follow-up period, 2.6y). Leg lean tissue percentage was associated with the probability of newly developed CTS (adjusted odds ratio, .64; P12% were less likely to have developed new CTS at the follow-up test (sensitivity, .75; specificity, .85; area under the curve, .88; Pphysical disabilities. Therefore, a preventive program for those subjects at risk can start early. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Organizational and psychosocial risk factors for carpal tunnel syndrome: a cross-sectional study of French workers.

    Science.gov (United States)

    Rigouin, Pascal; Ha, Catherine; Bodin, Julie; Le Manac'h, Audrey Petit; Descatha, Alexis; Goldberg, Marcel; Roquelaure, Yves

    2014-02-01

    The aim of the study was to examine the organizational and psychosocial risk factors for carpal tunnel syndrome (CTS) in workers exposed to various levels of work-related constraints, with a special focus on factors related to the work organization. From 3,710 workers, representative of a French region's working population, trained occupational physicians diagnosed a total of 156 cases of CTS between 2002 and 2005. Diagnoses were established by standardized physical examination, while personal factors and work exposure were assessed by self-administered questionnaires. Statistical associations between CTS and personal and work-related factors were analyzed for each gender using logistic regression modeling. Among the factors related to work organization, working with temporary workers was associated with CTS for women (OR = 1.99, 95 % CI 1.23-3.25), but not for men. Task rotation during the job (OR = 2.45 95 % CI 1.41-4.24) and work pace dependent on quantified targets (OR = 1.93 95 % CI 1.08-3.46) were associated with CTS only for men. The work-related psychosocial factors highlighted by the logistic modeling were high psychological demand for women (OR = 1.90, 95 % CI 1.17-3.09) and low skill discretion (OR = 1.77, 95 % CI 1.01-3.11) for men. This study has identified some psychosocial factors and factors related to work organization associated with clinically diagnosed and symptom-only cases of CTS as well as personal and biomechanical factors. However, due to the cross-sectional design of the study, no causal conclusion could be drawn and longitudinal studies are necessary to confirm these results.

  13. Pressure pain sensitivity topographical maps reveal bilateral hyperalgesia of the hands in patients with unilateral carpal tunnel syndrome.

    Science.gov (United States)

    Fernández-de-Las-Peñas, César; Madeleine, Pascal; Martínez-Perez, Almudena; Arendt-Nielsen, Lars; Jiménez-García, Rodrigo; Pareja, Juan A

    2010-08-01

    To assess topographical pressure pain sensitivity maps of the hand in patients with unilateral carpal tunnel syndrome (CTS) as compared with healthy subjects. A total of 20 women with CTS (ages 32-52 years) and 20 healthy matched women (ages 32-51 years) were recruited. Pressure pain thresholds (PPTs) were measured bilaterally over 30 locations of the palm of each hand by an assessor blinded to the subjects' conditions. Patients showed lower PPTs in both hands in all of the measurement points as compared with controls (P < 0.001 for all). PPTs were lower in those points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers (P < 0.001). CTS patients showed lower PPT levels in dermatomes C6, C7, and C8 when compared with healthy controls (P < 0.001 for all), but without differences between dermatomes (P = 0.4). PPT was negatively correlated with both hand pain intensity and duration of symptoms (P < 0.001 for all). Our findings revealed bilateral generalized pressure pain hyperalgesia in unilateral CTS because lower PPT levels were found in all of the points. The pressure pain hyperalgesia was not uniformly distributed since PPTs were lower in points over the proximal phalanx of the fingers and the thenar eminency as compared with those points located over the distal phalanx of the fingers. The decrease in PPT levels was associated with the intensity and the duration of the pain symptoms, supporting a role of both peripheral and central sensitization mechanisms in this pain condition.

  14. 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.

  15. Ultrasound-Guided Versus Landmark-Guided Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Babaei-Ghazani, Arash; Roomizadeh, Peyman; Forogh, Bijan; Moeini-Taba, Seyed-Mohammad; Abedini, Amin; Kadkhodaie, Mona; Jahanjoo, Fateme; Eftekharsadat, Bina

    2018-04-01

    To review the literature and assess the comparative effectiveness of ultrasound-guided versus landmark-guided local corticosteroid injections in patients with carpal tunnel syndrome (CTS). Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase (Ovid), and Web of Science (from inception to February 1, 2017). Randomized controlled trials (RCTs) comparing ultrasound-guided injection with landmark-guided injection in patients with CTS were included. Two authors independently screened abstracts and full texts. The outcomes of interest were Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores of the Boston Carpal Tunnel Questionnaire and 4 electrodiagnostic parameters, including compound muscle action potential (CMAP), sensory nerve action potential (SNAP), distal motor latency (DML), and distal sensory latency (DSL). Overall, 569 abstracts were retrieved and checked for eligibility; finally, 3 RCTs were included (181 injected hands). Pooled analysis showed that ultrasound-guided injection was more effective in SSS improvement (mean difference [MD], -.46; 95% confidence interval [CI], -.59 to -.32; P.99), DML (MD, .05; 95% CI, -.30 to .39; P=.80), or DSL (MD, .00; 95% CI, -.65 to .65; P>.99). This review suggested that ultrasound-guided injection was more effective than landmark-guided injection in symptom severity improvement in patients with CTS; however, no significant differences were observed in functional status or electrodiagnostic improvements between the 2 methods. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. [Prevalence and Co-prevalence of Complex Regional Pain Syndrome (CRPS) and Carpal Tunnel Syndrome (CTS) in Hand Rehabilitation].

    Science.gov (United States)

    Neubrech, F; Gentzsch, T; Kotsougiani, D; Bickert, B; Kneser, U; Harhaus, L

    2016-06-01

    In the current literature, there are reports of associations between complex regional pain syndromes (CRPS) and carpal tunnel syndromes (CTS). The aim of this study was to determine the prevalence of both disease patterns in hand rehabilitation patients and to investigate whether there is a correlation between CTS and CRPS. Furthermore, differences in the healing process of patients with and without additional CTS, and the effectiveness of the rehabilitative therapy for both diseases, were investigated. The computerised medical records of 791 patients in the years 2009-2015 who had been in hand rehabilitation were retrospectively analysed. At the beginning and end of rehabilitation, measurements were made of pain by visual analogue scales (VAS, 0-10), grip strength and finger mobility (mean distance from finger pulp to palmar D2-D5). The clinical course was statistically analysed. CRPS diagnosis was confirmed clinically by a pain therapist, CTS diagnosis was confirmed by neurological and neurophysiological examination. Surgical therapy was performed despite CRPS diagnosis. The prevalence of CRPS was 161/1000 and of CTS 62/1000; the co-prevalence of the 2 diagnoses was 24/1000 (pCRPS group, after a mean of 8 (1-21) weeks of rehabilitative therapy, mean pain was reduced from 5 (1-10) to 3 (0-9), grip strength improved from 10 (0-39)kg to 18.5 (2.5-45.5)kg and finger mobility increased from 2.9 (0-7.6)cm to 1.8 (0-7.8)cm. In the CRPS+CTS group, after a mean of 6.8 (3-23) weeks of rehabilitative therapy, mean pain was reduced from 5 (0-8) to 2.6 (0-5), grip strength improved from 9.7 (2.4-25.5)kg to 17.4 (0.9-47.4)kg and finger mobility increased from 2.7 (0-5.3)cm to 1.7 (0-5.3)cm. Improvement over the period of rehabilitation was significant in both groups, though the period of therapy was significantly shorter in the CRPS+CTS group. CRPS and CTS are often associated. Rehabilitative therapy was effective for CRPS- and CRPS+CTS patients. © Georg Thieme Verlag KG

  18. The effect of symptoms of carpal tunnel syndrome on ultrasonographic median nerve measures before and after wheelchair propulsion.

    Science.gov (United States)

    Impink, Bradley G; Collinger, Jennifer L; Boninger, Michael L

    2011-09-01

    To quantify median nerve characteristics before and after strenuous wheelchair propulsion and relate them to symptoms of carpal tunnel syndrome (CTS). We hypothesized that persons with and without symptoms of CTS would have significantly different nerve characteristics at baseline and after propulsion. A repeated-measures design was used to obtain ultrasound images of the median nerve at 3 levels of the wrist (radius, pisiform, and hamate) before and after wheelchair propulsion. Investigators were blinded to subject history related to CTS. The 2007 and 2008 National Veterans Wheelchair Games and the Human Engineering Research Laboratories. Fifty-four participants between the ages of 18 and 65 years with a nonprogressive disability who used a manual wheelchair as their primary means of mobility completed this study. Participants completed questionnaires regarding demographics and the presence and severity of symptoms of CTS. Ultrasound images of the median nerve were obtained before and after a 15-minute strenuous wheelchair-propulsion task. Baseline values and post-propulsion changes were determined for median nerve cross-sectional area, flattening ratio, and swelling ratio. Differences in median nerve variables between symptomatic and asymptomatic groups were assessed. No significant differences between symptom groups were identified at baseline; however, persons with symptoms of CTS showed a significantly different percent change from baseline compared with the asymptomatic participants for cross-sectional area at pisiform (P = .014) and flattening ratio at hamate (P = .022), and they showed a strong trend toward a difference in swelling ratio (P = .0502). For each of these variables, the change in the symptomatic group was in the opposite direction of the change in the asymptomatic group. We found several median nerve responses to wheelchair propulsion associated with symptoms of CTS. These responses occurred even though no baseline ultrasound difference was

  19. Is the Control of Applied Digital Forces During Natural Five-digit Grasping Affected by Carpal Tunnel Syndrome?

    Science.gov (United States)

    Chen, Po-Tsun; Jou, I-Ming; Lin, Chien-Ju; Chieh, Hsiao-Feng; Kuo, Li-Chieh; Su, Fong-Chin

    2015-07-01

    The impaired sensory function of the hand induced by carpal tunnel syndrome (CTS) is known to disturb dexterous manipulations. However, force control during daily grasping configuration among the five digits has not been a prominent focus of study. Because grasping is so important to normal function and use of a hand, it is important to understand how sensory changes in CTS affect the digit force of natural grasp. We therefore examined the altered patterns of digit forces applied during natural five-digit grasping in patients with CTS and compared them with those seen in control subjects without CTS. We hypothesized that the patients with CTS will grasp by applying larger forces with lowered pair correlations and more force variability of the involved digits than the control subjects. Specifically, we asked: (1) Is there a difference between patients with CTS and control subjects in applied force by digits during lift-hold-lower task? (2) Is there a difference in force correlation coefficient of the digit pairs? (3) Are there force variability differences during the holding phase? We evaluated 15 female patients with CTS and 15 control subjects matched for age, gender, and hand dominance. The applied radial forces (Fr) of the five digits were recorded by respective force transducers on a cylinder simulator during the lift-hold-lower task with natural grasping. The movement phases of the task were determined by a video-based motion capture system. The applied forces of the thumb in patients with CTS (7 ± 0.8 N; 95% CI, 7.2-7.4 N) versus control subjects (5 ± 0.8 N; 95% CI, 5.1-5.3 N) and the index finger in patients with CTS (3 ± 0.3 N; 95% CI, 3.2-3.3 N) versus control subjects (2 ± 0.3 N; 95% CI, 2.2-2.3 N) observed throughout most of the task were larger in the CTS group (p ranges 0.035-0.050 for thumb and 0.016-0.050 for index finger). In addition, the applied force of the middle finger in patients with CTS (1 ± 0.1 N; 95% CI, 1.3-1.4

  20. Carpal Tunnel Syndrome

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    ... OII) Timed Up & Go (TUG) Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) Young Investigators Resources for Doctoral Students/Post-Doctoral Fellows Evidence-Based Practice for Academic Researchers Responsible Data Management in Research Career Planning Treatments Patient ...

  1. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... stress, repeated use of vibrating hand tools, fluid retention during pregnancy or menopause, or the development of ... confined to people in a single industry or job, but is especially common in those performing assembly ...

  2. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... federal government website managed by the Office on Women's Health in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services . 200 Independence Avenue, S.W., Washington, DC 20201 1-800-994- ...

  3. Acute effect of topical menthol on chronic pain in slaughterhouse workers with carpal tunnel syndrome: triple-blind, randomized placebo-controlled trial

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus Due; Brandt, Mikkel

    2014-01-01

    Topical menthol gels are classified "topical analgesics" and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS). We screened 645 slaughterhouse workers and recruited 10...... participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze) or placebo (gel with a menthol scent) during the working day and 48 hours later the other treatment (crossover design). Participants rated arm/hand pain intensity during...... the last hour of work (scale 0-10) immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC) in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol (P = 0...

  4. Reliability and construct validity of the Spanish version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome.

    Science.gov (United States)

    Rosales, Roberto S; Martin-Hidalgo, Yolanda; Reboso-Morales, Luis; Atroshi, Isam

    2016-03-03

    The purpose of this study was to assess the reliability and construct validity of the Spanish version of the 6-item carpal tunnel syndrome (CTS) symptoms scale (CTS-6). In this cross-sectional study 40 patients diagnosed with CTS based on clinical and neurophysiologic criteria, completed the standard Spanish versions of the CTS-6 and the disabilities of the arm, shoulder and hand (QuickDASH) scales on two occasions with a 1-week interval. Internal-consistency reliability was assessed with the Cronbach alpha coefficient and test-retest reliability with the intraclass correlation coefficient, two way random effect model and absolute agreement definition (ICC2,1). Cross-sectional precision was analyzed with the Standard Error of the Measurement (SEM). Longitudinal precision for test-retest reliability coefficient was assessed with the Standard Error of the Measurement difference (SEMdiff) and the Minimal Detectable Change at 95 % confidence level (MDC95). For assessing construct validity it was hypothesized that the CTS-6 would have a strong positive correlation with the QuickDASH, analyzed with the Pearson correlation coefficient (r). The standard Spanish version of the CTS-6 presented a Cronbach alpha of 0.81 with a SEM of 0.3. Test-retest reliability showed an ICC of 0.85 with a SRMdiff of 0.36 and a MDC95 of 0.7. The correlation between CTS-6 and the QuickDASH was concordant with the a priori formulated construct hypothesis (r 0.69) CONCLUSIONS: The standard Spanish version of the 6-item CTS symptoms scale showed good internal consistency, test-retest reliability and construct validity for outcomes assessment in CTS. The CTS-6 will be useful to clinicians and researchers in Spanish speaking parts of the world. The use of standardized outcome measures across countries also will facilitate comparison of research results in carpal tunnel syndrome.

  5. Pain and Function Following Revision Cubital Tunnel Surgery.

    Science.gov (United States)

    Davidge, Kristen M; Ebersole, Gregory C; Mackinnon, Susan E

    2017-11-01

    The purpose of this study was to determine pain and functional outcomes following revision cubital tunnel surgery and to identify predictors of poor postoperative outcome. A retrospective cohort study was conducted of all patients undergoing revision cubital tunnel surgery over a 5-year period at a high-volume peripheral nerve center. Intraoperative findings, demographic and injury factors, and outcomes were reviewed. Average pain, worst pain, and impact of pain on self-perceived quality of life were each measured using a 10-cm visual analog scale (VAS). Function was evaluated using pinch and grip strength, as well as the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Differences in preoperative and postoperative pain, strength, and DASH were analyzed using nonparametric tests. Predictors of postoperative average pain were evaluated using odds ratios and linear regression analyses. The final cohort consisted of 50 patients (mean age: 46.3 ± 12.5 years; 29 [68%] male) undergoing 52 revision ulnar nerve transpositions (UNTs). Pain VAS scores decreased significantly following revision UNT. Strength and DASH scores demonstrated nonsignificant improvements postoperatively. Worse preoperative pain and greater than 1 prior cubital tunnel procedure were significant predictors of worse postoperative average pain VAS scores. Patients can and do improve following revision cubital tunnel surgery, particularly as it relates to pain. Intraoperative findings during the revision procedure suggest that adherence to specific principles in the primary operation is key to prevention of secondary cubital tunnel syndrome.

  6. Carpal instability

    International Nuclear Information System (INIS)

    Schmitt, R.; Froehner, S.; Coblenz, G.; Christopoulos, G.

    2006-01-01

    This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads (''dyskinetics'') or suffers from abnormal motion of its bones during movement (''dyskinematics''). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being ''occult'' for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the handsurgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis. (orig.)

  7. Kinesio taping in conservative treatment of mild-to-moderate cases of carpal tunnel syndrome = Kinesio taping w leczeniu zachowawczym łagodnego i umiarkowanego przebiegu zespołu cieśni nadgarstka

    Directory of Open Access Journals (Sweden)

    Janusz Kocjan

    2016-09-01

    SUMMARY             Carpal tunnel syndrome (CTS is the most common peripheral neuropathy. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of the study was to investigate the effect of kinesiotaping (KT on pain level, hand functional status, and carpal joint range of movement compared with that of „wait and see” group in mild-to-moderate cases of CTS. In this randomized study, 32 participants (38 hands of ages between 35-50 years with clinical and electrodiagnostic evidence of carpal tunnel syndrome were allocated into one of two groups: (1 experimental Kinesiotaping group (KG, tape applied with 40% tension from hand to medial epicondyle, and (2 Control Group („wait and see” - without tape applied. Following measures were used in the present study: BCTQ, DASH and VAS scale. In any of the groups reported no statistically significant improvement in the analyzed variables. In conclusion, there is no evidence on the efficacy of KT application for the treatment of CTS.

  8. The Strain Index (SI) and Threshold Limit Value (TLV) for Hand Activity Level (HAL): risk of carpal tunnel syndrome (CTS) in a prospective cohort.

    Science.gov (United States)

    Garg, A; Kapellusch, J; Hegmann, K; Wertsch, J; Merryweather, A; Deckow-Schaefer, G; Malloy, E J

    2012-01-01

    A cohort of 536 workers was enrolled from 10 diverse manufacturing facilities and was followed monthly for six years. Job physical exposures were individually measured. Worker demographics, medical history, psychosocial factors, current musculoskeletal disorders (MSDs) and nerve conduction studies (NCS) were obtained. Point and lifetime prevalence of carpal tunnel syndrome (CTS) at baseline (symptoms + abnormal NCS) were 10.3% and 19.8%. During follow-up, there were 35 new CTS cases (left, right or both hands). Factors predicting development of CTS included: job physical exposure (American conference of governmental industrial hygienists Threshold Limit Value (ACGIH TLV) for Hand Activity Level (HAL) and the Strain Index (SI)), age, BMI, other MSDs, inflammatory arthritis, gardening outside of work and feelings of depression. In the adjusted models, the TLV for HAL and the SI were both significant per unit increase in exposure with hazard ratios (HR) increasing up to a maximum of 5.4 (p = 0.05) and 5.3 (p = 0.03), respectively; however, similar to other reports, both suggested lower risk at higher exposures. Data suggest that the TLV for HAL and the SI are useful metrics for estimating exposure to biomechanical stressors. This study was conducted to determine how well the TLV for HAL and the SI predict risk of CTS using a prospective cohort design with survival analysis. Both the TLV for HAL and the SI were found to predict risk of CTS when adjusted for relevant covariates.

  9. Transforming growth factor-β (TGF-β) expression is increased in the subsynovial connective tissues of patients with idiopathic carpal tunnel syndrome.

    Science.gov (United States)

    Chikenji, Takako; Gingery, Anne; Zhao, Chunfeng; Passe, Sandra M; Ozasa, Yasuhiro; Larson, Dirk; An, Kai-Nan; Amadio, Peter C

    2014-01-01

    Non-inflammatory fibrosis of the subsynovial connective tissue (SSCT) is a hallmark of carpal tunnel syndrome (CTS). The etiology of this finding and its relationship to the development of CTS remain poorly understood. Recent studies have found that transforming growth factor-β (TGF-β) plays a central role in fibrosis. The purpose of this study was to investigate the expression of TGF-β and connective tissue growth factor (CTGF), a downstream mediator of TGF-β, in the pathogenesis of CTS. We compared SSCT specimens from 26 idiopathic CTS patients with specimens from 10 human cadaver controls with no previous diagnosis of CTS. Immunohistochemistry was performed to determine levels TGF-β1, CTGF, collagen 1(Col1) and collagen 3 (Col3) expression. TGF-β1 (p tissue. In addition, a strong positive correlation was found between TGF-β1 and CTGF, (R(2) = 0.80, p < 0.01) and a moderate positive correlation between Col3 and TGF-β1 (R(2) = 0.49, p < 0.01). These finding suggest that there is an increased expression of TGF-β and CTGF, a TGF-β regulated protein, and that this TGF-β activation may be responsible for SSCT fibrosis in CTS patients. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  10. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Emil Sundstrup

    2014-01-01

    Full Text Available Topical menthol gels are classified “topical analgesics” and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS. We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze or placebo (gel with a menthol scent during the working day and 48 hours later the other treatment (crossover design. Participants rated arm/hand pain intensity during the last hour of work (scale 0–10 immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol (P=0.026 and P=0.044, resp.. Pain intensity of the arm/hand decreased by −1.2 (CI 95%: −1.7 to −0.6 following topical menthol compared with placebo, corresponding to a moderate effect size of 0.63. In conclusion, topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain.

  11. Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery.

    Science.gov (United States)

    Zuhr, Otto; Rebele, Stephan F; Cheung, Stefani L; Hürzeler, Markus B

    2018-06-01

    Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Validity of F-wave minimal latency of median and ulnar nerves for diagnosis and severity assessment of carpal tunnel syndrome in type II diabetes mellitus

    International Nuclear Information System (INIS)

    Hussain, A.; Habib, S.S.; Omar, S.A.; Drees, M.A.

    2011-01-01

    Type II diabetes mellitus is a common problem and is sometimes associated with Carpal Tunnel Syndrome (CTS) due to compression of median nerve at wrist. Electrophysiological tests are frequently used for its diagnosis. In this work, F-wave minimal latency (FWML) difference between median and ulnar nerve and F-ratio is used to facilitate the diagnosis and severity of CTS in type II diabetes mellitus (T2DM). Methods: Thirty control cases were selected who were physically fit for normal electrophysiological values. Thirty-two patients with a long history of type II diabetes mellitus were studied for electro-diagnostic tests. All patients had clinical evidence of CTS. Among all diabetics about 20 cases had poor glycaemic control (HbA1c>7.5). F-wave minimal latency (FWML) were measured in median and ulnar nerves and F-ratio of median nerve were also noted. The mean values in different groups were compared using t-test and p greater or equal to 0.05 was considered significant. Results: In control group, the ulnar FWML was either equal or slightly longer that the median FWML value. In CTS group with type II diabetes mellitus the FWML value of median nerve were significantly longer than FWML of the ulnar nerve. Moreover, in uncontrolled diabetic patients the FWML values was very much longer than controlled group. Similarly the F-ratio of median nerve was significantly low. Conclusion: In addition to the specific criteria for CTS diagnosis, the parameters like FWML difference in median and ulnar nerve with reduced F-ratio of median nerve can be useful in establishing the diagnosis and severity of CTS in type II diabetes mellitus. (author)

  13. Bilateral deficits in fine motor control and pinch grip force are not associated with electrodiagnostic findings in women with carpal tunnel syndrome.

    Science.gov (United States)

    de la Llave-Rincón, Ana Isabel; Fernández-de-Las-Peñas, César; Pérez-de-Heredia-Torres, Marta; Martínez-Perez, Almudena; Valenza, Marie Carmen; Pareja, Juan A

    2011-06-01

    : The aim of this study was to analyze the differences in deficits in fine motor control and pinch grip force between patients with minimal, moderate/mild, or severe carpal tunnel syndrome (CTS) and healthy age- and hand dominance-matched controls. : A case-control study was conducted. The subtests of the Purdue Pegboard Test (one-hand and bilateral pin placements and assemblies) and pinch grip force between the thumb and the remaining four fingers of the hand were bilaterally evaluated in 66 women with minimal (n = 16), moderate (n = 16), or severe (n = 34) CTS and in 20 age- and hand-matched healthy women. The differences among the groups were analyzed using different mixed models of analysis of variance. : A two-way mixed analysis of variance revealed significant differences between groups, not depending on the presence of unilateral or bilateral symptoms (side), for the one-hand pin placement subtest: patients showed bilateral lower scores compared with controls (P < 0.001), without differences among those with minimal, moderate, or severe CTS (P = 0.946). The patients also exhibited lower scores in bilateral pin placement (P < 0.001) and assembly (P < 0.001) subtests, without differences among them. The three-way analysis of variance revealed significant differences among groups (P < 0.001) and fingers (P < 0.001), not depending on the presence of unilateral/bilateral symptoms (P = 0.684), for pinch grip force: patients showed bilateral lower pinch grip force in all fingers compared with healthy controls, without differences among those with minimal, moderate, or severe CTS. : The current study revealed similar bilateral deficits in fine motor control and pinch grip force in patients with minimal, moderate, or severe CTS, supporting that fine motor control deficits are a common feature of CTS not associated with electrodiagnostic findings.

  14. Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012.

    Science.gov (United States)

    Stocks, S Jill; McNamee, Roseanne; van der Molen, Henk F; Paris, Christophe; Urban, Pavel; Campo, Giuseppe; Sauni, Riitta; Martínez Jarreta, Begoña; Valenty, Madeleine; Godderis, Lode; Miedinger, David; Jacquetin, Pascal; Gravseth, Hans M; Bonneterre, Vincent; Telle-Lamberton, Maylis; Bensefa-Colas, Lynda; Faye, Serge; Mylle, Godewina; Wannag, Axel; Samant, Yogindra; Pal, Teake; Scholz-Odermatt, Stefan; Papale, Adriano; Schouteden, Martijn; Colosio, Claudio; Mattioli, Stefano; Agius, Raymond

    2015-04-01

    The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Kinesio taping in conservative treatment of mild-to-moderate cases of carpal tunnel syndrome = Kinesio taping w leczeniu zachowawczym łagodnego i umiarkowanego przebiegu zespołu cieśni nadgarstka

    OpenAIRE

    Kocjan, Janusz

    2016-01-01

    Kocjan Janusz. Kinesio taping in conservative treatment of mild-to-moderate cases of carpal tunnel syndrome = Kinesio taping w leczeniu zachowawczym łagodnego i umiarkowanego przebiegu zespołu cieśni nadgarstka. Journal of Education, Health and Sport. 2016;6(9):604-609. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.155060 http://ojs.ukw.edu.pl/index.php/johs/article/view/3886 The journal has had 7 points in Ministry of Science and Higher Education param...

  16. Racing performance of Standardbred trotting horses undergoing surgery of the carpal flexor sheath and age- and sex-matched control horses.

    Science.gov (United States)

    Carmalt, James L; Johansson, Bengt C; Zetterström, Sandra M; McOnie, Rebecca C

    2017-07-01

    OBJECTIVE To determine factors affecting race speed in Swedish Standardbred horses undergoing surgery of the carpal flexor sheath (CFS), to investigate whether preoperative racing speed was associated with specific intraoperative findings and whether horses returned to racing, and to compare the performance of horses undergoing surgery of the CFS with that of age- and sex-matched control horses. ANIMALS 149 Swedish Standardbred trotters undergoing surgery of the CFS and 274 age- and sex-matched control horses. PROCEDURES Medical records of CFS horses were examined. Racing data for CFS and control horses were retrieved from official online records. Generalizing estimating equations were used to examine overall and presurgery racing speeds and the association of preoperative clinical and intraoperative findings with preoperative and postoperative speeds. Multivariable regression analysis was used to examine career earnings and number of career races. Kaplan-Meier survival analysis was used to compare career longevity between CFS and control horses. RESULTS CFS horses were significantly faster than control horses. The CFS horses that raced before surgery were slower as they approached the surgery date, but race speed increased after surgery. There were 124 of 137 (90.5%) CFS horses that raced after surgery. No intrathecal pathological findings were significantly associated with preoperative racing speed. Career longevity did not differ between CFS and control horses. CONCLUSIONS AND CLINICAL RELEVANCE Horses undergoing surgery of the CFS had a good prognosis to return to racing after surgery. Racing careers of horses undergoing surgery of the CFS were not significantly different from racing careers of control horses.

  17. Construct validity, test-retest reliability and internal consistency of the Thai version of the disabilities of the arm, shoulder and hand questionnaire (DASH-TH) in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Buntragulpoontawee, Montana; Phutrit, Suphatha; Tongprasert, Siam; Wongpakaran, Tinakon; Khunachiva, Jeeranan

    2018-03-27

    This study evaluated additional psychometric properties of the Thai version of the disabilities of the arm, shoulder and hand questionnaire (DASH-TH) which included, test-retest reliability, construct validity, internal consistency of in patients with carpal tunnel syndrome. As for determining construct validity, the Thai EuroQOL questionnaire (EQ-5D-5L) was also administered in order to examine convergent and divergent validity. Fifty patients completed both questionnaires. The DASH-TH showed excellent test-retest reliability (intraclass correlation coefficient = 0.811) and internal consistency (Cronbach's alpha = 0.911). The exploratory factor analysis yielded a six-factor solution while the confirmatory factor analysis denoted that the hypothesized model adequately fit the data with a comparative fit index of 0.967 and a Tucker-Lewis index of 0.964. The related subscales between the DASH-TH and the Thai EQ-5D-5L were significantly correlated, indicating the DASH-TH's convergent and discriminant validity. The DASH-TH demonstrated good reliability, internal consistency construct validity, and multidimensionality, in assessing the upper extremity function in carpal tunnel syndrome patients.

  18. Effects of Carpal Tunnel Syndrome on adaptation of multi-digit forces to object mass distribution for whole-hand manipulation

    Directory of Open Access Journals (Sweden)

    Zhang Wei

    2012-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a compression neuropathy of the median nerve that results in sensorimotor deficits in the hand. Until recently, the effects of CTS on hand function have been studied using mostly two-digit grip tasks. The purpose of this study was to investigate the coordination of multi-digit forces as a function of object center of mass (CM during whole-hand grasping. Methods Fourteen CTS patients and age- and gender-matched controls were instructed to grasp, lift, hold, and release a grip device with five digits for seven consecutive lifts while maintaining its vertical orientation. The object CM was changed by adding a mass at different locations at the base of the object. We measured forces and torques exerted by each digit and object kinematics and analyzed modulation of these variables to object CM at object lift onset and during object hold. Our task requires a modulation of digit forces at and after object lift onset to generate a compensatory moment to counteract the external moment caused by the added mass and to minimize object tilt. Results We found that CTS patients learned to generate a compensatory moment and minimized object roll to the same extent as controls. However, controls fully exploited the available degrees of freedom (DoF in coordinating their multi-digit forces to generate a compensatory moment, i.e., digit normal forces, tangential forces, and the net center of pressure on the finger side of the device at object lift onset and during object hold. In contrast, patients modulated only one of these DoFs (the net center of pressure to object CM by modulating individual normal forces at object lift onset. During object hold, however, CTS patients were able to modulate digit tangential force distribution to object CM. Conclusions Our findings suggest that, although CTS did not affect patients’ ability to perform our manipulation task, it interfered with the modulation of specific grasp

  19. The Effectiveness of Limited Dynamic Wrist Splints on the Symptoms, Function, and Strength of Women with Carpal Tunnel Syndrome: A Controlled Trial Study

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    Seyedeh Marjan Jaladat

    2017-03-01

    Full Text Available Background: Splinting is the most common conservative method of treating patients with mild and moderate Carpal Tunnel Syndrome (CTS. The aim of this study was to determine the effectiveness of the limited dynamic wrist splint on the symptoms, function, and strength of women with CTS. In this controlled trial study, the subjects wore a splint of a new design called the “limited dynamic wrist splint”, which allowed the wrist motion in the range (between 15-degree flexion and 15-degree extension that exerts minimum pressure on the median nerve and prevents extra pressure on the nerve by limiting the range of motions out of the allowed range. Methods: In this study, 24 women diagnosed with mild to moderate CTS were initially evaluated on the basis of the Boston questionnaire, the dexterity test of the Purdue pegboard, grip and pinch strength, distal sensory latency, and sensory nerve conduction velocity. The subjects were randomly divided into two groups, control and treatment. Both groups received routine rehabilitation treatment for six weeks. The treatment group received the limited dynamic wrist splint for about six to eight hours a day. After six weeks, the initial examinations were repeated. The SPSS-16, independent t, and paired t-tests were used for data analysis. Results: All the variables in the treatment and the control groups showed improvement. The function test of the Boston questionnaire, the Purdue pegboard test, and the pinch strength were significantly improved in the treatment group. The “severity of the symptoms” test of the Boston questionnaire and the pinch strength in the control group showed a statistically significant difference (P < 0.05. In a comparison of the two groups, the function test of the Boston questionnaire showed a significant difference. Conclusion: This study showed that the use of the limited dynamic wrist splint for about six weeks for six to eight hours a day could have a significant effect on the

  20. Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study.

    Science.gov (United States)

    Mansiz Kaplan, Basak; Akyuz, Gulseren; Kokar, Serdar; Yagci, Ilker

    2018-02-17

    The aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). A single-blind randomized controlled study. Patients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. There were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05). Adding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS. Copyright © 2018 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  1. Carpal Tunnel Syndrome (For Kids)

    Science.gov (United States)

    ... and in people who play racquet sports, like tennis. Broken or dislocated wrist bones or even sprains ... to follow these rules while sitting: Hold your elbows at your sides with your wrists in front ...

  2. Axonal degeneration in association with carpal tunnel syndrome Degeneração axonal na síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Marcelo Ribeiro Caetano

    2003-03-01

    Full Text Available Median nerve entrapment in the palm to wrist segment is known as carpal tunnel syndrome (CTS. Electromyography is the best evaluation test to confirm the disease, as it shows a median reduced conduction velocity and/or conduction block; however, the usual CTS electrodiagnostic tests do not separate segmental demyelination alone from segmental demyelination plus secondary axonal degeneration. We studied 100 hands from CTS patients (classified as mild, moderate, and severe, and 50 hands from normal subjects. The median palmar sensory nerve action potential (SNAP amplitude was measured and compared between the two groups. It would be expected that SNAP was normal if no axonal degeneration had occurred. The results showed that in mild CTS group and part of moderate CTS group SNAP amplitude was normal, whereas in severe CTS group, and part of moderate group SNAP amplitude was reduced, proving that axonal degeneration was involved. As it is well stated that axonal lesions have worse prognosis than segmental demyelinating ones, this simple test may help to preditic the CTS outcome and treatment.A compressão do nervo mediano no segmento punho-palma produz uma entidade clínica conhecida como síndrome do túnel do carpo (STC. A eletroneuromiografia é o exame de escolha para o diagnóstico da STC, através da identificação de diminuição de velocidade e/ou bloqueio de condução quando estudamos a neurocondução do nervo mediano, no trecho do punho. Entretanto, as técnicas comumente usadas não conseguem separar a lesão em mielínica focal com ou sem degeneração axonal secundária. Avaliamos 100 mãos de pacientes com STC e comparamos com 50 mãos de um grupo controle. Medimos a amplitude do potencial de ação do nervo sensitivo do mediano, com estímulo na palma e captação no dedo, e comparamos entre os grupos controle e de pacientes (o grupo de STC foi subdividido em leve, moderado e grave. Era esperado que a amplitude do potencial

  3. Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures.

    Science.gov (United States)

    Martin, Jacob A; Mayhew, Christopher R; Morris, Amanda J; Bader, Angela M; Tsai, Mitchell H; Urman, Richard D

    2018-04-01

    Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a

  4. Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

    Science.gov (United States)

    Martin, Jacob A.; Mayhew, Christopher R.; Morris, Amanda J.; Bader, Angela M.; Tsai, Mitchell H.; Urman, Richard D.

    2018-01-01

    Background Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. Methods In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. Results We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. Conclusions TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re

  5. Usefulness of additional nerve conduction techniques in mild carpal tunnel syndrome Utilidade de técnicas adicionais de condução nervosa para o dignóstico de síndrome do túnel do carpo leve

    OpenAIRE

    João Aris Kouyoumdjian; Maria P. A. Morita; Amalia F. P. Molina

    2002-01-01

    This study was done to assess the percentage of abnormality in additional nerve conduction techniques after normal median distal latency (routine) in mild carpal tunnel syndrome (CTS). Bilateral nerve conduction studies were carried out in 116 consecutive symptomatic CTS patients (153 hands). Mild cases were based on normal routine (< 3.7 ms, peak-measured, 14 cm) and at least one technique abnormal of the following: sensory median-radial difference (MR); sensory median-ulnar difference (MU4)...

  6. 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.

  7. ABERRANT ABDUCTOR DIGITI MINIMI MUSCLE FOUND DURING OPEN SURGICAL DECOMPRESSION OF THE CARPAL TUNNEL: CASE REPORT. Músculo abductor digiti minimi aberrante hallado durante una cirugía abierta descompresiva del tunel carpiano: reporte de caso

    Directory of Open Access Journals (Sweden)

    Svetoslav A Slavchev

    2016-03-01

    Full Text Available En este artículo reportamos un caso interesante de músculo hipotenar aberrante encontrado durante una descompresión del túnel carpiano. La variante muscular surgía de la fascia antebraquial voloradial, y pasaba sobre la arteria y el nervio ulnar en el canal de Guyón, y se insertaba en la cara ulnar hipotenar. La tensión en el vientre muscular produjo ligera abducción de la quinta articulación metacarpofa-lángica, lo que confirmó que el músculo era abductor digiti minimi aberrante. Observamos asimismo las diferentes variaciones de este músculo y ponemos énfasis en su potencial implicancia clínica. Herein, we present an interesting case of an aberrant hypothenar muscle found during carpal tunnel decompression. The variant muscle arised from the voloradial antebrachial fascia and coursed over the ulnar artery and nerve in the Guyon canal, and inserted into the ulnar aspect of the hypothenar. Tension on the muscle belly provided slight abduction of the fifth metacarpophalangeal joint, which confirmed it to be an aberrant abductor digiti minimi muscle. We also discuss different variations of this muscle and emphasize its potential clinical implications.

  8. Dor e parestesias nos membros superiores e diagnóstico da síndrome do túnel do carpo Pain and numbness in the arms and hands and carpal tunnel syndrome diagnosis

    Directory of Open Access Journals (Sweden)

    Valéria Ribeiro Nogueira Barbosa

    2006-12-01

    Full Text Available Nós avaliamos a freqüência e localização de dor e parestesias em pacientes com síndrome do túnel do carpo (STC e em indivíduos da população geral, pareados por gênero e idade. Determinamos a sensibilidade e a especificidade desses sintomas para o diagnóstico de STC. Dor foi um sintoma comum nos dois grupos de pacientes. Parestesia ocorreu com mais freqüência em pacientes com STC (p75% quando são localizadas nas mãos.We studied the frequency and localization of pain and numbness in patients with carpal tunnel syndrome (CTS, in comparison with individuals of the general population, matched for sex and age, and we determined the sensitivity and the specificity of these symptoms for the CTS diagnosis. Pain was a common symptom in the two groups of patients. Numbness occurred more frequently in CTS group (p<0.05. In CTS patients, pain complaints were present in neck (42.8%, arms (36.8% and hands (82.8%. Among controls, pain was more common in head (11.4%, trunk (37.1%, legs (22.8%. In our casuistics, in relation to the CTS diagnosis, the presence of pain and numbness have low sensitivity and high specificity when they occur in the arms, and high sensitivity and specificity when they occur in the hands.

  9. Ultrasound assessment on selected peripheral nerve pathologies. Part I: Entrapment neuropathies of the upper limb – excluding carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Berta Kowalska

    2012-09-01

    Full Text Available Ultrasound (US is one of the methods for imaging entrapment neuropathies, post-trau‑ matic 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 assess‑ ment 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. Entrap‑ ment 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 tun‑ nel 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 Ultrasonog‑ raphy 2012; 12 (49: 120–163 – Normal and sonographic anatomy of selected peripheral nerves. Part I: Sonohistology and general principles of examination, following the exam‑ ple 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

  10. Is epineurectomy necessary in the surgical management of carpal ...

    African Journals Online (AJOL)

    2016-04-29

    Apr 29, 2016 ... Background: In this study, it was aimed to determine whether median nerve epineurectomy is beneficial in the surgical management of carpal tunnel syndrome (CTS). Materials and Methods: The study enrolled 72 patients including 34 patients without epineurectomy (Group A) and. 38 patients with ...

  11. Proximal tibial fracture following anterior cruciate ligament reconstruction surgery: a biomechanical analysis of the tibial tunnel as a stress riser.

    Science.gov (United States)

    Aldebeyan, Wassim; Liddell, Antony; Steffen, Thomas; Beckman, Lorne; Martineau, Paul A

    2017-08-01

    This is the first biomechanical study to examine the potential stress riser effect of the tibial tunnel or tunnels after ACL reconstruction surgery. In keeping with literature, the primary hypothesis tested in this study was that the tibial tunnel acts as a stress riser for fracture propagation. Secondary hypotheses were that the stress riser effect increases with the size of the tunnel (8 vs. 10 mm), the orientation of the tunnel [standard (STT) vs. modified transtibial (MTT)], and with the number of tunnels (1 vs. 2). Tibial tunnels simulating both single bundle hamstring graft (8 mm) and bone-patellar tendon-bone graft (10 mm) either STT or MTT position, as well as tunnels simulating double bundle (DB) ACL reconstruction (7, 6 mm), were drilled in fourth-generation saw bones. These five experimental groups and a control group consisting of native saw bones without tunnels were loaded to failure on a Materials Testing System to simulate tibial plateau fracture. There were no statistically significant differences in peak load to failure between any of the groups, including the control group. The fracture occurred through the tibial tunnel in 100 % of the MTT tunnels (8 and 10 mm) and 80 % of the DB tunnels specimens; however, the fractures never (0 %) occurred through the tibial tunnel of the standard tunnels (8 or 10 mm) (P = 0.032). In the biomechanical model, the tibial tunnel does not appear to be a stress riser for fracture propagation, despite suggestions to the contrary in the literature. Use of a standard, more vertical tunnel decreases the risk of ACL graft compromise in the event of a fracture. This may help to inform surgical decision making on ACL reconstruction technique.

  12. Ultrasonographic median nerve cross-section areas measured by 8-point 'inching test' for idiopathic carpal tunnel syndrome: a correlation of nerve conduction study severity and duration of clinical symptoms

    International Nuclear Information System (INIS)

    Chen, Shu-Fang; Lu, Cheng-Hsien; Huang, Chi-Ren; Chuang, Yao-Chung; Tsai, Nai-Wen; Chang, Chiung-Chih; Chang, Wen-Neng

    2011-01-01

    Incremental palmar stimulation of the median nerve sensory conduction at the wrist, the 'inching test', provides an assessment with reference to segments proximal and distal to the entrapment. This study used high-resolution ultrasonography (US) to measure the median nerve's cross-section areas (CSAs) like the 'inching test' and to correlate with the nerve conduction study (NCS) severity and duration of carpal tunnel syndrome (CTS). Two hundred and twelve (212) 'CTS-hands' from 135 CTS patients and 50 asymptomatic hands ('A-hands') from 25 control individuals were enrolled. The median nerve CSAs were measured at the 8-point marked as i4, i3, i2, i1, w, o1, o2, and 03 in inching test. The NCS severities were classified into six groups based on motor and sensory responses (i.e., negative, minimal, mild, moderate, severe, and extreme). Results of US studies were compared in terms of NCS severity and duration of clinical CTS symptoms. There was significantly larger CSA of the NCS negative group of 'CTS-hands' than of 'A-hands'. The cut-off values of the CSAs of the NCS negative CTS group were 12.5 mm 2 , 11.5 mm 2 and 10.1 mm 2 at the inlet, wrist crease, and outlet, respectively. Of the 212 'CTS-hands', 32 were NCS negative while 40 had minimal, 43 mild, 85 moderate, 10 severe, and two extreme NCS severities. The CSAs of 'CTS-hands' positively correlated with different NCS severities and with the duration of CTS symptoms. By duration of clinical symptoms, 12 of the 212 'CTS-hands' were in the 1 month group; 82 in >1 month and ≤12 months group, and 118 in >12 months group. In 'inching test', segments i4-i3 and i3-i2 were the most common 'positive-site'. The corresponding CSAs measured at i4 and i3, but not at i2, were significantly larger than those measured at points that were not 'positive-site'. Using the 8-point measurement of the median

  13. Carpal tunnel syndrome: age, nerve conduction severity and duration of symptomatology Síndrome do túnel do carpo: correlação de idade, anormalidade de condução nervosa e tempo de sintomatologia

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    JOAO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Median sensory and motor distal latencies (SDL/MDL were correlated with age and duration of symptomatology in 1498 carpal tunnel syndrome (CTS patients (17-90 years old, 87.6% female. Patients were distributed in four groups according to distal latencies severity. There was an increase in age as long as SDL/MDL became more severe, ranging from 47.5 to 67 years old (mild to severe-absence potentials in both hands groups, respectively. There was a less dramatic increase in duration of complaints as long as SDL/MDL became more severe, ranging from 12 to 30.7 months (mild to severe-absence potentials in both hands groups, respectively. Aging correlates more positively than duration of complaints with severity of SDL/MDL in CTS. The effects of increasing median blockage in CTS are more severe as long as patients become older regardless duration of symptomatology.Latências distais sensitivas e motoras (LDS/LDM do nervo mediano foram correlacionadas com idade e duração da sintomatologia em 1498 pacientes com síndrome do túnel do carpo (STC; a idade variou de 17 a 90 anos e 87,6% eram do sexo feminino. Os casos foram distribuídos em quatro grupos de acordo com a gravidade das latências distais. Houve aumento de idade proporcional ao aumento de LDS/LDM, variando de 47,5 a 67 anos nos grupos leve e grave-ausência de potenciais nas duas mãos, respectivamente. Houve aumento menos dramático na duração da sintomatologia proporcional ao aumento de LDS/LDM, variando de 12 a 30,7 meses nos grupos leve e grave-ausência de potenciais nas duas mãos, respectivamente. O aumento da idade correlaciona-se melhor que a duração da sintomatologia com o aumento de LDS/LDM. Os efeitos do aumento do bloqueio do nervo mediano no STC são mais graves com o avanço da idade, independentemente da duração da sintomatologia.

  14. Carpal tunnel syndrome in the elderly: nerve conduction parameters Síndrome do túnel do carpo em idosos: parâmetros de condução nervosa

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    Thiago Guimarães Naves

    2010-02-01

    Full Text Available OBJECTIVE: To establish nerve conduction parameters for carpal tunnel syndrome (CTS electrodiagnosis in the elderly. METHOD: Thirty healthy subjects (65-86 years, 9 male and 21 female, were studied. Routine median and ulnar sensory and motor nerve conduction studies, median mixed palmar latency, comparative latency techniques median to ulnar (sensory, mixed and motor lumbrical-interossei, median to radial (sensory, and combined sensory index (CSI were performed in both hands. RESULTS: The upper limits of normality (97.5% were: median sensory distal latency 3.80 ms (14 cm; median motor distal latency 4.30 ms (8 cm; median palmar latency 2.45 ms (8 cm; lumbrical-interossei latency difference 0.60 ms (8 cm; comparative median to radial 0.95 ms (10 cm; comparative median to ulnar 0.95 ms (14 cm; comparative palmar median to ulnar 0.50 ms (8 cm; and CSI 2.20 ms. Sensory and mixed latencies were measured at peak. CONCLUSION: Our results establish new nerve conduction parameters for mild CTS electrodiagnosis in the elderly and will be helpful to reduce the number of false positive cases in this age.OBJETIVO: Estabelecer parâmetros de condução nervosa para o eletrodiagnóstico da síndrome do túnel do carpo (STC em idosos. MÉTODO: Foram estudadas 30 pessoas idosas (65-86 anos saudáveis. Foi realizado estudo de condução nervosa sensitiva e motora rotineira dos nervos mediano e ulnar, latência palmar mista do mediano, técnicas de comparação de latências mediano-ulnar (sensitivo, misto e motor lumbrical-interósseo e mediano-radial (sensitivo e índice sensitivo combinado (ISC em ambas as mãos. RESULTADOS: Os limites superiores de normalidade, 97,5% foram: latência distal sensitiva do mediano 3,80 ms (14 cm; latência distal motora do mediano 4,30 ms (8 cm, latência palmar do mediano 2,45 ms (8 cm, diferença de latência lumbrical-interósseo 0,60 ms (8 cm, comparação mediano-radial 0,95 ms (10 cm, comparação mediano-ulnar 0,95 ms (14

  15. Comparative study between endoscopic technique by a proximal port and mini palmary incision in the surgical treatment of carpal tunnel syndrome Estudo comparativo entre a técnica endoscópica pelo portal proximal e a técnica de mini-incisão palmar no tratamento cirúrgico da síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Eduardo A.R. Pereira

    2003-01-01

    Full Text Available The authors present a prospective study comparing two surgical techniques for carpal tunnel release. A minimal - incision open decompression(3 is compared with an endoscopic release(2, that utilizes only a single proximal portal. There were operated on, 28 wrists in 28 patients, with clinical signs and EMG changes consistent on idiopathic carpal tunnel syndrome, that failed under previous conservative treatment. They were randomized into two groups , undertaken surgical treatment, either by endoscopic release or by open decompression. Grip strength (measured by dynamometric, sensitivity (measured by Semmes-Weinstein monofilaments, presence of pain and paresthesia, date of return to activities of daily living and complications were evaluated pre-operative and at 1, 2, 4, 6, 12 weeks after surgery. After 12 months average follow up, the results indicated that this proximal portal endoscopic technique can be safely performed, showing advantages over open conventional method, in terms of sooner return of grip strength, date of return to activities of daily living, and less incidence of pillar pain. No differences in paresthesia resolution, sensibility improvement or complications incidence were found.Os autores apresentam estudo prospectivo onde comparam duas técnicas cirúrgicas empregadas no tratamento de pacientes acometidos pela síndrome do túnel do carpo. A técnica de descompressão por via aberta, através de mini-incisão palmar(3, é analisada em relação à técnica por via endoscópica, descrita por Agee et al.(2, que utiliza apenas um único portal proximal. Foram operados, de forma randomizada, 28 punhos em 28 pacientes com o diagnóstico clínico e eletromiográfico de síndrome do túnel do carpo idiopático, e que não obtiveram melhora com o tratamento conservador prévio. Os seguintes parâmetros, foram analisados no pré-operatório e na primeira, segunda, quarta, sexta e décima segunda semanas de pós-operatório: força de

  16. Arthroscopic removal of discrete palmar carpal osteochondral fragments in horses: 25 cases (1999-2013).

    Science.gov (United States)

    Lang, Hayley M; Nixon, Alan J

    2015-05-01

    To characterize discrete palmar carpal osteochondral fragmentation in horses and to document the effect of osteoarthritis and surgical removal of these fragments on functional outcome. Retrospective case series. 25 horses. Medical records and radiographic views were reviewed to identify horses that had radiographic evidence of palmar carpal fragmentation, which was subsequently treated by arthroscopic removal. Information collected included cause of fracture, initial and long-term clinical and radiographic findings, and functional outcome. Palmar carpal fragmentation of 30 carpal bones was identified in 25 unilaterally affected horses. A known traumatic event was reported to cause the fragmentation in 17 of the 25 (68%) horses. Of the 25 horses, 17 (68%) had fragmentation involving the antebrachiocarpal joint, 7 (28%) had fragmentation involving the middle carpal joint, and 1 (4%) had fragmentation involving the carpometacarpal joint. The proximal aspect of the radial carpal bone was the most commonly affected site (12/30 fragments), followed by the accessory carpal bone (6/30). Of the 25 horses, 19 (76%) were not lame (sound) after surgery and returned to their intended use, 4 (16%) were considered pasture sound, and 2 were euthanized (because of severe postoperative osteoarthritis or long bone fracture during recovery from anesthesia). Eight of the 14 horses with preoperative evidence of osteoarthritis returned to function after surgery. Twelve of 17 horses with antebrachiocarpal joint fragments and 6 of 7 horses with middle carpal joint fragments returned to their previous use. Results indicated that the prognosis for horses after arthroscopic removal of palmar carpal osteochondral fragments is good. Early intervention, before the development of osteoarthritis, is recommended.

  17. Essential hand surgery procedures for mastery by graduating plastic surgery residents: a survey of program directors.

    Science.gov (United States)

    Noland, Shelley S; Fischer, Lauren H; Lee, Gordon K; Friedrich, Jeffrey B; Hentz, Vincent R

    2013-12-01

    This study was designed to establish the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. This framework can then be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach technical skills in hand surgery. Ten expert hand surgeons were surveyed regarding the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. The top 10 procedures from this survey were then used to survey all 89 Accreditation Council for Graduate Medical Education-approved plastic surgery program directors. There was a 69 percent response rate to the program director survey (n = 61). The top nine hand surgery procedures included open carpal tunnel release, open A1 pulley release, digital nerve repair with microscope, closed reduction and percutaneous pinning of metacarpal fracture, excision of dorsal or volar ganglion, zone II flexor tendon repair with multistrand technique, incision and drainage of the flexor tendon sheath for flexor tenosynovitis, flexor tendon sheath steroid injection, and open cubital tunnel release. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method for accomplishing this task. There has been no consensus regarding which hand surgery procedures should be mastered by graduating plastic surgery residents. The authors have identified nine procedures that are overwhelmingly supported by plastic surgery program directors. These nine procedures can be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach and document technical skills in hand surgery.

  18. Luxation of the radial carpal bone in a cat

    International Nuclear Information System (INIS)

    Pitcher, G.D.C.

    1996-01-01

    A case of radial carpal bone luxation in the cat and its management is described. Open reduction was performed and surgically maintained, in combination with repair of rupture of the short radial collateral ligament and joint capsule. The carpus was supported for one month following surgery by application of transarticular external fixation. Four months after treatment the cat was sound, despite evidence of degenerative joint disease. The mechanism of luxation appears to be analogous to that seen in the dog

  19. Carpal conformation in relation to carpal chip fracture

    International Nuclear Information System (INIS)

    Barr, A.R.S.

    1994-01-01

    An objective radiological method of assessing the degree to which horses are conformationally 'back at the knee' (hyper-extended) is described. The effects on the measurements of variations in the direction of the incident X-ray beam and variations in weight bearing by the horse were assessed. A change from a lateromedial projection towards a plamaro-lateral-dorsomedial oblique projection consistently tended to reduce the observed degree of hyperextension of the carpus. Raising the contralateral limb to increase the load on the carpus had little effect on the measurements. The carpi of 21 thoroughbred racehorses with carpal chip fractures were not significantly more hyperextended than those of 10 thoroughbred racehorses with normal carpi. Back at the knee conformation was unlikely to have played a major role in the aetiopathogenesis of the carpal injuries

  20. Didatic approach of ultrasonographic examination for evaluation of the carpal joint in horses

    Directory of Open Access Journals (Sweden)

    Maria Cristina Ferrarini Nunes Soares Hage

    2017-11-01

    Full Text Available ABSTRACT: The carpus is a complex articulation, which is often involved in injuries in equine athletes. The objective of this study was to suggest a didactic approach for ultrasonography training for the examination of the carpal joint in horses. Ultrasonograhy examination was performed in a healthy 14-year-old horse. The images were compared with those of a dissected anatomic specimen of the carpal region of a senior horse and with those reported in the literature. Identifiable structures were as follows: (dorsal tendon of the muscle extensor carpi radialis, tendon of the muscle extensor carpi obliquus, tendon of the muscle commom digital extensor, dorsal synovial outpouchings, joint capsule and fat cushion, (lateral tendon of the muscle lateral digital extensor, lateral collateral ligament (deep and superficial components, (medial medial collateral ligament (deep and superficial components and (palmar palmar intercarpal ligament, carpal sheath, carpal tunnel, superficial digital flexor tendon, proximal origin of the deep digital flexor tendon, and palmar carpal ligament. Prior knowledge of the anatomy in combination with the study of anatomical specimens is essential for recognizing musculoskeletal structures during ultrasound examination, contributing to the training and learning processes.

  1. Valoración clínica y neurofisiológica del tratamiento rehabilitador en pacientes con síndrome del túnel carpiano Clinical and neurophysiological evaluation of the rehabilitation treatment in patients with carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    María Julia Rodríguez Nápoles

    2013-01-01

    Full Text Available Se realizó un ensayo clinicoterapéutico, multicéntrico, de fase III, en 42 pacientes con síndrome del túnel carpiano, atendidos en los servicios de rehabilitación integral de los policlínicos "30 de Noviembre" y "Josué País García" de Santiago de Cuba, desde junio de 2009 hasta igual mes de 2010, para evaluar la efectividad del tratamiento rehabilitador. Los integrantes de la casuística fueron asignados aleatoriamente a 2 grupos: los que recibieron laserterapia (grupo de estudio y los tratados con terapia medicamentosa y postural (grupo control. Se aplicó la prueba de Ji al cuadrado (pA clinical and therapeutic multicentric phase III trial was carried out in 42 patients with carpal tunnel syndrome, assisted in the comprehensive rehabilitation services of "30 de Noviembre" and "Josué País García" polyclinics in Santiago de Cuba, from June, 2009 to the same month of 2010, to evaluate the effectiveness of the rehabilitation treatment. The members of the case material were randomly assigned to 2 groups: those who received laser therapy (study group and those treated with drug and postural therapy (control group. Chi-square test was applied (p<0.05 and the percentage was used as summary measure. Female sex and the age group 50-59 years prevailed in the series. After the procedure, the analgesia was achieved in 33.3 % of the affected patients. In the first group there was electrophysiological variation toward the chronic neurogenic pattern (47.0 %, with improvement in the magnitude of nervous compromise, and the final results were partially optimal (26.2 %, so that the rehabilitation treatment was effective (42.9 %. It was concluded that the physiotherapy can progressively modify clinical and neurophysiological parameters in those presenting this disorder.

  2. Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Mahmud Ahmad Ismail Mahmud

    2006-06-01

    Full Text Available O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm e o parâmetro eletrofisiológico em 38 pacientes com sintomas da síndrome do túnel do carpo (STC, submetidos a estudos de condução nervosa (ECN. As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN e parâmetros dos ECN, dividindo-se os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e com alteração eletrofisiológica grave. Correlação significante entre TNAm e parâmetros dos ECN foram encontrados (pThe purpose of this study was to evaluate, through a series of cases, the relationship between the adverse neural tension of median nerve (ANTm and the electrophysiological involvement in 38 patients with symptoms of the carpal tunnel syndrome (CTS, submitted to nerve conduction studies (NCS. The main measures had been ANTm (in degrees obtained through the test of neural tension provocation (TNTP and parameters of the NCS, divided into three groups: normal, without severe electrophysiological alteration and with severe electrophysiological alteration. Significant correlations were found between ANTm and parameters of the NCS (p<0.05, as well as between ANTm and the three groups defined by the electrophysiologic alteration (r s=+0.437, p=0.002. The TNAm values were significantly higher in the arms with electrophysiologic diagnoses (p=0.007. It is suggested that the ANTm does have a participation in the physiopathology of the CTS, and the useof therapeutical procedures that diminish the development of neural tension.

  3. Partial carpal arthrodesis for multiple carpal fractures and subluxation in a pony

    International Nuclear Information System (INIS)

    Barr, A.R.S.; Hillyer, M.H.; Richardson, J.D.

    1994-01-01

    Carpal fractures in horses may occur as a result of external trauma or during athletic activity. The management of individual carpal fractures has received considerable attention in the equine orthopaedic literature (Ordidge 1980; Mcllwraith et a/. 1987; Martin et a/. 1988; Schneider et a/. 1988; Barr et a/. 1990). However, there are relatively few reports on the management of multiple carpal injuries by either primary reconstruction or arthrodesis procedures (Auer et a/. 1986; Bertone et a/. 1989). This report documents the treatment of a pony with a complex traumatic carpometacarpal injury by partial carpal arthrodesis

  4. Avaliação do questionário de Boston aplicado no pós-operatório tardio da síndrome do tunel do carpo operados pela técnica de retinaculótomo de paine por via palmar Evaluation of Boston questionnaire applied at late pos-operative period of carpal tunnel syndrome operated with the paine retinaculatome through palmar port

    Directory of Open Access Journals (Sweden)

    Lia Miyamoto Meirelles

    2006-01-01

    Full Text Available Entre os anos de 1995 e 1998, foram realizadas 112 cirurgias para tratamento da Síndrome do Túnel do Carpo (STC pela técnica de incisão palmar e utilização do retináculo de Paine. Com o objetivo de avaliar os resultados em longo prazo, os pacientes foram convocados. Houve o retorno de 44 pacientes. Deste total, três pacientes, por terem doenças associadas, foram excluídos, resultando, um total de 53 mãos analisadas. Apresentaremos os resultados da avaliação subjetiva, obtidos através da aplicação de um teste de auto-avaliação chamado de questionário de Boston. Este questionário consiste em perguntas que avaliam a gravidade dos sintomas e o estado funcional no momento da aplicação do mesmo. Através da aplicação do referido questionário encontramos um escore de 1,41 ± 0,57 para gravidade dos sintomas e 1,59 ± 0,93 para o estado funcional. Como este questionário não foi aplicado no pré-operatório deste grupo de pacientes analisados, comparou-se a pontuação obtida com as encontradas na literatura pertinente. Os resultados obtidos demonstraram que as pontuações pós-operatórias são similares àquelas existentes na literatura, mesmo sendo referidas a tempos diferentes de seguimento pós-operatórios, concluindo que havendo uma melhora dos sintomas, o questionário de Boston é sensível a esta mudança clínica.Between the years of 1995 and 1998, 112 surgeries were performed for treating Carpal Tunnel Syndrome (CTS using the technique of palmar incision employing the Paine retinaculum. With the objective of analyzing results in the long-term, the patients were called for review. Forty four patients returned. From these, three patients were excluded due to associated diseases, thus resulting in a total of 53 hands assessed. Here we present the results of the subjective evaluation achieved by applying a self-assessment test called Boston questionnaire. This questionnaire consists of questions evaluating symptoms

  5. Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment

    Science.gov (United States)

    Hunter, Barbara; Duesterdieck-Zellmer, Katja F.; Huber, Michael J.; Parker, Jill E.; Semevolos, Stacy A.

    2014-01-01

    This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery. PMID:25477542

  6. Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

    Science.gov (United States)

    Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

    2009-08-01

    Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

  7. Carpal tunnel syndrome: treatment with small transverse incision Utilização de técnica de incisão transversal mínima no tratamento da síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Paulo Roland Kaleff

    2010-02-01

    Full Text Available OBJECTIVE: To evaluate the application of a limited transverse incision technique to treat the carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the flexor retinaculum (FR. METHOD: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively. RESULTS: No major complications were observed. Two cases presented small local hematoma. One patient presented with transient neuropraxia of digital branch. In two of the first five cases, incomplete FR opening was identified during endoscopic revision with need of complementary opening. All patients reported relief of paresthesias and nocturnal pain symptoms. CONCLUSION: The technique was safely performed on the prospection group, no major complications were detected and the opening of FR was observed in the majority of the patients.OBJETIVO: Avaliação de técnica de incisão limitada no tratamento da síndrome do túnel do carpo, quanto à segurança clínica e efetividade na abertura do Retináculo Flexor (RF. MÉTODO: Estudo prospectivo de trinta procedimentos realizados em vinte e oito pacientes submetidos a técnica com incisão transversa mínima. A segurança da técnica e a abertura total do RF foram avaliadas através de questionário baseado em observações clinicas e inspeção endoscópica, respectivamente. RESULTADOS: Não foram observadas complicações maiores. Um único paciente apresentou neuropraxia de nervo interdigital. Dois pacientes apresentaram hematoma local pequeno. Em dois dos cinco primeiros casos observou-se uma abertura incompleta do RF, sendo necessária abertura complementar. Todos os pacientes apresentaram melhora do quadro clínico de dor noturna e parestesias. CONCLUSÃO: A técnica foi executada com segurança no grupo analisado, sem a ocorrência de

  8. Cooling modifies mixed median and ulnar palmar studies in carpal tunnel syndrome Influência do resfriamento nos parâmetros de condução nervosa mista do mediano e ulnar na síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    Rogério Gayer Machado de Araújo

    2007-09-01

    Full Text Available Temperature is an important and common variable that modifies nerve conduction study parameters in practice. Here we compare the effect of cooling on the mixed palmar median to ulnar negative peak-latency difference (PMU in electrodiagnosis of carpal tunnel syndrome (CTS. Controls were 22 subjects (19 women, mean age 42.1 years, 44 hands. Patients were diagnosed with mild symptomatic CTS (25 women, mean age 46.6 years, 34 hands. PMU was obtained at the usual temperature, >32°C, and after wrist/hand cooling to Temperatura é uma variável comum e importante que modifica os parâmetros de condução nervosa na prática eletrodiagnóstica. Neste trabalho nós estudamos o efeito do esfriamento na diferença de latências palmares entre o nervo mediano e ulnar (PMU, segmento palma-pulso, utilizada rotineiramente para o eletrodiagnóstico da síndrome do túnel do carpo (STC. Foram estudados 22 controles (19 mulheres, média de idade 42,1 anos, 44 mãos e 25 pacientes (25 mulheres, média de idade 46,6 anos, 34 mãos com diagnóstico de STC leve. PMU foi obtida em temperatura usual (>32°C, e após resfriamento de mão/pulso em água com gelo (<27°C. Após o resfriamento houve aumento significativo na PMU e na latência mista palmar do nervo ulnar nos pacientes quando comparados aos controles. Nós concluímos que o resfriamento modifica significativamente a PMU e propomos que as latências obtidas em nervos submetidos à compressão reagem de maneira mais acentuada ao frio e isso poderia ser uma arma útil para o eletrodiagnóstico da STC incipiente. Da mesma forma, houve reação mais acentuada ao frio no estudo da latência mista palmar do nervo ulnar nos pacientes mas não nos controles, que poderia levantar a hipótese de compressão subclínica do nervo ulnar.

  9. Usefulness of additional nerve conduction techniques in mild carpal tunnel syndrome Utilidade de técnicas adicionais de condução nervosa para o dignóstico de síndrome do túnel do carpo leve

    Directory of Open Access Journals (Sweden)

    João Aris Kouyoumdjian

    2002-12-01

    Full Text Available This study was done to assess the percentage of abnormality in additional nerve conduction techniques after normal median distal latency (routine in mild carpal tunnel syndrome (CTS. Bilateral nerve conduction studies were carried out in 116 consecutive symptomatic CTS patients (153 hands. Mild cases were based on normal routine (Este estudo foi realizado para avaliação da percentagem de anormalidade de técnicas adicionais de condução nervosa no síndrome do túnel do carpo (STC leve quando o valor de latência distal sensitiva do nervo mediano (rotina está dentro dos limites normais. Condução nervosa bilateral foi realizada em 116 pacientes consecutivos com STC sintomático (153 mãos. A seleção foi feita baseada na rotina normal (< 3,7 ms, medida no pico, 14 cm e, pelo menos uma técnica anormal entre as seguintes: diferença sensitiva mediano-radial (MR; diferença sensitiva mediano-ulnar (MU4; diferença mediano-ulnar palmar (MUP; latência palmar do mediano (PW; e latência distal motora do mediano (MDL. Os valores normais da rotina foram separados em grupos desde 3,1 até 3,6 ms (< 3,7 ms, obtendo-se valores anormais entre 86,6 e 93,4% (MR, 40 e 81.7% (MU4, 20 e 71,2% (MUP, 0 e 41,1% (PW e 0 e 19,6% (MDL. A associação anormal mais frequente foi MR com MU4 em 90,1%, seguido de MR com MUP e MU4 com MUP. A técnica adicional isolada anormal mais frequente foi MR seguida de MU4 e MUP. O percentual de anormalidade da técnica MR foi muito elevada, independentemente do valor de corte na condução rotina (3,1 a 3,6 ms.

  10. Laserterapia de baixa intensidade no pós-operatório da síndrome do túnel do carpo Low-level laser therapy after carpal tunnel release

    Directory of Open Access Journals (Sweden)

    Marcelo de Pinho Teixeira Alves

    2011-01-01

    from treatment was 3.6 months in both groups, and fewer patients had postoperative complaints in Group 1 than in Group 2. At the end of the treatment, in Group 1, 29.41% of the patients presented electromyographic abnormalities, while in Group 2, 63.64% of the patients had abnormalities, after six months. CONCLUSION: This was an initial study on adjuvant therapy using postoperative LLLT on CTS. The method presented was sufficient for postoperative evaluation of the patients in this study. Patients undergoing LLLT after surgery for CTS were benefited and had better functional outcomes than shown by the control group. The technique was effective and did not have any adverse effects on the patients studied.

  11. The use of small (2.7 mm) screws for arthroscopically guided repair of carpal chip fractures.

    Science.gov (United States)

    Wright, I M; Smith, M R W

    2011-05-01

    Removal of large chip fractures of the carpal bones and the osteochondral deficits that result, have been associated with a worse prognosis than removal of small fragments in similar locations. Reducing the articular defects by repair of large osteochondral fragments may have advantages over removal. Horses with osteochondral chip fractures that were of sufficient size and infrastructure to be repaired with small (2.7 mm diameter) AO/ASIF cortex screws were identified and repair effected by arthroscopically guided internal fixation. Thirty-three horses underwent surgery to repair 35 fractures of the dorsodistal radial carpal bone (n = 25), the dorsal margin of the radial facet of the third carpal bone (n = 9) and the intermediate facet of the distal radius (n = 1). There were no surgical complications and fractures healed satisfactorily in 26 of 28 horses and 23 horses returned to racing performance. Arthroscopically guided repair of carpal chip fractures with small diameter cortex screws is technically feasible and experiences with 33 cases suggest that this may have advantages over fragment removal in managing such cases. Surgeons treating horses with large chip fractures of the carpal bones should consider arthroscopically guided internal fixation as an alternative to removal. © 2010 EVJ Ltd.

  12. Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage.

    Science.gov (United States)

    Van der Bracht, H; Verhelst, L; Stuyts, B; Page, B; Bellemans, J; Verdonk, P

    2014-05-01

    To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel. A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45% of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45°. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang. A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang.

  13. The second lumbrical-interossei latency difference in carpal tunnel ...

    African Journals Online (AJOL)

    All were subjected to routine median motor nerve conduction study with stimulation at midpalm, wrist and elbow, median-versus-radial sensory comparison study and Second lumbrical-versus-interosseus (2L-INT) motor comparison study. Results: The results showed that the most sensitive tests were the median-radial ...

  14. The second lumbrical-interossei latency difference in carpal tunnel ...

    African Journals Online (AJOL)

    Eman A. Tawfik

    2012-12-06

    Dec 6, 2012 ... All were subjected to routine median motor nerve con- duction study with ... The ability to confirm the diagnosis of CTS using electrodi- agnostic ... obesity6. These factors along with the influence of systemic dis- ease are well ...

  15. Second carpal bone slab fracture and subluxation of the middle carpal joint in a horse subsequent to arthrodesis of the carpometacarpal joint.

    Science.gov (United States)

    MacKay, Angela V; Panizzi, Luca; Sparks, Holly D; Barber, Spencer M

    2015-02-01

    To report complications of arthrodesis of the carpometacarpal (CMC) joint using a drilling technique in an adult horse. Case report. Horse (n = 1). A 12-year-old Quarter Horse mare with CMC osteoarthritis (CMC-OA) had arthrodesis under general anesthesia in right lateral recumbency. Under fluoroscopic guidance, a 4.5 mm drill bit was inserted at 3 drilling sites 5-6 cm into the CMC joint and was fanned 30-45° in the plane of the joint and 5-10° in the long axis of the limb to destroy articular cartilage and expose the subchondral bone. The horse presented 2 weeks after surgery for severe lameness of the operated limb. A slab fracture of the 2nd carpal bone (C2) and subluxation of the middle carpal (MC) joint was diagnosed. The horse was humanely euthanatized due to poor prognosis. The fanning technique of arthrodesis of the CMC joint may lead to fracture of carpal bones, joint instability, and MC joint subluxation. A balance between articular surface destruction and maintenance of joint stability should be achieved when using this technique. © Copyright 2014 by The American College of Veterinary Surgeons.

  16. Carpal ligamentous laxity with bilateral perilunate dislocation in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Pennes, D R; Braunstein, E M; Shirazi, K K

    1985-01-01

    A case of persistent bilateral perilunate dislocation unrelated to trauma in a patient with Marfan syndrome is discussed. This finding is believed to be a manifestation of the generalized ligamentous laxity occurring in this disorder. Radiographs of eight additional Marfan syndrome patients failed to demonstrate similar carpal instability. Because some carpal derangements are dynamic events, stress views or wrist fluoroscopy may be necessary to demonstrate unsuspected carpal instability in Marfan patients.

  17. Carpal ligamentous laxity with bilateral perilunate dislocation in Marfan syndrome

    International Nuclear Information System (INIS)

    Pennes, D.R.; Braunstein, E.M.; Shirazi, K.K.

    1985-01-01

    A case of persistent bilateral perilunate dislocation unrelated to trauma in a patient with Marfan syndrome is discussed. This finding is believed to be a manifestation of the generalized ligamentous laxity occurring in this disorder. Radiographs of eight additional Marfan syndrome patients failed to demonstrate similar carpal instability. Because some carpal derangements are dynamic events, stress views or wrist fluoroscopy may be necessary to demonstrate unsuspected carpal instability in Marfan patients. (orig.)

  18. MR imaging of avascular necrosis of carpal bones

    International Nuclear Information System (INIS)

    Taniguchi, Yasunori; Funaoka, Nobuhiko; Yoshida, Munehito; Iwahashi, Toshiyuki; Egawa, Hiromitsu; Shima, Kimihiro; Tamaoki, Tetsuya.

    1991-01-01

    The usefulness of MRI in carpal avascular necrosis was investigated in 20 cases, 16 in lunates, 3 in scaphoids and 1 in triquetrum, with T1 and T2 weighted images of the spin echo and T2 weighted images of the field echo. Early diagnosis of carpal bone necrosis was possible when the T1 weighted image showed a moderate low intensity signal. A high intensity signal in the T2 weighted image indicated the onset of revascularization, and a favorable prognosis. A normal signal indicated healing of carpal avascular necrosis. MRI was found to be very useful in establishing the diagnosis and in determining the prognosis of carpal osteonecrosis. (author)

  19. MR imaging of avascular necrosis of carpal bones

    Energy Technology Data Exchange (ETDEWEB)

    Taniguchi, Yasunori; Funaoka, Nobuhiko; Yoshida, Munehito [Kinan General Hospital, Wakayama (Japan); Iwahashi, Toshiyuki; Egawa, Hiromitsu; Shima, Kimihiro; Tamaoki, Tetsuya

    1991-03-01

    The usefulness of MRI in carpal avascular necrosis was investigated in 20 cases, 16 in lunates, 3 in scaphoids and 1 in triquetrum, with T1 and T2 weighted images of the spin echo and T2 weighted images of the field echo. Early diagnosis of carpal bone necrosis was possible when the T1 weighted image showed a moderate low intensity signal. A high intensity signal in the T2 weighted image indicated the onset of revascularization, and a favorable prognosis. A normal signal indicated healing of carpal avascular necrosis. MRI was found to be very useful in establishing the diagnosis and in determining the prognosis of carpal osteonecrosis. (author).

  20. Fluoroscopic and arthrographic evaluation of carpal instability

    Energy Technology Data Exchange (ETDEWEB)

    Braunstein, E.M.; Louis, D.S.; Greene, T.L.; Hankin, F.M.

    1985-06-01

    The efficacy of a diagnostic protocol involving videotape fluoroscopy of carpal motion and radiocarpal arthrography was evaluated in patients with wrist pain unexplained by physical examination and conventional radiographs. Videotape fluoroscopy was performed as the first study in 68 consecutive cases and was positive in 44 (66%). Radiocarpal arthrography was performed after videotape fluoroscopy in 39 of the cases (57%), including the 24 in which videotape fluoroscopy was normal and 15 others in which further information was desired in spite of positive videotape fluoroscopy. The addition of radiocarpal arthrography to videotape fluoroscopy increased the diagnostic yield to 52 (76%) of the 68 cases and excluded significant anatomic or dynamic abnormality in the others. The diagnosis was proven surgically in 25 cases. This protocol was efficacious for ligament tears of the proximal carpal row, triangular fibrocartilage tears, and proximal and midcarpal instability.

  1. Medline Plus

    Full Text Available ... Fusion Surgery for Relief of Chronic Lower Back Pain (Shawnee Mission Medical Center, Shawnee Mission, KS, 3/05/2014) Carpal Tunnel Syndrome Minimally Invasive Endoscopic Carpal Tunnel Release (Bon Secours ...

  2. Scaphoid and lunate movement in different ranges of carpal radioulnar deviation.

    Science.gov (United States)

    Tang, Jin Bo; Xu, Jing; Xie, Ren Guo

    2011-01-01

    We aimed to investigate scaphoid and lunate movement in radial deviation and in slight and moderate ulnar deviation ranges in vivo. We obtained computed tomography scans of the right wrists from 20° radial deviation to 40° ulnar deviation in 20° increments in 6 volunteers. The 3-dimensional bony structures of the wrist, including the distal radius and ulna, were reconstructed with customized software. The changes in position of the scaphoid and lunate along flexion-extension motion (FEM), radioulnar deviation (RUD), and supination-pronation axes in 3 parts--radial deviation and slight and moderate ulnar deviation--of the carpal RUD were calculated and analyzed. During carpal RUD, scaphoid and lunate motion along 3 axes--FEM, RUD, and supination-pronation--were the greatest in the middle third of the measured RUD (from neutral position to 20° ulnar deviation) and the smallest in radial deviation. Scaphoid motion along the FEM, RUD, and supination-pronation axes in the middle third was about half that in the entire motion range. In the middle motion range, lunate movement along the FEM and RUD axes was also the greatest. During carpal RUD, the greatest scaphoid and lunate movement occurs in the middle of the arc--slight ulnar deviation--which the wrist frequently adopts to accomplish major hand actions. At radial deviation, scaphoid and lunate motion is the smallest. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Seasonal distribution and demographical characteristics of carpal tunnel syndrome in 1039 patients Distribuição sazonal e características demográficas da síndrome do túnel do carpo em 1039 pacientes

    Directory of Open Access Journals (Sweden)

    Irênio Gomes

    2004-09-01

    Full Text Available OBJECTIVE: To describe the demographic characteristics of gender, age, and presence of repetitive movements, intake of alcohol and non-steroid anti-inflammatories (NSAI, medical specialties that referred patients to nerve conduction studies and electromyography (NCS-EMG, school attainment, and seasonal distribution in patients with a neurophysiological diagnosis of carpal tunnel syndrome (CTS in the State of Rio Grande do Sul, Brazil. METHOD: A series of 1039 patients (1549 hands with neurophysiologically defined CTS was studied. Patients were referred for NCS-EMG in 3 universities and 2 private services, from August 2001 to January 2003. All patients completed a questionnaire containing demographic information. The diagnosis of CTS was established following a pre-established protocol, with defined diagnostic criteria. RESULTS: Around one fourth of patients had already performed NCS-EMG; the greatest frequency of CTS was observed in women (5.6:1 and in patients above the age of 40. Most patients reported performing repetitive movements in their daily routine (69.7%; 12.9% reported use of NSAI and 14.9% regular intake of alcoholic beverages. A greater frequency of CTS was observed in the months of July and August, when compared to the other months of the year. Around 2/3 of the study population had completed at least secondary school. Most requests of nerve conduction studies did not provide a diagnostic hypothesis (59.9% and neurophysiologic studies were requested mostly by traumatology/orthopedics (71.1%. CONCLUSION: We have concluded that, in our environment, CTS shows some demographical characteristics that are similar to what the literature describes. Also, we have found that most of our sample concluded at least secondary school, and was referred to neurophysiologic studies by orthopedists. To be pointed out is the seasonal distribution of CTS, which demonstrates a significant association with winter months.OBJETIVO: Descrever as caracter

  4. Submucosal tunneling techniques: current perspectives.

    Science.gov (United States)

    Kobara, Hideki; Mori, Hirohito; Rafiq, Kazi; Fujihara, Shintaro; Nishiyama, Noriko; Ayaki, Maki; Yachida, Tatsuo; Matsunaga, Tae; Tani, Johji; Miyoshi, Hisaaki; Yoneyama, Hirohito; Morishita, Asahiro; Oryu, Makoto; Iwama, Hisakazu; Masaki, Tsutomu

    2014-01-01

    Advances in endoscopic submucosal dissection include a submucosal tunneling technique, involving the introduction of tunnels into the submucosa. These tunnels permit safer offset entry into the peritoneal cavity for natural orifice transluminal endoscopic surgery. Technical advantages include the visual identification of the layers of the gut, blood vessels, and subepithelial tumors. The creation of a mucosal flap that minimizes air and fluid leakage into the extraluminal cavity can enhance the safety and efficacy of surgery. This submucosal tunneling technique was adapted for esophageal myotomy, culminating in its application to patients with achalasia. This method, known as per oral endoscopic myotomy, has opened up the new discipline of submucosal endoscopic surgery. Other clinical applications of the submucosal tunneling technique include its use in the removal of gastrointestinal subepithelial tumors and endomicroscopy for the diagnosis of functional and motility disorders. This review suggests that the submucosal tunneling technique, involving a mucosal safety flap, can have potential values for future endoscopic developments.

  5. A radiographic investigation of third carpal bone injury in 42 racing thoroughbreds

    International Nuclear Information System (INIS)

    De Haan, C.E.; O'Brien, T.R.; Koblik, P.D.

    1987-01-01

    A retrospective study of carpal radiographs from 42 racing thoroughbreds with carpal lameness was performed. Radiographs from 50 carpal examinations were available for review. The radiographic findings pertaining to the third carpal bone were described. Fractures and/or sclerosis occurred almost exclusively within the radial fossa. The occurrence of sclerosis without fracture in 20 of the 50 carpal examinations was higher than anticipated, occurring in both the right and left third carpal bone with equal frequency. The right third carpal bone was more frequently fractured and more severely affected than the left. The sclerotic changes seen in the radial fossa of the third carpal bone may be stress-induced, possibly preceding more serious changes in the joint such as cartilage damage or gross fracture. Earlier recognition of sclerosis of the third carpal bone may help prevent more serious changes from occurring

  6. 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. © The Author(s) 2015.

  7. Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer.

    Science.gov (United States)

    Tan, Yuyong; Lv, Liang; Duan, Tianying; Zhou, Junfeng; Peng, Dongzi; Tang, Yao; Liu, Deliang

    2016-07-01

    Submucosal tunneling endoscopic resection (STER) has been proved to be safe and effective for removal of esophageal leiomyoma originating from the muscularis propria (MP) layer. However, there are still technical challenges for tumors ≥35 mm due to the limited space of the submucosal tunnel. The aim of the study was to estimate the safety and efficacy of STER for large esophageal leiomyoma originating from the MP layer as well as compare its efficacy with video-assisted thoracoscopic surgery (VATS), which is a standard procedure for treating esophageal leiomyoma. We retrospectively collected the clinical data of the patients with esophageal leiomyoma of 35-55 mm who underwent STER or VATS at our hospital between January 2010 and December 2014. Epidemiological data (gender, age), tumor location, tumor size, procedure-related parameters, complications, length of stay and cost were compared between STER and VATS. A total of 31 patients were enrolled, and 18 patients underwent STER and the other 13 received VATS. There was no significant difference between the two groups in gender, age, tumor location, tumor size, complications and rate of en bloc resection (P > 0.05). However, patients in the STER groups had a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost (P leiomyoma of 35-55 mm. However, STER is superior to VATS in a shorter operation time, a less decrease in hemoglobin level, a shorter length of hospital stay and a decreased cost.

  8. [RESEARCH PROGRESS OF BIOMECHANICS OF PROXIMAL ROW CARPAL INSTABILITY].

    Science.gov (United States)

    Guo, Jinhai; Huang, Fuguo

    2015-01-01

    To review the research progress of the biomechanics of proximal row carpal instability (IPRC). The related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. The muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. Some strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.

  9. Frontal plane fractures of the accessory carpal bone and implications for the carpal sheath of the digital flexor tendons.

    Science.gov (United States)

    Minshall, G J; Wright, I M

    2014-09-01

    Accurate radiological and ultrasonographic descriptions of frontal plane fractures of the accessory carpal bone (ACB) are lacking, and implications of these fractures for the carpal sheath and its contents have not previously been reported. Aims were as follows: 1) to describe the location and radiological features of frontal plane fractures of the ACB; 2) to document communication of displaced fractures with the carpal sheath and consequent injury to the deep digital flexor tendon (DDFT); 3) to describe ultrasonographic identification of lesions; and 4) to report tenoscopic evaluation and treatment. Retrospective case series. Analysis of frontal plane fractures of the ACB referred to a single hospital between 2006 and 2012, including review of radiographic, ultrasonographic and tenoscopic images. Nine fractures were identified, of which 8 displaced fractures all communicated with the carpal sheath. Comminuted fragments and/or protruding fracture margins lacerated the lateral margin of the enclosed DDFT. This was identifiable ultrasonographically and confirmed at tenoscopy in 7 cases. Treatment in these horses consisted of removal of torn tendon tissue together with fragmentation and protuberant fracture edges, and 7 of 7 cases returned to work. One horse with a nondisplaced fracture was managed with immobilisation; the fracture healed, and the horse returned to work. One horse with a displaced fracture was retired to stud. Frontal plane fractures of the ACB occur palmar to the groove in its lateral margin for the tendon of insertion of ulnaris lateralis. Comminuted fragments can displace distally within the carpal sheath to a mid-metacarpal level or abaxially to lie extrathecally, lateral to the parent bone. Displaced fractures communicate with the carpal sheath and traumatise the DDFT. © 2013 EVJ Ltd.

  10. Surgical and nonsurgical management of sagittal slab fractures of the third carpal bone in racehorses: 32 cases (1991-2001).

    Science.gov (United States)

    Kraus, Beth M; Ross, Michael W; Boston, Raymond C

    2005-03-15

    To compare results (ie, return to racing and earnings per race start) of surgical versus nonsurgical management of sagittal slab fractures of the third carpal bone in racehorses. Retrospective study. 32 racehorses (19 Thoroughbreds, 11 Standardbreds, and 2 Arabians). Medical records and radiographs were reviewed to obtain information regarding signalment and treatment. Follow-up information was obtained from race records. Robust regression analysis was performed to evaluate earnings per start in horses that raced at least once before and after injury. 22 (69%) horses raced at least once after treatment of the fracture. All 7 horses treated by means of interfragmentary compression raced after treatment, and horses that underwent interfragmentary compression had significantly higher earnings per start after the injury than did horses treated without surgery. Eight of 9 horses treated by means of arthroscopic debridement of the damaged cartilage and bone raced after treatment, but only 7 of 16 horses treated without surgery (ie, stall rest) were able to return to racing after treatment. Results suggest that racehorses with sagittal slab fractures of the third carpal bone have a favorable prognosis for return to racing after treatment. Horses treated surgically were more likely to race after treatment than were horses treated without surgery.

  11. Tunneling works. Tunnel koji

    Energy Technology Data Exchange (ETDEWEB)

    Higo, M [Hazam Gumi, Ltd., Tokyo (Japan)

    1991-10-25

    A mountain tunneling method for rock-beds used to be applied mainly to construction works in the mountains under few restrictions by environmental problems. However, construction works near residential sreas have been increasing. There are such enviromental problems due to tunneling works as vibration, noise, lowering of ground-water level, and influences on other structures. This report mainly describes the measurement examples of vibration and noise accompanied with blasting and the effects of the measures to lessen such influences. When the tunneling works for the railroad was carried out on the natural ground mainly composed of basalt, vibration of the test blasting was measured at three stations with piezoelectric accelerometers. Then, ordinary blasting, mutistage blasting, and ABM blasting methods were used properly besed on the above results, and only a few complaints were made. In the different works, normal noise and low-frequency sound were mesured at 22 stations around the pit mouth. As countermeasures for noise, sound-proof sheets, walls, and single and double doors were installed and foundto be effective. 1 ref., 6 figs., 1 tab.

  12. Post Traumatic Avascular Necrosis of the Proximal Carpal Row--A Case Report.

    Science.gov (United States)

    Manohara, Ruben; Sebastin, Sandeep Jacob; Puhaindran, Mark Edward

    2015-10-01

    We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21-year-old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist. We present this unusual case of simultaneous avascular necrosis of multiple carpal bones and discuss the possible risk factors and subsequent management plans for this complex injury. Our patient has no identifiable contributing factors to developing avascular necrosis. We suspect that the violence of the injury and surgery may have compromised the circulation, and advise caution when treating and counseling these patients pre-operatively.

  13. Vascularized bone grafting in a canine carpal avascular necrosis model

    NARCIS (Netherlands)

    Willems, Wouter F.; Alberton, Gregory M.; Bishop, Allen T.; Kremer, Thomas

    2011-01-01

    Limited experimental research has been performed on the treatment of avascular necrosis (AVN) by vascularized bone grafting. A new model simulating carpal AVN was created to investigate surgical revascularization of necrotic bone. In seven mongrel dogs, AVN was induced by removal of the radial

  14. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

    Science.gov (United States)

    Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude

    2017-10-01

    The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  15. A digital database of wrist bone anatomy and carpal kinematics.

    Science.gov (United States)

    Moore, Douglas C; Crisco, Joseph J; Trafton, Theodore G; Leventhal, Evan L

    2007-01-01

    The skeletal wrist consists of eight small, intricately shaped carpal bones. The motion of these bones is complex, occurs in three dimensions, and remains incompletely defined. Our previous efforts have been focused on determining the in vivo three-dimensional (3-D) kinematics of the normal and abnormal carpus. In so doing we have developed an extensive database of carpal bone anatomy and kinematics from a large number of healthy subjects. The purpose of this paper is to describe that database and to make it available to other researchers. CT volume images of both wrists from 30 healthy volunteers (15 males and 15 females) were acquired in multiple wrist positions throughout the normal range of wrist motion. The outer cortical surfaces of the carpal bones, radius and ulna, and proximal metacarpals were segmented and the 3-D motion of each bone was calculated for each wrist position. The database was constructed to include high-resolution surface models, measures of bone volume and shape, and the 3-D kinematics of each segmented bone. The database does not include soft tissues of the wrist. While there are numerous digital anatomical databases, this one is unique in that it includes a large number of subjects and it contains in vivo kinematic data as well as the bony anatomy.

  16. 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 one...

  17. 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 one-piece...

  18. 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 one...

  19. Cosmetic surgery volume and its correlation with the major US stock market indices.

    Science.gov (United States)

    Gordon, Chad R; Pryor, Landon; Afifi, Ahmed M; Benedetto, Paul X; Langevin, C J; Papay, Francis; Yetman, Randall; Zins, James E

    2010-01-01

    As a consumer-driven industry, cosmetic plastic surgery is subject to ebbs and flows as the economy changes. There have been many predictions about the short, intermediate, and long-term impact on cosmetic plastic surgery as a result of difficulties in the current economic climate, but no studies published in the literature have quantified a direct correlation. The authors investigate a possible correlation between cosmetic surgery volume and the economic trends of the three major US stock market indices. A volume analysis for the time period from January 1992 to October 2008 was performed (n = 7360 patients, n = 8205 procedures). Four cosmetic procedures-forehead lift (FL), rhytidectomy (Rh), breast augmentation (BA), and liposuction (Li)-were chosen; breast reduction (BRd), breast reconstruction (BRc), and carpal tunnel release (CTR) were selected for comparison. Case volumes for each procedure and fiscal quarter were compared to the trends of the S&P 500, Dow Jones (DOW), and NASDAQ (NASD) indices. Pearson correlation statistics were used to evaluate a relationship between the market index trends and surgical volume. P values indices. FL (n =312) only correlated to the NASD (P = .021) and did not reach significance with the S&P 500 (P = .077) or DOW (P = .14). BRd and BRc demonstrated a direct correlation to two of the three stock market indices, whereas CTR showed an inverse (ie, negative) correlation to two of the three indices. This study, to our knowledge, is the first to suggest a direct correlation of four cosmetic and two reconstructive plastic surgery procedures to the three major US stock market indices and further emphasizes the importance of a broad-based plastic surgery practice in times of economic recession.

  20. Strategic Planning for Irwin Army Community Hospital: The Assessment and Implementation of Services, in Order to Meet Fort Riley’s Increasing Population

    Science.gov (United States)

    2008-07-05

    Hemorrhoidectomy Mastectomy Gallbladder Removal Thyroid Removal Peripheral Vascular Surgery Exploratory Laparotomy Ear, Nose and Throat Tonsilleetomy... Extraction Periodontal Surgery Orthopedic Surgery Arthroscopy (Shoulder, Wrist, Hip, Knee and Ankle) Carpal Tunnel Release Tendon Repair Removal

  1. Wrist arthroscopy

    Science.gov (United States)

    Wrist surgery; Arthroscopy - wrist; Surgery - wrist - arthroscopy; Surgery - wrist - arthroscopic; Carpal tunnel release ... You might need wrist arthroscopy if you have one of these problems: Wrist pain . Arthroscopy allows the surgeon to explore what is causing your wrist ...

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Acute carpal tunnel syndrome of the hand following a cat bite | Sbai ...

    African Journals Online (AJOL)

    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 ...

  4. An Association between Carpal Tunnel Syndrome and Migraine Headaches—National Health Interview Survey, 2010

    Directory of Open Access Journals (Sweden)

    Huay-Zong Law, MD

    2015-03-01

    Conclusions: This study is the first to demonstrate an association between CTS and migraine headache. Longitudinal and genetic studies with physician verification of migraine headaches and CTS are needed to further define this association.

  5. Patient-Reported Disability Measures Do Not Correlate with Electrodiagnostic Severity in Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Jacob E. Tulipan, MD

    2017-08-01

    Conclusions:. Electrodiagnostic severity grades do not correlate with patient-reported disability, including the DASH and MCS–12 surveys. There is a counterintuitive correlation between more-severe electrodiagnostic findings and decreased physical disability. These findings indicate that disability may not correlate with electrodiagnostic severity of median neuropathy in CTS.

  6. Meta-Analysis: Association Between Wrist Posture and Carpal Tunnel Syndrome Among Workers

    Directory of Open Access Journals (Sweden)

    Doohee You

    2014-03-01

    Conclusion: We found evidence that prolonged exposure to non-neutral wrist postures is associated with a twofold increased risk for CTS compared with low hours of exposure to non-neutral wrist postures. Workplace interventions to prevent CTS should incorporate training and engineering interventions that reduce sustained non-neutral wrist postures.

  7. Medline Plus

    Full Text Available ... Center, Shawnee Mission, KS, 3/05/2014) Carpal Tunnel Syndrome Minimally Invasive Endoscopic Carpal Tunnel Release (Bon ... General Hospital, Norfolk, VA, 5/08/2008) Carpal Tunnel Syndrome Minimally Invasive Endoscopic Carpal Tunnel Release (Bon ...

  8. Recognition tunneling

    Czech Academy of Sciences Publication Activity Database

    Lindsay, S.; He, J.; Sankey, O.; Hapala, Prokop; Jelínek, Pavel; Zhang, P.; Chang, S.; Huang, S.

    2010-01-01

    Roč. 21, č. 26 (2010), 262001/1-262001/12 ISSN 0957-4484 R&D Projects: GA ČR GA202/09/0545 Institutional research plan: CEZ:AV0Z10100521 Keywords : STM * tunneling current * molecular electronics * DFT calculations Subject RIV: BM - Solid Matter Physics ; Magnetism Impact factor: 3.644, year: 2010

  9. COBRA-Bee Carpal-Wrist Gimbal for Astrobee, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — TUI proposes to develop a carpal-wrist gimbal payload for the Astrobee free-flier, called 'COBRA-Bee' to satisfy Astrobee mission needs for a lightweight, integrated...

  10. Global spectral graph wavelet signature for surface analysis of carpal bones

    Science.gov (United States)

    Masoumi, Majid; Rezaei, Mahsa; Ben Hamza, A.

    2018-02-01

    Quantitative shape comparison is a fundamental problem in computer vision, geometry processing and medical imaging. In this paper, we present a spectral graph wavelet approach for shape analysis of carpal bones of the human wrist. We employ spectral graph wavelets to represent the cortical surface of a carpal bone via the spectral geometric analysis of the Laplace-Beltrami operator in the discrete domain. We propose global spectral graph wavelet (GSGW) descriptor that is isometric invariant, efficient to compute, and combines the advantages of both low-pass and band-pass filters. We perform experiments on shapes of the carpal bones of ten women and ten men from a publicly-available database of wrist bones. Using one-way multivariate analysis of variance (MANOVA) and permutation testing, we show through extensive experiments that the proposed GSGW framework gives a much better performance compared to the global point signature embedding approach for comparing shapes of the carpal bones across populations.

  11. Tunnel - history of

    International Nuclear Information System (INIS)

    1998-11-01

    This book introduces history of tunnel in ancient times, the middle ages and modern times, survey of tunnel and classification of bedrock like environment survey of position, survey of the ground, design of tunnel on basic thing of the design, and design of tunnel of bedrock, analysis of stability of tunnel and application of the data, construction of tunnel like lattice girder and steel fiber reinforced shot crete, and maintenance control and repair of tunnel.

  12. [Resection of a carpal bone row in a Pustertaler Sprinze cow with chronic purulent arthritis of the carpal joint and osteomyelitis].

    Science.gov (United States)

    Kofler, J; Peterbauer, C

    2014-01-01

    This case report describes the clinical and radiographic findings and the surgical treatment of a serofibrinous arthritis of the antebrachiocarpal joint and of a chronic purulent arthritis of the intercarpal and carpometacarpal joints with osteomyelitis of the distal carpal bones and subchondral osteomyelitis of the proximal metacarpal bones in a cow of the breed "Pustertaler Sprinze". The therapy comprised an arthrotomy of both joint spaces and the resection of the distal row of the carpal bones. The right forelimb had been immobilised for 70 days by a full limb cast. After this period, radiographs revealed an ob- vious ankylosis of the carpal joint, and the cow showed only a slight lameness. Six years postoperatively this cow was still in the herd and had produced six calves.

  13. Nutrient vessel canals. Differential diagnosis of zystoid carpal lesions on MRI?; Nutritialgefaesskanaele. Magnetresonanztomographische Differentialdiagnose karpaler zystischer Laesionen?

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.; Schild, H.H. [Bonn Univ. (Germany). Radiologische Klinik; Brueser, P. [Malteser Krankenhaus, Bonn (Germany). Hand- und Mikrochirurgische Abt.; Schmidt, H.M. [Bonn Univ. (Germany). Anatomisches Inst.

    2000-05-01

    Purpose: To find and describe potential MRI criteria of nutrient vessel canals of carpal bones. Methods and material: 16 wrists of 13 patients with pain and radiographic depiction of cystic changes within the lunate were examined. The MRI protocol included coronal and sagittal T1- and T2-weighted SE sequences (4 mm slices, 120 FOV, 256x256 matrix) as well as coronal STIR images. Final diagnosis was confirmed by surgery (n=5) and follow up. 10 cadaveric ossa lunata were studied to describe size, number, location and shape of nutrient vessel canals. Results: Ganglion cysts (n=6) showed characteristic signs. In ulnar impaction syndrome (n=1) small cystic lesions in the lunate were surrounded by a sclerotic rim and located near the proximal ulnar surface. In Kienboeck's disease (n=3) cystic components were irregular and surrounded by bone marrow edema. Nutrient vessel canals (n=7) imaged as 1 to 3 small cystic lesions within the palmar or dorsal subchondral region. Conclusion: MRI can aid in differential diagnosis of cystic carpal lesions. Nutrient vessel canals may not be mistaken for pathologic cystic lesions. Carpal ganglion cysts show distinct diagnostic patterns. (orig.) [German] Fragestellung: Sind karpale Nutritialgefaesskanaele auf MRI Bildern sichtbar und welche differentialdiagnostischen Kriterien lassen sich finden. Material und Methode. In 16 Faellen lagen bei 13 Patienten roentgenologisch wenige mm bis 2 cm grosse zystische Laesionen im OS lunatum vor. Das MRT-Protokoll umfasste koronare und sagittale T1- und T2-gewichtete SE-Sequenzen mit 4 mm Schichtdicke, 120 mm Messfeld und 256{sup 2} Matrix sowie koronare STIR-Sequenzen. Die Diagnosesicherung erfolgte durch Operation in 5 Faellen sowie Verlaufskontrollen. 10 mazerierte Ossa lunata wurden auf Form, Lokalisation, Anzahl und Groesse der Nutritialgefaesskanaele untersucht. Ergebnisse: Ganglien (n=6) wiesen typische Zeichen auf. Im Falle eines Ulnaimpaktionssyndroms bei Ulna-Nullvariante wurden

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

    International Nuclear Information System (INIS)

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

    1985-01-01

    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. (orig./WL)

  15. Ultrasonographic evaluation of normal extrinsic and intrinsic carpal ligaments: preliminary experience

    International Nuclear Information System (INIS)

    Boutry, Nathalie; Lapegue, Franck; Demondion, Xavier; Masi, Laetitia; Cotten, Anne; Claret, Antoine

    2005-01-01

    To determine normal anatomy of extrinsic and intrinsic carpal ligaments at ultrasonography (US). In the first part of the study, two musculoskeletal radiologists retrospectively reviewed in consensus the photographs of anatomic sections and dissections derived from 20 cadaveric wrists. This cadaveric study gave the two readers the opportunity to learn the anatomy and orientation of the various extrinsic and intrinsic carpal ligaments and, thus, to develop a US protocol to facilitate the recognition of each carpal ligament. In the second part of the study, these two radiologists prospectively and independently evaluated the visibility of extrinsic and intrinsic carpal ligaments in 30 wrists of volunteers, using the same US protocol. With regard to extrinsic carpal ligaments, the radioscaphocapitate ligament (partially visible, 38%; completely visible, 62%), the radiolunotriquetral ligament (partially visible, 27%; completely visible, 73%), the palmar ulnotriquetral ligament (partially visible, 12%; completely visible, 88%), and the dorsal radiotriquetral ligament (partially visible, 7%; completely visible, 93%) were visualized at US. The dorsal ulnotriquetral ligament (partially visible, 21%; completely visible, 74%), the ulnolunate ligament (partially visible, 5%; completely visible, 70%), and the radial collateral ligament (partially visible, 18%; completely visible, 12%) were more difficult to recognize. The radioscapholunate ligament was never seen. With regard to intrinsic carpal ligaments, the dorsal (partially visible, 11%; completely visible, 89%) and palmar (partially visible, 38%; completely visible, 62%) scaphotriquetral ligaments as well as the dorsal scapholunate ligament (partially visible, 3%; completely visible, 97%) were visualized at US. The dorsal lunotriquetral ligament (partially visible, 39%; completely visible, 61%) and the palmar scapholunate ligaments (partially visible, 12%; completely visible, 81%) were more difficult to recognize. US may

  16. [Carpal canal ultrasound examination in patients with mild hand-arm vibration disease].

    Science.gov (United States)

    Liu, Y Z; Ye, Z H; Yang, W L; Zhu, J X; Lu, Q J; Su, W L

    2016-08-20

    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 cross-sectional area of the median nerve at the level of pisiform bone ( 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.

  17. Tunneling technologies for the collider ring tunnels

    International Nuclear Information System (INIS)

    Frobenius, P.

    1989-01-01

    The Texas site chosen for the Superconducting Super Collider has been studied, and it has been determined that proven, conventional technology and accepted engineering practice are suitable for constructing the collider tunnels. The Texas National Research Laboratory Commission report recommended that two types of tunneling machines be used for construction of the tunnels: a conventional hard rock tunnel boring machine (TBM) for the Austin chalk and a double shielded, rotary TBM for the Taylor marl. Since the tunneling machines usually set the pace for the project, efficient planning, operation, and coordination of the tunneling system components will be critical to the schedule and cost of the project. During design, tunneling rate prediction should be refined by focusing on the development of an effective tunneling system and evaluating its capacity to meet or exceed the required schedules. 8 refs., 13 figs

  18. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy

    Science.gov (United States)

    Bonilla, Alvaro G.; Santschi, Elizabeth M.

    2015-01-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging. PMID:25694665

  19. Arthrography of the traumatized wrist: correlation with radiography and the carpal instability series

    Energy Technology Data Exchange (ETDEWEB)

    Levinsohn, E.M.; Palmer, A.K.

    1983-03-01

    Arthrography with fluoroscopic monitoring was used to assess the soft tissues of the wrist in 100 patients who had chronic traumatic pain but did not have rheumatoid arthritis. Findings were correlated with plain radiographs and the carpal instability series. Arthrograms were normal in 26% of cases and demonstrated perforation of the triangular fibrocartilage in 26%, radiocarpal-midcarpal communication in 30%, capsular lesions in 31%, lymphatic opacification in 12%, and tendon sheath filling in 10%. Communication between the radiocarpal and pisiform-troiquetral compartments, a normal finding, was seen in 69%. There was a significant association between perforation of the triangular fibrocartilage and both ulna-plus variance and carpal instability.

  20. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy.

    Science.gov (United States)

    Bonilla, Alvaro G; Santschi, Elizabeth M

    2015-02-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging.

  1. 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.)

  2. Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Muller, Bart; Hofbauer, Marcus; Atte, Akere; van Dijk, C Niek; Fu, Freddie H

    2015-12-01

    To quantify the mean difference in femoral tunnel angle (FTA) as measured on knee radiographs between rigid and flexible tunnel drilling after anatomic anterior cruciate ligament (ACL) reconstruction. Fifty consecutive patients that underwent primary anatomic ACL reconstruction with a single femoral tunnel drilled with a flexible reamer were included in this study. The control group was comprised of 50 patients all of who underwent primary anatomic ACL reconstruction with a single femoral tunnel drilled with a rigid reamer. All femoral tunnels were drilled through a medial portal to ensure anatomic tunnel placement. The FTA was determined from post-operative anterior-to-posterior (AP) radiographs by two independent observers. A 5° difference between the two mean FTA was considered clinically significant. The average FTA, when drilled with a rigid reamer, was 42.0° ± 7.2°. Drilling with a flexible reamer resulted in a mean FTA of 44.7° ± 7.0°. The mean difference of 2.7° was not statistically significant. The intraclass correlation coefficient for inter-tester reliability was 0.895. The FTA can be reliably determined from post-operative AP radiographs and provides a useful and reproducible metric for characterizing femoral tunnel position after both rigid and flexible femoral tunnel drilling. This has implications for post-operative evaluation and preoperative treatment planning for ACL revision surgery. IV.

  3. Histological Observation of Regions around Bone Tunnels after Compression of the Bone Tunnel Wall in Ligament Reconstruction

    International Nuclear Information System (INIS)

    Maeda, Shintaro; Ishikawa, Hiroki; Tanigawa, Naoaki; Miyazaki, Kyosuke; Shioda, Seiji

    2012-01-01

    The objectives of this study were to investigate the time-course of influence of compression of bone tunnel wall in ligament reconstruction on tissue around the bone tunnel and to histologically examine the mechanism of preventing the complication of bone tunnel dilation, using rabbit tibia. A model in which the femoral origin of the extensor digitorum longus tendon was cut and inserted into a bone tunnel made proximal to the tibia was prepared in the bilateral hind legs of 20 Japanese white rabbits. In each animal, a tunnel was made using a drill only in the right leg, while an undersized bone tunnel was made by drilling and then dilated by compression using a dilator to the same tunnel size as that in the right leg. Animals were sacrificed at 0, 2, 4, 8 and 12 weeks after surgery (4 animals at each time point). Observation of bone tunnels by X-ray radiography showed osteosclerosis in the 2- and 4-week dilation groups. Osteosclerosis appeared as white lines around the bone tunnel on X-ray radiography. This suggests that dilation promotes callus formation in the bone tunnel wall and prevents the complication of bone tunnel enlargement after ligament reconstruction

  4. [Occupational risk factors for radial tunnel syndrome in factory workers].

    Science.gov (United States)

    Roquelaure, Y; Raimbeau, G; Saint-Cast, Y; Martin, Y H; Pelier-Cady, M C

    2003-12-01

    The purpose of the study was to evaluate the professional and extraprofessional risk factors for radial tunnel syndrome (RTS) in employees of three large companies. Twenty-one cases of RTS were compared to 21 controls, matched for age, sex, and activity. In nine cases, RTS was associated with carpal tunnel syndrome. The analysis considered medical history, extraprofessional activity, and the ergonomic and organisational aspects of work. The study demonstrated three risk factors of RTS related to work conditions. The regular use of a force of at least 1 kg (OR = 9.1 (1.4-56.9)) more than 10 times per hour is the main biomechanical risk factor. Static work (OR = 5.9 (1.2-29.9)) as well as work with the elbow constantly extended 0 degree to 45 degrees, is strongly associated with an increased risk of RTS (OR = 4.9 (1.0-25.0)). Complete extension of the elbow associated with pronation and supination of the forearm may cause trauma to the radial nerve in the radial tunnel. On the other hand, we found no personal factors and no extraprofessional activities which were associated with an increased risk of RTS. This study shows that motions of the forearm requiring intense effort and performed with the elbow in extension and the forearm in pronation and supination increase the risk of RTS.

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

    NARCIS (Netherlands)

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

    2010-01-01

    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

  6. Surgical treatment of a comminuted articular fracture of the accessory carpal bone in a thoroughbred horse

    International Nuclear Information System (INIS)

    Munroe, G.A.; Cauvin, E.

    1997-01-01

    The clinical, radiographic and ultrasonographic findings in a case ofa comminuted articular fracture of the accessory carpal bone of a thoroughbred chaser are described, and its surgical treatment and aftercare are detailed. The horse made an uneventful recovery and successfully returned to racing

  7. Transonic Dynamics Tunnel (TDT)

    Data.gov (United States)

    Federal Laboratory Consortium — The Transonic Dynamics Tunnel (TDT) is a continuous flow wind-tunnel facility capable of speeds up to Mach 1.2 at stagnation pressures up to one atmosphere. The TDT...

  8. Quantum theory of tunneling

    CERN Document Server

    Razavy, Mohsen

    2014-01-01

    In this revised and expanded edition, in addition to a comprehensible introduction to the theoretical foundations of quantum tunneling based on different methods of formulating and solving tunneling problems, different semiclassical approximations for multidimensional systems are presented. Particular attention is given to the tunneling of composite systems, with examples taken from molecular tunneling and also from nuclear reactions. The interesting and puzzling features of tunneling times are given extensive coverage, and the possibility of measurement of these times with quantum clocks are critically examined. In addition by considering the analogy between evanescent waves in waveguides and in quantum tunneling, the times related to electromagnetic wave propagation have been used to explain certain aspects of quantum tunneling times. These topics are treated in both non-relativistic as well as relativistic regimes. Finally, a large number of examples of tunneling in atomic, molecular, condensed matter and ...

  9. Road and Railroad Tunnels

    Data.gov (United States)

    Department of Homeland Security — Tunnels in the United States According to the HSIP Tiger Team Report, a tunnel is defined as a linear underground passageway open at both ends. This dataset is based...

  10. Hypersonic Tunnel Facility (HTF)

    Data.gov (United States)

    Federal Laboratory Consortium — The Hypersonic Tunnel Facility (HTF) is a blow-down, non-vitiated (clean air) free-jet wind tunnel capable of testing large-scale, propulsion systems at Mach 5, 6,...

  11. Proton tunneling in solids

    Energy Technology Data Exchange (ETDEWEB)

    Kondo, J.

    1998-10-01

    The tunneling rate of the proton and its isotopes between interstitial sites in solids is studied theoretically. The phonons and/or the electrons in the solid have two effects on the tunneling phenomenon. First, they suppress the transfer integral between two neighbouring states. Second, they give rise to a finite lifetime of the proton state. Usually the second effect is large and the tunneling probability per unit time (tunneling rate) can be defined. In some cases, however, a coherent tunneling is expected and actually observed. (author)

  12. Proton tunneling in solids

    International Nuclear Information System (INIS)

    Kondo, J.

    1998-01-01

    The tunneling rate of the proton and its isotopes between interstitial sites in solids is studied theoretically. The phonons and/or the electrons in the solid have two effects on the tunneling phenomenon. First, they suppress the transfer integral between two neighbouring states. Second, they give rise to a finite lifetime of the proton state. Usually the second effect is large and the tunneling probability per unit time (tunneling rate) can be defined. In some cases, however, a coherent tunneling is expected and actually observed. (author)

  13. Outcome of lag-screw treatment of incomplete fractures of the frontal plane of the radial facet of the third carpal bone in horses.

    Science.gov (United States)

    Rutherford, D J; Bladon, B; Rogers, C W

    2007-04-01

    To describe outcomes for horses diagnosed with incomplete, non-displaced fractures of the frontal plane of the radial facet (INFR) of the third carpal bone (C3) treated by placement of a lag screw across the fracture under arthroscopic guidance. Horses (n=13) diagnosed with INFR and treated between December 1999 and January 2005 using a lag screw placed over the fracture were studied. For each case, five horses matched for sire, age and sex which were not known to have INFR were sought for comparison. Racing performance data were collected from a commercial online database. The racing performance of cases pre- and post-operatively, and of cases and matched horses in the post-operative period was compared. Sixteen INFR were found in the 13 horses. Radiographic evidence of healed fracture lines 2-4 months after surgery was seen in 11/16 (69%) fractures; 11/13 (85%) cases raced again after a median recovery period of 292 (range 149-681) days. Treatment was considered successful in 9/13 (69%) cases, which were still in training or had been retired for reasons other than lameness localised to the middle carpal joint at the end of the study period. Just 6/13 (46%) cases had raced prior to injury. The racing ability pre- and post-operatively of five cases was compared, three (60%) of which performed better post-operatively than they had before. There was no significant difference in racing longevity or ability post-operatively between patients and matched (control) horses. Post-operatively, there was little difference in the racing performance between horses diagnosed with INFR which had a lag screw placed across the fracture line and horses matched for sire, age and sex which were not known to have INFR. Horses which were diagnosed with INFR of C3 and had a lag screw placed across the fracture had a good prognosis for future racing performance.

  14. Sex assessment from carpals bones: discriminant function analysis in a contemporary Mexican sample.

    Science.gov (United States)

    Mastrangelo, Paola; De Luca, Stefano; Sánchez-Mejorada, Gabriela

    2011-06-15

    Sex assessment is one of the first essential steps in human identification, in both medico-legal cases and bio-archaeological contexts. Fragmentary human remains compromised by different types of burial or physical insults may frustrate the use of the traditional sex estimation methods, such as the analysis of the skull and pelvis. Currently, the application of discriminant functions to sex unidentified skeletal remains is steadily increasing. However, several studies have demonstrated that, due to variation in size and patterns of sexual dimorphism, discriminant functions are population-specific. In this study, in order to improve sex assessment from skeletal remains and to establish population-specific discriminant functions, the diagnostic values of the carpal bones were considered. A sample of 136 individuals (78 males, 58 females) of known sex and age was analyzed. They belong to a contemporary identified collection from the Laboratory of Physical Anthropology, Faculty of Medicine, UNAM (Universidad Nacional Autónoma de México, Mexico City). The age of the individuals ranged between 25 and 85 years. Between four and nine measurements of each carpal bone were taken. Independent t-tests confirm that all carpals are sexually dimorphic. Univariate measurements produce accuracy levels that range from 61.8% to 90.8%. Classification accuracies ranged between 81.3% and 92.3% in the multivariate stepwise discriminant analysis. In addition, intra- and inter-observer error tests were performed. These indicated that replication of measurements was satisfactory for the same observer over time and between observers. These results suggest that carpal bones can be used for assessing sex in both forensic and bio-archaeological identification procedures and that bone dimensions are population specific. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  15. Comparison of Three Techniques for Arthrocentesis of the Carpal Joint in Dromedary Camels: A Prospective Study

    OpenAIRE

    Adel M. Badawy; Eman A. Eshra

    2016-01-01

    The aim of this prospective study was to determine the appropriate approaches for arthrocentesis of the carpal joint in dromedary camels and to compare between these approaches with regard to their success rate, feasibility, accuracy and ease of performance. Twenty-two cadaveric camel forelimbs obtained from 11 camel cadavers, and 4 living camels (6 joints) underwent arthrocentesis for therapeutic and diagnostic purposes, were used in this study. For studying gross anatomy of the suggested ap...

  16. Sagittal fractures of the third carpal bone in horses: 12 cases (1977-1985)

    International Nuclear Information System (INIS)

    Fischer, A.T. Jr.; Stover, S.M.

    1987-01-01

    Third carpal sagittal fractures were found to be related to racing injuries in 10 of 12 horses. These fractures occurred most commonly on the medial aspect of the bone. A dorsoproximal-dorsodistal view of the carpus was required to visualize the fracture in all cases. Healing of the fracture required periods of rest of up to one year. Conservative management of these fractures resulted in return to function in 7 of 12 horses

  17. The asymmetry of the carpal joint and the evolution of wing folding in maniraptoran theropod dinosaurs

    Science.gov (United States)

    Sullivan, Corwin; Hone, David W. E.; Xu, Xing; Zhang, Fucheng

    2010-01-01

    In extant birds, the hand is permanently abducted towards the ulna, and the wrist joint can bend extensively in this direction to fold the wing when not in use. Anatomically, this asymmetric mobility of the wrist results from the wedge-like shape of one carpal bone, the radiale, and from the well-developed convexity of the trochlea at the proximal end of the carpometacarpus. Among the theropod precursors of birds, a strongly convex trochlea is characteristic of Coelurosauria, a clade including the highly derived Maniraptora in addition to tyrannosaurs and compsognathids. The shape of the radiale can be quantified using a ‘radiale angle’ between the proximal and distal articular surfaces. Measurement of the radiale angle and reconstruction of ancestral states using squared-change parsimony shows that the angle was small (15°) in primitive coelurosaurs but considerably larger (25°) in primitive maniraptorans, indicating that the radiale was more wedge-shaped and the carpal joint more asymmetric. The radiale angle progressively increased still further within Maniraptora, with concurrent elongation of the forelimb feathers and the forelimb itself. Carpal asymmetry would have permitted avian-like folding of the forelimb in order to protect the plumage, an early advantage of the flexible, asymmetric wrist inherited by birds. PMID:20200032

  18. Interrelation in the carpal bone index and orthopantomographic dental ages on the Korean children

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Hyung Kyu; You, Dong Soo; Park, Tae Won [College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1973-11-15

    The authors have taken the x-ray films of carpal bone and orthopantomographs in Korean children to research the degree of ossification of carpal bone, that of calcification of tooth in jaw bone, the eruption rate of tooth, and the completion rate of apical foramen, and have compared the bone age with tooth age. We have gained a series of interesting conclusions to dare to report. 1. The ossification of carpal bone and the growth of tooth had processed proportionally to each other. 2. Both the bone age and tooth age were earlier in the female than in the male. 3. The completion of tooth crown formation and that of tooth root formation had processed proportionally to each other, and the general tendency of process was earliest in the mandibular first molar and the latest in the second molar. 4. The eruption of tooth was earliest in the mandibular first molar. The other teeth had erupted in the following order : the central incisor, the lateral incisor, the first premolar, the second premolar, the canine, and the second molar.

  19. Interrelation in the carpal bone index and orthopantomographic dental ages on the Korean children

    International Nuclear Information System (INIS)

    Ahn, Hyung Kyu; You, Dong Soo; Park, Tae Won

    1973-01-01

    The authors have taken the x-ray films of carpal bone and orthopantomographs in Korean children to research the degree of ossification of carpal bone, that of calcification of tooth in jaw bone, the eruption rate of tooth, and the completion rate of apical foramen, and have compared the bone age with tooth age. We have gained a series of interesting conclusions to dare to report. 1. The ossification of carpal bone and the growth of tooth had processed proportionally to each other. 2. Both the bone age and tooth age were earlier in the female than in the male. 3. The completion of tooth crown formation and that of tooth root formation had processed proportionally to each other, and the general tendency of process was earliest in the mandibular first molar and the latest in the second molar. 4. The eruption of tooth was earliest in the mandibular first molar. The other teeth had erupted in the following order : the central incisor, the lateral incisor, the first premolar, the second premolar, the canine, and the second molar.

  20. Quantum tunneling time

    International Nuclear Information System (INIS)

    Wang, Z.S.; Lai, C.H.; Oh, C.H.; Kwek, L.C.

    2004-01-01

    We present a calculation of quantum tunneling time based on the transition duration of wave peak from one side of a barrier to the other. In our formulation, the tunneling time comprises a real and an imaginary part. The real part is an extension of the phase tunneling time with quantum corrections whereas the imaginary time is associated with energy derivatives of the probability amplitudes

  1. Charge Islands Through Tunneling

    Science.gov (United States)

    Robinson, Daryl C.

    2002-01-01

    It has been recently reported that the electrical charge in a semiconductive carbon nanotube is not evenly distributed, but rather it is divided into charge "islands." This paper links the aforementioned phenomenon to tunneling and provides further insight into the higher rate of tunneling processes, which makes tunneling devices attractive. This paper also provides a basis for calculating the charge profile over the length of the tube so that nanoscale devices' conductive properties may be fully exploited.

  2. Josephson tunneling and nanosystems

    OpenAIRE

    Ovchinnikov, Yurii; Kresin, Vladimir

    2010-01-01

    Josephson tunneling between nanoclusters is analyzed. The discrete nature of the electronic energy spectra, including their shell ordering, is explicitly taken into account. The treatment considers the two distinct cases of resonant and non-resonant tunneling. It is demonstrated that the current density greatly exceeds the value discussed in the conventional theory. Nanoparticles are shown to be promising building blocks for nanomaterials-based tunneling networks.

  3. About tunnelling times

    International Nuclear Information System (INIS)

    Olkhovsky, V.S.; Recami, E.

    1991-08-01

    In this paper, first we critically analyse the main theoretical definitions and calculations of the sub-barrier tunnelling and reflection times. Secondly, we propose a new, physically sensible definition of such durations, on the basis of a recent general formalism (already tested for other types of quantum collisions). At last, we discuss some results regarding temporal evolution of the tunnelling processes, and in particular the ''particle'' speed during tunnelling. (author). 36 refs, 1 fig

  4. Microsystem Aeromechanics Wind Tunnel

    Data.gov (United States)

    Federal Laboratory Consortium — The Microsystem Aeromechanics Wind Tunnel advances the study of fundamental flow physics relevant to micro air vehicle (MAV) flight and assesses vehicle performance...

  5. Carpal spasm in a girl as initial presentation of celiac disease: a case report.

    Science.gov (United States)

    Ramosaj-Morina, Atifete; Keka-Sylaj, A; Hasbahta, V; Baloku-Zejnullahu, A; Azemi, M; Zunec, R

    2017-09-04

    Celiac disease is an immune-mediated disorder elicited by ingestion of gluten in genetically susceptible persons. This disorder is characterized by specific histological changes of the small intestine mucosa resulting in malabsorption. This case was written up as it was an unusual and dramatic presentation of celiac disease. We report the case of a 3-year-old Albanian girl who presented at our clinic with carpal spasms and hand paresthesia. A physical examination at admission revealed a relatively good general condition and body weight of 10.5 kg (10 percentile). Carpal spasms and paresthesias of her extremities were present. Neuromuscular irritability was demonstrated by positive Chvostek and Trousseau signs. Blood tests showed severe hypocalcemia with a total serum calcium of 1.2 mmol/L (normal range 2.12 to 2.55 mmol/L), ionized calcium of 0.87 (normal range 1.11 to 1.30 mmol/L), and 24-hour urine calcium excretion of 9.16 mmol (normal range female celiac disease was performed: antigliadin immunoglobulin A, anti-tissue transglutaminase, and anti-endomysial immunoglobulin A antibodies were positive. A duodenal biopsy revealed lymphocyte infiltration, crypt hyperplasia, and villous atrophy compatible with celiac disease grade IIIb according to the Marsh classification. Following the diagnosis of celiac disease, human leukocyte antigen typing was performed, giving a definite diagnosis of celiac disease. She was started on a gluten-free diet. Due to failure to follow a gluten-free diet, episodes of carpal spasms appeared again. Unfortunately, at the age of 7 years she presents with delayed psychophysical development. Although hypocalcemia is a common finding in celiac disease, hypocalcemic carpal spasm is a rare initial manifestation of the disease. Therefore, the possibility of celiac disease should be considered in patients with repeated carpal spasms that seem unduly difficult to treat. This should be evaluated even in the absence of gastrointestinal

  6. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.

    Science.gov (United States)

    Laronde, Pascale; Christiaens, Nicolas; Aumar, Aurélien; Chantelot, Christophe; Fontaine, Christian

    2016-04-01

    Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P<0.0001). Our clinical results and analysis of the literature indicate that 4CA is not superior to PRC when it comes to grip strength, whereas carpal height is significantly decreased after PRC. The decreased tendon excursion after PRC is balanced by an increase in joint stresses after 4CA. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  7. Scanning tunneling microscopy

    International Nuclear Information System (INIS)

    Binnig, G.; Rohrer, H.

    1983-01-01

    Based on vacuum tunneling, a novel type of microscope, the scanning tunneling microscope (STM) was developed. It has an unprecedented resolution in real space on an atomic scale. The authors review the important technical features, illustrate the power of the STM for surface topographies and discuss its potential in other areas of science and technology. (Auth.)

  8. Electron tunneling in chemistry

    International Nuclear Information System (INIS)

    Zamaraev, K.I.; Khajrutdinov, R.F.; Zhdanov, V.P.; Molin, Yu.N.

    1985-01-01

    Results of experimental and theoretical investigations are outlined systematically on electron tunnelling in chemical reactions. Mechanism of electron transport to great distances is shown to be characteristic to chemical compounds of a wide range. The function of tunnel reactions is discussed for various fields of chemistry, including radiation chemistry, electrochemistry, chemistry of solids, chemistry of surface and catalysis

  9. ′Cuff Sign′ a new maneuver for decision-making in patients with carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Keivan Basiri

    2015-01-01

    Conclusion: Considering the fact that cooperation of the patients is not necessary and the double effects of direct pressure and ischemia over the proximal parts of the median nerve leads to prolonged latencies, this test is a useful method for decision-making in patients with severe symptoms of CTS, despite the mild electrodiagnostic findings.

  10. Manual therapy intervention in the treatment of patients with carpal tunnel syndrome: median nerve mobilization versus medical treatment

    Directory of Open Access Journals (Sweden)

    Faten I Mohamed

    2016-01-01

    Conclusion CTS improves after median nerve mobilization, which is better than conventional medical treatment. It provides support for the use of manual therapy in conservative management of CTS with satisfactory Results .

  11. Relationship between adverse neural tension and nerve conduction studies in patients with symptoms of the carpal tunnel syndrome

    OpenAIRE

    Mahmud, Mahmud Ahmad Ismail; Merlo, Álvaro Roberto Crespo; Gomes, Irênio; Becker, Jefferson; Nora, Daniel Bocchese

    2006-01-01

    O propósito deste estudo foi avaliar, através de uma série de casos, a relação entre tensão neural adversa do nervo mediano (TNAm) e o parâmetro eletrofisiológico em 38 pacientes com sintomas da s í n d rome do túnel do carpo (STC), submetidos a estudos de condução nervosa (ECN). As principais medidas foram a TNAm obtida no teste de provocação de tensão neural (TPTN) e parâmetros dos ECN, dividindose os braços avaliados em três grupos: normal, com alteração eletrofisiológica sem gravidade e c...

  12. Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome

    OpenAIRE

    Madenci, Ercan; Altindag, Ozlem; Koca, Irfan; Yilmaz, Mustafa; Gur, Ali

    2011-01-01

    We aimed to bring a more understandable and applicable technique to the literature instead of “massage therapy” in CTS. We compared our new technique with the splint wear, of which the efficacy in CTS has been proven with many studies. Eighty-four patients between 31 and 65 years of age were included in the study. The patients were divided into two equal groups. In the first group, splint and “Madenci” hand massage technique were applied, and in the second group only splint was applied. A spl...

  13. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial

    NARCIS (Netherlands)

    Schrijver, H.M.; Gerritsen, A.A.M.; Strijers, R.L.; Uitdehaag, B.M.J.; Scholten, R.J.P.M.; Vet, de H.C.W.; Bouter, L.M.

    2005-01-01

    0.4) were found between the neurophysiologic and clinical outcome measures after 12 months, and between the changes in these different categories of outcome measures. This study confirms that the parameters of NCS improve significantly after treatment for CTS, but the modest correlations between

  14. The value of quantitative MRI using 1.5 T magnet in diagnosis of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Mohammad Fouad Abdel Baki Allam

    2017-03-01

    Conclusion: Quantitative 1.5 T MRI is an accurate diagnostic tool in CTS. The increase in MN ADC value from proximal to distal with an ADC ratio cutoff value of 1 is highly accurate in diagnosing CTS.

  15. Tunnel fire dynamics

    CERN Document Server

    Ingason, Haukur; Lönnermark, Anders

    2015-01-01

    This book covers a wide range of issues in fire safety engineering in tunnels, describes the phenomena related to tunnel fire dynamics, presents state-of-the-art research, and gives detailed solutions to these major issues. Examples for calculations are provided. The aim is to significantly improve the understanding of fire safety engineering in tunnels. Chapters on fuel and ventilation control, combustion products, gas temperatures, heat fluxes, smoke stratification, visibility, tenability, design fire curves, heat release, fire suppression and detection, CFD modeling, and scaling techniques all equip readers to create their own fire safety plans for tunnels. This book should be purchased by any engineer or public official with responsibility for tunnels. It would also be of interest to many fire protection engineers as an application of evolving technical principles of fire safety.

  16. Ultrafast scanning tunneling microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Botkin, D.A. [California Univ., Berkeley, CA (United States). Dept. of Physics]|[Lawrence Berkeley Lab., CA (United States)

    1995-09-01

    I have developed an ultrafast scanning tunneling microscope (USTM) based on uniting stroboscopic methods of ultrafast optics and scanned probe microscopy to obtain nanometer spatial resolution and sub-picosecond temporal resolution. USTM increases the achievable time resolution of a STM by more than 6 orders of magnitude; this should enable exploration of mesoscopic and nanometer size systems on time scales corresponding to the period or decay of fundamental excitations. USTM consists of a photoconductive switch with subpicosecond response time in series with the tip of a STM. An optical pulse from a modelocked laser activates the switch to create a gate for the tunneling current, while a second laser pulse on the sample initiates a dynamic process which affects the tunneling current. By sending a large sequence of identical pulse pairs and measuring the average tunnel current as a function of the relative time delay between the pulses in each pair, one can map the time evolution of the surface process. USTM was used to measure the broadband response of the STM`s atomic size tunnel barrier in frequencies from tens to hundreds of GHz. The USTM signal amplitude decays linearly with the tunnel junction conductance, so the spatial resolution of the time-resolved signal is comparable to that of a conventional STM. Geometrical capacitance of the junction does not appear to play an important role in the measurement, but a capacitive effect intimately related to tunneling contributes to the measured signals and may limit the ultimate resolution of the USTM.

  17. Tunnel magnetoresistance in alumina, magnesia and composite tunnel barrier magnetic tunnel junctions

    International Nuclear Information System (INIS)

    Schebaum, Oliver; Drewello, Volker; Auge, Alexander; Reiss, Guenter; Muenzenberg, Markus; Schuhmann, Henning; Seibt, Michael; Thomas, Andy

    2011-01-01

    Using magnetron sputtering, we have prepared Co-Fe-B/tunnel barrier/Co-Fe-B magnetic tunnel junctions with tunnel barriers consisting of alumina, magnesia, and magnesia-alumina bilayer systems. The highest tunnel magnetoresistance ratios we found were 73% for alumina and 323% for magnesia-based tunnel junctions. Additionally, tunnel junctions with a unified layer stack were prepared for the three different barriers. In these systems, the tunnel magnetoresistance ratios at optimum annealing temperatures were found to be 65% for alumina, 173% for magnesia, and 78% for the composite tunnel barriers. The similar tunnel magnetoresistance ratios of the tunnel junctions containing alumina provide evidence that coherent tunneling is suppressed by the alumina layer in the composite tunnel barrier. - Research highlights: → Transport properties of Co-Fe-B/tunnel barrier/Co-Fe-B magnetic tunnel junctions. → Tunnel barrier consists of MgO, Al-Ox, or MgO/Al-Ox bilayer systems. → Limitation of TMR-ratio in composite barrier tunnel junctions to Al-Ox values. → Limitation indicates that Al-Ox layer is causing incoherent tunneling.

  18. Tunneling current between graphene layers

    OpenAIRE

    Poklonski, Nikolai A.; Siahlo, Andrei I.; Vyrko, Sergey A.; Popov, Andrey M.; Lozovik, Yurii E.

    2013-01-01

    The physical model that allows to calculate the values of the tunneling current be-tween graphene layers is proposed. The tunneling current according to the pro-posed model is proportional to the area of tunneling transition. The calculated value of tunneling conductivity is in qualitative agreement with experimental data.

  19. Vacuum phonon tunneling.

    Science.gov (United States)

    Altfeder, Igor; Voevodin, Andrey A; Roy, Ajit K

    2010-10-15

    Field-induced phonon tunneling, a previously unknown mechanism of interfacial thermal transport, has been revealed by ultrahigh vacuum inelastic scanning tunneling microscopy (STM). Using thermally broadened Fermi-Dirac distribution in the STM tip as in situ atomic-scale thermometer we found that thermal vibrations of the last tip atom are effectively transmitted to sample surface despite few angstroms wide vacuum gap. We show that phonon tunneling is driven by interfacial electric field and thermally vibrating image charges, and its rate is enhanced by surface electron-phonon interaction.

  20. Radiographical survey of carpal joints with ulcerous lesions of articular cartilage in Japanese black cattle

    International Nuclear Information System (INIS)

    Taura, Y.; Nishimura, R.; Sasaki, N.; Takeuchi, A.; Usui, K.

    1989-01-01

    For the purpose of investigating a different feeding factor in the outbreak of ulcerous lesions of articular cartilage, a radiographical survey of carpal joints was carried out, using Japanese Black cattle at Yamanashi prefecture, and the following results were obtained. 1) The samples for this study were obtained from farms in which using different feeding systems were adopted, such as fattening in drylot (A) : 12 steers (7-32 months old, 221-643 kg body weight), rearing in pasture (B) : 10 steers (7-12 months old, 124-210 kg body weight) and fattening in drylot after rearing in pasture (C) : 5 steers (11-14 months old, 238-271 kg body weight). 2) The radiographic lesions of the carpometacarpal joint were classified into the following five grades, normal (0), slight (I, II), moderate (III) and severe (IV), using a high contrast radiogram. 3) In group A, the lesions were observed in all the metacarpal bone III and carpal bone II@@@III. In the former case, incidence of radiographic lesions was 100%, in which 67% were severe and the remaining 33% consisted of moderate (25%) and slight changes (8%), which was higher than the others. 4) In group B, the incidence of the radiographic lesions of metacarpal bone III was 90%, but in which all of those were of slight changes (I and II). 5) In group C, the incidence of radiographic lesions of the metacarpal bone III was 80%, in which 20% were severe and the remaining 60% were slight ones. 6) No lesions were observed in any lateral half of the joint (carpal bone IV and metacarpal bone IV). 7) Although only the 7 months old steers of group A had very severe radiographic changes, the 10-12 months old steers of the group B showed no clear changes

  1. Subject-Specific Carpal Ligament Elongation in Extreme Positions, Grip, and the Dart Thrower's Motion

    Science.gov (United States)

    Rainbow, Michael J.; Kamal, Robin N.; Moore, Douglas C.; Akelman, Edward; Wolfe, Scott W.; Crisco, Joseph J.

    2015-01-01

    This study examined whether the radiocarpal and dorsal capsular ligaments limit end-range wrist motion or remain strained during midrange wrist motion. Fibers of these ligaments were modeled in the wrists of 12 subjects over multiple wrist positions that reflect high demand tasks and the dart thrower's motion. We found that many of the volar and dorsal ligaments were within 5% of their maximum length throughout the range of wrist motion. Our finding of wrist ligament recruitment during midrange and end-range wrist motion helps to explain the complex but remarkably similar intersubject patterns of carpal motion. PMID:26367853

  2. [A single metastasis in the carpal bones as the first clinical manifestation of a hepatocellular carcinoma].

    Science.gov (United States)

    Corrales Pinzón, R; Alonso Sánchez, J M; de la Mano González, S; El Karzazi Tarazona, K

    2014-01-01

    Hepatocellular carcinoma is the most common primary tumor of the liver. Spreading outside the liver usually takes place in advanced stages of the disease, and bone is the third most common site of metastases. We present a case of hepatocellular carcinoma in which the first clinical manifestation was a single metastasis to the carpal bones. The interest of this case lies in the way this hepatocellular carcinoma manifested as well as in the unusual site of the metastasis. Copyright © 2012 SERAM. Published by Elsevier Espana. All rights reserved.

  3. Quantum tunneling with friction

    Science.gov (United States)

    Tokieda, M.; Hagino, K.

    2017-05-01

    Using the phenomenological quantum friction models introduced by P. Caldirola [Nuovo Cimento 18, 393 (1941), 10.1007/BF02960144] and E. Kanai [Prog. Theor. Phys. 3, 440 (1948), 10.1143/ptp/3.4.440], M. D. Kostin [J. Chem. Phys. 57, 3589 (1972), 10.1063/1.1678812], and K. Albrecht [Phys. Lett. B 56, 127 (1975), 10.1016/0370-2693(75)90283-X], we study quantum tunneling of a one-dimensional potential in the presence of energy dissipation. To this end, we calculate the tunneling probability using a time-dependent wave-packet method. The friction reduces the tunneling probability. We show that the three models provide similar penetrabilities to each other, among which the Caldirola-Kanai model requires the least numerical effort. We also discuss the effect of energy dissipation on quantum tunneling in terms of barrier distributions.

  4. Wind Tunnel Testing Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — NASA Ames Research Center is pleased to offer the services of our premier wind tunnel facilities that have a broad range of proven testing capabilities to customers...

  5. INCAS TRISONIC WIND TUNNEL

    Directory of Open Access Journals (Sweden)

    Florin MUNTEANU

    2009-09-01

    Full Text Available The 1.2 m x 1.2 m Trisonic Blowdown Wind Tunnel is the largest of the experimental facilities at the National Institute for Aerospace Research - I.N.C.A.S. "Elie Carafoli", Bucharest, Romania. The tunnel has been designed by the Canadian company DSMA (now AIOLOS and since its commissioning in 1978 has performed high speed aerodynamic tests for more than 120 projects of aircraft, missiles and other objects among which the twin jet fighter IAR-93, the jet trainer IAR-99, the MIG-21 Lancer, the Polish jet fighter YRYDA and others. In the last years the wind tunnel has been used mostly for experimental research in European projects such as UFAST. The high flow quality parameters and the wide range of testing capabilities ensure the competitivity of the tunnel at an international level.

  6. The ISI Tunnel

    Science.gov (United States)

    1993-10-01

    DP /etc/tunnelvisa p zephyr dark -star TCP /etc/tunnelvisa p zephyr dak’star ICMP /etc/tunnelvisa p zephyr quark MDP /etc/tunnelvisa p zephyr quark ...drax-net-yp 128.9.32.2 1 route add quark -net-yp 128.9.32.3 1 route add vlsi-net-yp 128.9.32.4 1 route add darkstar-net-yp 128.9.32.3 1 route add rocky...TCP /etc/tunnel-visa p zephyr quark ICMP /etc/tunnel-visa p zephyr drax tTI)P /etc/tunnel-visa p zephyr drax TCP /etc/tunnel_visa p zephyr drax ICMP

  7. Wind Tunnel Facility

    Data.gov (United States)

    Federal Laboratory Consortium — This ARDEC facility consists of subsonic, transonic, and supersonic wind tunnels to acquire aerodynamic data. Full-scale and sub-scale models of munitions are fitted...

  8. Water Tunnel Facility

    Data.gov (United States)

    Federal Laboratory Consortium — NETL’s High-Pressure Water Tunnel Facility in Pittsburgh, PA, re-creates the conditions found 3,000 meters beneath the ocean’s surface, allowing scientists to study...

  9. The Beginner's Guide to Wind Tunnels with TunnelSim and TunnelSys

    Science.gov (United States)

    Benson, Thomas J.; Galica, Carol A.; Vila, Anthony J.

    2010-01-01

    The Beginner's Guide to Wind Tunnels is a Web-based, on-line textbook that explains and demonstrates the history, physics, and mathematics involved with wind tunnels and wind tunnel testing. The Web site contains several interactive computer programs to demonstrate scientific principles. TunnelSim is an interactive, educational computer program that demonstrates basic wind tunnel design and operation. TunnelSim is a Java (Sun Microsystems Inc.) applet that solves the continuity and Bernoulli equations to determine the velocity and pressure throughout a tunnel design. TunnelSys is a group of Java applications that mimic wind tunnel testing techniques. Using TunnelSys, a team of students designs, tests, and post-processes the data for a virtual, low speed, and aircraft wing.

  10. Tunnelling of a molecule

    International Nuclear Information System (INIS)

    Jarvis, P.D.; Bulte, D.P.

    1998-01-01

    A quantum-mechanical description of tunnelling is presented for a one-dimensional system with internal oscillator degrees of freedom. The 'charged diatomic molecule' is frustrated on encountering a barrier potential by its centre of charge not being coincident with its centre of mass, resulting in transitions amongst internal states. In an adiabatic limit, the tunnelling of semiclassical coherent-like oscillator states is shown to exhibit the Hartman and Bueuttiker-Landauer times t H and t BL , with the time dependence of the coherent state parameter for the tunnelled state given by α(t) = α e -iω(t+Δt) , Δt = t H - it BL . A perturbation formalism is developed, whereby the exact transfer matrix can be expanded to any desired accuracy in a suitable limit. An 'intrinsic' time, based on the oscillator transition rate during tunnelling, transmission or reflection, is introduced. In simple situations the resulting intrinsic tunnelling time is shown to vanish to lowest order. In the general case a particular (nonzero) parametrisation is inferred, and its properties discussed in comparison with the literature on tunnelling times for both wavepackets and internal clocks. Copyright (1998) CSIRO Australia

  11. Comparison of Three Techniques for Arthrocentesis of the Carpal Joint in Dromedary Camels: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Adel M. Badawy

    2016-03-01

    Full Text Available The aim of this prospective study was to determine the appropriate approaches for arthrocentesis of the carpal joint in dromedary camels and to compare between these approaches with regard to their success rate, feasibility, accuracy and ease of performance. Twenty-two cadaveric camel forelimbs obtained from 11 camel cadavers, and 4 living camels (6 joints underwent arthrocentesis for therapeutic and diagnostic purposes, were used in this study. For studying gross anatomy of the suggested approaches, 4 forelimbs were used. For CT anatomy 3 forelimbs (one/each technique were scanned before and after injection of iodinated contrast medium. For in-vitro evaluation of the techniques 15 forelimbs were used (5/each technique. To test the ease of performance in the living camels, arthrocentesis of 6 joints in 4 camels was performed by a single operator while the animal sited in kneeling position (3 camels and standing position (one camel. Based on the results, there were three feasible approaches for arthrocentesis of carpal joint in camel, the dorso-medial, dorso-lateral, and the lateral approaches. The dorso-medial approach was easily performed and more accurate than the other approaches. The dorso-medial approach was successful with accuracy index of 100% after the first attempts, whilst the dorso-lateral and the lateral approaches have lower rates of success. The procedure was well tolerated in all camels.

  12. Single Electron Tunneling

    International Nuclear Information System (INIS)

    Ruggiero, Steven T.

    2005-01-01

    Financial support for this project has led to advances in the science of single-electron phenomena. Our group reported the first observation of the so-called ''Coulomb Staircase'', which was produced by tunneling into ultra-small metal particles. This work showed well-defined tunneling voltage steps of width e/C and height e/RC, demonstrating tunneling quantized on the single-electron level. This work was published in a now well-cited Physical Review Letter. Single-electron physics is now a major sub-field of condensed-matter physics, and fundamental work in the area continues to be conducted by tunneling in ultra-small metal particles. In addition, there are now single-electron transistors that add a controlling gate to modulate the charge on ultra-small photolithographically defined capacitive elements. Single-electron transistors are now at the heart of at least one experimental quantum-computer element, and single-electron transistor pumps may soon be used to define fundamental quantities such as the farad (capacitance) and the ampere (current). Novel computer technology based on single-electron quantum dots is also being developed. In related work, our group played the leading role in the explanation of experimental results observed during the initial phases of tunneling experiments with the high-temperature superconductors. When so-called ''multiple-gap'' tunneling was reported, the phenomenon was correctly identified by our group as single-electron tunneling in small grains in the material. The main focus throughout this project has been to explore single electron phenomena both in traditional tunneling formats of the type metal/insulator/particles/insulator/metal and using scanning tunneling microscopy to probe few-particle systems. This has been done under varying conditions of temperature, applied magnetic field, and with different materials systems. These have included metals, semi-metals, and superconductors. Amongst a number of results, we have

  13. Resonant tunnel magnetoresistance in a double magnetic tunnel junction

    KAUST Repository

    Useinov, Arthur; Useinov, Niazbeck Kh H; Tagirov, Lenar R.; Kosel, Jü rgen

    2011-01-01

    We present quasi-classical approach to calculate a spin-dependent current and tunnel magnetoresistance (TMR) in double magnetic tunnel junctions (DMTJ) FML/I/FMW/I/FMR, where the magnetization of the middle ferromagnetic metal layer FMW can

  14. Bone tunnel change develops within two weeks of double-bundle anterior cruciate ligament reconstruction using hamstring autograft: A comparison of different postoperative immobilization periods using computed tomography.

    Science.gov (United States)

    Shimizu, Ryo; Adachi, Nobuo; Ishifuro, Minoru; Nakamae, Atsuo; Ishikawa, Masakazu; Deie, Masataka; Ochi, Mitsuo

    2017-10-01

    The purpose of this study was to evaluate bone tunnel changes following anterior cruciate ligament (ACL) reconstruction during the early postoperative period using computed tomography (CT), and to understand the impact of postoperative immobilization on these changes. Twenty patients who underwent double-bundle ACL reconstruction using hamstring tendon autografts were included. We subcategorized patients into two groups: patients who underwent isolated ACL reconstruction and had three days of knee immobilization (Group A, n=10); and patients with concomitant meniscus injuries who underwent ACL reconstruction and meniscus repair simultaneously (Group B, n=10) had their knees immobilized for two weeks after surgery. Bone tunnel enlargement was evaluated using CT imaging at one to three days, two weeks, one month, three months and six months after surgery. The cross-sectional area of the femoral and tibial tunnels was measured, and enlargement rate was calculated. The tunnel center location at two weeks after surgery was also evaluated. The mean cross-sectional area adjacent to the joint space of the femoral and tibial tunnels significantly increased immediately after surgery, especially in the first month (P0.01). There was no significant difference in tunnel enlargement rate between group A and B. Tunnel center location changed even in the first two weeks. Bone tunnel enlargement following double-bundle ACL reconstruction occurred at an earlier time point after surgery than anticipated. Postoperative immobilization could not prevent bone tunnel enlargement, but might prevent tunnel migration. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Interaction between groundwater and TBM (Tunnel Boring Machine) excavated tunnels

    OpenAIRE

    Font Capó, Jordi

    2012-01-01

    A number of problems, e.g. sudden inflows are encountered during tunneling under the piezometric level, especially when the excavation crosses high transmissivity areas. These inflows may drag materials when the tunnel crosses low competent layers, resulting in subsidence, chimney formation and collapses. Moreover, inflows can lead to a decrease in head level because of aquifer drainage. Tunnels can be drilled by a tunnel boring machine (TBM) to minimize inflows and groundwater impacts, restr...

  16. Seepage into PEP tunnel

    International Nuclear Information System (INIS)

    Weidner, H.

    1990-01-01

    The current rate of seepage into the PEP tunnel in the vicinity of IR-10 is very low compared to previous years. Adequate means of handling this low flow are in place. It is not clear whether the reduction in the flow is temporary, perhaps due to three consecutive dry years, or permanent due to drainage of a perched water table. During PEP construction a large amount of effort was expended in attempts to seal the tunnel, with no immediate effect. The efforts to ''manage'' the water flow are deemed to be successful. By covering equipment to protect it from dripping water and channeling seepage into the drainage gutters, the seepage has been reduced to a tolerable nuisance. There is no sure, safe procedure for sealing a leaky shotcreted tunnel

  17. Uncooled tunneling infrared sensor

    Science.gov (United States)

    Kenny, Thomas W. (Inventor); Kaiser, William J. (Inventor); Podosek, Judith A. (Inventor); Vote, Erika C. (Inventor); Muller, Richard E. (Inventor); Maker, Paul D. (Inventor)

    1995-01-01

    An uncooled infrared tunneling sensor in which the only moving part is a diaphragm which is deflected into contact with a micromachined silicon tip electrode prepared by a novel lithographic process. Similarly prepared deflection electrodes employ electrostatic force to control the deflection of a silicon nitride, flat diaphragm membrane. The diaphragm exhibits a high resonant frequency which reduces the sensor's sensitivity to vibration. A high bandwidth feedback circuit controls the tunneling current by adjusting the deflection voltage to maintain a constant deflection of the membrane. The resulting infrared sensor can be miniaturized to pixel dimensions smaller than 100 .mu.m. An alternative embodiment is implemented using a corrugated membrane to permit large deflection without complicated clamping and high deflection voltages. The alternative embodiment also employs a pinhole aperture in a membrane to accommodate environmental temperature variation and a sealed chamber to eliminate environmental contamination of the tunneling electrodes and undesireable accoustic coupling to the sensor.

  18. Instabilities in thin tunnel junctions

    International Nuclear Information System (INIS)

    Konkin, M.K.; Adler, J.G.

    1978-01-01

    Tunnel junctions prepared for inelastic electron tunneling spectroscopy are often plagued by instabilities in the 0-500-meV range. This paper relates the bias at which the instability occurs to the barrier thickness

  19. Tunneling in axion monodromy

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Jon; Cottrell, William; Shiu, Gary; Soler, Pablo [Department of Physics, University of Wisconsin,Madison, WI 53706 (United States)

    2016-10-06

    The Coleman formula for vacuum decay and bubble nucleation has been used to estimate the tunneling rate in models of axion monodromy in recent literature. However, several of Coleman’s original assumptions do not hold for such models. Here we derive a new estimate with this in mind using a similar Euclidean procedure. We find that there are significant regions of parameter space for which the tunneling rate in axion monodromy is not well approximated by the Coleman formula. However, there is also a regime relevant to large field inflation in which both estimates parametrically agree. We also briefly comment on the applications of our results to the relaxion scenario.

  20. LEP tunnel monorail

    CERN Multimedia

    1985-01-01

    A monorail from CERN's Large Electron Positron collider (LEP, for short). It ran around the 27km tunnel, transporting equipment and personnel. With its 27-kilometre circumference, LEP was the largest electron-positron accelerator ever built and ran from 1989 to 2000. During 11 years of research, LEP's experiments provided a detailed study of the electroweak interaction. Measurements performed at LEP also proved that there are three – and only three – generations of particles of matter. LEP was closed down on 2 November 2000 to make way for the construction of the Large Hadron Collider in the same tunnel.

  1. Excavating a transfer tunnel

    CERN Multimedia

    Laurent Guiraud

    2000-01-01

    The transfer tunnel being dug here will take the 450 GeV beam from the SPS and inject it into the LHC where the beam energies will be increased to 7 TeV. In order to transfer this beam from the SPS to the LHC, two transfer tunnels are used to circulate the beams in opposite directions. When excavated, the accelerator components, including magnets, beam pipes and cryogenics will be installed and connected to both the SPS and LHC ready for operation to begin in 2008.

  2. Gap anisotropy and tunneling currents. [MPS3

    DEFF Research Database (Denmark)

    Lazarides, N.; Sørensen, Mads Peter

    1996-01-01

    The tunneling Hamiltonian formalism is applied to calculate the tunnelingcurrents through a small superconducting tunnel junction. The formalism isextended to nonconstant tunneling matrix elements. The electrodes of thejunction are assumed to......The tunneling Hamiltonian formalism is applied to calculate the tunnelingcurrents through a small superconducting tunnel junction. The formalism isextended to nonconstant tunneling matrix elements. The electrodes of thejunction are assumed to...

  3. Breaking through the tranfer tunnel

    CERN Document Server

    Laurent Guiraud

    2001-01-01

    This image shows the tunnel boring machine breaking through the transfer tunnel into the LHC tunnel. Proton beams will be transferred from the SPS pre-accelerator to the LHC at 450 GeV through two specially constructed transfer tunnels. From left to right: LHC Project Director, Lyn Evans; CERN Director-General (at the time), Luciano Maiani, and Director for Accelerators, Kurt Hubner.

  4. Control of tunneling in heterostructures

    International Nuclear Information System (INIS)

    Volokhov, V M; Tovstun, C A; Ivlev, B

    2007-01-01

    A tunneling current between two rectangular potential wells can be effectively controlled by applying an external ac field. A variation of the ac frequency by 10% may lead to the suppression of the tunneling current by two orders of magnitude, which is a result of quantum interference under the action of the ac field. This effect of destruction of tunneling can be used as a sensitive control of tunneling current across nanosize heterostructures

  5. Ivar Giaever, Tunneling, and Superconductors

    Science.gov (United States)

    dropdown arrow Site Map A-Z Index Menu Synopsis Ivar Giaever, Tunneling, and Superconductors Resources with in Superconductors Measured by Electron Tunneling; Physical Review Letters, Vol. 5 Issue 4: 147 - 148 ; August 15, 1960 Electron Tunneling Between Two Superconductors; Physical Review Letters, Vol. 5 Issue 10

  6. Scanning tunneling microscope nanoetching method

    Science.gov (United States)

    Li, Yun-Zhong; Reifenberger, Ronald G.; Andres, Ronald P.

    1990-01-01

    A method is described for forming uniform nanometer sized depressions on the surface of a conducting substrate. A tunneling tip is used to apply tunneling current density sufficient to vaporize a localized area of the substrate surface. The resulting depressions or craters in the substrate surface can be formed in information encoding patterns readable with a scanning tunneling microscope.

  7. Physics of optimal resonant tunneling

    NARCIS (Netherlands)

    Racec, P.N.; Stoica, T.; Popescu, C.; Lepsa, M.I.; Roer, van de T.G.

    1997-01-01

    The optimal resonant tunneling, or the complete tunneling transparence of a biased double-barrier resonant-tunneling (DBRT) structure, is discussed. It is shown that its physics does not rest on the departure from the constant potential within the barriers and well, due to the applied electric

  8. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  9. Bariatric Surgery

    Science.gov (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  10. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  11. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  12. Clinicomicrobiological characteristics and treatment outcome of sclerocorneal tunnel infection.

    Science.gov (United States)

    Roy, Aravind; Sahu, Srikant K; Padhi, Tapas R; Das, Sujata; Sharma, Savitri

    2012-07-01

    To analyze the clinical presentation, microbiological evaluation, and management of post-cataract surgery sclerocorneal tunnel infection. This is a retrospective chart review of 11 patients with sclerocorneal tunnel infection after cataract surgery, managed between November 2006 and October 2009. The clinical characteristics and treatment outcomes were analyzed. All patients presented within 1 to 10 weeks of primary surgery. The presenting visual acuity ranged from hand motions to 20/50. Ten of 11 patients had sclerocorneal involvement, and 4 patients had associated endophthalmitis. The causative organisms were fungus (n = 6), bacteria (n = 4), or both (n = 1). Deroofing of the tunnel and sclerocorneal patch graft was done in 4 patients. Intensive medication was administered to all patients. The final visual acuity ranged from light perception to 20/50 at a mean follow-up of 119 days (median, 66 days; range, 2-357 days). Five patients had ≥20/100 vision. The mean interval between presentation to resolution of infiltrate and formation of peripheral scarring was 20 days (median, 11 days; range, 2-66 days). Sclerocorneal tunnel infection must be microbiologically evaluated. Intensive medical management, wound revision and repair may lead to a favorable outcome.

  13. Tunneling path toward spintronics

    International Nuclear Information System (INIS)

    Miao Guoxing; Moodera, Jagadeesh S; Muenzenberg, Markus

    2011-01-01

    The phenomenon of quantum tunneling, which was discovered almost a century ago, has led to many subsequent discoveries. One such discovery, spin polarized tunneling, was made 40 years ago by Robert Meservey and Paul Tedrow (Tedrow and Meservey 1971 Phys. Rev. Lett. 26 192), and it has resulted in many fundamental observations and opened up an entirely new field of study. Until the mid-1990s, this field developed at a steady, low rate, after which a huge increase in activity suddenly occurred as a result of the unraveling of successful spin tunneling between two ferromagnets. In the past 15 years, several thousands of papers related to spin polarized tunneling and transport have been published, making this topic one of the hottest areas in condensed matter physics from both fundamental science and applications viewpoints. Many review papers and book chapters have been written in the past decade on this subject. This paper is not exhaustive by any means; rather, the emphases are on recent progress, technological developments and informing the reader about the current direction in which this topic is moving.

  14. Magnetic Fluxtube Tunneling

    Science.gov (United States)

    Dahlburg, Russell B.; Antiochos,, Spiro K.; Norton, D.

    1996-01-01

    We present numerical simulations of the collision and subsequent interaction of two initially orthogonal, twisted, force free field magnetic fluxtubes. The simulations were carried out using a new three dimensional explicit parallelized Fourier collocation algorithm for solving the viscoresistive equations of compressible magnetohydrodynamics. It is found that, under a wide range of conditions, the fluxtubes can 'tunnel' through each other. Two key conditions must be satisfied for tunneling to occur: the magnetic field must be highly twisted with a field line pitch much greater than 1, and the magnetic Lundquist number must be somewhat large, greater than or equal to 2880. This tunneling behavior has not been seen previously in studies of either vortex tube or magnetic fluxtube interactions. An examination of magnetic field lines shows that tunneling is due to a double reconnection mechanism. Initially orthogonal field lines reconnect at two specific locations, exchange interacting sections and 'pass' through each other. The implications of these results for solar and space plasmas are discussed.

  15. Tunnel nitrogen spill experiment

    International Nuclear Information System (INIS)

    Ageyev, A.I.; Alferov, V.N.; Mulholland, G.T.

    1983-01-01

    The Energy Saver Safety Analysis Report (SAR) found the tunnel oxygen deficiency considerations emphasized helium spills. These reports concluded the helium quickly warms and because of its low denisty, rises to the apex of the tunnel. The oxygen content below the apex and in all but the immediate vicinity of the helium spill is essentially unchanged and guarantees an undisturbed source of oxygen especially important to fallen personnel. In contrast nitrogen spills warm slower than helium due to the ratio of the enthalpy changes per unit volume spilled spread more uniformly across the tunnel cross-section when warmed because of the much smaller density difference with air, and generally provides a greater hazard than helium spills as a result. In particular there was concern that personnel that might fall to the floor for oxygen deficiency or other reasons might find less, and not more, oxygen with dire consequences. The SAR concluded tunnel nitrogen spills were under-investigated and led to this work

  16. The scanning tunneling microscope

    International Nuclear Information System (INIS)

    Salvan, F.

    1986-01-01

    A newly conceived microscope, based on a pure quantum phenomenon, is an ideal tool to study atom by atom the topography and properties of surfaces. Applications are presented: surface ''reconstruction'' of silicon, lamellar compound study, etc... Spectroscopy by tunnel effect will bring important information on electronic properties; it is presented with an application on silicon [fr

  17. Supramolecular tunneling junctions

    NARCIS (Netherlands)

    Wimbush, K.S.

    2012-01-01

    In this study a variety of supramolecular tunneling junctions were created. The basis of these junctions was a self-assembled monolayer of heptathioether functionalized ß-cyclodextrin (ßCD) formed on an ultra-flat Au surface, i.e., the bottom electrode. This gave a well-defined hexagonally packed

  18. Monitoring pilot projects on bored tunnelling : The Second Heinenoord Tunnel and the Botlek Rail Tunnel

    NARCIS (Netherlands)

    Bakker, K.J.; De Boer, F.; Admiraal, J.B.M.; Van Jaarsveld, E.P.

    1999-01-01

    Two pilot projects for bored tunnelling in soft soil have been undertaken in the Netherlands. The monitoring was commissioned under the authority of the Centre for Underground Construction (COB). A description of the research related to the Second Heinenoord Tunnel and the Botlek Rail Tunnel will be

  19. Steel syndrome: dislocated hips and radial heads, carpal coalition, scoliosis, short stature, and characteristic facial features.

    Science.gov (United States)

    Flynn, John M; Ramirez, Norman; Betz, Randal; Mulcahey, Mary Jane; Pino, Franz; Herrera-Soto, Jose A; Carlo, Simon; Cornier, Alberto S

    2010-01-01

    A syndrome of children with short stature, bilateral hip dislocations, radial head dislocations, carpal coalitions, scoliosis, and cavus feet in Puerto Rican children, was reported by Steel et al in 1993. The syndrome was described as a unique entity with dismal results after conventional treatment of dislocated hips. The purpose of this study is to reevaluate this patient population with a longer follow-up and delineate the clinical and radiologic features, treatment outcomes, and the genetic characteristics. This is a retrospective cohort study of 32 patients in whom we evaluated the clinical, imaging data, and genetic characteristics. We compare the findings and quality of life in patients with this syndrome who have had attempts at reduction of the hips versus those who did not have the treatment. Congenital hip dislocations were present in 100% of the patients. There was no attempt at reduction in 39% (25/64) of the hips. In the remaining 61% (39/64), the hips were treated with a variety of modalities fraught with complications. Of those treated, 85% (33/39) remain dislocated, the rest of the hips continue subluxated with acetabular dysplasia and pain. The group of hips that were not treated reported fewer complaints and limitation in daily activities compared with the hips that had attempts at reduction. Steel syndrome is a distinct clinical entity characterized by short stature, bilateral hip and radial head dislocation, carpal coalition, scoliosis, cavus feet, and characteristic facial features with dismal results for attempts at reduction of the hips. Prognostic Study Level II.

  20. Measuring fire size in tunnels

    International Nuclear Information System (INIS)

    Guo, Xiaoping; Zhang, Qihui

    2013-01-01

    A new measure of fire size Q′ has been introduced in longitudinally ventilated tunnel as the ratio of flame height to the height of tunnel. The analysis in this article has shown that Q′ controls both the critical velocity and the maximum ceiling temperature in the tunnel. Before the fire flame reaches tunnel ceiling (Q′ 1.0), Fr approaches a constant value. This is also a well-known phenomenon in large tunnel fires. Tunnel ceiling temperature shows the opposite trend. Before the fire flame reaches the ceiling, it increases very slowly with the fire size. Once the flame has hit the ceiling of tunnel, temperature rises rapidly with Q′. The good agreement between the current prediction and three different sets of experimental data has demonstrated that the theory has correctly modelled the relation among the heat release rate of fire, ventilation flow and the height of tunnel. From design point of view, the theoretical maximum of critical velocity for a given tunnel can help to prevent oversized ventilation system. -- Highlights: • Fire sizing is an important safety measure in tunnel design. • New measure of fire size a function of HRR of fire, tunnel height and ventilation. • The measure can identify large and small fires. • The characteristics of different fire are consistent with observation in real fires

  1. Tunnel boring machine applications

    International Nuclear Information System (INIS)

    Bhattacharyya, K.K.; McDonald, R.; Saunders, R.S.

    1992-01-01

    This paper reports that characterization of Yucca Mountain for a potential repository requires construction of an underground Exploratory Studies Facility (ESF). Mechanical excavating methods have been proposed for construction of the ESF as they offer a number of advantages over drilling and blasting at the Yucca Mountain site, including; less ground disturbance and therefore a potential for less adverse effects on the integrity of the site, creation of a more stable excavation cross section requiring less ground support, and an inherently safer and cleaner working environment. The tunnel boring machine (TBM) provides a proven technology for excavating the welded and unwelded Yucca Mountain tuffs. The access ramps and main underground tunnels form the largest part of the ESF underground construction work, and have been designed for excavation by TBM

  2. Programmable ferroelectric tunnel memristor

    Directory of Open Access Journals (Sweden)

    Andy eQuindeau

    2014-02-01

    Full Text Available We report an analogously programmable memristor based on genuine electronic resistive switching combining ferroelectric switching and electron tunneling. The tunnel current through an 8 unit cell thick epitaxial Pb(Zr[0.2]Ti[0.8]O[3] film sandwiched between La[0.7]Sr[0.3]MnO[3] and cobalt electrodes obeys the Kolmogorov-Avrami-Ishibashi model for bidimensional growth with a characteristic switching time in the order of 10^-7 seconds. The analytical description of switching kinetics allows us to develop a characteristic transfer function that has only one parameter viz. the characteristic switching time and fully predicts the resistive states of this type of memristor.

  3. Hawking Radiation As Tunneling

    International Nuclear Information System (INIS)

    Parikh, Maulik K.; Wilczek, Frank

    2000-01-01

    We present a short and direct derivation of Hawking radiation as a tunneling process, based on particles in a dynamical geometry. The imaginary part of the action for the classically forbidden process is related to the Boltzmann factor for emission at the Hawking temperature. Because the derivation respects conservation laws, the exact spectrum is not precisely thermal. We compare and contrast the problem of spontaneous emission of charged particles from a charged conductor

  4. Tunnel blasting - recent developments

    Energy Technology Data Exchange (ETDEWEB)

    White, T.E.

    1999-05-01

    While tunnelling machines are more efficient than previously, there are still areas where blasting is a more efficient method of advance. Drilling and design methods are increasingly sophisticated, as is choice of explosive. Explosive deployment must be carefully calculated so as to avoid desensitisation. Nitroglycerine may be used as slurries; bulk mixing on site of ANFO is also practised in mining in the UK. Electric detonators, Nonel tubes, and electronic detonators are also increasingly employed.

  5. The beam dump tunnels

    CERN Multimedia

    Patrice Loïez

    2002-01-01

    In these images workers are digging the tunnels that will be used to dump the counter-circulating beams. Travelling just a fraction under the speed of light, the beams at the LHC will each carry the energy of an aircraft carrier travelling at 12 knots. In order to dispose of these beams safely, a beam dump is used to extract the beam and diffuse it before it collides with a radiation shielded graphite target.

  6. Primary Tunnel Junction Thermometry

    International Nuclear Information System (INIS)

    Pekola, Jukka P.; Holmqvist, Tommy; Meschke, Matthias

    2008-01-01

    We describe the concept and experimental demonstration of primary thermometry based on a four-probe measurement of a single tunnel junction embedded within four arrays of junctions. We show that in this configuration random sample specific and environment-related errors can be avoided. This method relates temperature directly to Boltzmann constant, which will form the basis of the definition of temperature and realization of official temperature scales in the future

  7. 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.)

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

    International Nuclear Information System (INIS)

    Boavida, Peter; Lambot-Juhan, Karen; Ording Mueller, Lil-Sofie; Damasio, Beatrice; Malattia, Clara; Tanturri de Horatio, Laura; Owens, Catherine M.; Rosendahl, Karen

    2015-01-01

    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.)

  9. Galloping exercise induces regional changes in bone density within the third and radial carpal bones of Thoroughbred horses

    International Nuclear Information System (INIS)

    Firth, E.C.; Delahunt, J.; Wichtel, J.W.; Birch, H.L.; Goodship, A.E.

    1999-01-01

    This study was performed to test the hypothesis that a localised bone hypertrophy could occur within the subchondral cancellous architecture of the third and radial carpal bones. Using 2 levels of controlled and defined exercise, it was observed that a high intensity treadmill exercise protocol resulted in functional adaptation of the carpal bones. The increase in trabecular thickening and density was seen to be localised to those regions underlying common sites of cartilage degradation, the interface of the thickened trabeculae with the normal architecture in the third carpal hone was coincident with a common site of clinical fractures. The bone changes were determined both qualitatively on examination of slab radiographs and quantified by dual energy x-ray absorptiometry. The findings from this study are relevant to mechanical factors involved in the pathophysiology of joint degeneration. The potential clinical implications of this study are in relation to changes in the type and duration of exercise regimens used in training of equine athletes. The rapid response of bone to mechanical stimulation has implications in the longer term for localised cartilage degradation. Imaging techniques could be developed to monitor these early bone changes in the specific areas identified in this study and thus allow appropriate changes in training intensity to minimise subsequent damage to the articular surface

  10. Hydrodynamic optical soliton tunneling

    Science.gov (United States)

    Sprenger, P.; Hoefer, M. A.; El, G. A.

    2018-03-01

    A notion of hydrodynamic optical soliton tunneling is introduced in which a dark soliton is incident upon an evolving, broad potential barrier that arises from an appropriate variation of the input signal. The barriers considered include smooth rarefaction waves and highly oscillatory dispersive shock waves. Both the soliton and the barrier satisfy the same one-dimensional defocusing nonlinear Schrödinger (NLS) equation, which admits a convenient dispersive hydrodynamic interpretation. Under the scale separation assumption of nonlinear wave (Whitham) modulation theory, the highly nontrivial nonlinear interaction between the soliton and the evolving hydrodynamic barrier is described in terms of self-similar, simple wave solutions to an asymptotic reduction of the Whitham-NLS partial differential equations. One of the Riemann invariants of the reduced modulation system determines the characteristics of a soliton interacting with a mean flow that results in soliton tunneling or trapping. Another Riemann invariant yields the tunneled soliton's phase shift due to hydrodynamic interaction. Soliton interaction with hydrodynamic barriers gives rise to effects that include reversal of the soliton propagation direction and spontaneous soliton cavitation, which further suggest possible methods of dark soliton control in optical fibers.

  11. Resonant Tunneling Spin Pump

    Science.gov (United States)

    Ting, David Z.

    2007-01-01

    The resonant tunneling spin pump is a proposed semiconductor device that would generate spin-polarized electron currents. The resonant tunneling spin pump would be a purely electrical device in the sense that it would not contain any magnetic material and would not rely on an applied magnetic field. Also, unlike prior sources of spin-polarized electron currents, the proposed device would not depend on a source of circularly polarized light. The proposed semiconductor electron-spin filters would exploit the Rashba effect, which can induce energy splitting in what would otherwise be degenerate quantum states, caused by a spin-orbit interaction in conjunction with a structural-inversion asymmetry in the presence of interfacial electric fields in a semiconductor heterostructure. The magnitude of the energy split is proportional to the electron wave number. Theoretical studies have suggested the possibility of devices in which electron energy states would be split by the Rashba effect and spin-polarized currents would be extracted by resonant quantum-mechanical tunneling.

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  13. Semiclassical description of resonant tunneling

    International Nuclear Information System (INIS)

    Bogomolny, E.B.; Rouben, D.C.

    1996-01-01

    A semiclassical formula is calculated for the tunneling current of electrons trapped in a potential well which can tunnel into and across a wide quantum well. The tunneling current is measured at the second interface of this well and the calculations idealized an experimental situation where a strong magnetic field tilted with respect to an electric field was used. It is shown that the contribution to the tunneling current, due to trajectories which begin at the first interface and end on the second, is dominant for periodic orbits which hit both walls of the quantum well. (author)

  14. Engineers win award for Swiss tunnel

    CERN Multimedia

    2003-01-01

    A Derby engineering consultancy has won the Tunnelling Industry Award 2003 for Excellence in Tunnel Design, offered by the British Tunnelling Society, for its work on the LHC in Geneva, Switzerland (1/2 page).

  15. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  16. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  17. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  18. Thermovoltages in vacuum tunneling investigated by scanning tunneling microscopy

    OpenAIRE

    Hoffmann, D. H.; Rettenberger, Armin; Grand, Jean Yves; Läuger, K.; Leiderer, Paul; Dransfeld, Klaus; Möller, Rolf

    1995-01-01

    By heating the tunneling tip of a scanning tunneling microscope the thermoelectric properties of a variable vacuum barrier have been investigated. The lateral variation of the observed thermovoltage will be discussed for polycrystalline gold, stepped surfaces of silver, as well as for copper islands on silver.

  19. Magnetic tunnel junctions with monolayer hexagonal boron nitride tunnel barriers

    Energy Technology Data Exchange (ETDEWEB)

    Piquemal-Banci, M.; Galceran, R.; Bouzehouane, K.; Anane, A.; Petroff, F.; Fert, A.; Dlubak, B.; Seneor, P. [Unité Mixte de Physique, CNRS, Thales, Univ. Paris-Sud, Université Paris-Saclay, Palaiseau 91767 (France); Caneva, S.; Martin, M.-B.; Weatherup, R. S.; Kidambi, P. R.; Robertson, J.; Hofmann, S. [Department of Engineering, University of Cambridge, Cambridge CB21PZ (United Kingdom); Xavier, S. [Thales Research and Technology, 1 avenue Augustin Fresnel, Palaiseau 91767 (France)

    2016-03-07

    We report on the integration of atomically thin 2D insulating hexagonal boron nitride (h-BN) tunnel barriers into Co/h-BN/Fe magnetic tunnel junctions (MTJs). The h-BN monolayer is directly grown by chemical vapor deposition on Fe. The Conductive Tip Atomic Force Microscopy (CT-AFM) measurements reveal the homogeneity of the tunnel behavior of our h-BN layers. As expected for tunneling, the resistance depends exponentially on the number of h-BN layers. The h-BN monolayer properties are also characterized through integration into complete MTJ devices. A Tunnel Magnetoresistance of up to 6% is observed for a MTJ based on a single atomically thin h-BN layer.

  20. Thyroid Surgery

    Science.gov (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  1. Planning of vessel grafts for reconstructive surgery in congenital heart diseases

    Science.gov (United States)

    Rietdorf, U.; Riesenkampff, E.; Schwarz, T.; Kuehne, T.; Meinzer, H.-P.; Wolf, I.

    2010-02-01

    The Fontan operation is a surgical treatment for patients with severe congenital heart diseases, where a biventricular correction of the heart can't be achieved. In these cases, a uni-ventricular system is established. During the last step of surgery a tunnel segment is placed to connect the inferior caval vein directly with the pulmonary artery, bypassing the right atrium and ventricle. Thus, the existing ventricle works for the body circulation, while the venous blood is passively directed to the pulmonary arteries. Fontan tunnels can be placed intra- and extracardially. The location, length and shape of the tunnel must be planned accurately. Furthermore, if the tunnel is placed extracardially, it must be positioned between other anatomical structures without constraining them. We developed a software system to support planning of the tunnel location, shape, and size, making pre-operative preparation of the tunnel material possible. The system allows for interactive placement and adjustment of the tunnel, affords a three-dimensional visualization of the virtual Fontan tunnel inside the thorax, and provides a quantification of the length, circumferences and diameters of the tunnel segments. The visualization and quantification can be used to plan and prepare the tunnel material for surgery in order to reduce the intra-operative time and to improve the fit of the tunnel patch.

  2. Theoretical distribution of load in the radius and ulna carpal joint.

    Science.gov (United States)

    Márquez-Florez, Kalenia; Vergara-Amador, Enrique; de Las Casas, Estevam Barbosa; Garzón-Alvarado, Diego A

    2015-05-01

    The purpose of this study is to validate a model for the analysis of the load distribution through the wrist joint, subjected to forces on the axes of the metacarpals from distal to proximal for two different mesh densities. To this end, the Rigid Body Spring Model (RBSM) method was used on a three-dimensional model of the wrist joint, simulating the conditions when making a grip handle. The cartilage and ligaments were simulated as springs acting under compression and tension, respectively, while the bones were considered as rigid bodies. At the proximal end of the ulna the movement was completely restricted, and the radius was allowed to move only in the lateral/medial direction. With these models, we found the load distributions on each carpal articular surface of radius. Additionally, the results show that the percentage of the applied load transmitted through the radius was about 86% for one mesh and 88% for the coarser one; for the ulna it was 21% for one mesh and 18% for the coarser. The obtained results are comparable with previous outcomes reported in prior studies. The latter allows concluding that, in theory, the methodology can be used to describe the changes in load distribution in the wrist. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Modified Carpal Box Technique in the Diagnosis of Suspected Scaphoid Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Toth, F.; Mester, S.; Cseh, G.; Bener, A.; Nyarady, J.; Lovasz, G. [Pecs Univ. (Hungary). Medical School

    2003-05-01

    Purpose: To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures. Material and Methods: Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically. Results: No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images. Conclusion: Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

  4. Spin tunnelling in mesoscopic systems

    Indian Academy of Sciences (India)

    We study spin tunnelling in molecular magnets as an instance of a mesoscopic phenomenon, with special emphasis on the molecule Fe8. We show that the tunnel splitting between various pairs of Zeeman levels in this molecule oscillates as a function of applied magnetic field, vanishing completely at special points in the ...

  5. Hawking temperature from tunnelling formalism

    OpenAIRE

    Mitra, P.

    2007-01-01

    It has recently been suggested that the attempt to understand Hawking radiation as tunnelling across black hole horizons produces a Hawking temperature double the standard value. It is explained here how one can obtain the standard value in the same tunnelling approach.

  6. Tunneling Ionization of Diatomic Molecules

    DEFF Research Database (Denmark)

    Svensmark, Jens Søren Sieg

    2016-01-01

    When a molecule is subject to a strong laser field, there is a probability that an electron can escape, even though the electrons are bound by a large potential barrier. This is possible because electrons are quantum mechanical in nature, and they are therefore able to tunnel through potential...... barriers, an ability classical particles do not possess. Tunnelling is a fundamental quantum mechanical process, a process that is distinctly non-classical, so solving this tunnelling problem is not only relevant for molecular physics, but also for quantum theory in general. In this dissertation the theory...... of tunneling ionizaion of molecules is presented and the results of numerical calculations are shown. One perhaps surprising result is, that the frequently used Born-Oppenheimer approximation breaks down for weak fields when describing tunneling ionization. An analytic theory applicable in the weak-field limit...

  7. Tunneling from the past horizon

    Science.gov (United States)

    Kang, Subeom; Yeom, Dong-han

    2018-04-01

    We investigate a tunneling and emission process of a thin-shell from a Schwarzschild black hole, where the shell was initially located beyond the Einstein-Rosen bridge and finally appears at the right side of the Penrose diagram. In order to obtain such a solution, we should assume that the areal radius of the black hole horizon increases after the tunneling. Hence, there is a parameter range such that the tunneling rate is exponentially enhanced, rather than suppressed. We may have two interpretations regarding this. First, such a tunneling process from the past horizon is improbable by physical reasons; second, such a tunneling is possible in principle, but in order to obtain a stable Einstein-Rosen bridge, one needs to restrict the parameter spaces. If such a process is allowed, this can be a nonperturbative contribution to Einstein-Rosen bridges as well as eternal black holes.

  8. Fluctuation Dominated Josephson Tunneling with a Scanning Tunneling Microscope

    International Nuclear Information System (INIS)

    Naaman, O.; Teizer, W.; Dynes, R. C.

    2001-01-01

    We demonstrate Josephson tunneling in vacuum tunnel junctions formed between a superconducting scanning tunneling microscope tip and a Pb film, for junction resistances in the range 50--300 k Omega. We show that the superconducting phase dynamics is dominated by thermal fluctuations, and that the Josephson current appears as a peak centered at small finite voltage. In the presence of microwave fields (f=15.0 GHz) the peak decreases in magnitude and shifts to higher voltages with increasing rf power, in agreement with theory

  9. Tunneling junction as an open system. Normal tunneling

    International Nuclear Information System (INIS)

    Ono, Y.

    1978-01-01

    The method of the tunneling Hamiltonian is reformulated in the case of normal tunneling by introducing two independent particle baths. Due to the baths, it becomes possible to realize a final stationary state where the electron numbers of the two electrodes in the tunneling system are maintained constant and where there exists a stationary current. The effect of the bath-system couplings on the current-voltage characteristics of the junction is discussed in relation to the usual expression of the current as a function of voltage. (Auth.)

  10. Frequency driven inversion of tunnel magnetoimpedance and observation of positive tunnel magnetocapacitance in magnetic tunnel junctions

    International Nuclear Information System (INIS)

    Parui, Subir; Ribeiro, Mário; Atxabal, Ainhoa; Llopis, Roger; Bedoya-Pinto, Amilcar; Sun, Xiangnan; Casanova, Fèlix; Hueso, Luis E.

    2016-01-01

    The relevance for modern computation of non-volatile high-frequency memories makes ac-transport measurements of magnetic tunnel junctions (MTJs) crucial for exploring this regime. Here, we demonstrate a frequency-mediated effect in which the tunnel magnetoimpedance reverses its sign in a classical Co/Al 2 O 3 /NiFe MTJ, whereas we only observe a gradual decrease in the tunnel magnetophase. Such effects are explained by the capacitive coupling of a parallel resistor and capacitor in the equivalent circuit model of the MTJ. Furthermore, we report a positive tunnel magnetocapacitance effect, suggesting the presence of a spin-capacitance at the two ferromagnet/tunnel-barrier interfaces. Our results are important for understanding spin transport phenomena at the high frequency regime in which the spin-polarized charge accumulation due to spin-dependent penetration depth at the two interfaces plays a crucial role.

  11. Frequency driven inversion of tunnel magnetoimpedance and observation of positive tunnel magnetocapacitance in magnetic tunnel junctions

    Energy Technology Data Exchange (ETDEWEB)

    Parui, Subir, E-mail: s.parui@nanogune.eu, E-mail: l.hueso@nanogune.eu; Ribeiro, Mário; Atxabal, Ainhoa; Llopis, Roger [CIC nanoGUNE, 20018 Donostia-San Sebastian (Spain); Bedoya-Pinto, Amilcar [CIC nanoGUNE, 20018 Donostia-San Sebastian (Spain); Max Planck Institute of Microstructure Physics, D-06120 Halle (Germany); Sun, Xiangnan [CIC nanoGUNE, 20018 Donostia-San Sebastian (Spain); National Center for Nanoscience and Technology, 100190 Beijing (China); Casanova, Fèlix; Hueso, Luis E., E-mail: s.parui@nanogune.eu, E-mail: l.hueso@nanogune.eu [CIC nanoGUNE, 20018 Donostia-San Sebastian (Spain); IKERBASQUE, Basque Foundation for Science, 48011 Bilbao (Spain)

    2016-08-01

    The relevance for modern computation of non-volatile high-frequency memories makes ac-transport measurements of magnetic tunnel junctions (MTJs) crucial for exploring this regime. Here, we demonstrate a frequency-mediated effect in which the tunnel magnetoimpedance reverses its sign in a classical Co/Al{sub 2}O{sub 3}/NiFe MTJ, whereas we only observe a gradual decrease in the tunnel magnetophase. Such effects are explained by the capacitive coupling of a parallel resistor and capacitor in the equivalent circuit model of the MTJ. Furthermore, we report a positive tunnel magnetocapacitance effect, suggesting the presence of a spin-capacitance at the two ferromagnet/tunnel-barrier interfaces. Our results are important for understanding spin transport phenomena at the high frequency regime in which the spin-polarized charge accumulation due to spin-dependent penetration depth at the two interfaces plays a crucial role.

  12. Cubital Tunnel Syndrome

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... behind the elbow. This can happen during sleep. Anatomy : ... thicker or there is an “extra” muscle over the nerve that can keep it from ...

  13. 99mTc-MDP combined blood pool and bone phase radionuclide imaging in papain-injected carpal joints

    International Nuclear Information System (INIS)

    Metcalf, M.R.; Twardock, A.R.; Sanecki, R.K.

    1985-01-01

    Scintigraphic changes, i.e., increased activity, were induced by 1% papain, dissolved in phosphate-buffered physiologic saline (pH 7.4), injected into one antebrachiocarpal joint in each of eight dogs. Scintigraphic evaluation was by the use of combined blood pool and bone phase scintigraphy of affected and normal carpi over a 28-day period. The qualitative and quantitative scintigraphic appearance in injected carpal joints were very similar in both blood pool and bone phases. The clinical use of combined blood pool and bone phase scintigraphy to diagnose early inflammatory joint changes appears limited

  14. Tunneling of Atoms, Nuclei and Molecules

    International Nuclear Information System (INIS)

    Bertulani, C.A.

    2015-01-01

    This is a brief review of few relevant topics on tunneling of composite particles and how the coupling to intrinsic and external degrees of freedom affects tunneling probabilities. I discuss the phenomena of resonant tunneling, different barriers seen by subsystems, damping of resonant tunneling by level bunching and continuum effects due to particle dissociation. (author)

  15. Computational Multiqubit Tunnelling in Programmable Quantum Annealers

    Science.gov (United States)

    2016-08-25

    ARTICLE Received 3 Jun 2015 | Accepted 26 Nov 2015 | Published 7 Jan 2016 Computational multiqubit tunnelling in programmable quantum annealers...state itself. Quantum tunnelling has been hypothesized as an advantageous physical resource for optimization in quantum annealing. However, computational ...qubit tunnelling plays a computational role in a currently available programmable quantum annealer. We devise a probe for tunnelling, a computational

  16. 78 FR 46117 - National Tunnel Inspection Standards

    Science.gov (United States)

    2013-07-30

    ... busiest vehicular tunnel in the world. The Fort McHenry Tunnel handles a daily traffic volume of more than... vehicular, transit, and rail tunnels in the New York City metropolitan area. Although it is still too early... congestion along alternative routes, and save users both dollars and fuel. If these tunnels were closed due...

  17. Een systeem voor classificatie van korte tunnels.

    NARCIS (Netherlands)

    Schreuder, D.A.

    1985-01-01

    The most difficult problems in the lighting of tunnels occur in daylight and in particular in the entrance of the tunnel, while drivers approaching the tunnel must be able to look into the tunnel from the outside to detect the road course and eventual obstacles. A classification should The made on

  18. Tunnel fire testing and modeling the Morgex North tunnel experiment

    CERN Document Server

    Borghetti, Fabio; Gandini, Paolo; Frassoldati, Alessio; Tavelli, Silvia

    2017-01-01

    This book aims to cast light on all aspects of tunnel fires, based on experimental activities and theoretical and computational fluid dynamics (CFD) analyses. In particular, the authors describe a transient full-scale fire test (~15 MW), explaining how they designed and performed the experimental activity inside the Morgex North tunnel in Italy. The entire organization of the experiment is described, from preliminary evaluations to the solutions found for management of operational difficulties and safety issues. This fire test allowed the collection of different measurements (temperature, air velocity, smoke composition, pollutant species) useful for validating and improving CFD codes and for testing the real behavior of the tunnel and its safety systems during a diesel oil fire with a significant heat release rate. Finally, the fire dynamics are compared with empirical correlations, CFD simulations, and literature measurements obtained in other similar tunnel fire tests. This book will be of interest to all ...

  19. Apparent tunneling in chemical reactions

    DEFF Research Database (Denmark)

    Henriksen, Niels Engholm; Hansen, Flemming Yssing; Billing, G. D.

    2000-01-01

    A necessary condition for tunneling in a chemical reaction is that the probability of crossing a barrier is non-zero, when the energy of the reactants is below the potential energy of the barrier. Due to the non-classical nature (i.e, momentum uncertainty) of vibrational states this is, however......, not a sufficient condition in order to establish genuine tunneling as a result of quantum dynamics. This proposition is illustrated for a two-dimensional model potential describing dissociative sticking of N-2 on Ru(s). It is suggested that the remarkable heavy atom tunneling, found in this system, is related...

  20. Tunneling progress on the Yucca Mountain Project

    International Nuclear Information System (INIS)

    Hansmire, W.H.; Munzer, R.J.

    1996-01-01

    The current status of tunneling progress on the Yucca Mountain Project (YMP) is presented in this paper. The Exploratory Studies Facility (ESF), a key part of the YMP, has been long in development and construction is ongoing. This is a progress report on the tunneling aspects of the ESF as of January 1, 1996. For purposes of discussion in this summary, the tunneling has progressed in four general phases. The paper describes: tunneling in jointed rock under low stress; tunneling through the Bow Ridge Fault and soft rock; tunneling through the Imbricate Fault Zone; and Tunneling into the candidate repository formation

  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. Automatic MPST-cut for segmentation of carpal bones from MR volumes.

    Science.gov (United States)

    Gemme, Laura; Nardotto, Sonia; Dellepiane, Silvana G

    2017-08-01

    In the context of rheumatic diseases, several studies suggest that Magnetic Resonance Imaging (MRI) allows the detection of the three main signs of Rheumatoid Arthritis (RA) at higher sensitivities than available through conventional radiology. The rapid, accurate segmentation of bones is an essential preliminary step for quantitative diagnosis, erosion evaluation, and multi-temporal data fusion. In the present paper, a new, semi-automatic, 3D graph-based segmentation method to extract carpal bone data is proposed. The method is unsupervised, does not employ any a priori model or knowledge, and is adaptive to the individual variability of the acquired data. After selecting one source point inside the Region of Interest (ROI), a segmentation process is initiated, which consists of two automatic stages: a cost-labeling phase and a graph-cutting phase. The algorithm finds optimal paths based on a new cost function by creating a Minimum Path Spanning Tree (MPST). To extract the region, a cut of the obtained tree is necessary. A new criterion of the MPST-cut based on compactness shape factor was conceived and developed. The proposed approach is applied to a large database of 96 T1-weighted MR bone volumes. Performance quality is evaluated by comparing the results with gold-standard bone volumes manually defined by rheumatologists through the computation of metrics extracted from the confusion matrix. Furthermore, comparisons with the existing literature are carried out. The results show that this method is efficient and provides satisfactory performance for bone segmentation on low-field MR volumes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Tunnel magnetoresistance in asymmetric double-barrier magnetic tunnel junctions

    International Nuclear Information System (INIS)

    Useinov, N.Kh.; Petukhov, D.A.; Tagirov, L.R.

    2015-01-01

    The spin-polarized tunnel conductance and tunnel magnetoresistance (TMR) through a planar asymmetric double-barrier magnetic tunnel junction (DBMTJ) have been calculated using quasi-classical model. In DBMTJ nanostructure the magnetization of middle ferromagnetic metal layer can be aligned parallel or antiparallel with respect to the fixed magnetizations of the top and bottom ferromagnetic electrodes. The transmission coefficients of an electron to pass through the barriers have been calculated in terms of quantum mechanics. The dependencies of tunnel conductance and TMR on the applied voltage have been calculated in case of non-resonant transmission. Estimated in the framework of our model, the difference between the spin-channels conductances at low voltages was found relatively large. This gives rise to very high magnitude of TMR. - Highlights: • The spin-polarized conductance through the junction is calculated. • Dependencies of the tunnel conductance vs applied bias are shown. • Bias voltage dependence of tunnel magnetoresistance for the structure is shown

  4. Tunneling through landsliding zone; Jisuberi chitainai no tunnel seko

    Energy Technology Data Exchange (ETDEWEB)

    Konbu, A; Hatabu, K; Kano, T [Tekken Corp., Tokyo (Japan)

    1994-08-01

    At the new tunnel construction site of the Shirakata tunnel on the Obama line in Yamaguchi Prefecture, a landsliding occurred at about 60 meters to the upper portion obliquely to the right hand side of the shaft when the excavation progressed to about 10 meters from the starting side. The landslide caused displacement at the shaft opening and change in the supports. As a result of the re-investigation, it was confirmed that the slide face went through the tunnel cross section. The measures taken were removal of the upper soil and an adoption of the all ground fastening (AGF) method (injection type long tip fastening method) as an auxiliary construction to stop loosening of the natural ground associated with the tunnel excavation. The result was a completion of tunneling the landsliding zone without a problem. This paper reports the AGF method adopted in the above construction, together with the construction works and natural ground conditions. The AGF method is about the same as the pipe roof method with regard to the natural ground accepting mechanism and the materials used. The difference is building an improved body in a limited area in the natural ground around the steel pipes by injecting the fixing material. The use of this method caused no problems in subsidence and displacement in the surrounding ground, and completed the tunneling construction without an unusual event. 1 ref., 7 figs., 2 tabs.

  5. FUNDAMENTAL TUNNELING PROCESSES IN MOSa SOLAR CELLS

    OpenAIRE

    Balberg , I.; Hanak , J.; Weakliem , H.; Gal , E.

    1981-01-01

    In previous studies of tunneling through a MOSa tunnel junction, where Sa was a-Si : H, it was shown that their characteristics resemble those of MOSc devices where Sc was crystalline silicon. In the present work we would like to report a demonstration of fundamental tunneling processes in such tunnel junctions. In particular, the transition from semiconductor controlled regime to tunneling controlled regime can be clearly distinguished. The present results represent one of the rare cases whe...

  6. Destructive quantum interference in spin tunneling problems

    OpenAIRE

    von Delft, Jan; Henley, Christopher L.

    1992-01-01

    In some spin tunneling problems, there are several different but symmetry-related tunneling paths that connect the same initial and final configurations. The topological phase factors of the corresponding tunneling amplitudes can lead to destructive interference between the different paths, so that the total tunneling amplitude is zero. In the study of tunneling between different ground state configurations of the Kagom\\'{e}-lattice quantum Heisenberg antiferromagnet, this occurs when the spi...

  7. 13th Australian tunnelling conference. Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    The theme of the conference was 'Engineering in a changing environment'. Topics covered include Australian tunnelling projects, design and development of ground support, tunnelling, international projects, fire and life safety, mining projects, risk management in tunnelling, and tunnel boring machine tunnelling. Papers of particular interest to the coal industry are: improving roadway development in underground coal mine (G. Lewis and G. Gibson), and polymer-based alternative to steel mesh for coal mine strata reinforcement (C. Lukey and others).

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  9. Tunnelling instability via perturbation theory

    Energy Technology Data Exchange (ETDEWEB)

    Graffi, S. (Bologna Univ. (Italy). Dip. di Matematica); Grecchi, V. (Moderna Univ. (Italy). Dip. di Matematica); Jona-Lasinio, G. (Paris-11 Univ., 91 - Orsay (France). Lab. de Physique Theorique et Hautes Energies)

    1984-10-21

    The semiclassical limit of low lying states in a multiwell potential is studied by rigorous perturbative techniques. In particular tunnelling instability and localisation of wave functions is obtained in a simple way under small deformations of symmetric potentials.

  10. Scanning Tunneling Microscopy - image interpretation

    International Nuclear Information System (INIS)

    Maca, F.

    1998-01-01

    The basic ideas of image interpretation in Scanning Tunneling Microscopy are presented using simple quantum-mechanical models and supplied with examples of successful application. The importance is stressed of a correct interpretation of this brilliant experimental surface technique

  11. Electron tunneling in proteins program.

    Science.gov (United States)

    Hagras, Muhammad A; Stuchebrukhov, Alexei A

    2016-06-05

    We developed a unique integrated software package (called Electron Tunneling in Proteins Program or ETP) which provides an environment with different capabilities such as tunneling current calculation, semi-empirical quantum mechanical calculation, and molecular modeling simulation for calculation and analysis of electron transfer reactions in proteins. ETP program is developed as a cross-platform client-server program in which all the different calculations are conducted at the server side while only the client terminal displays the resulting calculation outputs in the different supported representations. ETP program is integrated with a set of well-known computational software packages including Gaussian, BALLVIEW, Dowser, pKip, and APBS. In addition, ETP program supports various visualization methods for the tunneling calculation results that assist in a more comprehensive understanding of the tunneling process. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Tunneling Plasmonics in Bilayer Graphene.

    Science.gov (United States)

    Fei, Z; Iwinski, E G; Ni, G X; Zhang, L M; Bao, W; Rodin, A S; Lee, Y; Wagner, M; Liu, M K; Dai, S; Goldflam, M D; Thiemens, M; Keilmann, F; Lau, C N; Castro-Neto, A H; Fogler, M M; Basov, D N

    2015-08-12

    We report experimental signatures of plasmonic effects due to electron tunneling between adjacent graphene layers. At subnanometer separation, such layers can form either a strongly coupled bilayer graphene with a Bernal stacking or a weakly coupled double-layer graphene with a random stacking order. Effects due to interlayer tunneling dominate in the former case but are negligible in the latter. We found through infrared nanoimaging that bilayer graphene supports plasmons with a higher degree of confinement compared to single- and double-layer graphene, a direct consequence of interlayer tunneling. Moreover, we were able to shut off plasmons in bilayer graphene through gating within a wide voltage range. Theoretical modeling indicates that such a plasmon-off region is directly linked to a gapped insulating state of bilayer graphene, yet another implication of interlayer tunneling. Our work uncovers essential plasmonic properties in bilayer graphene and suggests a possibility to achieve novel plasmonic functionalities in graphene few-layers.

  13. Shaft and tunnel sealing considerations

    International Nuclear Information System (INIS)

    Kelsall, P.C.; Shukla, D.K.

    1980-01-01

    Much of the emphasis of previous repository sealing research has been placed on plugging small diameter boreholes. It is increasingly evident that equal emphasis should now be given to shafts and tunnels which constitute more significant pathways between a repository and the biosphere. The paper discusses differences in requirements for sealing shafts and tunnels as compared with boreholes and the implications for seal design. Consideration is given to a design approach for shaft and tunnel seals based on a multiple component design concept, taking into account the requirements for retrievability of the waste. A work plan is developed for the future studies required to advance shaft and tunnel sealing technology to a level comparable with the existing technology for borehole sealing

  14. Organic tunnel field effect transistors

    KAUST Repository

    Tietze, Max Lutz; Lussem, Bjorn; Liu, Shiyi

    2017-01-01

    Various examples are provided for organic tunnel field effect transistors (OTFET), and methods thereof. In one example, an OTFET includes a first intrinsic layer (i-layer) of organic semiconductor material disposed over a gate insulating layer

  15. Bijzondere belastingen in tunnels : Eindrapport

    NARCIS (Netherlands)

    Molenaar, D.J.; Weerheijm, J.; Vervuurt, A.; Burggraaf, H.; Roekaerts, D.; Meijers, P.

    2009-01-01

    Verkeerstunnels en overkapte wegen (landtunnels) komen de milieukundige en stedenbouwkundige inpassing ten goede en maken meervoudig ruimtegebruik in de stad mogelijk. Het aantal tunnels en overkappingen groeit dan ook. Dit maakt het vervoer van explosiegevaarlijke stoffen en onder hoge druk

  16. Free Surface Water Tunnel (FSWT)

    Data.gov (United States)

    Federal Laboratory Consortium — Description: The Free Surface Water Tunnel consists of the intake plenum, the test section and the exit plenum. The intake plenum starts with a perforated pipe that...

  17. Direct, coherent and incoherent intermediate state tunneling and scanning tunnel microscopy (STM)

    International Nuclear Information System (INIS)

    Halbritter, J.

    1997-01-01

    Theory and experiment in tunneling are still qualitative in nature, which hold true also for the latest developments in direct-, resonant-, coherent- and incoherent-tunneling. Those tunnel processes have recently branched out of the field of ''solid state tunnel junctions'' into the fields of scanning tunnel microscopy (STM), single electron tunneling (SET) and semiconducting resonant tunnel structures (RTS). All these fields have promoted the understanding of tunneling in different ways reaching from the effect of coherence, of incoherence and of charging in tunneling, to spin flip or inelastic effects. STM allows not only the accurate measurements of the tunnel current and its voltage dependence but, more importantly, the easy quantification via the (quantum) tunnel channel conductance and the distance dependence. This new degree of freedom entering exponentially the tunnel current allows an unique identification of individual tunnel channels and their quantification. In STM measurements large tunnel currents are observed for large distances d > 1 nm explainable by intermediate state tunneling. Direct tunneling with its reduced tunnel time and reduced off-site Coulomb charging bridges distances below 1 nm, only. The effective charge transfer process with its larger off-site and on-site charging at intermediate states dominates tunnel transfer in STM, biology and chemistry over distances in the nm-range. Intermediates state tunneling becomes variable range hopping conduction for distances larger than d > 2 nm, for larger densities of intermediate states n 1 (ε) and for larger temperatures T or voltages U, still allowing high resolution imaging

  18. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik [Dept. of Radiology, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of); Park, Hong Gi; Kwak, Ji Hoon [Dept. of Orthopedic Surgery, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of)

    2012-02-15

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  19. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    International Nuclear Information System (INIS)

    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik; Park, Hong Gi; Kwak, Ji Hoon

    2012-01-01

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  20. The anatomy and histology of the bicipital tunnel of the shoulder.

    Science.gov (United States)

    Taylor, Samuel A; Fabricant, Peter D; Bansal, Manjula; Khair, M Michael; McLawhorn, Alexander; DiCarlo, Edward F; Shorey, Mary; O'Brien, Stephen J

    2015-04-01

    The bicipital tunnel is the extra-articular, fibro-osseous structure that encloses the long head of the biceps tendon. Twelve cadaveric shoulder specimens underwent in situ casting of the bicipital tunnel with methyl methacrylate cement to demonstrate structural competence (n = 6) and en bloc harvest with gross and histologic evaluation (n = 6). The percentage of empty tunnel was calculated histologically by subtracting the proportion of cross-sectional area of the long head of the biceps tendon from that of the bicipital tunnel for each zone. Cement casting demonstrated that the bicipital tunnel was a closed space. Zone 1 extended from the articular margin to the distal margin of the subscapularis tendon. Zone 2 extended from the distal margin of the subscapularis tendon to the proximal margin of the pectoralis major tendon. Zone 3 was the subpectoral region. Zones 1 and 2 were both enclosed by a dense connective tissue sheath and demonstrated the presence of synovium. Zone 3 had significantly greater percentage of empty tunnel than zones 1 and 2 did (P < .01). The bicipital tunnel is a closed space with 3 distinct zones. Zones 1 and 2 have similar features, including the presence of synovium, but differ from zone 3. A significant bottleneck occurs between zone 2 and zone 3, most likely at the proximal margin of the pectoralis major tendon. The bicipital tunnel is a closed space where space-occupying lesions may produce a bicipital tunnel syndrome. Careful consideration should be given to surgical techniques that decompress both zones 1 and 2 of the bicipital tunnel. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  2. GENERAL SURGERY

    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  3. Quantum resonances in physical tunneling

    International Nuclear Information System (INIS)

    Nieto, M.M.; Truax, D.R.

    1985-01-01

    It has recently been emphasized that the probability of quantum tunneling is a critical function of the shape of the potential. Applying this observation to physical systems, we point out that in principal information on potential surfaces can be obtained by studying tunneling rates. This is especially true in cases where only spectral data is known, since many potentials yield the same spectrum. 13 refs., 10 figs., 1 tab

  4. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

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

    International Nuclear Information System (INIS)

    Nishimura, G.; Satoh, Masato; Aihara, Toshinori; Aida, Noriko; Yamamoto, Takehisa; Ozono, Keiichi

    1998-01-01

    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.)

  6. Detection of the carpal bone contours from 3-D MR images of the wrist using a planar radial scale-space snake

    NARCIS (Netherlands)

    Snel, J. G.; Venema, H. W.; Grimbergen, C. A.

    1998-01-01

    In this paper we consider the problems encountered when applying snake models to detect the contours of the carpal bones in 3-D MR images of the wrist. In order to improve the performance of the original snake model introduced by Kass [1], we propose a new image force based on one-dimensional (1-D)

  7. Two-step tunneling technique of deep brain stimulation extension wires-a description.

    Science.gov (United States)

    Fontaine, Denys; Vandersteen, Clair; Saleh, Christian; von Langsdorff, Daniel; Poissonnet, Gilles

    2013-12-01

    While a significant body of literature exists on the intracranial part of deep brain stimulation surgery, the equally important second part of the intervention related to the subcutaneous tunneling of deep brain stimulation extension wires is rarely described. The tunneling strategy can consist of a single passage of the extension wires from the frontal incision site to the subclavicular area, or of a two-step approach that adds a retro-auricular counter-incision. Each technique harbors the risk of intraoperative and postoperative complications. At our center, we perform a two-step tunneling procedure that we developed based on a cadaveric study. In 125 consecutive patients operated since 2002, we did not encounter any complication related to our tunneling method. Insufficient data exist to fully evaluate the advantages and disadvantages of each tunneling technique. It is of critical importance that authors detail their tunneling modus operandi and report the presence or absence of complications. This gathered data pool may help to formulate a definitive conclusions on the safest method for subcutaneous tunneling of extension wires in deep brain stimulation.

  8. Tunnelling without barriers

    International Nuclear Information System (INIS)

    Lee, K.

    1987-01-01

    The evolution in flat and curved space-time of quantum fields in theories with relative flat potential and its consequences are considered. It is shown that bubble nucleation, a quantum mechanical tunnelling process, may occur in flat space-time, having a bounce solution, even if V(phi) has no barrier. It is shown that bubble nucleation can also occur in curved space-time even though there is no bounce solution in the standard formalism for the bubble nucleation rate in curved space-time. Additionally, bubbles can nucleate during the slow rolling period on the potential in flat and curved space-time, in this case also there is no bounce solution. It is known in the new inflationary scenario that energy density perturbations caused by quantum fluctuations of the scalar field can satisfy the presently observed bounds on density perturbations. Bubble nucleation during the slow rolling period also gives rise to density perturbations. For a model potential density perturbations by bubbles are calculated at the horizon reentering. By applying the bound from the almost isotropic microwave black body radiation on these density perturbations, a constraint on the model potential is obtained. Finally, some further implications on the galaxy formation and applications in more realistic potential are discussed

  9. Scanning Tunneling Optical Resonance Microscopy

    Science.gov (United States)

    Bailey, Sheila; Wilt, Dave; Raffaelle, Ryne; Gennett, Tom; Tin, Padetha; Lau, Janice; Castro, Stephanie; Jenkins, Philip; Scheiman, Dave

    2003-01-01

    Scanning tunneling optical resonance microscopy (STORM) is a method, now undergoing development, for measuring optoelectronic properties of materials and devices on the nanoscale by means of a combination of (1) traditional scanning tunneling microscopy (STM) with (2) tunable laser spectroscopy. In STORM, an STM tip probing a semiconductor is illuminated with modulated light at a wavelength in the visible-to-near-infrared range and the resulting photoenhancement of the tunneling current is measured as a function of the illuminating wavelength. The photoenhancement of tunneling current occurs when the laser photon energy is sufficient to excite charge carriers into the conduction band of the semiconductor. Figure 1 schematically depicts a proposed STORM apparatus. The light for illuminating the semiconductor specimen at the STM would be generated by a ring laser that would be tunable across the wavelength range of interest. The laser beam would be chopped by an achromatic liquid-crystal modulator. A polarization-maintaining optical fiber would couple the light to the tip/sample junction of a commercial STM. An STM can be operated in one of two modes: constant height or constant current. A STORM apparatus would be operated in the constant-current mode, in which the height of the tip relative to the specimen would be varied in order to keep the tunneling current constant. In this mode, a feedback control circuit adjusts the voltage applied to a piezoelectric actuator in the STM that adjusts the height of the STM tip to keep the tunneling current constant. The exponential relationship between the tunneling current and tip-to-sample distance makes it relatively easy to implement this mode of operation. The choice of method by which the photoenhanced portion of the tunneling current would be measured depends on choice of the frequency at which the input illumination would be modulated (chopped). If the frequency of modulation were low enough (typically tunneling current

  10. Electronic noise of superconducting tunnel junction detectors

    International Nuclear Information System (INIS)

    Jochum, J.; Kraus, H.; Gutsche, M.; Kemmather, B.; Feilitzsch, F. v.; Moessbauer, R.L.

    1994-01-01

    The optimal signal to noise ratio for detectors based on superconducting tunnel junctions is calculated and compared for the cases of a detector consisting of one single tunnel junction, as well as of series and of parallel connections of such tunnel junctions. The influence of 1 / f noise and its dependence on the dynamical resistance of tunnel junctions is discussed quantitatively. A single tunnel junction yields the minimum equivalent noise charge. Such a tunnel junction exhibits the best signal to noise ratio if the signal charge is independent of detector size. In case, signal charge increases with detector size, a parallel or a series connection of tunnel junctions would provide the optimum signal to noise ratio. The equivalent noise charge and the respective signal to noise ratio are deduced as functions of tunnel junction parameters such as tunneling time, quasiparticle lifetime, etc. (orig.)

  11. Theory of superconducting tunneling without the tunneling Hamiltonian

    International Nuclear Information System (INIS)

    Arnold, G.B.

    1987-01-01

    When a tunneling barrier is nearly transparent, the standard tunneling (or transfer) Hamiltonian approximation fails. The author describes the theory which is necessary for calculating the tunneling current in these cases, and illustrate it by comparing theory and experiment on superconductor/insulator/superconductor (SIS) junctions have ultra-thin tunnel barriers. This theory accurately explains the subgap structure which appears in the dynamical resistance of such SIS junctions, including many observed details which no previous theory has reproduced. The expression for the current through an SIS junction with an ultrathin barrier is given by I(t) = Re{Sigma/sub n/ J/sub n/ (omega/sub o/)e/sup in omega/o/sup t/} where omega/sub o/ = 2eV/h is the Josephson frequency, V is the bias voltage, and the J/sub n/ are voltage dependent coefficients, one for each positive or negative integer, n, and n=0. The relative sign of the terms involving cos(n omega/sub o/t) and sin(n omega/sub o/t) agrees with experiment, in contrast to previous theories of Josephson tunneling

  12. Improved multidimensional semiclassical tunneling theory.

    Science.gov (United States)

    Wagner, Albert F

    2013-12-12

    We show that the analytic multidimensional semiclassical tunneling formula of Miller et al. [Miller, W. H.; Hernandez, R.; Handy, N. C.; Jayatilaka, D.; Willets, A. Chem. Phys. Lett. 1990, 172, 62] is qualitatively incorrect for deep tunneling at energies well below the top of the barrier. The origin of this deficiency is that the formula uses an effective barrier weakly related to the true energetics but correctly adjusted to reproduce the harmonic description and anharmonic corrections of the reaction path at the saddle point as determined by second order vibrational perturbation theory. We present an analytic improved semiclassical formula that correctly includes energetic information and allows a qualitatively correct representation of deep tunneling. This is done by constructing a three segment composite Eckart potential that is continuous everywhere in both value and derivative. This composite potential has an analytic barrier penetration integral from which the semiclassical action can be derived and then used to define the semiclassical tunneling probability. The middle segment of the composite potential by itself is superior to the original formula of Miller et al. because it incorporates the asymmetry of the reaction barrier produced by the known reaction exoergicity. Comparison of the semiclassical and exact quantum tunneling probability for the pure Eckart potential suggests a simple threshold multiplicative factor to the improved formula to account for quantum effects very near threshold not represented by semiclassical theory. The deep tunneling limitations of the original formula are echoed in semiclassical high-energy descriptions of bound vibrational states perpendicular to the reaction path at the saddle point. However, typically ab initio energetic information is not available to correct it. The Supporting Information contains a Fortran code, test input, and test output that implements the improved semiclassical tunneling formula.

  13. Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery.

    Science.gov (United States)

    Ma, Yong; Ao, Ying-Fang; Yu, Jia-Kuo; Dai, Ling-Hui; Shao, Zhen-Xing

    2013-01-01

    Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure. One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed. Fifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees). Technical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

  14. Cataract Surgery

    Science.gov (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  15. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  16. Foot Surgery

    Science.gov (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  17. Hemorrhoid surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002939.htm Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...

  18. PLASTIC SURGERY

    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.

  19. GENERAL SURGERY

    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

  20. GENERAL SURGERY

    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.