WorldWideScience

Sample records for carpal tunnel syndrome

  1. Carpal tunnel syndrome

    Science.gov (United States)

    Median nerve dysfunction; Median nerve entrapment ... Calandruccio JH. Carpal tunnel syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; 2013: ...

  2. Carpal tunnel syndrome caused by cysticercosis

    OpenAIRE

    Sharma S; Sharma Nalini; Yeolekar M

    2010-01-01

    We present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an inflammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extr...

  3. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... carried out for the condition of carpal tunnel syndrome. Carpal Tunnel Syndrome is a neuropathy where the median nerve gets ... of the hand. The surgery for carpal tunnel syndrome consists of a release of the transverse carpal ...

  4. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography.

    Science.gov (United States)

    Lee, D; van Holsbeeck, M T; Janevski, P K; Ganos, D L; Ditmars, D M; Darian, V B

    1999-07-01

    This article presents a new technique for diagnosing carpal tunnel syndrome using ultrasound. The ultrasound characteristics of the normal and abnormal median nerve are discussed in relation to carpal tunnel syndrome. The development of ultrasound as a new diagnostic modality for carpal tunnel syndrome is presented in a three-part study correlating the ultrasound measurements of the median nerve and electromyogram of the median nerve. A new algorithm for evaluating patients with carpal tunnel syndrome is presented. PMID:10442084

  5. Ganglion cysts and carpal tunnel syndrome.

    Science.gov (United States)

    Kerrigan, J J; Bertoni, J M; Jaeger, S H

    1988-09-01

    We review 12 cases of ganglion cyst with carpal tunnel syndrome in 11 patients seen at the Hand Rehabilitation Center. Mean age was 42 years (range, 28 to 60 years). One half of the cysts were associated with direct trauma, usually with wrist hyperextension. Symptoms usually developed after the appearance or sudden growth of the cyst. Motor conduction or distal sensory latency was abnormal in seven of eight studied cases. Tinel's sign on tapping the cyst may be pathognomonic for this syndrome. Cyst removal and incision of the flexor retinaculum relieved the symptoms in 11 cases. The other case had total resolution after spontaneous cyst rupture. This syndrome is successfully treated with cyst decompression with release of the carpal canal and has an excellent prognosis. To our knowledge this represents the largest operative series of carpal tunnel syndrome and ganglion cyst. PMID:3241055

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

    OpenAIRE

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

    1980-01-01

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

  7. Incidence of Recurrent and Persistent Carpal Tunnel Syndrome following Open Transverse Carpal Ligament Release

    Directory of Open Access Journals (Sweden)

    Parviz Yazdanpanah

    2015-01-01

    Full Text Available Background: Carpal tunnel syndrome is entrapment of the median nerve in carpal tunnel of the wrist. In severe cases of carpal tunnel syndrome, or those refractory to conservative treatment, surgery is performed. The main aim of this research was to determine the incidence of recurrent and persistent rates of carpal tunnel syndrome following open surgery. Materials and Methods: This descriptive cross sectional study was performed on 105 patients having open carpal tunnel release in the range of 5 to 60 months ago. These cases were operated at Shahid Beheshti hospital in Yasuj, Iran. Assessment of carpal tunnel syndrome after open surgical release of the median nerve was done by electrodiagnostic studies and MRI. If symptoms of carpal tunnel syndrome maintain after surgery, this condition is persistent and if reappearance of the syndrome 3 months or more following surgery this is recurrent. In cases of observing changes from severe to lower stages of the disease in electrodiagnostic studies, treatment is considered successful. Results: All of 58.1% of patients had right severe carpal tunnel syndrome and 41.9 % had left severe carpal tunnel syndrome prior to surgery. The incidence of recurrent and persistent carpal tunnel syndrome following open transverse carpal release was 12.4% and 10.4%, respectively. Conclusion: The incidence of persistent and recurrent rates of carpal tunnel syndrome following open transverse carpal release was higher than the expected rate. These rates were dependant to the appropriate patient, the correct diagnosis and duration of symptoms before surgery.

  8. Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients.

    Science.gov (United States)

    Marquardt, Tamara L; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2016-07-01

    The purpose of this study was to investigate the morphological changes of the carpal arch and median nerve during the application of radiounlarly directed compressive force across the wrist in patients with carpal tunnel syndrome. Radioulnar compressive forces of 10 N and 20 N were applied at the distal level of the carpal tunnel in 10 female patients diagnosed with carpal tunnel syndrome. Immediately prior to force application and after 3 min of application, ultrasound images of the distal carpal tunnel were obtained. It was found that applying force across the wrist decreased the carpal arch width (p 1234-1240, 2016. PMID:26662276

  9. 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...

  10. Optimal management of carpal tunnel syndrome

    OpenAIRE

    Shimpei Ono; Clapham, Philip J; Chung, Kevin C.

    2010-01-01

    Shimpei Ono, Philip J Clapham, Kevin C ChungSection of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USAAbstract: In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS) published a guideline for treatment of carpal tunnel syndrome (CTS) in 2009 based on review of the literature up to April 6, 2007. We have no...

  11. Carpal tunnel syndrome and vitamin B6

    OpenAIRE

    Ryan-Harshman, Milly; Aldoori, Walid

    2007-01-01

    QUESTION A 42-year-old woman with carpal tunnel syndrome tells you she has started taking a vitamin B6 supplement to relieve her symptoms. Her work in an automotive parts department involves both lifting moderately heavy packages and typing at a computer terminal. What does the research indicate about vitamin B6 as a treatment option, and what health issues should you discuss with this patient?

  12. The magnetic resonance imaging of idiopathic carpal tunnel syndrome. An investigation about the etiology of idiopathic carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Jun; Inagaki, Katsunori; Hirahara, Hirotsune; Miyaoka, Hideyo [Showa Univ., Tokyo (Japan). School of Medicine; Takigawa, Souichirou [Showa Univ., Tokyo (Japan). Toyosu Hospital

    2002-10-01

    The etiology of idiopathic carpal tunnel syndrome has not been clarified. We evaluated cross sectional area of carpal tunnel, flexor tendons, median nerve and thickness of transverse carpal ligament by enhanced MRI. Twenty-six patients were tested who has been diagnosed based on electromyogram and clinical symptons as idiopathic carpal tunnel syndrome. All patients were female and the mean age was 64 years old. The cross sectional area of carpal tunnel, the median nerve, the flexor tendons and synovium around them in carpal tunnel were calculated. And the thickness of the transverse carpal ligament as well. The mean area of the flexor tendons with synovium in carpal tunnel was 110.5{+-}25.5 mm{sup 2} (control group; 79.3{+-}13.8 mm{sup 2}), ratio of flexor tendon area to carpal tunnel area was 51.6{+-}8.9% (control; 40.5{+-}2.4%), and the thickness of the transverse carpal ligament was 3.3{+-}0.5 mm (control; 2.5{+-}0.4 mm) in severe idiopathic carpal tunnel syndrome. The mean area of the flexor tendons with synovium in severe idiopathic carpal tunnel syndrome was significantly greater than that of mild type (p<0.05). In such a process, we could classify these MRI findings into the following four subgroups. Enlargement of cross sectional area of flexor tendons and synovium (n=8; 25.8%), thickened transverse carpal ligament (n=11; 35.5%), combined type (n=7; 22.6%) and impossible to classify (n=5; 16.1%). This classification with enhanced MRI was correlated to clinical course and electrophysiologic severity. In conclusion, we can suggest that to evaluate cross sectional area of the wrist (carpal tunnel) with enhanced MRI is one of the useful assistant method for diagnosing and investigating the etiology of severe idiopathic carpal tunnel syndrome. (author)

  13. [ Topography of carpal bone - An experimental model for carpal tunnel syndrome ].

    Science.gov (United States)

    Kornek, G V; Rosen, H R; Mohr, W; Firbas, W

    1990-01-01

    By preparing a new experimental model for the carpal tunnel syndrome, the authors evaluated the differences of the human and rabbit carpal tunnels using a comparative anatomical study. A nearly identical situation-regarding the osseous and connective tissue formations in the carpal channel--was found. Therefore, the carpal tunnel of the rabbit is recommended for a model of chronic nerve compression, which is now planned by the authors. PMID:2288184

  14. Bilateral carpal tunnel syndrome associated with interleukin 2 therapy.

    OpenAIRE

    Heys, S. D.; Mills, K. L.; Eremin, O.

    1992-01-01

    We report the development of synchronous bilateral carpal tunnel syndrome in a woman with metastatic colorectal cancer, undergoing treatment with recombinant interleukin 2. A carpal tunnel decompression was carried out on the hand which was more severely affected, with a gradual recovery in median nerve function. To the best of our knowledge, this is the first reported case of carpal tunnel syndrome in association with recombinant interleukin 2.

  15. The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome.

    Science.gov (United States)

    Priganc, Victoria W; Henry, Sharon M

    2003-01-01

    The purpose of this research was to examine the relationship among clinical carpal tunnel syndrome (CTS) tests and the severity of CTS. A total of 66 subjects with electrodiagnostically confirmed CTS were tested on five CTS tests, then classified according to the severity of CTS. An association was found between testing positive on Phalen's test and the severity of CTS (p Katz-Stirrat hand diagram, or carpal tunnel outcomes assessment tool. The more severe the CTS, the more likely one is to test positive on Phalen's test. Tinel's sign and the mCCT are not influenced by the severity of CTS. This study suggests that Tinel's sign and mCCT may not be useful in assessing the effectiveness of treatment. The Katz-Stirrat hand diagram and the carpal tunnel outcomes assessment tool are not influenced by the severity of CTS, indicating that numerous factors can influence a patient's response on subjective questionnaires. PMID:12943125

  16. Subclinical Carpal Tunnel Syndrome in Patients with Acute Stroke

    Directory of Open Access Journals (Sweden)

    Soroosh Dabiri

    2012-07-01

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

  17. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... that is putting pressure on the median nerve. This is the procedure of carpal tunnel syndrome release, ... for the condition of carpal tunnel syndrome. At this point in time, we have the patient under ...

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

    OpenAIRE

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

    2013-01-01

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

  19. 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%.

  20. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... carpal tunnel syndrome. At this point in time, we have the patient under anesthesia. We have the hand prepped. Great. And then, the ... the carpal tunnel, and it’s the ligament that we incise to release the carpal canal. The carpal ...

  1. Optimal management of carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Shimpei Ono

    2010-08-01

    Full Text Available Shimpei Ono, Philip J Clapham, Kevin C ChungSection of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USAAbstract: In order to improve health care efficiency and effectiveness, treatments should provide disease improvement or resolution at a reasonable cost. The American Academy of Orthopedic Surgeons (AAOS published a guideline for treatment of carpal tunnel syndrome (CTS in 2009 based on review of the literature up to April 6, 2007. We have now reviewed the material published since then. Through reviewing evidence-based articles published during this period, this paper examines the current options and trends for treating CTS. We performed a systematic review of the randomized controlled trials, meta-analyses, systematic reviews, and practice guidelines to present the outcomes of current treatments for this disease. Twenty-five studies met our inclusion criteria. Thirteen randomized, controlled trials and 12 systematic reviews, including three Cochrane database systematic reviews, were retrieved. Our review revealed that most of the recent studies support the AAOS guideline. However, the recent literature demonstrates a trend towards recommending early surgery for CTS cases with or without median nerve denervation, although the AAOS guideline recommends early surgical treatment only for cases with denervation. The usefulness of splinting and steroids as initial treatments for improving patients’ symptoms are also supported by the recent literature, but these effects are temporary. The evidence level for ultrasound treatment is still low, and further studies are needed to determine the effectiveness of this treatment. Finally, our review revealed a paucity of articles comparing the costs of CTS diagnosis and treatment. With the recent focus on health care reform and rising costs, attention to the direct and indirect costs of health care is important for all conditions. Future well designed studies

  2. Association between wrist angle and carpal tunnel syndrome among workers

    OpenAIRE

    You, Doohee

    2013-01-01

    Abstract Association between wrist angle and carpal tunnel syndrome among workersbyDoohee YouDoctor of Philosophy in Environmental Health Science University of California, Berkeley Professor David Rempel, Chair IntroductionCarpal Tunnel Syndrome (CTS) is the most common work-related peripheral neuropathy among workers who perform hand-intensive tasks. It has a greater impact on time away from work and disability than almost all other workplace injuries. For prevention, the National Institute ...

  3. CARPAL TUNNEL SYNDROME PADA PEKERJA GARMEN DI JAKARTA

    OpenAIRE

    Lusianawaty Tana; FX Suharyanto Halim; Delima Delima; Woro Ryadina

    2012-01-01

    Carpal tunnel syndrome (CTS) is a disorder caused by medianus nerve entrapment in carpal tunnel in the wrist and gives many symptoms as painfully, numbness, hyperesthesia at nerve medianus area. The objective of this study was to asses CTS in garment factory workers and determine the prevalence of CTS, CTS relation to age, sex, workhour, and repeated biomechanical pressure in hand/wrist. A cross sectional design was used in the study conducted in Jakarta in 2002, to 814 person sample with sim...

  4. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... the lining of the tendons that will sometimes increase in size, giving rise to the increased pressure --. ... incriminating structure in carpal tunnel syndrome. As it increases in size, the pressures within the carpal canal ...

  5. Medical history of carpal tunnel syndrome.

    Science.gov (United States)

    Michelsen, Heidi; Posner, Martin A

    2002-05-01

    The anatomical configuration of the carpal tunnel is that of an inelastic channel. Consequently, any increase in its volume or alteration in shape will usually result in a significant increase in interstitial pressure. At a pressure threshold of 20 mm Hg to 30 mm Hg, epineurial blood flow is compromised. When that pressure is sustained, the symptoms and physical findings associated with CTS appear. Typically, patients present with intermittent pain and paresthesias in all or part of the median nerve distribution of their hand(s). As weeks and months pass, symptoms progressively increase in frequency and severity. Eventually, thenar muscle weakness develops that initially manifests itself as "fatigue," or "tiredness." The progressive increase in symptoms and physical findings, usually accompanied by a progressive deterioration in electrodiagnostic studies, facilitates the classification of the condition into early, intermediate, and advanced stages. The increase in interstitial pressure in the carpal tunnel is in the vast majority of cases idiopathic (spontaneous). It can also be caused by a myriad of other conditions that can be classified into three other categories: intrinsic factors that increase the volume of the tunnel (outside and inside the nerve), extrinsic factors that alter the contour of the tunnel, and repetitive/overuse conditions. In addition, there is another category of neuropathic factors that affect the nerve without increasing interstitial pressure. In rare situations CTS can present as an acute problem. Far less common than the chronic form of the condition, it can follow acute wrist trauma, rheumatologic disorders, hemorrhagic problems, vascular disorders affecting a patent median artery, and high pressure injection injuries. Prompt recognition is important, followed in most cases by urgent surgical decompression of the median nerve. PMID:12371028

  6. EXTRACORPOREAL SHOCKWAVE THERAPY FOR POST BURN CARPAL TUNNEL SYNDROME

    Directory of Open Access Journals (Sweden)

    Hesham Galal Mahran

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Adham do Amaral e Castro

    2015-10-01

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

  8. Current options for nonsurgical management of carpal tunnel syndrome

    OpenAIRE

    Carlson, Hans; Colbert, Agatha; Frydl, Jennifer; Arnall, Elizabeth; Elliot, Molly; Carlson, Nels

    2010-01-01

    Carpal tunnel syndrome (CTS) is the most common of the entrapment neuropathies. Surgical decompression is commonly performed and has traditionally been considered the defnitive treatment for CTS. Conservative treatment options include physical therapy, bracing, steroid injections and alternative medicine. While CTS is often progressive, patients may get better without formal treatment. The resolution of symptoms is not necessarily related to the severity of the clinical findings and self-limi...

  9. Electrophysiological evaluation of ulnar nerve in carpal tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    刘娜

    2014-01-01

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

  10. CARPAL TUNNEL SYNDROME PADA PEKERJA GARMEN DI JAKARTA

    Directory of Open Access Journals (Sweden)

    Lusianawaty Tana

    2012-10-01

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

  11. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... of carpal tunnel syndrome. At this point in time, we have the patient under anesthesia. We have ... and is not visible over a period of time. You can barely see a surgical scar. My ...

  12. Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

    OpenAIRE

    2007-01-01

    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 of 10% dextrose solution in 1 paw and 0.05 ml of saline in the contralateral paw, to serve as a control. The animals were killed at 1, 2, 4, 8, or 12 weeks. While the saline side showed minimal ch...

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

    Directory of Open Access Journals (Sweden)

    Schols Ludger

    2004-11-01

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

  14. 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

  15. Mini transverse versus longitudinal incision in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    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)

  16. Impact of cell therapy in carpal tunnel syndrome

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    Michael Alexander Malahias

    2015-01-01

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

  18. Magnetic resonance imaging evaluation of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    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)

  19. In-continuity neuroma of the median nerve after surgical release for carpal tunnel syndrome: case report

    OpenAIRE

    Depaoli, R.; Coscia, D.R.; Alessandrino, F.

    2014-01-01

    Iatrogenic injuries of the median nerve after surgical release for carpal tunnel syndrome resulting in the formation of a neuroma are rare. We present here the case of two patients, one with a bifid median nerve, showing in-continuity neuroma after surgical release for carpal tunnel syndrome. The patients reported persistent post-operative pain and showing symptoms. In both cases, ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the carpal tunnel. The ...

  20. Electromyography in diagnostic of median nerve lesion in carpal tunnel syndrome of children with mucopolysaccharidoses

    OpenAIRE

    A. L. Kurenkov; T. V. Podkletnova; Kuzenkova, L.M.; B. I. Bursagova; S. S. Nikitin; A. K. Gevorkyan; Vashakmadze, N.D.

    2015-01-01

    Carpal tunnel syndrome (CTS) is a frequent syndrome in adults, but is very rare in children. CTS was described in children with mucopolysaccharidoses (MPS) as condition due to the deformation of carpal bones, deposition of glycosaminoglycans in tendosynovial tissue and connective tissue of flexor retinaculum. Electromyography is essential method for diagnostic CTS in children because typical symptoms of CTS (paresthesia, numbness of hand and fingers, atrophy and paresis of certain muscles) se...

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

    Science.gov (United States)

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

    2016-01-01

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

  2. Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: a historical perspective.

    Science.gov (United States)

    Boskovski, Marko T; Thomson, J Grant

    2014-09-01

    This article presents the history of the discovery of compression of the median nerve in the carpal tunnel without an identifiable cause as a distinct clinical entity. By analyzing primary sources, we show that, at the beginning of the twentieth century, physicians described patients with paresthesias and numbness in the hands, most prominent at night, accompanied by bilateral symmetrical atrophy along the radial side of thenar eminence. At the time, the 2 most influential hypotheses regarding etiology were, first, compression of the lower trunk of the brachial plexus by a cervical or first rib, and second, compression of the thenar branch of the median nerve as it passes beneath the anterior annular ligament of the wrist. The condition was named syndrome of partial thenar atrophy and was considered a distinct clinical entity. In 1946, after extensive analysis, neurologist Walter Russell Brain concluded that both sensory and motor symptoms of the syndrome were caused by "compression neuritis" of the median nerve in the carpal tunnel. At his suggestion, surgeon Arthur Dickson Wright performed decompression of the nerve by "an incision of the carpal ligament," with excellent results. Brain presented this work at the Royal Society of Medicine in London in 1946 and published his landmark paper in Lancet the following year. In so doing, he established the basis for the disease we know today as idiopathic carpal tunnel syndrome. Unfortunately, in 1947, Brain did not realize that another "condition" with the same clinical picture but without atrophy of the thenar muscles, known as acroparesthesia at the time, was actually the same disease as syndrome of partial thenar atrophy, but of lesser severity. As a result of Brain's influence, 7 other papers were published by 1950. Between 1946 and 1950, there were at least 10 papers that presented, in total, 31 patients (26 women) who exhibited symptoms of compression of the median nerve without an identifiable cause and underwent

  3. The Diagnostic Assessment of Hand Elevation Test in Carpal Tunnel Syndrome

    OpenAIRE

    Ma, Hyunjin; Kim, Insoo

    2012-01-01

    Objective The aim of this study is to establish the value of hand elevation test as a reproducible provocative test for the diagnosis of carpal tunnel syndrome (CTS). Methods We had a prospective study of 45 hands of 38 patients diagnosed with CTS between April 2005 and February 2009. The diagnosis of CTS was based on the American Academy of Neurology clinical diagnostic criteria. Experimental and control group patients underwent Tinel's test, Phalen's test, carpal compression test and hand e...

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

    Science.gov (United States)

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

    2013-04-01

    We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure-morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p 62 mm(2) at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p < 0.05). As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery. PMID:23184493

  5. 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.

  6. Treatment of carpal tunnel syndrome with alpha-lipoic acid.

    Science.gov (United States)

    Di Geronimo, G; Caccese, A Fonzone; Caruso, L; Soldati, A; Passaretti, U

    2009-01-01

    Carpal Tunnel Syndrome (CTS) is the most common peripheral mononeuropathy; its symptoms and functional limitations significantly penalize the daily activities and quality of life of many people. While surgery is reserved to most severe cases, the earlier stages of disease may be controlled by a pharmacological treatment aimed to "neuroprotection", i.e. to limiting and correcting the nerve damage. Our study was aimed to compare the efficacy of a fixed association of alpha-lipoic acid (ALA) 600 mg/die and gamma-linolenic acid (GLA) 360 mg/die, and a multivitamin B preparation (Vit B6 150 mg, Vit B1 100 mg, Vit B12 500 microg daily) for 90 days in 112 subjects with moderately severe CTS. Demographic, case-history and treatment efficacy data were collected; the Boston questionnaire was administered and the patients were evaluated by Hi-Ob scale and electro-myography. A significant reduction in both symptoms scores and functional impairment (Boston questionnaire) was observed in ALA/GLA group, while the multivitamin group experienced a slight improvement of symptoms and a deterioration of functional scores. Electromyography showed a statistically significant improvement with ALA/GLA, but not with the multivitamin product. The Hi-Ob scale showed significant efficacy of ALA/GLA in improving symptoms and functional impairment, while in the multivitamin group the improvement was significant, but less marked than in the ALA/GLA group. In conclusion, the fixed association of ALA and GLA proved to be a useful tool and may be proposed for controlling symptoms and improving the evolution of CTS, especially in the earlier stages of disease. PMID:19499849

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

    International Nuclear Information System (INIS)

    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)

  8. Diagnosis of Carpal Tunnel Syndrome: Interobserver Reliability of the Blinded Scratch-Collapse Test

    OpenAIRE

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

    2013-01-01

    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 observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing. The treating hand surgeon performed the...

  9. High resolution ultrasonography in the diagnosis of the carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Purpose. Carpal tunnel syndrome (CTS) is a neuropathy caused by compression of the median nerve in the carpal tunnel. Our purpose was to evaluate the role of high-resolution ultrasonography (US), performed with a 10-13 MHz probe, in the detection of morpho volumetric changes of the median nerve to confirm the clinical diagnosis. Materials and Methods. Fifty healthily volunteers were examined firstly US; subsequently we studied 294 wrists in 186 symptomatic patients, calculating the cross-sectional area of the median nerve at three levels: before the median nerve enters the carpal tunnel, at the carpal tunnel in let and at the outlet. US was considered diagnostic for CTS when the median nerve area increased at the inlet or flattening was present along the carpal tunnel. Results. Ultrasonography showed pathologic findings in 267 wrists: in 261 cases morpho volumetric changes of the median nerve were found; in six cases anatomic variant of the median nerve was detected. Surgery was performed in 277 cases and all patients became symptom-free. The sensitivity of US was 96.3 % . Confusions. Our study confirms that quantitative ultrasonographic assessment is a useful support in confirming the clinical diagnosis of CTS

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

    Science.gov (United States)

    Beleu, Steve

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

  11. Improved inching method for the diagnosis and prognosis of carpal tunnel syndrome.

    Science.gov (United States)

    Imaoka, H; Yorifuji, S; Takahashi, M; Nakamura, Y; Kitaguchi, M; Tarui, S

    1992-03-01

    A modified sensory "inching" method for the electrodiagnosis of carpal tunnel syndrome (CTS) is described. The median nerve as stimulated at the cubital portion, with 8 channel recording electrodes placed along the nerve across the carpal tunnel. In most of the CTS cases, there was a conductive abnormality from 3 to 4.5 cm distal to the proximal ending of the flexor retinaculum. Subjects' values, obtained by subtracting the theoretical latency from the measured latency, which were more than 0.6 ms, could not be improved by conservative therapy. As we could determine from subtle change at the short span of nerve conduction, below the electrodes from the proximal to the affected site of the carpal tunnel, this method provides high sensitivity and specificity for the diagnosis of CTS. PMID:1557079

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

    Directory of Open Access Journals (Sweden)

    P yazdan panah

    2016-03-01

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

  13. Thrombosis of the persistent median artery as a cause of carpal tunnel syndrome - case study.

    Science.gov (United States)

    Rzepecka-Wejs, Ludomira; Multan, Aleksandra; Konarzewska, Aleksandra

    2012-12-01

    Carpal tunnel syndrome is the most frequent neuropathy of the upper extremity, that mainly occurs in manual workers and individuals, whose wrist is overloaded by performing repetitive precise tasks. In the past it was common among of typists, seamstresses and mechanics, but nowadays it is often caused by long hours of computer keyboard use. The patient usually complains of pain, hypersensitivity and paresthesia of his hand and fingers in the median nerve distribution. The symptoms often increase at night. In further course of the disease atrophy of thenar muscles is observed. In the past the diagnosis was usually confirmed in nerve conduction studies. Nowadays a magnetic resonance scan or an ultrasound scan can be used to differentiate the cause of the symptoms. The carpal tunnel syndrome is usually caused by compression of the median nerve passing under the flexor retinaculum due to the presence of structures reducing carpal tunnel area, such as an effusion in the flexor tendons sheaths (due to overload or in the course of rheumatoid diseases), bony anomalies, muscle and tendon variants, ganglion cysts or tumors. In some cases diseases of upper extremity vessels including abnormalities of the persistent median artery may also result in carpal tunnel syndrome. We present a case of symptomatic carpal tunnel syndrome caused by thrombosis of the persistent median artery which was diagnosed in ultrasound examination. The ultrasound scan enabled for differential diagnosis and resulted in an immediate referral to clinician, who recommended instant commencement on anticoagulant treatment. The follow-up observation revealed nearly complete remission of clinical symptoms and partial recanalization of the persistent median artery. PMID:26676173

  14. 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.

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

    OpenAIRE

    Ji-young Ku; Kyoung-hee Lee; Sung-Woo Cho; Sang-Chan Lee; Hyoun-min Youn; Kyung-jeon Jang; Choon-ho Song; Chang-beohm Ahn; Cheol-hong Kim

    2010-01-01

    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 4week...

  16. 14C. Case Studies on the Outcome of Integrative Management of Carpal Tunnel Syndrome and Trigger Fingers

    OpenAIRE

    Tick, Heather

    2013-01-01

    Focus Areas: Integrative Approaches to Care, Alleviating Pain Carpal tunnel syndrome, trigger fingers, and deQuervaines' tenosynovitis are often regarded as surgical lesions. Using an interprofessional team approach, all these conditions can be treated with nonsurgical techniques. A 44-year-old accountant presented with hand pain requiring workplace accommodation. He had electrodiagnositc evidence of carpal tunnel syndrome bilaterally with the right side worse than the left. He was scheduled ...

  17. Sonographic Wrist Measurements and Detection of Anatomical Features in Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Esther Vögelin

    2014-01-01

    Full Text Available Introduction. This study compares anatomical findings at wrist level in patients with known carpal tunnel syndrome (CTS and controls by ultrasonography (US. Material and Methods. Wrist-US investigations of 28 consecutive patients with 38 diagnosed, idiopathic CTS were compared to 49 healthy volunteers without history of CTS. Internal wrists dimensions, the presence of flexor muscle bellies in the carpal tunnel, and cross-sectional area of the median nerve were analyzed. The findings were correlated to gender, age, and BMI. Results. US demonstrated a square internal carpal tunnel configuration in CTS patients compared to controls (P<0.001. Patients with CTS showed a trend towards the presence of flexor muscles bellies in the carpal tunnel (odds ratio 1.77, 95% CI 0.337–8.33. CTS was present in women with higher BMI (P=0.015. Conclusion. US allowed detection of specific anatomical features at wrist level in CTS patients. This observation may enable—following confirmation in larger prospective studies—risk evaluation for CTS development.

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

    Directory of Open Access Journals (Sweden)

    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

  19. Effect of age on subjective complaints and objective severity of carpal tunnel syndrome: prospective study

    OpenAIRE

    Povlsen, B; Aggelakis, K; KOUTROUMANIDIS, M

    2010-01-01

    Objectives Older patients with carpal tunnel syndrome who are resistant to conservative treatment often have a less than satisfactory outcome after surgery. We therefore investigated whether the age of the patient affects the subjective complaints or the objective severity of the nerve entrapment prior to surgery in patients younger than 40 years compared with those above 70 years of age. Design Prospective study. Setting NHS specialist neurophysiology department. Participants One hundred and...

  20. The Effects of Low Intensity Laser on Clinical and Electrophysiological Parameters of Carpal Tunnel Syndrome

    OpenAIRE

    2013-01-01

    Introduction: Carpal Tunnel Syndrome (CTS) is the most common type of entrapment neuropathy. Conservative therapy is usually considered as the first step in the management of CTS. Low Level Laser Therapy (LLLT) is among the new physical modalities, which has shown therapeutic effects in CTS. The aim of the present study was to compare the effects of applying LASER and splinting together with splinting alone in patients with CTS.

  1. Biomechanical risk factors for carpal tunnel syndrome: a pooled study of 2474 workers

    OpenAIRE

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

    2014-01-01

    Background Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries and collected detailed subject-level exposure information with follow-up of symptoms, electrophysiological measures and job changes. Objective This analysis examined the associations between workplace biomechanical factors and incidence of dominant-hand CTS, adjusting for personal risk factors. Methods 2474 particip...

  2. Thrombosis of the persistent median artery as a cause of carpal tunnel syndrome – case study

    OpenAIRE

    Rzepecka-Wejs, Ludomira; Multan, Aleksandra; Konarzewska, Aleksandra

    2012-01-01

    Carpal tunnel syndrome is the most frequent neuropathy of the upper extremity, that mainly occurs in manual workers and individuals, whose wrist is overloaded by performing repetitive precise tasks. In the past it was common among of typists, seamstresses and mechanics, but nowadays it is often caused by long hours of computer keyboard use. The patient usually complains of pain, hypersensitivity and paresthesia of his hand and fingers in the median nerve distribution. The symptoms often incre...

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

    OpenAIRE

    Lisa A. Zukowski, MA; Jaimie A. Roper, MS; Orit Shechtman, PhD, OTR/L; Dana M. Otzel, PhD; Patty W. Hovis, MSESS; Mark D. Tillman, PhD

    2014-01-01

    Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury part...

  4. Effects of Carpal Tunnel Syndrome on Dexterous Manipulation Are Grip Type-Dependent

    OpenAIRE

    ZHANG Wei; Johnston, Jamie A; Ross, Mark A.; Sanniec, Kyle; Gleason, Elizabeth A.; Dueck, Amylou C.; Santello, Marco

    2013-01-01

    Carpal tunnel syndrome (CTS) impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits re...

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

    OpenAIRE

    Eleftheriou Andreas; Rachiotis George; Varitimidis Socratis E; Koutis Charilaos; Malizos Konstantinos N; Hadjichristodoulou Christos

    2012-01-01

    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 rat...

  6. Intradermal Therapy (Mesotherapy) for the Treatment of Acute Pain in Carpal Tunnel Syndrome: A Preliminary Study

    OpenAIRE

    Conforti, Giorgio; Capone, Loredana; Corra, Stefano

    2013-01-01

    Background 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). Methods 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, cyanocobalamin...

  7. Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study

    Directory of Open Access Journals (Sweden)

    Saeid Khosrawi

    2012-01-01

    Full Text Available BACKGROUND: Carpal tunnel syndrome (CTS is the most preva lent form of peripheral neuropathy. The efficacy of acupuncture in management of mild to moderate CTS has been investigated in limited studies with controversial results. The aim of this study was to assess the short-term effects of acupuncture in treatment of mild to moderate carpal tunnel syndrome. METHODS: In a randomized controlled trial study, participants were randomly assigned to either control group which night splinting, vitamin B1, B6 and sham acupuncture for four weeks were administered, or intervention group that un-derwent acupuncture in 8 sessions over 4 weeks and night splinting. The clinical symptoms using global symptom score (GSS and electrophysiological parameters were assessed at baseline and four weeks after the intervention. RESULTS: Of 72 patients met the inclusion criteria, 64 patients actually completed the 4 week intervention and were evaluated for the outcome. There was a statistically significant difference in GSS between two arms of treatment after the intervention (p 0.05. CONCLUSIONS: Our findings indicated that the acupuncture can improve the overall subjective symptoms of carpal tun-nel syndrome and could be adopted in comprehensive care programs of these patients.

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

    Science.gov (United States)

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

    2015-01-01

    Objective To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. Material and methods This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. Results The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01). In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. Conclusion Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result. PMID:26962490

  9. The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome

    OpenAIRE

    Deniz, Orhan; Aygül, Recep; Kotan, Dilcan; Özdemir, Gökhan; Odabaş, Faruk Ömer; Kaya, M. Dursun; Ulvi, Hızır

    2011-01-01

    The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the ...

  10. Prospective analysis of the accuracy of diagnosis of carpal tunnel syndrome using a web-based questionnaire

    OpenAIRE

    Bland, Jeremy D P; Rudolfer, Stephan; Weller, Peter

    2014-01-01

    Objective To confirm the accuracy of a diagnostic questionnaire for carpal tunnel syndrome (CTS) when presented via a public website rather than on paper. Design Prospective comparison of the probability of CTS as assessed by the web-based questionnaire at http://www.carpal-tunnel.net with the results of nerve conduction studies. Setting Subregional neurophysiology laboratory serving a population of 700 000 in East Kent, UK. Participants 2821 individuals who were able to complete an online di...

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

    International Nuclear Information System (INIS)

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

  12. The Usefulness of Latency Difference Tests of Median-Ulnar and Median-Radial Nerves in Mild Carpal Tunnel Syndrome

    OpenAIRE

    Berrin LEBLEBİCİ; Adam, Mehmet; BAĞIŞ, Selda; M. Nafiz AKMAN

    2008-01-01

    Objective: To investigate of the usefulness of latency differences of median nerve-ulnar nerve and median nerve-radial nerve in patients with mild idiopathic carpal tunnel syndrome. Materials and Methods: 168 women, 243 hands with the clinical diagnosis of carpal tunel syndrome and 46 healthy women were evaluated. In addition to the conventional electrophysiological measurement, median nerve-ulnar nerve latency differences and median nerve-radial nerve latency differences were also measured. ...

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

    International Nuclear Information System (INIS)

    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)

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

    Science.gov (United States)

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

    2011-02-01

    Some occupational factors have been implicated in the development of disorders manifested as hand pain. The associations seem to be well documented in processes such as hand-arm vibration syndrome (HAVS) or writer's cramp. There are contradictory data in the literature about the relationships of trigger finger, De Quervain's tenosynovitis (DQT) and tenosynovitis of the wrist with occupational factors. In this article, we review current knowledge about clinical manifestations, case definition, implicated occupational factors, diagnosis and treatment of the most relevant hand pain disorders that have been associated with occupational factors, excluding carpal tunnel syndrome (CTS). PMID:21663848

  15. 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

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

    Science.gov (United States)

    Ettema, Anke M; Zhao, Chunfeng; Amadio, Peter C; O'Byrne, Megan M; An, Kai-Nan

    2007-04-01

    The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the ulnar tenosynovial bursa. Fibrosis of the SSCT may well affect its gliding characteristics. To investigate this possibility, the relative motion of the flexor tendon and VS was observed during finger flexion in patients undergoing carpal tunnel surgery, and for comparison in hands without CTS, in an in vitro cadaver model. We used a camera to document the gliding motion of the middle finger flexor digitorum superficialis (FDS III) tendon and SSCT in three patients with CTS during carpal tunnel release and compared this with simulated active flexion in three cadavers with no antemortem history of CTS. The data were digitized with the use of Analyze Software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN). In the CTS patients, the SSCT moved en bloc with the tendon, whereas, in the controls the SSCT moved smoothly and separately from the tendon. The ratio of VS to tendon motion was higher for the patients than in the cadaver controls. These findings suggest that in patients with CTS the synovial fibrosis has altered the gliding characteristics of the SSCT. The alterations in the gliding characteristics of the SSCT may affect the ability of the tendons in the carpal tunnel to glide independently from each other, or from the nearby median nerve. These abnormal tendon mechanics may play a role in the etiology of CTS. PMID:16944527

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

    Directory of Open Access Journals (Sweden)

    Turner Judith A

    2005-01-01

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

  18. Carpal tunnel release

    DEFF Research Database (Denmark)

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

    2013-01-01

    A single-blind, randomized, controlled trial was done to compare the results of carpal tunnel release using classic incision, short incision, or endoscopic technique. In total, 90 consecutive cases were included. Follow-up was 24 weeks. We found a significantly shorter sick leave in the endoscopic...

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

    OpenAIRE

    Kearns, Gary; Wang, Sharon

    2012-01-01

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

  20. Wrist flexion as an adjunct to the diagnosis of carpal tunnel syndrome.

    Science.gov (United States)

    Dunnan, J B; Waylonis, G W

    1991-03-01

    The effects of five minutes of wrist flexion on median motor and sensory evoked potential latencies in 87 individuals were studied. Nineteen subjects had carpal tunnel syndrome (CTS) as diagnosed by increased median nerve latencies across the wrist, and 68 had values in the normal range and were assigned to the control group. A slight prolongation of up to 0.5m sec of evoked potential latencies was observed in both groups after flexion, but the differences between the two groups were not significant to establish the value of adding wrist flexion to conventional screening methods. PMID:1998456

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

    OpenAIRE

    Choi Seok-woo; Park Pyeong-beom; Oh Sung-jong

    2009-01-01

    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 evalu...

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

    Directory of Open Access Journals (Sweden)

    Mark van Suchtelen

    2014-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Atroshi Isam

    2008-10-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

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

  5. The Efficacy of 100 and 300 mg Gabapentin in the Treatment of Carpal Tunnel Syndrome.

    Science.gov (United States)

    Eftekharsadat, Bina; Babaei-Ghazani, Arash; Habibzadeh, Afshin

    2015-01-01

    Carpal tunnel syndrome (CTS) is a neuropathy due to the compression of the median nerve. It is shown that gabapentin in high doses is effective in treatment of CTS patients. In this study we evaluated the efficacy of low doses of gabapentin in treatment of CTS patients. Ninety patients with CTS were randomly assigned to groups A, B and C. Gabapentin was administered to group A with dose of 100 mg/day and to group B with dose of 300 mg/day for 2 months. Group C received no treatment. Before and after treatment, patients were evaluated using Visual analogue scale (VAS) for pain and parasthesia, Boston carpal tunnel questionnaire (BCTQ) including Symptom Severity Scale (SSS) and Functional Status Scale (FSS) to evaluate the efficacy of the treatment. The pinch and grip strength was also measured. There was significant improvement in VAS, grip strength, pinch strength, SSS, FSS and BCTQ score in all three groups (p CMAP and SNAP was not significant. Groups A and B in comparison to group C had significantly better improvement in VAS, pinch strength, SSS, FSS and BCTQ total score (p < 0.05). There was significantly more improvement in pinch strength and SSS score in group B compared to group A (p < 0.05). Gabapentin in low doses is a useful drug in treatment of CTS symptoms with no side effects and intolerance. Gabapentin with dose of 300 mg/day is more effective than the dose of 100 mg/day. PMID:26664397

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

    Directory of Open Access Journals (Sweden)

    KOUYOUMDJIAN JOAO ARIS

    1999-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-03-15

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

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

    Directory of Open Access Journals (Sweden)

    Hülya Uzkeser

    2011-12-01

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

  9. Electromyography in diagnostic of median nerve lesion in carpal tunnel syndrome of children with mucopolysaccharidoses

    Directory of Open Access Journals (Sweden)

    A. L. Kurenkov

    2015-02-01

    Full Text Available Carpal tunnel syndrome (CTS is a frequent syndrome in adults, but is very rare in children. CTS was described in children with mucopolysaccharidoses (MPS as condition due to the deformation of carpal bones, deposition of glycosaminoglycans in tendosynovial tissue and connective tissue of flexor retinaculum. Electromyography is essential method for diagnostic CTS in children because typical symptoms of CTS (paresthesia, numbness of hand and fingers, atrophy and paresis of certain muscles seen in adults are absent or not realized by children with MPS because of cognitive deficit despite the presence of nerve involvement. EMG results from 40 children with different types of MPS (age 1 year 8 months to 18 years are presented. Neurophysiologic abnormalities related to CTS were found in every child with MPS I, in 80,9 % of cases – with MPS II and in every case – with MPS VI; no EMG signs of median nerve lesions incarpal channel were detected in patients with MPS III and MPS IV. CTS was bilateral in children with MPS I, II and VI, but usuallythere was an asymmetry of changes. We revealed CTS in one patient with MPS II as early as at the age 2 years 11 months. All children with MPS II had already CTS at the age of 4 years except one patient. Children with MPS I and MPS VI were not investigate before the age 4 years old, but one child 4 years old with MPS I had severe CTS. In children with MPS atrophy of thenar eminence muscles developed rapidly as complication of CTS. Therefore we recommend repeating of EMG regularly to identify earliest signs of median nerve disturbance in carpal channel and opportune surgical decompression of the entrapped nerve. It allows preserving normal function of hand that it is very important for adequate child development and quality of life.

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

    Science.gov (United States)

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

    2014-01-01

    Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression. PMID:25856042

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

    Directory of Open Access Journals (Sweden)

    Lisa A. Zukowski, MA

    2015-03-01

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

  12. Feasibility of a Novel Functional Sensibility Test as an Assisted Examination for Determining Precision Pinch Performance in Patients with Carpal Tunnel Syndrome

    OpenAIRE

    Hsu, Hsiu-Yun; Kuo, Li-Chieh; Kuo, Yao-Lung; Chiu, Haw-Yen; Jou, I-Ming; Wu, Po-Ting; Su, Fong-Chin

    2013-01-01

    To understand the feasibility of a novel functional sensibility test for determining precision pinch performance in patients with carpal tunnel syndrome, this study investigates the validity, sensitivity and specificity of functional sensibility derived from a pinch-holding-up activity (PHUA) test. Participants include 70 clinically defined carpal tunnel syndrome (CTS) patients with 119 involved hands and 70 age- and gender-matched controls. To examine the discriminating ability of the functi...

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

    Directory of Open Access Journals (Sweden)

    Amirhossein Hashemi Attar

    2009-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

    We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome. PMID:22553311

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

    Science.gov (United States)

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

    2014-06-01

    The reliability of the scratch-collapse test for diagnosis of carpal tunnel syndrome (CTS) has not been tested by independent investigators. This study measured the reliability of the scratch-collapse test comparing the treating hand surgeon and blinded evaluators. We performed a prospective observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing. The treating hand surgeon performed the scratch-collapse test. Next, the test was administered by one of the six observers, unaware of the patient's symptoms and the diagnosis made by treating hand surgeon. The kappa statistic (κ) was used to calculate the interrater reliability between the treating hand surgeons and blinded scratchers. The agreement between the blinded observers and the hand surgeons on the scratch-collapse test was substantial 0.63 (95 % CI, 0.34-0.87; p scratch test in our sample was 32 %. In a small study with a spectrum bias favoring electrophysiologically confirmed CTS the reliability was lower than that reported by the inventors of the test, but was still substantial. We propose a larger study of patients with a greater variety of electrodiagnostic test results using fewer observers with more experience. PMID:24876682

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

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    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)

  18. The evaluation of vitamin D levels in patients with carpal tunnel syndrome.

    Science.gov (United States)

    Gürsoy, Azize Esra; Bilgen, Halide Rengin; Dürüyen, Hümeyra; Altıntaş, Özge; Kolukisa, Mehmet; Asil, Talip

    2016-07-01

    The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP- group). 25(OH) D deficiency (25(OH)D ng/ml) was found in 96.1 % of EP- group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP- groups compared to control group (p = 0.006, p vitamin D level in EP- group was lower than EP+ group, statistically difference was not significant between EP+ and EP- groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP- groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results. PMID:26939675

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

    OpenAIRE

    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 pa...

  20. 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

    OpenAIRE

    Nazım Karalezli; Harun Kütahya; Ali Güleç; Serdar Toker; Hakan Karabörk; Ogun, Tunc C.

    2013-01-01

    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 ...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Carpal tunnel syndrome due to a plexiform neurofibroma of the median nerve in a neurofibromatosis type 1 patient: clinical approach

    OpenAIRE

    Freitas, Daniel; Aido, Ricardo; Sousa, Marco; Costa, Luís; Oliveira, Vânia; Cardoso, Pedro

    2013-01-01

    The authors report the case of a 56-year-old male patient with neurofibromatosis type 1 (NF1) diagnosed during adolescence and with an insidious clinical evolution, characterised by an exuberant cutaneous involvement, referred to the orthopaedics outpatient clinic presenting with carpal tunnel syndrome secondary to a plexiform neurofibroma of the median nerve. A comprehensive clinical approach is discussed, considering the natural history of the disease and its potential complications, as wel...

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

    Science.gov (United States)

    Barbieri, P G

    1996-01-01

    Tests were carried out on five manual assembly departments in a variety of different factories, in order to assess the risks associated with the onset of Carpal Tunnel Syndrome and to describe the prevalence of this disorder among exposed workers. The application of the risk analysis method proposed by the EPM Research Unit in Milan (Italy) demonstrated the presence of numerous jobs featuring both a high frequency of actions per minute and a total lack of recovery times, in addition to a variety of incongrous upper limb postures. The clinical and instrumental investigation diagnosed 76 cases of Carpal Tunnel Syndrome among the 170 exposed workers. 62% of the cases was bilateral and 24% was associated with Guyon Channel Syndrome. In two of the five departments reviewed, the carpal tunnel disorders detected were endemic, and featured unusually high prevalence. The situation had been seriously underestimated by the company technical and medical staff, resulting in a failure to call for the urgent adoption of individual protection and collective prevention measures. The authors recommend that an extensive and adequate occupational risk assessment analysis be performed: the local occupational health services could play a critical role in identifying the highest risk industries and the diseases diagnosed in a hospital environment. PMID:9148125

  4. High-resolution MRI with a microscopy coil for carpal tunnel syndrome patients. Morphological changes in the carpal canal during finger motion

    International Nuclear Information System (INIS)

    Thickening of the flexor tendon synovium has been considered as the cause of idiopathic carpal tunnel syndrome; however, this pathogenesis has not been clarified. We investigated the dynamic morphological changes in the carpal canal during finger motion by using high-resolution MRI with a microscopy coil. We examined 11 wrists of 10 patients. They were diagnosed with idiopathic carpal tunnel syndrome based on clinical symptoms and electrophysiological examination, and they finally underwent carpal canal release surgery. The patients were all females and the mean age was 59.1 years. As a control group, 9 wrists of 9 asymptomatic individuals were also examined. The control group consisted of 6 males and 3 females, and the mean age was 33.4 years. A 1.5T MR system (Philips) and a 47-mm microscopy surface coil were used. Axial sections of 2.0 mm thickness with a spacing of 0.2 mm were obtained by T1-weighted and T2-weighted fast spin echo and T2-weighted fast field echo. The field of view (F.O.V.) was 50 mm. We evaluated the cross-sectional area of the flexor tendons that included their surrounding flexor tendon synovium and the median nerve in both the finger-extended and finger-flexed positions. The structures in the carpal canal were clearly revealed on the MR images. The cross-sectional area of the flexor tendons, including the flexor tendon synovium, in patients was significantly enlarged in the finger-flexed position as compared with the finger-extended position. In the finger-flexed position, the median nerve was compressed in the radiovolar direction because of the enlarged flexor tendon synovium around the flexor digitorum profundus (FDP) tendons, which covered the entire ulnar side of the central carpal canal. In the control group, these changes were negligible. Therefore, we suggest that repeated mechanical stress of the flexor tendons with the thickening of the flexor tendon synovium can result in median nerve neuropathy. (author)

  5. Narrowing carpal arch width to increase cross-sectional area of carpal tunnel – a cadaveric study

    Science.gov (United States)

    Li, Zong-Ming; Gabra, Joseph N.; Marquardt, Tamara L.; Kim, Dong Hee

    2013-01-01

    Background Carpal tunnel morphology plays an essential role in the etiology and treatment of carpal tunnel syndrome. The purpose of this study was to observe the morphological changes of the carpal tunnel as a result of carpal arch width narrowing. It was hypothesized carpal arch width narrowing would result in increased height and area of the carpal arch. Methods The carpal arch width of eight cadaveric hands was narrowed by a custom apparatus and cross-sectional ultrasound images were acquired. The carpal arch height and area were quantified as the carpal arch width was narrowed. Correlation and regression analyses were performed for the carpal arch height and area with respect to the carpal arch width. Findings The carpal tunnel became more convex as the carpal arch width was narrowed. The initial carpal arch width, height, and area were 25.7 (SD 1.9) mm, 4.1 (SD 0.6) mm, and 68.5 (SD 14.0) mm2, respectively. The carpal arch height and area negatively correlated with the carpal arch width, with correlation coefficients of −0.974 (SD 0.018) and −0.925 (SD 0.034), respectively. Linear regression analyses showed a 1 mm narrowing of the carpal arch width resulted in proportional increases of 0.40 (SD 0.14) mm in the carpal arch height and 4.0 (SD 2.2) mm2 in the carpal arch area. Interpretation This study demonstrates that carpal arch width narrowing leads to increased carpal arch height and area, a potential mechanism to reduce the mechanical insult to the median nerve and relieve symptoms associated with carpal tunnel syndrome. PMID:23583095

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

    Directory of Open Access Journals (Sweden)

    Alemdar M

    2015-08-01

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

  7. Changes in carpal tunnel compliance with incremental flexor retinaculum release

    OpenAIRE

    Ratnaparkhi, Rubina; Xiu, Kaihua; Guo, Xin; Li, Zong-Ming

    2016-01-01

    Background Flexor retinaculum transection is a routine surgical treatment for carpal tunnel syndrome, yet the biomechanical and clinical sequelae of the procedure remain unclear. We investigated the effects of flexor retinaculum release on carpal tunnel structural compliance using cadaveric hands. Methods The flexor retinaculum was incrementally and sequentially released with transections of 25, 50, 75, and 100 % of the transverse carpal ligament, followed by the distal aponeurosis and then t...

  8. A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Sung Hye [Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722 (Korea, Republic of); Kwon, Bong Cheol, E-mail: hallymradms@gmail.com [Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Park, Chanyeong [Department of Radiology, Hallym University Sacred Heart Hospital, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796 (Korea, Republic of); Hwang, Su Yeon; Lee, Joon Woo [Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707 (Korea, Republic of); Kim, Sam Soo [Department of Radiology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon-Si, Gangwon-Do, 200-722 (Korea, Republic of)

    2014-11-15

    Highlights: • The good parameters of both scans in CTS diagnosis were CSA(P1), FA(P1) and FA(P0). • Median nerve signal intensity and flexor retinacular bowing were not significantly different between CTS and controls. • The prestenotic swelling of median nerve of CTS was demonstrated as relatively large CSA and low FA value at P1 level. • Combination of both scans in evaluation of carpal tunnel increased diagnostic performance, and provided merits of both scans. - Abstract: Purpose: To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS). Materials and methods: We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1 cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans. Results: The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P > 0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each. Conclusion: The individual performances of both scans were not significantly different in diagnosing CTS

  9. A comparison of the performance of anatomical MRI and DTI in diagnosing carpal tunnel syndrome

    International Nuclear Information System (INIS)

    Highlights: • The good parameters of both scans in CTS diagnosis were CSA(P1), FA(P1) and FA(P0). • Median nerve signal intensity and flexor retinacular bowing were not significantly different between CTS and controls. • The prestenotic swelling of median nerve of CTS was demonstrated as relatively large CSA and low FA value at P1 level. • Combination of both scans in evaluation of carpal tunnel increased diagnostic performance, and provided merits of both scans. - Abstract: Purpose: To compare the performance of anatomical magnetic resonance imaging (MRI) with that of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS). Materials and methods: We performed 3T anatomical MRI and DTI on 42 patients and 42 age-matched controls. The median nerve cross-sectional area (CSA), relative median nerve signal intensity, and palmar bowing of the flexor retinaculum, assessed with anatomical MRI, and fractional anisotropy (FA) and apparent diffusion coefficient of the median nerve, assessed with DTI, were measured at four locations: the hamate level, the pisiform level (P0), the level located 1 cm proximal to the P0 level (P1), and the distal radioulnar joint level (DR). Adding the ratios and differences of the median nerve parameters between the measurements at the DR and other locations to the diagnostic parameters, we evaluated the area under the receiver operating characteristic curves (AUCs) of all the diagnostic parameters of both scans. Results: The AUCs of FA(P1) (0.814) and FA(P0) (0.824) in DTI were larger than the largest AUC for anatomical MRI, CSA(P1) (0.759). However, the receiver operating characteristics of the three parameters were not significantly different (P > 0.1). The sensitivity and specificity of CSA(P1) (76.2% and 73.8%) and FA(P1) (73.8% and 76.2%) increased after inclusive and exclusive combination to 90.5% each. Conclusion: The individual performances of both scans were not significantly different in diagnosing CTS

  10. Incidence of trapezius myofascial trigger points in patients with the possible carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Hamid Azadeh

    2010-01-01

    Full Text Available Background: Patients with carpal tunnel syndrome (CTS often complain of prominent pain in shoulder and arm, also there are patients that have pain in their shoulder and arm which is due to myofascial trigger point (MTP located in their upper trapezius muscle. Despite the frequency of this observation, few studies have previously sought to establish possible relationship between the CTS and MTP in shoulder area. Methods: Samples were 160 patients (221 hands consist of 130 females and 30 males, with suspected diagnosis of CTS, from March 2008 to October 2008. In this study after performing electrodiagnosis searches, another evaluation was performed to find out if there was any sign of myofascial trigger point. The correlation between these two was sought. Results: It was found that all of 36 hands with normal electrodiagnostic findings had myofascial trigger points in their upper trapezius muscle. Out of 185 hands, 130 hands (70% with electrophysiological evidences of CTS showed myofascial trigger points in their trapezius muscles. Statistical analysis revealed significant (p < 0.001 reverse correlation between the severity of CTS and the presence of MTP. Conclusions: The findings of this study imply the significant correlation between occurrence of CTS and MTP. It is suggested that clinicians consider the probability of existence of MTP in patients referred for diagnosis of CTS.

  11. Mechanosensitivity of the median nerve in patients with chronic carpal tunnel syndrome.

    Science.gov (United States)

    Jaberzadeh, Shapour; Zoghi, Maryam

    2013-04-01

    The aim was to investigate the relationship between the effects of median nerve strain during the elbow extension component of the upper limb neurodynamic test 1 (ULNT1) and the evoked musculoskeletal changes. 11 patients with chronic carpal tunnel syndrome (CTS) and 11 matched asymptomatic controls participated in the study. In all subjects, elbow extension was carried out in both ULNT1 and neutral positions of the shoulder and arm. From these two starting positions a KIN-COM(®) dynamometer carried out passive elbow extension while EMG activity of 10 arm and shoulder muscles, elbow-flexor resistive torque and elbow extension ROM were measured concurrently. The result showed that, in the ULNT1 position, increased EMG activity of the involved muscles, increased elbow extension resistive torque and pain responses occurred much earlier in the range of elbow extension in the CTS group compared to healthy controls. These findings demonstrated increased mechanosensitivity of the median nerve in CTS patients compared to healthy controls. PMID:23561861

  12. Technical advances in ultrasound and MR imaging of carpal tunnel syndrome

    International Nuclear Information System (INIS)

    The aim of this study was to compare the latest ultrasound-array technology to a conventional ''high-resolution'' transducer, modified MRI technique, and nerve conduction studies (NCS), in the diagnosis of carpal tunnel syndrome (CTS). In 19 normal wrists and 15 wrists with CTS, US with two different transducers was performed: a conventional linear-array transducer (LA) and a newly developed Multi-D linear-array transducer (MDA) were used. The US images were evaluated determining the swelling and the flattening ratios of the median nerve and correlated to respective findings in MRI (1.5 T) and to NCS. The NCS confirmed CTS in all 15 wrists. Measures of median nerve compression (swelling and flattening ratios) were significantly different in patients with CTS and controls (p<0.01) with both types of US transducers and MRI. The MDA yielded higher correlation to MRI than the LA. Using critical values of 1.3 for the swelling and 3.4 for the flattening ratio, MRI, and US with the MDA yielded a sensitivity of 100% each. Modern imaging modalities allow for an exact diagnosis of CTS even in cases with only slight median nerve pathology. (orig.)

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

    Science.gov (United States)

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

    2014-02-01

    This prospective study measured and compared the diagnostic performance characteristics of various clinical signs and physical examination manoeuvres for carpal tunnel syndrome (CTS), including the scratch collapse test. Eighty-eight adult patients that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Attending surgeons documented symptoms and results of standard clinical manoeuvres. The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen's test (67%), Durkan's test (77%), Tinel's test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan's test (18%) and CTS-6 lax (13%). The sensitivity of the scratch collapse test was not superior to other clinical signs and physical examination manoeuvers for CTS, and the specificity of the scratch collapse test was superior to that of Durkan's test and CTS-6 lax. Further studies should seek to limit the influence of a patient's clinical presentation on scratch test performance and assess the scratch test's inter-rater reliability. PMID:23855039

  14. Utility of MRI Diffusion Tensor Imaging in Carpal Tunnel Syndrome: A Meta-Analysis.

    Science.gov (United States)

    Wang, Hong; Ma, Jingxu; Zhao, Liping; Wang, Yunling; Jia, Xiaowen

    2016-01-01

    BACKGROUND After successful utilization of diffusion tensor imaging (DTI) in detecting brain pathologies, it is now being examined for use in the detection of peripheral neuropathies. The aim of this meta-analysis was to evaluate the diagnostic potentials of DTI in carpal tunnel syndrome (CTS). MATERIAL AND METHODS The literature search was performed in multiple electronic databases using a keyword search and final selection of the studies was based on predetermined inclusion and exclusion criteria. We performed a meta-analyses of mean differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between CTS patient and healthy subjects. Publication bias detection was done with Begg's test and sensitivity analyses were performed to explore the source/s of higher heterogeneity and the authenticity of results. RESULTS FA was significantly lower in CTS patients in comparison with healthy subjects (mean and the difference [95% confidence interval] was -0.06 [-0.10, -0.02] (p=0.003). The ADC was significantly higher in CTS patients (mean difference [95% CI] was 0.10 [0.02, 0.18], p=0.02). Overall sensitivity of FA-based diagnosis was 82.82%, with 77.83% specificity. CONCLUSIONS DTI can be a valuable tool in diagnosing CTS. PMID:26942911

  15. The Effect of Provocative Tests on Electrodiognosis of Clinical Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    MR Emad

    2006-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Nerve conduction study is the most sensitive test for diagnosis of carpal tunnel syndrome (CTS. This test is normal in some patients with mild CTS. Median nerve conduction study evaluation after a provocative test (e.g. wrist flexion may be helpful for diagnosis of mild CTS. This study aimed to determine the effect of wrist flexion on median nerve conduction in patients suspected to CTS and in healthy subjects. Materials & Methods: In this case-controlled study, 20 patients (20 hands with clinical signs of CTS and normal routine electrodiagnosis test results and 20 healthy subjects were investigated. Measured parameters included: median nerve distal sensory latency (DSL, nerve conduction velocity (NCV, compound nerve action potential (CNAP, distal motor latency (DML and compound muscle action potential amplitude (CMAP AMP. The above noted parameters were measured before and after 5 minutes of full wrist flexion. Data were collected by filling out a questionnaire and were analyzed using Paired T-test. Results: Distal Sensory Latency increment and NCV decrement after 5 minutes wrist flexion in the patients group were statistically significant (p<0.05. The same parameters did not show a significant incremental or decremental change in the control group. Conclusion: Median nerve DSL and NCV measurement after 5 minutes wrist flexion may be helpful in determining more sensitive parameters in the electrodiagnosis of CTS.

  16. 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. PMID:11885919

  17. Carpal tunnel syndrome and HIV infection. A case report and literature review

    Directory of Open Access Journals (Sweden)

    Andrés Reyes-Corcho

    2009-11-01

    Full Text Available The first clinical case of carpal tunnel syndrome (CTS in Cuban HIV-infected patient was described, and the scientific literature indexed in: PUBMED/MEDLINE, LILACS and BIREME were revised. The case presented was a male with HIV infection without preceding opportunistic illnesses, CD4+ T cell count over 200 cells/mm3 and clinical symptoms of pain, tingling and numbness in the right hand and wrist for three months. The electrophysiological study was compatible with CTS. The pharmacological treatment did not modify the symptoms and the patient received specific surgical treatment with absolute resolution of symptoms. CTS is a compressive neuropathy that can occur in HIV-positive individuals with as similar frequency as in the general population. The association between HIV infection and CTS is scarcely described in the medical scientific literature and probably does not represent a different phenomenon from what happens in the HIV-negative population. Nevertheless, its clinical recognition among other neurological and muscle-skeletal manifestations in HIV-infected patients is important.

  18. Epithelioid Sarcoma of the Forearm Arising from Perineural Sheath of Median Nerve Mimicking Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    JOÃO ARIS KOUYOUMDJIAN

    1999-06-01

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

  20. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... made in the forearm somewhere here, and a second incision is made here, and then through one ... camera inside the carpal canal, and through the second incision you put a knife to cut that ...

  1. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... layer of tissue that comes in from the forearm and it merges into the transverse carpal ligament, ... of the nerve supplies these muscles of the forearm, the base of the forearm. The motor branch ...

  2. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... just going to spread the skin on the tissues. The fibers that are becoming visible now – knife -- ... that you see beneath the ligament is the tissue now within the carpal canal. So, I’ve ...

  3. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... a release of the transverse carpal ligament, and it involves making an incision in the palm of ... the incision in the crease of the hand, it lends itself to faster healing and also it ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-06-15

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

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

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  7. A Comparison of Boosting Tree and Gradient Treeboost Methods for Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Gülhan OREKİCİ TEMEL

    2014-10-01

    Full Text Available Objective: Boosting is one of the most successful combining methods. The principal aim of these combining algorithms is to obtain a strong classifier with small estimation error from the combination of weak classifiers. Boosting based on combining tree has many advantages. Data sets can contain mixtures of nominal, ordinal and numerical variables. AdaBoost and Gradient TreeBoost are commonly used boosting procedure. Both methods are a stage wise additive model fitting procedure. Our goal in this study is to explain the both method and to compare the algorithm results on a neurology data set on the purpose of classification. Material and Methods: The data set consists of 4076 incidences in total. The condition of being a patient with Carpal Tunnel Syndrome (CTS or not was considered as the dependent variable. Boosting Tree and Gradient TreeBoost applications were conducted in Statistica 7.0 and Salford Predictive Modeler: TreeNet (R trial version 6.6.0.091. Results: In AdaBoost and Gradient TreeBoost algorithm, multiple trees are grown of the training data. 200 trees are produced for both models. 70 trees in the AdaBoost Algorithm and 196 trees in the Gradient TreeBoost algorithm are chosen as the optimal trees. Conclusion: The sensitivity or specify values in the test data of Gradient TreeBoost are high indicates that they can be used as a successful method in CTS diagnosis. . It is believed that the boosting methods will become very more and more popular in health science due to its easy implementation and high predictive performance.

  8. Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts

    Science.gov (United States)

    Mediouni, Z; Bodin, J; Dale, A M; Herquelot, E; Carton, M; Leclerc, A; Fouquet, N; Dumontier, C; Roquelaure, Y; Evanoff, B A; Descatha, A

    2015-01-01

    Objectives The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work. Settings and participants The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix. Primary and secondary outcome measures During a follow-up of 3–5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders. Results In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort. Conclusions Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion. PMID:26353869

  9. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review

    Directory of Open Access Journals (Sweden)

    Shi Qiyun

    2011-04-01

    Full Text Available Abstract Background Carpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare the efficacy of surgical treatment of carpal tunnel syndrome with conservative treatment Methods We included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010, MEDLINE (1980 to June 2010, EMBASE (1980 to June 2010, PEDro (searched in June 2010, international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR and 95% confidence intervals for electrophysiological studies and complication were also calculated. Results We assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47 and symptom severity 0.43 (95% CI 0.29, 0.57. There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months ( 0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56. The RR for secondary outcomes of normal

  10. Carpal tunnel syndrome due to a plexiform neurofibroma of the median nerve in a neurofibromatosis type 1 patient: clinical approach.

    Science.gov (United States)

    Freitas, Daniel; Aido, Ricardo; Sousa, Marco; Costa, Luís; Oliveira, Vânia; Cardoso, Pedro

    2013-01-01

    The authors report the case of a 56-year-old male patient with neurofibromatosis type 1 (NF1) diagnosed during adolescence and with an insidious clinical evolution, characterised by an exuberant cutaneous involvement, referred to the orthopaedics outpatient clinic presenting with carpal tunnel syndrome secondary to a plexiform neurofibroma of the median nerve. A comprehensive clinical approach is discussed, considering the natural history of the disease and its potential complications, as well as the lack of consensus regarding standard therapeutic options for the compressive peripheral neuropathies in the NF1 disease. PMID:23853185

  11. Sickness Absence from Work among Persons with New Physician-Diagnosed Carpal Tunnel Syndrome: A Population-Based Matched-Cohort Study

    Science.gov (United States)

    Atroshi, Isam; Zhou, Caddie; Jöud, Anna; Petersson, Ingemar F.; Englund, Martin

    2015-01-01

    Background Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. Methods In Skåne region in Sweden we identified all subjects, aged 17–57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004–2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27–45) for women and 41 days (IQR 28–50) for men. Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis. Gender differences were small. PMID:25803841

  12. Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

    Directory of Open Access Journals (Sweden)

    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

  13. [Outbreak of carpal tunnel syndrome of the upper limbs in automobile seat assemblers: results of exposure evaluation and clinical investigation].

    Science.gov (United States)

    Barbieri, P G; Colombini, D; Rocco, A; Custureri, F; Paderno, G

    1996-01-01

    A group of 59 female workers in the sewing and upholstery departments of a factory manufacturing automobile seats underwent clinical and instrumental tests following reports of several cases of suspected carpal tunnel syndrome. A risk evaluation analysis for disorders attributable to repeated trauma of the upper limbs (WMSDs) was simultaneously carried out using the protocol recommended by the EPM Research Unit in Milan. Evidence was found of a high frequency of elementary actions associated with considerable muscular involvement along with inadequate recovery periods. The clinical investigation revealed an unusually high percentage of carpal tunnel syndromes, often associated with Guyon channel syndrome. This disorder affects males and females equally, is often bilateral, and is not associated with known non-occupational factors. The widespread outbreak of work-related musculo-skeletal disorders reported in the departments in question may have arisen from a combination of significant risk factors relating to the types of activities performed, and the long service of the workers. It is reasonable to assume that failure to adopt technical preventive and organisational measures may have stemmed primarily from a poor evaluation of the relevant occupational risks, and from many years of substandard health surveillance practices. PMID:9148122

  14. 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

    Directory of Open Access Journals (Sweden)

    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.

  15. Carpal tunnel syndrome in administrative workers of the Universidad de Cartagena, Colombia

    Directory of Open Access Journals (Sweden)

    Bedoya-Marrugo Elías Alberto

    2012-12-01

    Full Text Available Introduction: occupational medicine and occupational health, when they try theconsequences that have the use of the computer in special the mouse, the keyboardand the handwritten work, they have checked that with the time, it generates symptomswith the time that affect the health, labor performance and the productivity of thecompany, while they cause lesions and sequels in the worker.Objective: to determine the clinical prevalence of the Carpal tunnel syndrome (CTSbetween the administrative workers of a public university.Methods: descriptive study by means of a socio-demographics survey and clinicalmanifestations of CTS designed for the study, autocompleted and applied forconvenience to 174 administrative workers of the Universidad de Cartagena, Colombia.To those who referred suggestive symptoms of STC, Tinel test, Phanel test and pressuretest were done in the carpal. There was considered STC to the presence of painfulsymptomatology and to the presence of positive result in the three clinical tests.Results: in the study, 174 workers were included. Average age: 41.7 ± 9.0 years old.Average antiquity in the job for the women: 12.1 years old and for men 8.9 years. 31(17.8% expressed to have painful symptomatology in hands. After the applicationof the three clinical tests, a clinical prevalence of STC of 4.5% (8 of 174 workerswas estimated. All the affected workers of STC according to clinical examination werewomen.Conclusion: clinical prevalence of STC in a group of administrative workers of aColombian public university was of 4.5%. The prevalence of SCT is of large variability.Rev.cienc.biomed. 2012;3(1: 254-259RESUMEN:Introducción: la medicina del trabajo y la salud ocupacional, al tratar las consecuenciasque tiene el uso del computador en especial el mouse, el teclado y el trabajo manuscrito,han comprobado que estos con el tiempo generan síntomas que afectan la salud,el rendimiento laboral y la productividad de la empresa, mientras causan

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-11-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Koyuncuoglu, Hasan Rifat [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Kutluhan, Suleyman [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey)]. E-mail: skutluhan@hotmail.com; Yesildag, Ahmet [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Oyar, Orhan [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Guler, Kezban [Department of Neurology, School of Medicine, Suleyman Demirel University, Isparta (Turkey); Ozden, Ahmet [Department of Radiology, School of Medicine, Suleyman Demirel University, Isparta (Turkey)

    2005-12-15

    The diagnosis of carpal tunnel syndrome (CTS) is mainly based on clinical findings and electrodiagnostic tests (EDT). However, EDT results do not support clinical findings in some cases. It has been recently suggested that ultrasonography (US) can be used to diagnose CTS. In this study, we aimed to investigate whether US has a diagnostic value for CTS in patients with negative EDT findings or not. EDT was performed on 319 wrists with clinical CTS findings in electrophysiology laboratory. Median and ulnar nerve conduction velocities were measured in all cases and electromyography was performed in patient with tenar atrophy and having suspicion involvement of brachial plexus as EDT. Fifty-nine wrists with negative EDT (study group) and 30 wrists from 15 healthy individuals (control group) were examined using US. The mean of cross-sectional areas (CSAs) measurements were found 8.83 {+-} 3.05 mm{sup 2} by tracing method (TM) and 8.51 {+-} 3.13 mm{sup 2} by ellipsoid formula (EF) in study group, and 7.63 {+-} 1.52 mm{sup 2} by TM and 7.66 {+-} 1.42 mm{sup 2} by EF in control group. The differences between study group and control group according to both TM and EF were significant (t-test p = 0.0079, p = 0.0460, respectively). In study group, CSAs were larger than 10.5 mm{sup 2} in 18 (30.51%) and 16 (27.12%) wrists according to TM and EF findings, respectively, and in only one wrist (3.33%) in control group by both TM and EF. The differences of ultrasonographic CTS numbers between study group and control group were significant (p = 0.0024 by TM, p = 0.0086 by EF). We confirmed the usefulness of quantitative US assessment in the diagnosis of CTS in the patients with negative EDT findings. If EDT findings are inadequate to confirm the CTS in the patients with clinical CTS, US studies may be helpful to diagnose.

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

    International Nuclear Information System (INIS)

    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 mm2 by tracing method (TM) and 8.51 ± 3.13 mm2 by ellipsoid formula (EF) in study group, and 7.63 ± 1.52 mm2 by TM and 7.66 ± 1.42 mm2 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 mm2 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

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

    Directory of Open Access Journals (Sweden)

    Johnsson Ragnar

    2003-05-01

    Full Text Available Abstract Background Numerous nerve conduction tests are used for the electrodiagnosis of carpal tunnel syndrome (CTS, with a wide range of sensitivity and specificity reported for each test in clinical studies. The tests have not been assessed in population-based studies. Such information would be important when using electrodiagnosis in epidemiologic research. The purpose of this study was to compare the diagnostic accuracy of various nerve conduction tests in population-based CTS and determine the properties of the most accurate test. Methods In a population-based study a questionnaire was mailed to a random sample of 3,000 persons. Of 2,466 responders, 262 symptomatic (numbness/tingling in the radial fingers and 125 randomly selected asymptomatic responders underwent clinical and electrophysiologic examinations. A standardized hand diagram was administered to the symptomatic persons. At the clinical examination, the examining surgeon identified 94 symptomatic persons as having clinically certain CTS. Nerve conduction tests were then performed on the symptomatic and the asymptomatic persons by blinded examiners. Analysis with receiver operating characteristic (ROC curves was used to compare the diagnostic accuracy of the nerve conduction tests in distinguishing the persons with clinically certain CTS from the asymptomatic persons. Results No difference was shown in the diagnostic accuracy of median nerve distal motor latency, digit-wrist sensory latency, wrist-palm sensory conduction velocity, and wrist-palm/forearm sensory conduction velocity ratio (area under curve, 0.75–0.76. Median-ulnar digit-wrist sensory latency difference had a significantly higher diagnostic accuracy (area under curve, 0.80. Using the optimal cutoff value of 0.8 ms for abnormal sensory latency difference shown on the ROC curve the sensitivity was 70%, specificity 82%, positive predictive value 19% and negative predictive value 98%. Based on the clinical diagnosis

  20. Exposure-response relationships between movements and postures of the wrist and carpal tunnel syndrome among male and female house painters

    DEFF Research Database (Denmark)

    Heilskov-Hansen, Thomas; Mikkelsen, Sigurd; Svendsen, Susanne Wulff;

    2016-01-01

    OBJECTIVES: To investigate exposure-response relationships between measured movements and postures of the wrist and the incidence of carpal tunnel syndrome (CTS), and any modifications by sex. METHODS: In 2011, we established a historical cohort of 9364 members of the Painters' Union in Denmark...

  1. 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...

  2. The effect of tendon excursion velocity on longitudinal median nerve displacement: differences between carpal tunnel syndrome patients and controls.

    Science.gov (United States)

    Filius, Anika; Thoreson, Andrew R; Wang, Yuexiang; Passe, Sandra M; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C

    2015-04-01

    The subsynovial connective tissue (SSCT) is a viscoelastic structure connecting the median nerve (MN) and the flexor tendons in the carpal tunnel. Increased strain rates increases stiffness in viscoelastic tissues, and thereby its capacity to transfer shear load. Therefore, tendon excursion velocity may impact the MN displacement. In carpal tunnel syndrome (CTS) the SSCT is fibrotic and may be ruptured, and this may affect MN motion. In this study, ultrasonography was performed on 14 wrists of healthy controls and 25 wrists of CTS patients during controlled finger motions performed at three different velocities. Longitudinal MN and tendon excursion were assessed using a custom speckle tracking algorithm and compared across the three different velocities. CTS patients exhibited significantly less MN motion than controls (p ≤ 0.002). While in general, MN displacement increased with increasing tendon excursion velocity (p ≤ 0.031). These findings are consistent with current knowledge of SSCT mechanics in CTS, in which in some patients the fibrotic SSCT appears to have ruptured from the tendon surface. PMID:25640903

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

    Directory of Open Access Journals (Sweden)

    Dimitriou Christos G

    2007-08-01

    Full Text Available Abstract Background Leiomyomas of the deep soft tissue are quite uncommon and occur even more rarely in upper extremity. Case presentation A 32-year old manual laborer man presented with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed but the patient experienced only temporary relief of his symptoms. MRI examination revealed a deep palmary located mass with well-defined margins and ovoid shape. Intraoperatively, the tumor was in continuity with the flexor digitorum superficialis tendon of the middle finger causing substantial compression to median nerve. Histopathological findings of the resected mass were consistent with leiomyoma. After two years the patient was pain-free without signs of tumor recurrence. Conclusion Despite the fact that reports on deep soft tissue leiomyoma are exceptional, this tumor had to be considered as differential diagnosis in painful non-traumatic hand syndromes especially in young patients.

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

    Institute of Scientific and Technical Information of China (English)

    Ilkerilhanli; Dilek Durmus; Gulhan Orekici

    2015-01-01

    Objective: Cultural adaptations of the questionnaires are important for easy use. We aimed to assess the reliability and validity of the Turkish Version of the Michigan Hand Outcomes Questionnaire in patients with Carpal Tunnel Syndrome. Methods: To assess test-retest reliability, the Turkish “Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand”questionnaires were answered by patients and controls and were repeated a week later. For testing internal consistency, the Cronbach's alpha test was used. For testing validity, correlations between the subscales of the“Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand” questionnaire were measured in patient groups. One hundred patients with idiopathic Carpal Tunnel Syndrome and 50 healthy participants were included in the study. Results: In test-retest reliability, intraclass correlations of the subscales of the“Michigan Hand Outcomes Questionnaire”were high. Cronbach's alphas were found to be high in all subscales. There was no significant correlation between asthetics and pain scales. We found significant differences between patients and controls regarding all subscales of the“Michigan Hand Outcomes Questionnaire”. Correlations between subscales of the “Michigan Hand Outcomes Questionnaire” and “Disabilities of Arm, Shoulder and Hand”questionnaire were significant. We found no difference between one-hand effected and two-hand effected patients, in terms of the “Michigan Hand Outcomes Questionnaire”, “Disabilities of Arm, Shoulder and Hand” questionnaire Function/Symptom and Work average scores. Conclusion: This study showed that the Turkish version of the“Michigan Hand Outcomes Questionnaire”is reliable and valid and can be used in Turkish patients with Carpal Tunnel Syndrome because it is comprehensible and practicable. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B

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

    Institute of Scientific and Technical Information of China (English)

    卢祖能; 汤晓芙

    1995-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nermin Tanik

    2016-03-01

    Full Text Available ABSTRACT Carpal tunnel syndrome (CTS is a condition involving nerve entrapment that often leads to chronic neuropathic pain. We aimed to evaluate sleep quality and related parameters in diabetic and non-diabetic CTS patients. Method This study included a total of 366 patients with chronic CTS. These patients’ sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI and depression using the Beck Depression Inventory (BDI. The severity of neuropathic pain was evaluated using the Douleur Neuropathique-4 (DN4 questionnaire and a visual analogue scale (VAS. Results In the non-diabetic patient group, the total PSQI score was found to affect BDI and VAS, while in the diabetic patient group, the duration of symptoms affected VAS, BDI and fasting glucose levels. Conclusion For diabetic patients, hyperglycemia depression and chronification of neuropathic pain may lead to deterioration of sleep quality. Therefore, consideration of these parameters in the treatment may break a vicious cycle.

  7. Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients.

    Science.gov (United States)

    Huang, Wen-Hung; Hsu, Ching-Wei; Weng, Cheng-Hao; Yen, Tzung-Hai; Lin, Jui-Hsiang; Lee, Meng

    2016-06-01

    Carpal tunnel syndrome (CTS) is the most common mononeuropathy in patients with end-stage renal disease (ESRD). The association between chronic inflammation and CTS in hemodialysis (HD) patients has rarely been investigated. HD patients with a high normalized protein catabolic rate (nPCR) and low serum albumin level likely have adequate nutrition and inflammation. In this study, we assume that a low serum albumin level and high nPCR is associated with CTS in HD patients. We recruited 866 maintenance hemodialysis (MHD) patients and divided them into 4 groups according to their nPCR and serum albumin levels: (1) nPCR MHD patients, nPCR ≥1.29 g/kg/d and serum albumin 7.5 years were associated with CTS. A high nPCR and low serum albumin level, which likely reflect adequate nutrition and inflammation, were associated with CTS in MHD patients. PMID:27368039

  8. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... tunnel pass the tendons and the nerves. So, right beneath this ligament is going to be the ... and it’s actually beneath this bridge of skin right in here. So, I’ve incised this ligament ...

  9. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Wu, Yung-Tsan; Ke, Ming-Jen; Chou, Yu-Ching; Chang, Chih-Ya; Lin, Ching-Yueh; Li, Tsung-Ying; Shih, Feng-Mei; Chen, Liang-Cheng

    2016-06-01

    Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo-controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double-blinded study to assess the effect of rESWT for treating CTS. Thirty-four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:977-984, 2016. PMID:26610183

  10. Chronic Synovitis after Open Carpal Tunnel Decompression.

    Science.gov (United States)

    Yousef, Justin; Chan, Patrick; Rahdon, Richard

    2016-06-01

    Open carpal tunnel decompression is a common procedure with potential long-term complications such as scar tenderness, pillar pain and neuroma. We present the case of a 65 year-old male with chronic lipomatous hypertrophy of the wrist and chronic flexor tenosynovitis after open carpal tunnel release for its rarity and severity of symptoms that required further surgery. PMID:27454645

  11. Carpal tunnel syndrome, diabetic neuropathy, fibromyalgia, glucosamine and chondroitin, hypnosis in pain management, marijuana for pain.

    Science.gov (United States)

    Fishman, Scott M

    2007-01-01

    This feature presents information for patients in a question and answer format. It is written to simulate actual questions that many pain patients ask and to provide answers in a context and language that most pain patients will comprehend. Issues addressed in this issue are carpel tunnel syndrome, fibromyalgia, glucosamine and chondroitin, hypnosis, marijuana. PMID:17844729

  12. Effect of Vitamin B6 on Clinical Symptoms and Electrodiagnostic Results of Patients with Carpal Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Mahnaz Talebi

    2013-08-01

    Full Text Available Purpose: Carpal tunnel syndrome (CTS refers to a cluster of signs and symptoms that stems from compression of the median nerve traveling through carpal tunnel. Surgery is a definite treatment for CTS; however, many conservative therapies have been proposed. The present study set out to assess the effect of vitamin B6 in patients with CTS. Methods: Forty patients (67 hands with mild-moderate CTS were initially selected and randomly assigned into two groups as follows: 1 Case group with 20 subjects (32 affected hands receiving vitamin B6 (120 mg/day for 3 months and splinting. 2 Control group with 19 subjects (35 affected hands only received splinting. One subject from the control group dispensed with continuing participation in the research. Daily symptoms and electrodiagnostic (NCV-EMG results were assessed at baseline and after 3 months. Results: Nocturnal awakening frequency due to pain, daily pain, daily pain frequency, daily pain persistence, hand numbness, hand weakness, hand tingling, severity of nocturnal numbness and tingling, nocturnal awakening frequency owing to hand numbness and tingling, and clumsiness in handling objects improved significantly in the vitamin B6-treated patients; even so, only problem with opening a jam bottle and handling phone significantly reduced in the control group. The median nerve sensory latency mean decreased following the treatment; and the median nerve sensory amplitude mean and sensory conduction velocity mean increased. Conclusion: The present study suggests that vitamin B6 treatment improves clinical symptoms and sensory electrodiagnostic results in CTS patients, and thus is recommended for CTS treatment.

  13. Mild leptospirosis with three-year persistence of IgG- and IgM-antibodies, initially manifesting as carpal tunnel syndrome.

    Science.gov (United States)

    Finsterer, Josef; Stöllberger, Claudia; Sehnal, Ernst; Stanek, Gerold

    2005-08-01

    Long-term persistence of IgG- and IgM-antibodies against leptospira after mild leptospirosis has not been reported. In a 45-year-old female pet-shop worker with carpal tunnel syndrome, accompanied by arthralgias, coughing, repeatedly elevated temperature, followed by easy fatigability, personality change, memory and speech disturbance, blurred vision, myalgia and swollen lymph nodes, leptospirosis was diagnosed, based upon history, clinical findings, and serological investigations. After the described symptoms had disappeared following doxycyclin for 2 weeks, IgG- and IgM-antibodies against leptospira remained positive during the next three years. This case illustrates that leptospirosis may start as carpal tunnel syndrome and that the severity of leptospirosis does not seem to be related to the intensity of the humoral immune response against the causative agent. PMID:16038755

  14. Clinical characteristics, neurophysiological grade and outcome of patients with carpal tunnel syndrome A retrospective study

    Institute of Scientific and Technical Information of China (English)

    Jingxia Dang

    2007-01-01

    BACKGROUND: Carpal tunnel syndrome (CTS) is diagnosed mainly according to clinical symptoms, physical sign and neurodiagnostic laboratory examination. The therapeutic effect of conservative management and surgical operation in treating CTS need to be further observed and evaluated. OBJECTIVE: To analyze the clinical characteristics, neurophysiological grade and outcome in patients with CTS.DESIGN: Retrospective case-analysis.SETTING: Department of Neurology, First Affiliated Hospital, Medical College, Xi'an Jiaotong University. PARTICIPANTS: Totally 161 patients with suspected CTS from National Neuroscience Institute of Singapore referred to the Neurodiagnostic Laboratory for the confirmatory testing between January and September 2002. The involved patients, 137 male and 24 female, were aged 21-85 years. METHODS:①The condition of diabetes mellitus complicated by abnormal thyroid function was observed.②The effect on predominant hand, and paraesthesia were observed.③Neuroelectrophysiological studies were performed and the results were graded into mild, moderate and severe CTS according to the American Association of Electrodiagnostic Medicine (AAEM) criteria.④Conservative management and surgical intervention were followed up 3 months later, and symptoms and physical sign basically disappeared, and function was basically recovered, which indicated that disease condition improved.MAIN OUTCOME MEASURES:①Condition of CTS complicated by metabolic disease;②Effects on predominant hand and paraesthesia;③Electrophysiological grading; ④Prognosis.RESULTS: Totally 161 patients participated in the final analysis.①Condition of CTS complicated by metabolic disease: Among 161 patients, 17.4% (28/161) were documented to have diabetes mellitus and 7(4.3%) had hypothyroidism.②Effects on predominant hand and paraesthesia: Dominant hand involvement was present in 134 patients (83.2%) and more than 75% had onset of symptoms in the dominant hand. Sensory symptoms like

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

    OpenAIRE

    Giorgio Pajardi; Paola Bortot; Veronica Ponti; Chiara Novelli

    2014-01-01

    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...

  16. Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

    OpenAIRE

    Barbosa Rafael Inácio; da Silva Rodrigues Eula Katucha; Tamanini Guilherme; Marcolino Alexandre Márcio; Elui Valéria Meirelles Carril; de Jesus Guirro Rinaldo Roberto; Mazzer Nilton; de Cássia Registro Fonseca Marisa

    2012-01-01

    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 conser...

  17. Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research

    OpenAIRE

    Kozak, Agnessa; Schedlbauer, Grita; Wirth, Tanja; Euler, Ulrike; Westermann, Claudia; Nienhaus, Albert

    2015-01-01

    Background Occupational risks for carpal tunnel syndrome (CTS) have been examined in various occupations, and several systematic reviews (SRs) have been published on this topic. There has been no critical appraisal or synthesis of the evidence in the SRs. The aims of this study are (1) to synthesise the observational evidence and evaluate the methodological quality of SRs that assess the effect of biomechanical risk factors on the development of CTS in workers, (2) to provide an update of cur...

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

    OpenAIRE

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

    2016-01-01

    Background 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). Methods 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 wa...

  19. Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation – incidence, risk factors and results of surgical treatment

    OpenAIRE

    Kopeć, Jerzy; Gądek, Artur; Drożdż, Maciej; Miśkowiec, Krzysztof; Dutka, Julian; Sydor, Antoni; Chowaniec, Eve; Sułowicz, Władysław

    2011-01-01

    Summary Background Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. Material/Methods The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs...

  20. Motor nerve conduction velocity and function in carpal tunnel syndrome following neural mobilization: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Manu Goyal

    2016-01-01

    Full Text Available Introduction: Carpal tunnel syndrome (CTS is the most common nerve entrapment syndrome in the upper extremity leading to the functional disability. The consequence of the entrapment is the poor health of the nerve (conduction, mobility, and blood flow. Purpose of the Study: The aim of the study is to evaluate the effect of neural mobilization on the motor nerve conduction velocity and function in the CTS patients. Methods: Thirty CTS patients (only females were scrutinized on the basis of the inclusion and exclusion criteria. They were randomized into two groups A (n = 15 and B (n = 15 using simple random sampling. Group A patients were treated with the conventional physiotherapy regimen and Group B were provided neural mobilization. Results: The data analysis was done using SPSS version 22. The t-test reveals that there was statistically significant improvement in posttreatment values of Group B for numeric pain rating scale, symptom severity scale, function status scale, motor nerve conduction latency, and velocity at P≤ 0.05. Conclusions: Neural mobilization in the CTS patients improves the motor nerve conduction and functional status. It may be incorporated in the physiotherapy treatment protocol of CTS patients.

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

    Directory of Open Access Journals (Sweden)

    Onur Armagan

    2014-08-01

    Full Text Available OBJECTIVE: The aim of this placebo-controlled study was to evaluate the effects of pulsed and continuous ultrasound treatments combined with splint therapy on patients with mild and moderate idiopathic carpal tunnel syndrome. METHODS: The study included 46 carpal tunnel syndrome patients who were randomly divided into 3 groups. The first group (n = 15 received a 0 W/cm2 ultrasound treatment (placebo; the second group (n = 16 received a 1.0 W/cm2 continuous ultrasound treatment and the third group (n = 15 received a 1.0 W/cm2 1:4 pulsed ultrasound treatment 5 days a week for a total of 15 sessions. All patients also wore night splints during treatment period. Pre-treatment and post-treatment Visual Analogue Scale, Symptom Severity Scale and Functional Status Scale scores, median nerve motor conduction velocity and distal latency and sensory conduction velocities of the median nerve in the 2nd finger and palm were compared. Clinicaltrials.gov: NCT02054247. RESULTS: There were significant improvements in all groups in terms of the post-treatment Functional Status Scale score (p<0.05 for all groups, Symptom Severity Scale score (first group: p<0.05, second group: p<0.01, third group: p<0.001 and Visual Analogue Scale score (first and third groups: p<0.01, second group: p<0.001. Sensory conduction velocities improved in the second and third groups (p<0.01. Distal latency in the 2nd finger showed improvement only in the third group (p<0.01 and action potential latency in the palm improved only in the second group (p<0.05. CONCLUSION: The results of this study suggest that splinting therapy combined with placebo and pulsed or continuous ultrasound have similar effects on clinical improvement. Patients treated with continuous and pulsed ultrasound showed electrophysiological improvement; however, the results were not superior to those of the placebo.

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

    International Nuclear Information System (INIS)

    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)

  3. Diagnostic Value of the Second Lumbrical-Interosseous Distal Motor Latency Comparison Test in Severe Carpal Tunnel Syndrome

    Science.gov (United States)

    Lee, SangHun; Kim, DongHyun; Cho, Hee-Mun; Nam, Ho-Sung

    2016-01-01

    Objective To examine the usefulness of the second lumbrical-interosseous (2L-INT) distal motor latency (DML) comparison test in localizing median neuropathy to the wrist in patients with absent median sensory and motor response in routine nerve conduction studies. Methods Electrodiagnostic results from 1,705 hands of patients with carpal tunnel syndrome (CTS) symptoms were reviewed retrospectively. All subjects were evaluated using routine nerve conduction studies: median sensory conduction recorded from digits 1 to 4, motor conduction from the abductor pollicis brevis muscle, and the 2L-INT DML comparison test. Results Four hundred and one hands from a total of 1,705 were classified as having severe CTS. Among the severe CTS group, 56 hands (14.0%) showed absent median sensory and motor response in a routine nerve conduction study, and, of those hands, 42 (75.0%) showed an abnormal 2L-INT response. Conclusion The 2L-INT DML comparison test proved to be a valuable electrodiagnostic technique in localizing median mononeuropathy at the wrist, even in the most severe CTS patients. PMID:26949669

  4. "…you earn money by suffering pain:" Beliefs About Carpal Tunnel Syndrome Among Latino Poultry Processing Workers.

    Science.gov (United States)

    Arcury, Thomas A; Mora, Dana C; Quandt, Sara A

    2015-06-01

    The nature of poultry processing puts workers at risk for developing neurological injuries, particularly carpal tunnel syndrome (CTS). Many poultry processing workers are Latino immigrants. This qualitative analysis uses an explanatory models of illness (EMs) framework to describe immigrant Latino poultry processing workers' (Guatemalan and Mexican) beliefs of CTS. Understanding these workers' CTS EMs provides a foundation for recommendations to reduce the risk factors for this occupational injury. In-depth interviews were completed with 15 poultry processing workers diagnosed with CTS. Systematic qualitative analysis was used to delineate beliefs about causes, symptoms, physiology, treatments, quality-of-life and health implications of CTS. Participants' EMs largely reflect current biomedical understanding of CTS. These EMs are similar for Guatemalan and Mexican workers. Beliefs about causes include factors in the work environment (e.g., repetition, cold) and individual physical weakness. Treatments include over-the-counter medicine, as well as traditional remedies. Most know the future impact of CTS will include chronic pain. These workers know what causes CTS and that curing it would require quitting their jobs, but feel that they must endure CTS to support their families. Latino poultry processing workers, whether Guatemalan or Mexican, have a fairly complete understanding of what causes CTS, how to treat it, and what they must do to cure it. However, situational factors force them to endure CTS. Policy changes are needed to change the structure of work in poultry processing, particularly line speed and break frequency, if the prevalence of CTS is to be reduced. PMID:24363119

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    Erkol İnal E

    2016-04-01

    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.

  7. Comparison of High Resolution Ultrasonography and Nerve Conduction Study in the Diagnosis of Carpal Tunnel Syndrome: Diagnostic Value of Median Nerve Cross-Sectional Area

    Directory of Open Access Journals (Sweden)

    A. Mohammadi

    2009-11-01

    Full Text Available Background/Objective: Carpal tunnel syndrome (CTS is a common peripheral entrapment neuropathy. This study was performed to evaluate whether high-resolution ultrasonography may be an alternative diagnostic method for nerve conduction study (NCS in the diagnosis of carpal tunnel syndrome. "nPatients and Methods: 132 wrists of 82 patients and 152 wrists of controls were enrolled in the study. The cross sectional area of the median nerve was measured at the carpal tunnel inlet and outlet in all patients and controls. All patients had a nerve conduction study. Then comparison between ultrasonography and NCS was performed. Combination of clinical diagnosis and NCS was used as the gold standard. "nResults: The mean cross-sectional area (CSA of the median nerve at the tunnel inlet was 11.4±1.7 mm2 for the patient group and 5.78 ±0.9 mm2 for the control group (P<0.001. The mean cross-sectional area at the tunnel outlet was 9.9±1.2 mm2 for the patient group and 4.7±0.7 mm2 for the control group (P<0.001. The best cut-off value of CSA at the tunnel inlet and the outlet was 7.5 mm2. "nConclusion: In patients with clinical diagnosis of CTS we confirmed that the diagnostic value of ultrasonography is similar to NCS and sonography may be used in primary evaluation of CTS.

  8. Carpal Tunnel Release: Do We Understand the Biomechanical Consequences?

    OpenAIRE

    Morrell, Nathan T.; Harris, Andrew; Skjong, Christian; Akelman, Edward

    2014-01-01

    Carpal tunnel release is a very common procedure performed in the United States. While the procedure is often curative, some patients experience postoperative scar sensitivity, pillar pain, grip weakness, or recurrent median nerve symptoms. Release of the carpal tunnel has an effect on carpal anatomy and biomechanics, including increases in carpal arch width and carpal tunnel volume and changes in muscle and tendon mechanics. Our understanding of how these biomechanical changes contribute to ...

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

    Directory of Open Access Journals (Sweden)

    Mohammad H Ebrahimzadeh

    2013-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Melani Carla

    2008-10-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a socially relevant condition associated with biomechanical risk factors. We evaluated age-sex-specific incidence rates of in-hospital cases of CTS in central/northern Italy and explored relations with marital status. Methods Seven regions were considered (overall population, 14.9 million over 3–6-year periods between 1997 and 2002 (when out-of-hospital CTS surgery was extremely rare. Incidence rates of in-hospital cases of CTS were estimated based on 1 codified demographic, diagnostic and intervention data in obligatory discharge records from all Italian public/private hospitals, archived (according to residence on regional databases; 2 demographic general population data for each region. We compared (using the χscore test age-sex-specific rates between married, unmarried, divorced and widowed subsets of the general population. We calculated standardized incidence ratios (SIRs for married/unmarried men and women. Results Age-standardized incidence rates (per 100,000 person-years of in-hospital cases of CTS were 166 in women and 44 in men (106 overall. Married subjects of both sexes showed higher age-specific rates with respect to unmarried men/women. SIRs were calculated comparing married vs unmarried rates of both sexes: 1.59 (95% confidence interval [95% CI], 1.57–1.60 in women, and 1.42 (95% CI, 1.40–1.45 in men. As compared with married women/men, widows/widowers both showed 2–3-fold higher incidence peaks during the fourth decade of life (beyond 50 years of age, widowed subjects showed similar trends to unmarried counterparts. Conclusion This large population-based study illustrates distinct age-related trends in men and women, and also raises the question whether marital status could be associated with CTS in the general population.

  11. Effects of carpal tunnel syndrome on adaptation of multi-digit forces to object weight for whole-hand manipulation.

    Directory of Open Access Journals (Sweden)

    Wei Zhang

    Full Text Available The delicate tuning of digit forces to object properties can be disrupted by a number of neurological and musculoskeletal diseases. One such condition is Carpal Tunnel Syndrome (CTS, a compression neuropathy of the median nerve that causes sensory and motor deficits in a subset of digits in the hand. Whereas the effects of CTS on median nerve physiology are well understood, the extent to which it affects whole-hand manipulation remains to be addressed. CTS affects only the lateral three and a half digits, which raises the question of how the central nervous system integrates sensory feedback from affected and unaffected digits to plan and execute whole-hand object manipulation. We addressed this question by asking CTS patients and healthy controls to grasp, lift, and hold a grip device (445, 545, or 745 g for several consecutive trials. We found that CTS patients were able to successfully adapt grip force to object weight. However, multi-digit force coordination in patients was characterized by lower discrimination of force modulation to lighter object weights, higher across-trial digit force variability, the consistent use of excessively large digit forces across consecutive trials, and a lower ability to minimize net moments on the object. Importantly, the mechanical requirement of attaining equilibrium of forces and torques caused CTS patients to exert excessive forces at both CTS-affected digits and digits with intact sensorimotor capabilities. These findings suggest that CTS-induced deficits in tactile sensitivity interfere with the formation of accurate sensorimotor memories of previous manipulations. Consequently, CTS patients use compensatory strategies to maximize grasp stability at the expense of exerting consistently larger multi-digit forces than controls. These behavioral deficits might be particularly detrimental for tasks that require fine regulation of fingertip forces for manipulating light or fragile objects.

  12. Carpal tunnel release: do we understand the biomechanical consequences?

    Science.gov (United States)

    Morrell, Nathan T; Harris, Andrew; Skjong, Christian; Akelman, Edward

    2014-11-01

    Carpal tunnel release is a very common procedure performed in the United States. While the procedure is often curative, some patients experience postoperative scar sensitivity, pillar pain, grip weakness, or recurrent median nerve symptoms. Release of the carpal tunnel has an effect on carpal anatomy and biomechanics, including increases in carpal arch width and carpal tunnel volume and changes in muscle and tendon mechanics. Our understanding of how these biomechanical changes contribute to postoperative symptoms is still evolving. We review the relevant morphometric and biomechanical changes that occur following release of the transverse carpal ligament. PMID:25364635

  13. Surgical treatment of synovial hyperplasia carpal tunnel syndrome%滑膜增生型腕管综合征的手术治疗

    Institute of Scientific and Technical Information of China (English)

    李建强; 姜保国; 陈建海; 付中国; 王天兵

    2014-01-01

    Background Carpal tunnel syndrome is the most common compressive peripheral neuropathy,which is a couple of clinical syndromes caused by the oppression of the median nerve in the carpal tunnel.The tough of the transverse carpal ligament and thickness of its edge are the major factors in the oppression of the median nerve.Under normal circumstances,there is a large amount of tendon synovial in the carpal tunnel,which plays a role of nutrition and lubrication to the nerve. However,the tendon synovial hyperplasia,or even congestion and edema can cause or aggravate the oppression of the median nerve.Also,it will cause an inflammatory stimulate to the nerve.The major clinical manifestations of carpal tunnel syndrome are numbness and pain of three and a half fingers of the radial side.Usually,the pain radiates to the hand and forearm,accompanied with dysfunction of thumb opposition,thenar muscle atrophy and decreased grip and pinch strength.But in the synovial hyperplasia carpal tunnel syndrome,because of increased congestion at night and reflux disorder,there will be a significant night pain and numbness,which sometimes even makes the patients awake at a fixed time at night.These are the typical symptoms of synovial hyperplasia carpal tunnel syndrome. When the patients wake up,many will activate the fingers and wrists to relieve the pain,which promotes the synovial reflux in the carpal tunnel and reduces the pressure of carpal tunnel.As such reasons,there will be a phenomenon that clinical manifestations in the resting state do not fully meet the electrophysiological examination after activity.Patients who were diagnosed as synovial hyperplasia carpal tunnel syndrome were admitted to our hospital.We performed transverse carpal ligament release,carpal tunnel decompression,synovial tissue removal and median nerve release.The purpose of this study is to describe clinical characteristics of synovial hyperplasia carpal tunnel syndrome and analyzes the outcome of treatment

  14. TC study of the carpal tunnel

    International Nuclear Information System (INIS)

    The standard technique for CT investigation of the carpal tunnel and its normal anatomy were studied. Ten healty asymptomatic volunteers, age 25-45, underwent wrist CT. The hand is placed in prone position with the third metacarpus in line with radius. Digital radiograph and four axial CT scans are performed respectively: at the distal end of the radius, at the scaphoid tubercle level, at the hamate hook level and at the carpal and metacarpal joint. Standard carpal tunnel diameters are thus available with good reliability and repeatibility when correct technique is adopted. The results permit a morphological description of the osseous walls, transverse ligament, flexor tendons with synovial sheets and median nerve. Gujon's canal and its content can also be investigated

  15. Local steroid injection for moderately severe idiopathic carpal tunnel syndrome: Protocol of a randomized double-blind placebo-controlled trial (NCT 00806871

    Directory of Open Access Journals (Sweden)

    Björk Jonas

    2010-04-01

    Full Text Available Abstract Background Patients with idiopathic carpal tunnel syndrome (CTS are commonly treated with steroid injection into or proximal to the carpal tunnel. However, evidence for its efficacy beyond one month has not been established in randomized placebo-controlled trials. The primary aim of this randomized trial is to assess the efficacy of steroid injection into the carpal tunnel in relieving symptoms of CTS in patients with symptoms of such severity to warrant surgical treatment but have not been treated with steroid injection. Methods/Design The study is a randomized double-blind placebo-controlled trial. Patients referred to one orthopedic department because of CTS are screened. Eligibility criteria are age 18 to 70 years, clinical diagnosis of primary idiopathic CTS and abnormal nerve conduction tests or clinical diagnosis made independently by two orthopedic surgeons, failed treatment with wrist splinting, symptom severity of such magnitude that the patient is willing to undergo surgery, no severe sensory loss or thenar muscle atrophy, and no previous steroid injection for CTS. A total of 120 patients will be randomized to injection of 80 mg Methylprednisolone, 40 mg Methylprednisolone, or normal saline, each also containing 10 mg Lidocaine. Evaluation at baseline and at 5, 10, 24 and 52 weeks after injection includes validated questionnaires (CTS symptom severity scale, QuickDASH and SF-6D, adverse events, physical examination by a blinded assessor, and nerve conduction tests. The primary outcome measures are change in the CTS symptom severity score at 10 weeks and the rate of surgery at 52 weeks. The secondary outcome measures are the score change in the CTS symptom severity scale at 52 weeks, time to surgery, and change in QuickDASH and SF-6D scores and patient satisfaction at 10 and 52 weeks. The primary analysis will be carried out using mixed model analysis of repeated measures. Discussion This paper describes the rationale and

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

    Science.gov (United States)

    Gabra, Joseph N; Li, Zong-Ming

    2013-02-01

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

  17. Mechanical behavior of carpal tunnel subsynovial connective tissue under compression.

    Science.gov (United States)

    Goetz, Jessica E; Baer, Thomas E

    2011-01-01

    Subsynovial connective tissue (SSCT) is a fluid-permeated loose connective tissue that occupies the majority of the space in the carpal tunnel not occupied by the digital flexor tendons or the median nerve. It is arranged in layers around these more discrete structures, presumably to assist with tendon gliding. As a result of this arrangement, the compressive behavior and the fluid permeability of this tissue may substantially affect the stresses in the median nerve resulting from contact with its neighboring tendons or with the walls of the tunnel itself. These stresses may contribute to damage of the median nerve and the development of carpal tunnel syndrome. In this study, the fluid permeability and the compressive behavior of the SSCT were investigated to better understand the mechanics of this tissue and how it may mediate mechanical insult to the median nerve. A custom experimental apparatus was built to allow simultaneous measurement of tissue compression and fluid flow. Using Darcy's law, the average SSCT fluid permeability was 8.78×10(15) m(4)/Ns. The compressive behavior of the SSCT demonstrated time dependence, with an initial modulus of 395kPa gradually decreasing to a value of 285kPa. These baseline tissue data may serve as a mechanical norm (toward which pathological tissue might be returned, therapeutically) and may serve as essential properties to include in future mechanical models of the carpal tunnel. PMID:22096431

  18. Does wrist immobilization following open carpal tunnel release improve functional outcome? A literature review

    OpenAIRE

    Isaac, S. M.; Okoro, T.; Danial, I.; Wildin, C.

    2010-01-01

    Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the median nerve in the carpal tunnel. It is the most common peripheral entrapment neuropathy. The surgical management includes dividing the flexor retinaculum to decompress the median nerve. Post-operative mobilization of the wrist is controversial. Some surgeons splint the wrist for 2–4 weeks whilst others encourage early mobilization. The literature has been inconclusive as to which method is most beneficial. The purpose of this s...

  19. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... or too far from your body. Don't rest your wrists on hard surfaces for long periods of time. Switch hands during work tasks. Make sure the tools you use aren't too big for your hands. ... give your hands and wrists time to rest. Don't sit or stand in the same ...

  20. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... 226-4267 Toll-Free; (301) 565-2966 TTY Internet Address: http://www.niams.nih.gov/ National Institute of Neurological ... 352-9424 Toll-Free; (301) 468-5981 TTY Internet Address: http://www.ninds.nih.gov/ National Institute for Occupational ...

  1. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... RhMSUS FAQs RhMSUS Designees RhMSUS Volunteer Opportunities Publications & Communications Journals A&R Table of Contents AC&R Table ... by the American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only. ...

  2. Carpal Tunnel Syndrome

    Science.gov (United States)

    ... Safety & Health Administration U.S. Department of Labor 200 Constitution Avenue, NW Washington, DC 20210 http://www.osha. ... of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of ...

  3. The carpal bones in Poland syndrome

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-06-15

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

  4. The carpal bones in Poland syndrome

    International Nuclear Information System (INIS)

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

  5. Cubital Tunnel Syndrome

    Science.gov (United States)

    ... Symptom Picker Hand and Arm Conditions Carpal Tunnel Ganglion Cysts Trigger Finger Arthritis Base of the Thumb See ... Symptom Picker Hand and Arm Conditions Carpal Tunnel Ganglion Cysts Trigger Finger Arthritis Base of the Thumb See ...

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

    OpenAIRE

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

    2011-01-01

    Carpal tunnel mechanics is relevant to our understanding of median nerve compression in the tunnel. The compliant characteristics of the tunnel strongly influence its mechanical environment. We investigated the distensibility of the carpal tunnel in response to tunnel pressure. A custom balloon device was designed to apply controlled pressure. Tunnel cross sections were obtained using magnetic resonance imaging (MRI) to derive the relationship between carpal tunnel pressure and morphological ...

  7. Changes in the carpal tunnel while wearing the Manu® soft hand brace: a sonographic study.

    Science.gov (United States)

    Manente, G; Melchionda, D; Staniscia, T; D'Archivio, C; Mazzone, V; Macarini, L

    2013-01-01

    We studied the effect of the Manu(®) soft hand brace, which has been designed to relieve median nerve entrapment in carpal tunnel syndrome. An observational, controlled study was conducted in 10 participants, five with bilateral carpal tunnel syndrome and five controls, using sonography to study changes in the dimensions of the carpal tunnel before and while wearing the brace. An increase in transverse diameter, thinning of the flexor retinaculum, and displacement of the proximal insertion of the lumbrical muscle to the middle finger from the edge of the carpal tunnel were observed in patients while wearing the brace. The changes in the morphology of the carpal tunnel while wearing the Manu(®) support its use as an alternative to a night wrist splint. PMID:22640934

  8. Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation – incidence, risk factors and results of surgical treatment

    Science.gov (United States)

    Kopeć, Jerzy; Gądek, Artur; Drożdż, Maciej; Miśkowiec, Krzysztof; Dutka, Julian; Sydor, Antoni; Chowaniec, Eve; Sułowicz, Władysław

    2011-01-01

    Summary Background Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. Material/Methods The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken. Results Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20–30 years), 100% required surgical release procedures, while 66.66% of those treated for 15–19 years, 42.1% of those treated for 10–14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula. Conclusions Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS. PMID:21873947

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Clinical usefulness of oral supplementation with alpha-lipoic Acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment.

    Science.gov (United States)

    Pajardi, Giorgio; Bortot, Paola; Ponti, Veronica; Novelli, Chiara

    2014-01-01

    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. PMID:24563654

  11. Surgery is more cost-effective than splinting for carpal tunnel syndrome in the Netherlands: results of an economic evaluation alongside a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Adèr Herman J

    2006-11-01

    Full Text Available Abstract Background Carpal tunnel syndrome (CTS is a common disorder, often treated with surgery or wrist splinting. The objective of this economic evaluation alongside a randomized trial was to evaluate the cost-effectiveness of splinting and surgery for patients with CTS. Methods Patients at 13 neurological outpatient clinics with clinically and electrophysiologically confirmed idiopathic CTS were randomly allocated to splinting (n = 89 or surgery (n = 87. Clinical outcome measures included number of nights waking up due to symptoms, general improvement, severity of the main complaint, paraesthesia at night and during the day, and utility. The economic evaluation was performed from a societal perspective and involved all relevant costs. Results There were no differences in costs. The mean total costs per patient were in the surgery group EURO 2,126 compared to EURO 2,111 in the splint group. After 12 months, the success rate in the surgery group (92% was significantly higher than in the splint group (72%. The acceptability curve showed that at a relatively low ceiling ratio of EURO 2,500 per patient there is a 90% probability that surgery is cost-effective. Conclusion In the Netherlands, surgery is more cost-effective compared with splinting, and recommended as the preferred method of treatment for patients with CTS.

  12. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

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

    International Nuclear Information System (INIS)

    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 mm2/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) mm2. 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 mm2 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.)

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

    Science.gov (United States)

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

    2011-12-01

    Carpal tunnel mechanics is relevant to our understanding of median nerve compression in the tunnel. The compliant characteristics of the tunnel strongly influence its mechanical environment. We investigated the distensibility of the carpal tunnel in response to tunnel pressure. A custom balloon device was designed to apply controlled pressure. Tunnel cross sections were obtained using magnetic resonance imaging to derive the relationship between carpal tunnel pressure and morphological parameters at the hook of hamate. The results showed that the cross-sectional area (CSA) at the level of the hook of hamate increased, on average, by 9.2% and 14.8% at 100 and 200 mmHg, respectively. The increased CSA was attained by a shape change of the cross section, displaying increased circularity. The increase in CSA was mainly attributable to the increase of area in the carpal arch region formed by the transverse carpal ligament. The narrowing of the carpal arch width was associated with an increase in the carpal arch. We concluded that the carpal tunnel is compliant to accommodate physiological variations of the carpal tunnel pressure, and that the increase in tunnel CSA is achieved by increasing the circularity of the cross section. PMID:21608024

  16. Ultrasound assessment of the median nerve: a biomarker that can help in setting a treat to target approach tailored for carpal tunnel syndrome patients.

    Science.gov (United States)

    El Miedany, Yasser; El Gaafary, Maha; Youssef, Sally; Ahmed, Ihab; Nasr, Annie

    2015-01-01

    Ultrasonography (US) is a valuable tool for confirming the diagnosis of carpal tunnel syndrome (CTS) as it enables the detection of changes in the median nerve shape and rule out anatomic variants as well as space-occupying lesions such as ganglion cysts or tenosynovitis. This work was carried out aiming at: 1. Ultrasonography assessment of the median nerve and its neurovascular blood-flow in CTS patients before and after management. 2. Verify the possibility of using baseline US parameters as a biomarker to predict likely outcomes and frame a treatment plan for CTS patients. 233 CTS subjects diagnosed based on clinical and electrophysiological (NCS) testing were included in this work. US measures at the tunnel inlet included: cross sectional area, flattening ratio and neural Power Doppler (PD) signals. Patients who had severe NCS outcomes or neurological deficit were referred for open surgical decompression; the remaining patients were given the choice of either conservative or surgical management. The main outcome variable was improvement >70% in CTS symptoms. Assessments were carried out at baseline, 1-week, 1-month and 6-months post treatment. Results revealed an inverse relation between the neural vasculature and CTS severity defined by NCS (r = - 0.648). In CTS cases treated conservatively, the US measures started to improve within 1-week, whereas in the surgically treated cohort there was an initial phase of post-operative nerve measures increase, before settling at 1-month time of follow-up. The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio. This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1). The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection. PMID

  17. 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. ...

  18. Biomechanical Role of the Transverse Carpal Ligament in Carpal Tunnel Compliance

    OpenAIRE

    Li, Zong-Ming; Marquardt, Tamara L.; Evans, Peter J.; Seitz, William H.

    2014-01-01

    The transverse carpal ligament (TCL) is a significant constituent of the wrist structure and forms the volar boundary of the carpal tunnel. It serves biomechanical and physiological functions, acting as a pulley for the flexor tendons, anchoring the thenar and hypothenar muscles, stabilizing the bony structure, and providing wrist proprioception. This article mainly describes and reviews our recent studies regarding the biomechanical role of the TCL in the compliant characteristics of the car...

  19. Carpal tunnel syndrome in the Clínica Universitaria San Juan de Dios de Cartagena, Colombia. Epidemiological, clinical profile and therapeutic evolution

    Directory of Open Access Journals (Sweden)

    Bedoya-Mosquera Jaddy Sandrey

    2012-06-01

    Full Text Available Introduction: carpal tunnel syndrome (CTS is one of the major health problems ofworkers who carry out tasks related to intense manual effort and repetitive movementsof the upper limb.Objectives: to determine the epidemiological and clinical profile of patientsattending a pain unit, identify job, clinical and therapeutic characteristicsto compare the clinical course of patients before and after surgery.Methods: a prospective descriptive study. The study population consisted of allworkers who were diagnosed with carpal tunnel syndrome as an occupational diseaseand looked at the Pain Unit at the San Juan de Dios Clinic in Cartagena, Colombia,from 2008 to 2010. Personal or telephone interview was conducted and clinical historyreview. Hypothesis tests were performed for quantitative variables (Student’s test or signtest and qualitative variables (Chi2 or Fisher’s test to compare the initial findings andafter interventions.Results: the incidence of work-related CTS is 10.7% in the Pain Unit at the San Juande Dios Clinic. We found that people who work in companies of shrimp or tuna are themost affected, with average time of absence from work for three years. We found thatin patients undergoing surgical treatment, most improve in early post-operative, but thesymptoms reappear again subjected to the same occupational hazard. We found delayeddiagnosis and therefore treatment.RESUMEN:Introducción: el síndrome del túnel carpiano (STC es uno de los principales problemasde salud de los trabajadores, que desarrollan tareas relacionadas con esfuerzosmanuales intensos y movimientos repetitivos del miembro superior.Objetivos: determinar el perfil epidemiológico y clínico de los pacientes que consultana una unidad de dolor, identificar las características laborales, clínicas y terapéuticas,comparar la evolución clínica de los pacientes antes y después de la intervenciónquirúrgica.Métodos: estudio observacional descriptivo prospectivo. La poblaci

  20. The role of sensory nerve conduction study of the palmar cutaneous nerve in the diagnosis of carpal tunnel syndrome in patients with polyneuropathy

    Directory of Open Access Journals (Sweden)

    Ayse Tokcaer

    2007-01-01

    Full Text Available Background: Conventional methods in the diagnosis of carpal tunnel syndrome (CTS in patients with polyneuropathy (PNP are insufficient. Aims: We suggest that the comparison of the conduction of the median nerve with that of the neighboring peripheral nerves may be more beneficial in the diagnosis of entrapment neuropathy. Setting and Design: The median nerve sensory conduction in healthy volunteers, in cases of CTS, PNP cases without CTS and in cases of PNP in whom clinical findings point to CTS, were compared by palmar cutaneous nerve (PCN sensory conduction. Materials and Methods: Comparative parameters were difference of PCN-1st digits′ nerve conduction velocities (NCV, PCN/1st digit NCVs ratio, difference of 5th-2nd digits′ NCVs and 5th/2nd digits′ NCVs ratio. Statistical Analysis: The statistical analysis was performed by the SPSS package for statistics. Student t test and receiver operating characteristic were used. Results: Although the ratio of PCN-1st digit did not differ significantly between the control group and the polyneuropathy group, there was a significant difference between CTS and PNP+CTS groups and the control group ( P < 0.001 and P < 0.001, respectively. The ratio of PCN-1st digit nerve conduction velocity was also significantly different between polyneuropathy and PNP+CTS groups ( P < 0.001. Conclusion: To diagnose CTS on a background of polyneuropathy in mild cases in which sensory conduction is preserved, the ratio of sensory nerve conduction velocities of the palmar cutaneous nerve and the median nerve 1st digit-wrist segment may be a criterion.

  1. 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)

    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)

  2. 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.

  3. Median nerve deformation and displacement in the carpal tunnel during index finger and thumb motion.

    Science.gov (United States)

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

    2010-10-01

    The purpose of this study was to investigate the deformation and displacement of the normal median nerve in the carpal tunnel during index finger and thumb motion, using ultrasound. Thirty wrists from 15 asymptomatic volunteers were evaluated. Cross-sectional images during motion from full extension to flexion of the index finger and thumb were recorded. On the initial and final frames, the median nerve, flexor pollicis longus (FPL), and index finger flexor digitorum superficialis (FDS) tendons were outlined. Coordinate data were recorded and median nerve cross-sectional area, perimeter, aspect ratio of the minimal-enclosing rectangle, and circularity in extension and flexion positions were calculated. During index finger flexion, the tendon moves volarly while the nerve moves radially. With thumb flexion, the tendon moves volarly, but the median nerve moves toward the ulnar side. In both motions, the area and perimeter of the median nerve in flexion were smaller than in extension. Thus, during index finger or thumb flexion, the median nerve in a healthy human subject shifts away from the index finger FDS and FPL tendons while being compressed between the tendons and the flexor retinaculum in the carpal tunnel. We are planning to compare these data with measurements in patients with carpal tunnel syndrome (CTS) and believe that these parameters may be useful tools for the assessment of CTS and carpal tunnel mechanics with ultrasound in the future. PMID:20225286

  4. Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas

    Directory of Open Access Journals (Sweden)

    Chen Shu-Fang

    2012-07-01

    Full Text Available Abstract Background Using high-resolution ultrasonography (US to measure the median nerve cross-sectional areas (CSAs such as in the “inching test” conducted in nerve conduction studies is a valuable tool to assess carpal tunnel syndrome (CTS. However, using this US measurement method to assess the median nerve CSA in diabetic patients with CTS has rarely been reported. Therefore, we used this US measurement method in this study to measure median nerve CSAs and to compare the CSAs of idiopathic, diabetic and diabetic polyneuropathy (DPN patients with CTS. Methods 124 hands belonging to 89 participants were included and assigned into four groups: control (32, idiopathic (38, diabetic (38 and DPN (16 CTS. In the latter two groups, only patients with mild and moderately severe CTS were included. The median nerve CSAs were measured at 8 points marked as i4, i3, i2, i1, w, o1, o2, and o3 in the inching test. The measured CSAs in each group of participants were compared. Results Compared with the CSAs of the control group, enlarged CSAs were found in the idiopathic, diabetic and DPN CTS groups. The CSAs were larger at i4, i3 and i2 in the diabetic CTS group compared to the idiopathic CTS group. The CSAs measured at the i1 and w levels of the DPN CTS group were smaller than those of the diabetic CTS group. In the diabetic CTS group, the cut-off values of CSAs measured at the inlet, wrist crease, and outlet were 15.3 mm2, 13.4 mm2 and 10.0 mm2, respectively, and 14.0 mm2, 12.5 mm2 and 10.5 mm2, respectively, in the DPN CTS group. Conclusions Compared with the median nerve CSAs of the control and idiopathic CTS groups, the median nerve CSAs of the diabetic patients with CTS were significantly enlarged. However, compared with the diabetic CTS group, the CSAs were significantly smaller in the DPN CTS group. This US 8-point measurement method can be of value as an important complementary tool for CTS studies and diagnosis among diabetic

  5. 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

  6. The electrophysiologicai diagnosis for severe carpal tunnel syndrome.%重症腕管综合征的神经电生理诊断

    Institute of Scientific and Technical Information of China (English)

    党静霞

    2011-01-01

    Objective: To explore the diagnostic value of electrophysiological detection for severe carpal tunnel syndrome(CTS). Methods: Thirty-eight patients(44 hands) with severe CTS were examined in associated absent median motor and sensory responses on routine nerve conduction,and the compound muscle action potential (CMP) latency difference recorded from the second lumbrical-palmar intherossei muscle was analyzed. Results: Forty out of 44 hands with CTS (91%)showed significant prolongation of the second lumbrical-palmar interossei latency difference, compared with normal values. The remaining 4 hands had absent median motor CMAPs recorded from second lumbrical muscles. All the patients had abnormal EMG in abductor pollicis brevis muscles. Conclusion: The examintion of the second lumbrical-palmar interossei latency difference is a valuable electrodiagnostic technique in diagnosing severe CTS, especially when associated with absent routine median motor and sensory responses.%目的:探讨重症腕管综合征(CTS)的神经电生理诊断价值.方法:回顾性分析了常规神经电生理检查正中神经运动和感觉传导均未诱发出电位即重症CTS者38例(44只手),分别在正中神经和尺神经手腕处刺激,在第二蚓状肌和手掌骨间肌记录混合肌肉动作电位(CMAP)起始潜伏时差.结果:重症CTS 44只手中,40只手(91%)在正中神经和尺神经刺激时,第二蚓状肌和手掌骨间肌记录CMAP起始潜伏时差延长,与正常对照组对比,其差异有统计学意义,4只手第二蚓状肌记录未引出波形;拇短展肌肌电图全部异常.结论:第二蚓状肌和手掌骨间肌记录CMAP起始潜伏时差测定是一项快速、简单而准确的诊断重症CTS的神经电生理检查方法.

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

    International Nuclear Information System (INIS)

    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.)

  8. 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.

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

    OpenAIRE

    Huisstede, Bionka; Hoogvliet, Peter

    2011-01-01

    Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Open decompression of the median nerve is considered the standard surgical treatment for CTS. This article describes a study to assess and compare the clinical efficacy of operative treatment performed by transverse carpal ligament release alone (limited carpel tunnel release (CTR)), to that achieved after transverse carpal ligament release with additional division of the proximal portion of the flexor retinaculum (e...

  10. MECHANICAL BEHAVIOR OF CARPAL TUNNEL SUBSYNOVIAL CONNECTIVE TISSUE UNDER COMPRESSION

    OpenAIRE

    Goetz, Jessica E; Baer, Thomas E.

    2011-01-01

    Subsynovial connective tissue (SSCT) is a fluid-permeated loose connective tissue that occupies the majority of the space in the carpal tunnel not occupied by the digital flexor tendons or the median nerve. It is arranged in layers around these more discrete structures, presumably to assist with tendon gliding. As a result of this arrangement, the compressive behavior and the fluid permeability of this tissue may substantially affect the stresses in the median nerve resulting from contact wit...

  11. Relationship between cervical spondylotic radiculopathy and carpal tunnel syndrome%神经根型颈椎病与腕管综合征的关系

    Institute of Scientific and Technical Information of China (English)

    马彦; 崔丽英; 管宇宙; 刘明生; 杜华; 吴双; 林楠

    2015-01-01

    Objective To explore the relationship between cervical spondylotic radiculopathy (CSR) and carpal tunnel syndrome (CTS) by investigating their electrophysiological characteristics and the incidence of CSR root injury and root injury complicating with CTS.Methods One hundred and twenty-four cases of CSR diagnosed in Peking Union Medical College Hospital from September 2013 to February 2014 by electromyography (EMG) were recruited.According to the results of EMG,patients were divided into root injury and root injury complicating with CTS groups.The distal motor latency (DML),motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),sensory nerve action potential (SNAP),compound muscle action potential (CMAP) and spontaneous potential (SP) were compared between the two groups.Results There were 81 (65.3%) cases with root injury,11 cases with double sides injury and 29 cases with normal EMG among these 124 patients.The CMAP,DML,MCV,SCV and SNAP were normal in 76 cases,CMAP lowered 5%-12% in 3 cases,DML extended 3% and 9% in 2 cases.There were 14 cases (11.3%) with concomitant CTS (female 10 cases and male 4 cases,double sides CTS 10 cases).Among the 14 cases with concomitant CTS,there were 9 cases with simply sensory nerve conduction abnormality,SCV slowing down 26%-47%,SNAP reducing 58%-86% or normal,while other 5 cases with motor conduction abnormality as well as sensory nerve conduction abnormality,CMAP reducing 21%-78%,DML extending 27%-39% in 3 cases,MCV slowing down 32% and 40% in 2 cases.Five cases had spontaneous electricity position movement in the abductor pollicis brevis.The incidence of root injury complicating with CTS in C6 (27.4%,9/33),C7 (26.9%,7/26) and C8 (5/7) showed statistically significant difference (x2 =5.96,P < 0.01).Conclusions There is a high incidence of root injury and CTS in CSR patients,indicating a possible double crush between CSR and CTS.%目的 研究神经根型颈椎病(CSR)

  12. Open carpal tunnel release with use of a nasal turbinate speculum.

    Science.gov (United States)

    Muppavarapu, Raghuveer C; Rajaee, Sean S; Ruchelsman, David E; Belsky, Mark R

    2015-11-01

    Incomplete release of the transverse carpal ligament (TCL) and median nerve injury are complications of carpal tunnel release (CTR). In this article, we describe a modified mini-open release using a fine nasal turbinate speculum to aid in the proximal release with direct visualization of the proximal limb of the TCL and the distal volar forearm fascia (DVFF). The technique begins with a 2.5-cm palmar longitudinal incision, and standard distal release of the TCL is completed. A fine nasal turbinate speculum is inserted into the plane above the proximal limb of the TCL and the DVFF. A long-handle scalpel is used to incise the TCL and the DVFF under direct visualization. We retrospectively analyzed a cohort of 101 consecutive CTR cases (63 right, 38 left). Carpal tunnel syndrome symptoms were relieved in all patients with a high degree of satisfaction. This modified mini-open technique provides surgeons with a reproducible and inexpensive method to ensure a safe proximal release of the TCL. PMID:26566548

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

    Directory of Open Access Journals (Sweden)

    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

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

    NARCIS (Netherlands)

    Huisstede, Bionka; Hoogvliet, Peter

    2011-01-01

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

  15. Evaluation of a new tourniquet for hand surgery: Comparison of 76 carpal tunnel syndrome cases operated using a Hemaclear(®) Model-F tourniquet versus a pneumatic tourniquet.

    Science.gov (United States)

    Pereira, A; Hendriks, S; Facca, S; Bodin, F; Gay, A; Liverneaux, P

    2015-04-01

    The aim of this study was to compare a forearm-specific, sterile, single-use, non-pneumatic tourniquet to a conventional pneumatic tourniquet during carpal tunnel syndrome procedures. Patients with a systolic blood pressure exceeding 160 mmHg were excluded. The study included 76 patients. In 38 patients, surgery was performed with a pneumatic tourniquet on the forearm. In the remaining 38 patients, surgery was performed with a Hemaclear(®) Model-F tourniquet. There were no significant differences between the two groups in terms of quality of the exsanguination or pain experienced by the patient. The duration of surgery was significantly faster by 30 seconds with the Hemaclear(®) tourniquet but the procedure cost was about €30 more. The forearm-specific Hemaclear(®) tourniquet has several theoretical advantages, but our clinical results do not support these advantages in terms of quality of the surgical exsanguination and pain experienced by the patient. The duration of surgery was significantly shorter, but at the price of a higher surgery cost. PMID:25772086

  16. MRI-Apparent Localized Deformation of the Median Nerve Within the Carpal Tunnel During Functional Hand Loading

    OpenAIRE

    Goetz, Jessica E.; Kunze, Nicole M.; Main, Erin K; Thedens, Daniel R.; Baer, Thomas E.; Lawler, Ericka A.; Brown, Thomas D.

    2013-01-01

    In MR images, the median nerve of carpal tunnel syndrome (CTS) patients frequently appears flatter than in healthy subjects. The purpose of this work was to develop a metric to quantify localized median nerve deformation rather than global nerve flattening, the hypothesis being that localized median nerve deformation would be elevated in CTS patients. Twelve patients with CTS and 12 matched normals underwent MRI scanning in eight isometrically loaded hand conditions. 2D cross sections of the ...

  17. Apparent Transverse Compressive Material Properties of the Digital Flexor Tendons and the Median Nerve in the Carpal Tunnel

    OpenAIRE

    Main, Erin K; Goetz, Jessica E; Rudert, M. James; Goreham-Voss, Curtis M; Thomas D. Brown

    2010-01-01

    Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these t...

  18. Review of the dimensions of the median nerve and carpal tunnel using sonography in asymptomatic adults

    International Nuclear Information System (INIS)

    Full text: The study aims to establish the normal range of all sono logic measurements of carpal tunnel (CT) structures in an asymptomatic population. Sonological evaluation of 150 wrists in 75 asymptomatic adults was performed. The cross-sectional area (CSA) of the median nerve at four levels, the flattening ratio (FR) at three levels, the antero-posterior (AP) diameter of the CT and the distance of the transverse carpal ligament (TCL) from the trapezium-hamate (TmH) line were measured. The mean (standard deviation (SD)) CSA of the median nerve at the distal forearm, CT inlet, mid and outlet were 6.8 (1.3), 704 (1.1),7.5 (1.0), 7.1 (1.0) mm2, respectively. The mean (SD) FR at the CT inlet, mid and outlet were 2.66 (0.54), 2.55 (0.54), 3.69 (0.82), respectively. The mean (SD) AP diameter of the CT was lOA mm (1.1). Volar bowing of the retinaculum was seen in 7.3% of normal wrists. The normal range at two SDs of the CSA of the median nerve at the inlet was 5.2-9.6 mm2. The upper limit of volar bowing of the flexor retinaculum was 0.8 mm. The FR overlaps with values obtained in other studies of patients with carpal tunnel syndrome. The mean AP diameter of the CT was lOA mm (SD 1.1). To the best of our knowledge, this is the largest study performed in an asymptomatic population assessing the different sono logical parameters related to the CT.

  19. Síndrome do túnel do carpo: estudo comparativo entre a medição ultrassonográfica e cirúrgica do nervo mediano nos casos moderados e severos da doença Carpal tunnel syndrome: comparative study between sonographic and surgical measurements of the median nerve in moderate and severe cases of disease

    Directory of Open Access Journals (Sweden)

    Marcelo de Pinho Teixeira Alves

    2013-02-01

    Full Text Available OBJETIVO: Comparar os perímetros ultrassonográfico e cirúrgico do nervo mediano, avaliar o diagnóstico da síndrome do túnel do carpo pela área seccional do nervo mediano, verificar associação entre área seccional do nervo mediano e gravidade da síndrome do túnel do carpo. MATERIAIS E MÉTODOS: Estudo de 30 pacientes com síndrome do túnel do carpo. Mediram-se a área seccional e o perímetro ultrassonográfico do nervo mediano. Avaliaram-se correlação clínica-ultrassonográfica e associação com a gravidade da doença. Compararam-se os perímetros ultrassonográfico e cirúrgico. Compararam-se classificação clínica com perímetro cirúrgico, área seccional e perímetro ultrassonográfico. RESULTADOS: Cinco perdas, 25 pacientes estudados; 60% dos pacientes com doença moderada, 60% de casos graves ultrassonográficos (área seccional > 0,15 cm². Distribuição não normal de perímetro cirúrgico (p = 0,5, distribuição normal de perímetro ultrassonográfico (p = 0. Diferença significativa entre perímetros (teste-t de amostras pareadas; p 0,09 cm² em todos os pacientes. CONCLUSÃO: Não houve associação entre perímetro ultrassonográfico e perímetro cirúrgico do nervo mediano. Área seccional do nervo mediano > 0,09 cm² foi válida para o diagnóstico. Não houve associação entre área seccional e gravidade da doença.OBJECTIVE: To compare sonographic and surgical measured perimeters of the median nerve; to evaluate the diagnosis of carpal tunnel syndrome by median nerve cross-sectional area; to verify the association between cross-sectional area of the median nerve and carpal tunnel syndrome severity. MATERIALS AND METHODS: Thirty patients with established carpal tunnel syndrome were studied. Cross-sectional area and sonographic perimeter of the median nerve were measured. The correlation between clinical and sonographic findings and association with carpal tunnel syndrome severity were evaluated. Sonographic

  20. Median Nerve with Intraoperative Monitor and Supramaximal Stimulation by Electrophysiology to Cure Carpal Tunnel Syndrome%术中超强电刺激治疗腕管综合征的临床效果研究

    Institute of Scientific and Technical Information of China (English)

    蒋毅; 张航; 田通; 赵睿

    2015-01-01

    目的:评估正中神经松解术结合术中超强电刺激治疗腕管综合征的临床效果。方法:将40例重度腕管综合征患者随机分为对照组和研究组,每组各纳入20名患者。对照组患者仅行正中神经松解术;研究组患者给予正中神经松解术结合术中超强电刺激治疗(80mA,2Hz,5min)。分别记录两组患者大鱼际肌复合肌肉动作电位(CMAP)的潜伏期及波幅并进行比较。结果:研究组患者正中神经外膜松解加超强电刺激后大鱼际肌CMAP的潜伏期和波幅分别为(7.2±0.5)ms和(2.4±0.3)mV,对照组正中神经外膜松解后大鱼际肌CMAP的潜伏期和波幅分别为(8.3±0.4)ms和(1.9±0.4)mV,两组数据均较术前明显恢复,两组间比较具有统计学意义(P<0.05)。结论:术中超强电刺激对腕管综合征患者的正中神经功能恢复具有辅助治疗作用。%Objective: To evaluate the therapeutic effect of the decompression of median nerve combined with intraoperative supramaximal stimulation.Methods:40 patients, who were diagnosed as carpal tunnel syndrome in severe damage, were randomly divided into the control group and the study group, and each group had 20 patients. Only decompression of median nerve was conducted to the patients in the control group. Decompression of median nerve combined with intraoperative supramaximal stimulation (80mA, 2Hz, 10min) was given to the patients in the study group. Record and analyze the latency period and amplitude of CMAP of the patients’ muscle of thenar in the two groups respectively.Results:In the study group, the latency period and amplitude of CMAP of muscle of thenar after decompression and supramaximal stimulation were (7.2±0.5) ms and (2.4±0.3) mV respectively. In the control group, the latency period and amplitude of CMAP were (8.3±0.4) ms and (1.9±0.4) mV respectively. Compared the study group with the control group, there was significant

  1. The sectional anatomy of the carpal tunnel and its related neurovascular structures studied by using plastination.

    Science.gov (United States)

    Sora, M-C; Genser-Strobl, B

    2005-05-01

    The aim of this study was to evaluate the morphology of the carpal tunnel and its related neurovascular structures. A slice anatomy study was performed on 12 right wrists of unfixed human cadavers by using the plastination technique. The measurements were performed at the level of the pisiform, hook of the hamate and in the middle between these structures. The diameters of the carpal tunnel and the median nerve were measured at the level of the hook of the hamate. The median nerve can be predicted to be 18 +/- 1.6 mm radial to the pisiform and the ulnar neurovascular bundle 6.8 +/- 1.4 mm radial to the pisiform. Between those structures there will be at least a 9-mm area, localized 8 mm radial to the pisiform, where the incision of the transverse carpal ligament could be performed risk-free. At the hamate hook the median nerve can be predicted at 9.24 +/- 1.18 mm and the ulnar artery lies usually 1.26 +/- 2.5 mm radial to the hook. An understanding of the contents and their positions, and relationships to each other allows an accurate identification of neurovascular structures in the carpal tunnel. Our findings can be used as anatomic landmarks of the carpal tunnel and could be helpful to physicians performing carpal tunnel investigations. PMID:15804269

  2. A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF as a reference tool

    Directory of Open Access Journals (Sweden)

    Leite José

    2006-12-01

    Full Text Available Abstract Background A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS, however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF. Methods The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical treatment for CTS. The outcomes assessed in these trials were identified, classified and linked to the different domains of the ICF. Results Twenty-eight studies were retrieved which met the inclusion criteria. The most frequently assessed outcomes were self-reported symptom resolution, grip or pinch strength and return to work. The majority of outcome measures employed assessed impairment of body function and body structure and a small number of studies used measures of activity and participation. Conclusion The ICF provides a useful framework for identifying the concepts contained in outcome measures employed to date in trials of surgical intervention for CTS and may help in the selection of the most appropriate domains to be assessed, especially where studies are designed to capture the impact of the intervention at individual and societal level. Comparison of results from different studies and meta-analysis would be facilitated through the use of a core set of standardised outcome measures which cross all domains of the ICF. Further work on developing consensus on such a core set is needed.

  3. CLINICAL ANALYSIS OF ACUTE CARPAL TUNNEL SYNDROME AFTER REDUCTION OF Colles' FRACTURE IN TWENTY-TWO PATIENTS%Colles骨折复位后致急性腕管综合征22例临床分析

    Institute of Scientific and Technical Information of China (English)

    冯仕明; 高顺红; 焦成; 陈超; 刘德群

    2011-01-01

    Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles' fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles' fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, falling in 8 cases, falling from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland & Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles' fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no relief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% lidocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were relief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The

  4. Ultrasound Assessment of Transverse Carpal Ligament Thickness: A Validity and Reliability Study

    OpenAIRE

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-01-01

    The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiological factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measu...

  5. Volar/Dorsal Compressive Mechanical Behavior of the Transverse Carpal Ligament

    OpenAIRE

    Main, Erin K; Goetz, Jessica E; Baer, Thomas E.; Klocke, Noelle F; Thomas D. Brown

    2012-01-01

    Mechanical insult to the median nerve caused by contact with the digital flexor tendons and/or carpal tunnel boundaries may contribute to the development of carpal tunnel syndrome. Since the transverse carpal ligament (TCL) comprises the volar boundary of the carpal tunnel, its mechanics in part govern the potential insult to the median nerve. Using unconfined compression testing in combination with a finite element-based optimization process, nominal stiffness measurements and first-order Og...

  6. Individual flexor tendon identification within the carpal tunnel: A semi-automated analysis method for serial cross-section MR images

    OpenAIRE

    Kunze, Nicole M.; Goetz, Jessica E.; Thedens, Daniel R.; Baer, Thomas E.; Lawler, Ericka A.; Brown, Thomas D.

    2009-01-01

    Carpal tunnel syndrome is commonly viewed as resulting from chronic mechanical insult of the median nerve by adjacent anatomical structures. Both the median nerve and its surrounding soft tissue structures are well visualized on magnetic resonance (MR) images of the wrist and hand. Addressing nerve damage from impingement of flexor digitorum tendons co-occupying the tunnel is attractive, but to date has been restricted by lack of means for making individual identifications of the respective t...

  7. A PROSPECTIVE RANDOMIZED STUDY ON THE CLINICO - ELECTROPHYSIOLOGICAL RESULTS OF OPEN AND ENDOSCOPIC CARPAL TUNNEL RELEASE SURGERIES

    Directory of Open Access Journals (Sweden)

    Sreejith

    2015-09-01

    Full Text Available OBJECTIVE: To compare short term surgical outcome of carpal tunnel syndrome release, against endoscopic approach. MATERIALS AND METHODS: A prospective randomized study was conducted on 91 patients with carpal tunnel syndrome, who were treated endoscopically or surgically from 2011 to 2013 at KMCT medical college, Calicut . All the patients were confirmed as a case of carpal tunnel syndrome after correlating sensory nerve conduction studies with clinical findings. None of these cases responded to medical treatment and hence opted surgery. Out of these 91 cases, 71 patients were available for post - surgical follow up. On 35 cases endoscopic CTR was performed and remaining 36 were open CTR. These patients were followed up for 6 months and each patient was evaluated for symptom amelioration, complications, operation time, time needed to resume normal lifestyle and the frequency of revision surgery if needed. RESULTS: First few months after surgery, it was observed that endoscopically treated patients were better symptomatically and functionally. Wound scarring, scar tenderness and other local wound problems were significantly more pronounced in patients who underwent open CTR. R eturn to normal daily activities were more delayed in open CTR patients compared to endoscopically treated wrists. Even then there was no significant symptom amelioration, electromyographic testing and complications at the end of six months between these two methods. CONCLUSION: Immediate, short term results were better in endoscopically treated patients due to cosmetic advantages as there is less scar and early return to activities of daily living. On a 6 month review, it was found that both the methods gave comparable results.

  8. 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

    Directory of Open Access Journals (Sweden)

    Chen Shu-Fang

    2011-12-01

    Full Text Available Abstract Background 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. Methods 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. Results 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 mm2, 11.5 mm2 and 10.1 mm2 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". Conclusions Using the 8-point measurement of the median nerve CSA from inlet to outlet similar to the "inching test" has

  9. 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)

    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 mm2, 11.5 mm2 and 10.1 mm2 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 nerve

  10. 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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel.

    Science.gov (United States)

    Main, Erin K; Goetz, Jessica E; Rudert, M James; Goreham-Voss, Curtis M; Brown, Thomas D

    2011-03-15

    Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome. PMID:21194695

  13. Individual flexor tendon identification within the carpal tunnel: A semi-automated analysis method for serial cross-section magnetic resonance images

    Directory of Open Access Journals (Sweden)

    Nicole M Kunze

    2009-12-01

    Full Text Available Nicole M Kunze1, Jessica E Goetz2, Daniel R Thedens3, Thomas E Baer2, Ericka A Lawler2, Thomas D Brown21Department of Biomedical Engineering, 2Department of Orthopaedics and Rehabilitation, 3Department of Radiology, University of Iowa, Iowa City, IA, USAAbstract: Carpal tunnel syndrome is commonly viewed as resulting from chronic mechanical insult of the median nerve by adjacent anatomical structures. Both the median nerve and its surrounding soft tissue structures are well visualized on magnetic resonance (MR images of the wrist and hand. Addressing nerve damage from impingement of flexor digitorum tendons co-occupying the tunnel is attractive, but to date has been restricted by a lack of means for making individual identifications of the respective tendons. In this image analysis work, we have developed a region-growing method to positively identify each individual digital flexor tendon within the carpal tunnel by tracking it from a more distal MR section where the respective tendon identities are unambiguous. Illustratively, the new method was applied to MRI scans from four different subjects in a variety of hand poses. Conventional shape measures yielded less discriminatory information than did evaluations of individual tendon location and arrangement. This new method of rapid identification of individual tendons will facilitate analysis of tendon/nerve interactions within the tunnel, thereby providing better information about mechanical insult of the median nerve.Keywords: carpal tunnel syndrome, magnetic resonance imaging, region growing, digital flexor tendons

  14. The best cutoff point for median nerve cross sectional area at the level of carpal tunnel inlet.

    Directory of Open Access Journals (Sweden)

    Payam Sarraf

    2014-08-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy. It accounts 90% of all entrapment neuropathies all over the world. Ultrasound is a non-invasive, cost effective and available para-clinical method which could be applied for CTS diagnosis. Cross-sectional area of the median nerve at the level of the inlet is considered as a diagnostic criterion in CTS cases. In this study, thirty-eight patients with electrophysiologically confirmed idiopathic CTS and 22 healthy controls were enrolled. Seventy-one affected nerves and 42 unaffected nerves were evaluated within 14 days after electrophysiological examination. The largest cross-sectional area (CSA was measured at the level of the carpal tunnel inlet and the maximum nerve perimeter was also recorded by means of the software. Mean CSA and perimeter were 14.02 ± 4.5 mm2 and 1.7±0.28m in all patients and 8.2±2.1 mm2, 1.3±0.19 m in controls (P<0.001, P<0.001. Mean CSA and Perimeter were significantly different between patient's groups and control. The best cut off point for CSA of the tunnel inlet was 10.5 mm2 with sensitivity and specificity of 80% and 76% (AUC (Area under the Curve = 0.9, P<0.001. The best cut off point for inlet perimeter was 1.44 m with sensitivity and specificity of 85% and 77 % (AUC=0.87, P<0.001. Our findings showed that median nerve CSA at carpal tunnel inlet could be used as the diagnostic criteria for CTS.

  15. Acral osteolysis in bilateral compartment syndrome

    Directory of Open Access Journals (Sweden)

    Iram Saeed

    2008-08-01

    Full Text Available Carpal tunnel syndrome is a common neurological condition with rare yet potentially serious cutaneous and skeletal complications. We present a case of mutilating/ulcerating bilateral carpal tunnel syndrome in a 63 year old female. Radiographs showed symmetrical acral osteolysis in the index and middle fingers distal phalanges bilaterally. Carpal tunnel decompressions provided symptomatic relief.

  16. Tarsal Tunnel Syndrome

    Science.gov (United States)

    ... and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel ... syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path ...

  17. Technical Tip for Proximal Release During Open Carpal Tunnel Release Using a Subcutaneous Pocket.

    Science.gov (United States)

    Nikkhah, Dariush; Sadr, Amir H; Akhavani, Mohammed Ali

    2016-06-01

    Technical steps to avoid incomplete proximal release of the carpal tunnel are described. Local anaesthesia is infiltrated as a subcutaneous bleb over the distal wrist crease and extending 2-3 cm over the forearm fascia. Tumescence of local anaesthesia into the subcutaneous plane helps create a pocket between the forearm fascia and subcutaneous tissues. Intraoperatively a subcutaneous pocket is made above the transverse carpal ligament and antebrachial fascia with blunt dissection. A retractor is placed under the pocket, which facilitates optimal visualization to allow reliable complete proximal release of compression.The authors have found that this technique is reproducible and reliable across their collective experience. PMID:27454649

  18. Síndrome do túnel do carpo: aspectos clínico-epidemiológicos em 668 casos Carpal tunnel syndrome: clinical and epidemiological studies in 668 cases

    Directory of Open Access Journals (Sweden)

    JOÃO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Foram estudados 668 pacientes (1059 mãos com síndrome do túnel do carpo entre janeiro de 1989 e junho de 1996. O critério de seleção e inclusão dos pacientes baseou-se na diferença de latência sensitiva > ou = 1,0 ms entre os potenciais de ação sensitivos dos nervos mediano e radial após estimulação no punho e registro no I dedo (diferença mediano-radial, DMR, representando diferença maior que 6 desvios-padrão (DP. Foi obtida DMR em 125 mãos normais (grupo controle com limite superior de normalidade de 0,43 ms (média + 2 DP. Todos os casos tiveram estudo eletrofisiológico bilateral, sendo excluídos casos com cirurgia prévia ou evidência de neuropatia periférica. A idade variou de 17 a 83 anos com média de 47,5 anos; 91,3% eram do sexo feminino; 72% referiam sintomatologia bilateral e 85,3% no período noturno/matinal. Dor, dormência e formigamento foram conjuntamente referidos por 64,4%, sendo que dor como sintoma isolado foi raro; além da mão, houve extensão do quadro álgico para outros territórios em 39,4%. Os sintomas ocorreram em todos dos dedos em 42,5% seguido do III, III-IV, I-II-III e II-III-IV dedos. Não houve correlação precisa com antecedentes traumáticos no punho. A duração da sintomatologia foi ampla, variando de 1 a >120 meses. A doença mais comumente referida pelos pacientes foi diabetes mellitus com 4,4% do total.Between January/1989 and June/1996, 1 059 carpal tunnel syndrome hands (CTS from 668 patients were studied. None had been previously operated and all had bilateral conduction studies; peripheral neuropathy was excluded. The patients were selected with sensory median/radial difference (MRD > or = 1.0 ms that strongly supports electrodiagnosis of CTS (standard deviation >6 after stimulation on wrist and recording on thumb. Normal MRD were obtained in 125 hands with upper limit of normality = 0,43 ms (mean + 2 SD. The age ranged from 17 to 83 years (mean 47.5 and 91.3% were female; the

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

    Directory of Open Access Journals (Sweden)

    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

  20. Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    G. Yeo

    2015-01-01

    Full Text Available Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase group receiving both hyaluronidase and local anaesthetic. Pain scores were rated using the visual analogue scale (VAS by patients immediately after local anaesthetic injection and again immediately after the carpal tunnel release. Results. Preoperative VAS scores, taken after local anaesthetic injection, were greater than postoperative VAS scores. Postoperative VAS scores were significantly lower in the hyaluronidase group and tourniquet times were significantly shorter in the hyaluronidase group. Conclusion. Hyaluronidase addition to local anaesthetic in carpal tunnel release resulted in significant reductions in operative time and pain immediately after operation.

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

    International Nuclear Information System (INIS)

    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)

  2. Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial

    OpenAIRE

    Yeo, G.; Gupta, A; Ding, G.; Skerman, H.; Khatun, M.; Melsom, D.

    2015-01-01

    Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase gro...

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

    OpenAIRE

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

    2010-01-01

    The purpose of this study was to investigate the deformation and displacement of the normal median nerve in the carpal tunnel during index finger and thumb motion, using ultrasound. Thirty wrists from 15 asymptomatic volunteers were evaluated. Cross-sectional images during motion from full extension to flexion of the index finger and thumb were recorded. On the initial and final frames, the median nerve, flexor pollicis longus (FPL), and index finger flexor digitorum superficialis (FDS) tendo...

  4. Superficial Palmar Arch Aneurysm after Carpal Tunnel Decompression, a Rare Complication: A Case Report

    Directory of Open Access Journals (Sweden)

    S. Gull

    2011-01-01

    Full Text Available False aneurysms of the palmar arteries are rare. They are usually associated with traumatic injuries to the hand vasculature. We present a case of superficial palmar arch aneurysm (SPAA, complicating carpal tunnel decompression which presented as a pulsatile mass at the site of previous surgery. Initial diagnosis was made on clinical examination and confirmed on doppler ultrasound (US and computed tomographic angiography (CTA. The feeding vessel of the aneurysm was subsequently occluded using coil embolization.

  5. In vivo high-resolution MR imaging of the carpal tunnel at 8.0 tesla

    International Nuclear Information System (INIS)

    Heading AbstractObjective. To determine the feasibility of acquiring in vivo images of the human carpal tunnel at 8 tesla (T).Design. The wrist of an asymptomatic volunteer was imaged with an 8 T /80 cm magnet. The subject was imaged prone with the arm over the head and the wrist placed in neutral position in a custom-built dedicated shielded wrist coil. Axial two-dimensional gradient-echo (GRE) images of the wrist were acquired.Results. Image contrast and resolution at 8 T are excellent. The infrastructure of the median nerve, particularly the interfascicular epineurium and individual fascicles, is better visualized at 8 T than at 1.5 T. The flexor tendons are well delineated from each other and the surrounding soft tissues, and tertiary tendon fiber bundles are resolved. The boundaries of the carpal tunnel are better defined at 8 T.Conclusion. We have obtained the first high-quality in vivo images of the human carpal tunnel at 8 T. The 8 T images demonstrated better contrast and resolution than those obtained at 1.5 T. (orig.)

  6. Carpal Fusion

    OpenAIRE

    Jalal Jalalshokouhi; Mohammad Hossein Herischi; Shahyar Pashaei; Ali Akbar Ameri

    2012-01-01

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

  7. Correlation between MRI, clinical findings and electrophysiological investigation for diagnosis of idiopathic carpal tunnel syndrome%特发性腕管综合征的MRI、临床表现及电生理检测的相关性研究

    Institute of Scientific and Technical Information of China (English)

    姜璐璐; 高佩虹; 于继徐; 车峰远

    2012-01-01

    目的 探讨MRI、临床表现及电生理检测对特发性腕管综合征病情程度的诊断价值.方法 对30名特发性腕管综合征患者进行临床、电生理检测及腕部磁共振成像,所得参数之间进行相关性检验.结果 除豌豆骨水平正中神经面积外,其它MRI参数、临床表现、电生理检测参数之间无相关性.豌豆骨水平正中神经面积与两点辨别觉呈正相关(P<0.01),与感觉潜伏时呈正相关(P<0.05),与感觉传导速度(sensory conduction velocity,SCV)呈负相关(P<0.05).结论 经腕MRI测量的豌豆骨水平正中神经面积,是评估病情程度的一个敏感指标.%Objective To explore MRI,clinical evaluation and electrophysiological investigation in diagnostic value about the severity of idiopathic carpal tunnel syndrome. Methods Thirty patients with idiopathic carpal tunnel syndrome were assessed by MRI,clinical evaluation and electrophysiological investigation. Correlation tests were used to determine the relationships between all the measured parameters. Results With exception of median nerve area at pisiform level, there was not correlation between MRI parameters and findings obtained by clinical assessments and electrophysiological measurements. Crosssectional area of median nerve at pisiform level correlated positively with twopoint discrimination ( P < 0. 01), sensory latency { P < 0. 05 ) and negatively with sensory nerve conduction velocity( P < 0.05). Conclusion The area of median nerve measured by wrist magnetic resonance at pisiform level was a sensitive indicator to valuale the disese.

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

    OpenAIRE

    Wright, Thomas W.; Dell, Paul C.; Conrad, Bryan P; Tanner, Marc A.

    2012-01-01

    Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and r...

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

    Directory of Open Access Journals (Sweden)

    Marc A. Tanner

    2012-01-01

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

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

    Science.gov (United States)

    Tanner, Marc A; Conrad, Bryan P; Dell, Paul C; Wright, Thomas W

    2012-01-01

    Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined. Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly. Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint. PMID:23251808

  11. 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.

  12. Biomechanical interaction between the transverse carpal ligament and the thenar muscles

    OpenAIRE

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-01-01

    The transverse carpal ligament (TCL) serves as the origin of the thenar muscles and is integral to thenar muscle contraction anatomically and biomechanically. TCL hypertrophy has been observed in patients with carpal tunnel syndrome and is potentially caused by repetitive hand use. The purpose of this study was to investigate the biomechanical interaction between the TCL and the thenar muscles. Specifically, the morphological changes of the carpal arch, formed by the TCL, in response to thena...

  13. 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.

  14. Carpal Fusion

    Directory of Open Access Journals (Sweden)

    Jalal Jalalshokouhi*

    2012-05-01

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

  15. Comparison of nerve conduction techniques in 95 mild carpal tunnel syndrome hands Síndrome do túnel do carpo leve: comparação de técnicas de condução nervosa em 95 mãos

    Directory of Open Access Journals (Sweden)

    JOAO ARIS KOUYOUMDJIAN

    1999-06-01

    Full Text Available Electrodiagnosis of carpal tunnel syndrome (CTS were prospectively studied in 95 hands. The following techniques were studied in all hands and when at least one abnormal value was found (onset-measured, it was included on results: 1. wrist-index finger latency (WIF, abnormal > or = 2.8 ms, 140 mm; 2. palm-wrist latency (PW, abnormal > or = 1.8 ms, 80 mm; 3. comparison median/ulnar palm-wrist latency (CPW, abnormal > or = 0.4 ms; 4. comparison median/ulnar latency, wrist-ring finger (CMU, abnormal > or = 0.5 ms, 140 mm; 5. comparison median/radial latency, wrist-thumb (CMR, abnormal > or = 0.4 ms, 100 mm. All 95 CTS hands selected have the WIF Eletrodiagnóstico da síndrome do túnel do carpo (STC foi estudado prospectivamente em 95 mãos sintomáticas. As técnicas estudadas foram realizadas em todas mãos com latência medida no ínicio dos potenciais e pelo menos uma delas estava anormal dentro dos limites descritos: 1. Latência punho- II dedo (PD, anormal > ou = 2,8 ms, 140 mm; 2. Latência palma-punho (PP, anormal > ou = 1,8 ms, 80 mm; 3. Comparação de latência palma-punho mediano-ulnar (CP, anormal > ou = 0,4 ms, 80 mm; 4. Comparação de latência mediano-ulnar, punho- IV dedo (CMU, anormal > ou = 0,5 ms, 140 mm; 5. Comparação de latência mediano-radial, punho- I dedo (CMR, anormal > ou = 0,4 ms, 100 mm. Todas 95 mãos selecionadas tiveram PD <= 3,5 ms (STC leve. Concluiu-se que a CMR foi a técnica mais sensível para STC leve (97,8% e o único método comparativo com todos potenciais de ação obtidos; seguiram-se CP (88,4%, PP (84,2%, CMU (72,6% e PD (68,4%.

  16. Revisión sistemática de tratamientos fisioterapéuticos con mejor evidencia para el síndrome del túnel carpiano Systematic review of phisiotherapy treatments with better evidence for the carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    C. S. Alvayay

    2008-10-01

    hay datos objetivados que indiquen que estas herramientas fisioterapéuticas disminuyen la compresión que afecta al nervio mediano.Introduction: The carpal tunnel syndrome (CTS is a pathology wich has a high incidence and it basically consist of a neuropathic compression of the median nerve at the wrist level. Initially, this compression is a nerve neuropraxia, but over the time and neglect this pathology evolves to axonotmesis and, in extreme cases, to neurotmesis. The symptoms and signs of this condition are very limiting to the patient. The pain and the parestesias in the dermatomic and myotomic regions of medial nerve will affect the manual performance of this patients decreasing the performance at work and life quality. Finally, the CTS ends in surgery. For these reasons it is necessary to use physiotherapeutic treatment techniques to avoid surgical procedures and abolish this signs and symptoms. Objetive: The aim of this study was to search and find the physiotherapeutic treatments with the best existing scientific evidence for the carpal tunnel syndrome with the aim of reducing the signs and symptoms as well as avoiding the surgical procedure. MATERIALS AND METHODS: we use the MEDLINE scientific searcher with de PUBMED datábase, later the papers were filtrated with the aim to obtain the best available evidence (according to the Oxford scale and finally were analyzed according to the PEDro scale to evalúate the works validity. Results: There were included three arricies: two randomized triáis (with a high score on the PEDro scale and a systematic review. Only this three papers approved the inclusión and exclusión criteria. CONCLUSIONS: The use of some physiotherapeutic treatments in doses and treatment time described in this review reduce significantly pain, subjective symptoms, distal motor latency, hand grip and finger pinch strength. However the treatment is symptomatic because there are no data indicating that these physiotherapeutic tools reduce the

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-02-01

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

  18. 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.

  19. Proposition d’un outil d’aide au diagnostic du syndrome du canal carpien pour les acteurs de la santé au travail Proposal of a tool for diagnosis of carpal tunnel syndrome for Personal of Health at Work Proposición de una herramienta de ayuda en el diagnóstico del síndrome del túnel carpiano para los actores de la salud en el trabajo

    Directory of Open Access Journals (Sweden)

    Florence Bazzaro

    2012-05-01

    Full Text Available Les acteurs de la santé au travail sont confrontés à un manque d’outils quantitatifs de suivi et de diagnostic du syndrome du canal carpien (SCC. Pour répondre à ce manque, un outil de diagnostic du SCC est proposé dans cette communication. Il est composé de deux tests : le test de la roue qui consiste à détecter des encoches sur une roue en mouvement et le test de la poutre qui détecte un niveau de sensibilité à une force exercée sur un doigt concerné par le SCC. Deux études expérimentales ont été conduites pour valider cet appareil. La première étude montre que les mesures effectuées avec l’appareil sont répétables, la seconde vise à étudier la sensibilité et la spécificité de l’outil en comparaison avec une étude électrodiagnostique. Les résultats montrent que l’appareil de détection du SCC a un excellent pouvoir discriminant permettant d’identifier les sujets sains et les sujets atteints du SCC.People involved with occupational health at work are faced with a lack of quantitative tools to monitor and diagnose Carpal Tunnel Syndrome (CTS. In order to fill this gap, we developed a device for rapid CTS diagnosis which is composed of two complementary quantitative tests: the wheel test, which consists in detecting notches on a rotating wheel, and the beam test, which consists in detecting various forces exerted on a finger. We conducted two experimental studies to validate this device. The first one demonstrated the repeatability of the measures. The second one studied the sensitivity and specificity of our tool as compared to an electro-diagnosis test. The results show that our CTS detection device has excellent discriminatory power that allows practitioners to differentiate between healthy and CTS-affected subjects.Los actores de la salud en el trabajo se enfrentan a una falta de herramientas cuantitativas de seguimiento y de diagnóstico del síndrome del túnel carpiano (STC. Como respuesta a esa

  20. 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

  1. Cubital Tunnel Syndrome Secondary To Anconeus-epitrochlearis Muscle: Case Report.

    Directory of Open Access Journals (Sweden)

    Martínez, Fernando

    2012-06-01

    Full Text Available The cubital tunnel syndrome is the most common entrapment neuropathy after carpal tunnel syndrome. While there are several anatomical sites where the ulnar nerve can be compressed, fibrous arch formed by the two heads of insertion of the flexor carpi ulnaris muscle is the place where this compression can be appreciate more often. At this level, there may be rare variants muscle, as anconeus-epitrochlearis muscle.We report a case of ulnar nerve compression secondary to this variant muscle.It was a muscle stretched from the medial epicondyle to the olecranon, crossing superficially and perpendicularly to the ulnar nerve. During surgery were sectioned muscle fibers, watching a compressed ulnar nerve.In the postoperative away, there was a partial improvement of symptoms.The anconeus-epitrochlearis muscle is a variant present between 1 and 40% of cases and it can be associated with ulnar neuropathy.

  2. 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

  3. Simple in situ decompression for idiopathic cubital tunnel syndrome using minimal skin incision

    Directory of Open Access Journals (Sweden)

    Jeon In-Ho

    2010-01-01

    Full Text Available Cubital tunnel syndrome is one of the most frequently occurring compression neuropathy in the upper limb next to carpal tunnel syndrome. Recent minimal invasive technique has prompted us to gain clinical experience with simple in situ decompression with minimal skin incision for idiopathic cubital tunnel syndrome. Sixty six consecutive patients with cubital tunnel syndrome were treated using minimal skin incision technique. The mean age of the patients was 49.7 (range: 15-77 years and average follow up period was 23.9 months (range: 12-60 months. The severity of ulnar neuropathy was classified according to the McGowan classification: there were 17 in grade I , 47 in grade II and 2 in grade III. A preoperative nerve conduction study was done by inching method, which revealed motor conduction delay around the medial epicondyle. All operations were carried out in a day surgery unit under local anesthetics. The postoperative outcome was evaluated by Messina classification. The mean duration of the operation was 12 minutes. The technique was highly satisfactorily esthetic for all. Over 80% of the patients were completely satisfied with the procedure taking into consideration their symptoms. Postoperative outcome measures and patient satisfactions (pain, return to normal activities and work, scar and pillar tenderness were comparable with published series of anterior transposition. The overall satisfactory results were recorded 81% in the patients of McGowan stage I and II. There were 2 cases of hematoma as a postoperative complication. This procedure is comparably effective alternative which involves less surgical trauma, morbidity and rehabilitation time with good surgical outcomes especially in mild and moderate degrees. Minimal skin incision is a simple, safe and effective method to treat patients with idiopathic cubital tunnel syndrome.

  4. Movement of the Distal Carpal Row during Narrowing and Widening of the Carpal Arch Width

    OpenAIRE

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

    2012-01-01

    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...

  5. Anatomia patológica da sinóvia de pacientes submetidos à liberação do túnel do carpo Pathological study of the synovial tissue of patients who underwent open carpal tunnel release

    Directory of Open Access Journals (Sweden)

    Pedro José Pires Neto

    2010-01-01

    according to the intensity of the inflammatory process. RESULTS: The anatomical pathology examination showed that 56.6% were classified as grade I (unchanged inflammation, 32.6%, grade II (leukocyte infiltration and discreetmoderate fibrosis, 4.3%, grade III (leukocyte infiltrate and intense fibrosis, the presence of fibrin and vascular neoformation and 6.5%, grade IV (changes described above associated with the presence of local calcification and giant cells. Two patients with amyloidosis were classified as grade I and II and no stockpiles of amyloid material were found on their slides. Two patients with hyperparathyroidism and another with chronic kidney failure were classified as grade IV. CONCLUSION: Synovial biopsy of the carpal tunnel did not make early diagnosis of potential systemic diseases possiblein patients with carpal tunnel syndrome, and adds extra costs to the procedure.

  6. 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

  7. 特发性腕管综合征马鞍形腕横韧带的MRI特征%Idiopathic carpal tunnel syndrome:a saddle-spaded transverse carpal ligament and its ;significances

    Institute of Scientific and Technical Information of China (English)

    苏萱; 徐雷鸣

    2016-01-01

    目的:探讨特发性腕管综合征(CTS)患者鞍状腕横韧带的MRI特征。方法回顾性分析经临床诊断为特发性CTS的21例患者(22个腕关节)作为特发性CTS组;无腕管综合征症状且无腕横韧带及其掌侧软组织病变的32例其他腕部疾病患者(33个腕关节)作为对照组。均行矢状面、横轴面腕关节MRI平扫。观察腕横韧带形态,判断腕横韧带是否为马鞍形,并计算腕横韧带掌凹曲率和正中神经压缩率。采用χ2检验比较2组患者腕横韧带形态的差异,采用非参数秩和检验比较2组患者腕横韧带掌凹曲率的差异,采用Pearson相关分析评价特发性CTS患者腕横韧带掌凹曲率与正中神经的压缩率的相关性。结果特发性CTS患者矢状面像上,马鞍形腕横韧带向掌侧凹,最凹点常位于钩骨钩水平。以马鞍形腕横韧带下凹0.25 mm为标准,马鞍形腕横韧带31例(特发性CTS患者20例、对照组11例),非马鞍形腕横韧带24例(特发性CTS 2例,对照组22例),2组患者腕横韧带形态的差异有统计学意义(χ2=17.791,P<0.01)。特发性CTS和对照组患者的腕横韧带掌凹曲率中位数分别为8.49%和0.00%,差异有统计学意义(Z=-4.79,P<0.01)。特发性CTS患者正中神经层面,腕横韧带掌凹曲率[(7.88±4.28)%)]与正中神经压缩率[(39.36±19.43)%]呈正相关(r=0.714,P<0.01)。结论马鞍形腕横韧带是特发性CTS患者的特征表现,腕横韧带矢状面掌凹屈率和正中神经压缩百分比有助于精确诊断。%Objective To explore the MRI characteristics of saddle transverse carpal ligament (TCL)of patients with idiopathic carpal tunnel syndrome (CTS). Methods The clinical diagnosis of 21 cases of idiopathic CTS patients (22 wrists) were retrospectively analyzed and as the idiopathic CTS group. Thirty two patients without CTS symptoms or TCL and volar soft tissue lesions (33 wrist

  8. Carpal osteoarthrosis.

    Science.gov (United States)

    Peterson, Brett; Szabo, Robert M

    2006-11-01

    Despite improved understanding of carpal mechanics, increased awareness of intercarpal ligament injuries, and improved techniques for treating carpal instability, post-traumatic intercarpal osteoarthrosis remains a common problem. Osteoarthritis of the carpal bones, including scapholunate advance collapse wrist, scaphotrapeziotrapezoid arthritis, lunotriquetral arthritis, triquetrohamate arthritis, and pisotriquetral arthritis, follows specific unique patterns, but in each, the final common pathway leads to degenerative change. Injury or deformity leads to instability and altered kinematics, producing abnormal joint contact pressures. Cartilage injury and eventual degeneration of the join follow. The etiology, prevalence, and current evaluation and treatment of these conditions are of importance to hand surgeons. PMID:17097471

  9. Management of tarsal tunnel syndrome: report of seven cases

    Directory of Open Access Journals (Sweden)

    Flavio A.P. Settanni

    1994-12-01

    Full Text Available Seven patients with clinical and electroneurographic evidence of tarsal tunnel syndrome were managed surgically, after failed attempts for non-surgical treatment. Post-operative results were more satisfactory than the previous responses to non-surgical therapies. Tarsal tunnel syndrome appears to respond better to surgical intervention than to conservative management.

  10. Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma

    Directory of Open Access Journals (Sweden)

    Ali Moradi

    2015-07-01

    Full Text Available Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of the fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.

  11. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... to about here, and I am going to use the crease. In this area, I am going ... bleeding from the skin edges, which we will use an electric cautery to control the bleeding. So, ...

  12. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... sitting on a hand table, and the hand has been positioned with this metallic equipment, piece of ... if you look at it very closely, it has small strands like telephone wires running on the ...

  13. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... 14, 2012 My name is Deepak Kapila, and I am an orthopaedic hand surgeon. I am also the Chairman of the Department of ... called the Lead Hand. For the procedure itself, I am going to utilize this particular crease in ...

  14. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... visible now – knife -- are called the palmar aponeurosis. These are the shiny, white fibers of the palmar ... The white structure here is the tendon, and these are the structures that go to power the ...

  15. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... and it involves making an incision in the palm of the hand and then releasing a ligament ... going to utilize this particular crease in the palm of the hand, and by making the incision ...

  16. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... and these are the structures that go to power the fingers in the front. The movement of the fingers is because of these tendons. The lining that I am removing right now is called, tenosynovium, and this is the lining ...

  17. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... important branch of this nerve, it’s called the motor branch. And this branch of the nerve supplies ... the forearm, the base of the forearm. The motor branch supplies these muscles, these are called the ...

  18. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... fingers -- the pull on the tendons by the muscles is what brings the fingers down. And so, ... And this branch of the nerve supplies these muscles of the forearm, the base of the forearm. ...

  19. Carpal Tunnel Surgery

    Medline Plus

    Full Text Available ... to spread the skin on the tissues. The fibers that are becoming visible now – knife -- are called the palmar aponeurosis. These are the shiny, white fibers of the palmar aponeurosis, and I am going ...

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

    Science.gov (United States)

    Mhanna, Christiane; Marquardt, Tamara L.; Li, Zong-Ming

    2016-01-01

    The transverse carpal ligament (TCL) plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL’s mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI) imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV). ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome. PMID:26953892

  1. Preliminary observation of the relationship between intraoperative electrophysiologic testing and surgical outcome of carpal tunnel release%腕管综合征术中神经电生理检测与手术疗效评价的初步探讨

    Institute of Scientific and Technical Information of China (English)

    陈劼; 徐雷; 徐建光; 田东; 朱艺; 韩栋; 顾玉东

    2010-01-01

    Objective To explore a reliable predicator of surgical outcomes of carpal tunnel release(CTR)by exploring the changes of pre-and intraoperative median nerve-abductor pollicis brevis compound muscle action potential(CMAP).Methods Fifteen patients with carpal tunnel syndrome were involved in the study.Electrophysiologic examination was carried out to record CMAP of abductor pollicis brevis muscle at following moments:before CTR right after brachial plexus block,immediate after CTR and tourniquet release,1minute,3 minutes,5 minutes and 7 minutes after tourniquet release.Statistics analysis was done to compare these parameters with preoperative values.Results There were statistically significant changes in both amplitude and latency of the CMAP within 5 minutes after toumiquet release(P0.05).正中神经-拇短展肌CMAP的潜伏期比术前缩短,差异有统计学意义(P<0.05),但波幅与术前相比差异有明显统计学意义(P<0.01).方论 对腕管综合征行神经松解术后,拇短展肌CMAP的波幅比其潜伏期更能体现神经松解的疗效,而在松止血带5 min后进行神经电生理检测来评价手术效果更为可靠.

  2. Carpal instability

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R.; Froehner, S.; Coblenz, G.; Christopoulos, G. [Institut fuer Diagnostische und Interventionelle Radiologie, Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany)

    2006-10-15

    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.)

  3. Volar/dorsal compressive mechanical behavior of the transverse carpal ligament.

    Science.gov (United States)

    Main, Erin K; Goetz, Jessica E; Baer, Thomas E; Klocke, Noelle F; Brown, Thomas D

    2012-04-30

    Mechanical insult to the median nerve caused by contact with the digital flexor tendons and/or carpal tunnel boundaries may contribute to the development of carpal tunnel syndrome. Since the transverse carpal ligament (TCL) comprises the volar boundary of the carpal tunnel, its mechanics in part govern the potential insult to the median nerve. Using unconfined compression testing in combination with a finite element-based optimization process, nominal stiffness measurements and first-order Ogden hyperelastic material coefficients (μ and α ) were determined to describe the volar/dorsal compressive behavior of the TCL. Five different locations on the TCL were tested, three of which were deep to the origins of the thenar and hypothenar muscles. The average (± standard deviation) low-strain and high-strain TCL stiffness values in compression sites outside the muscle attachment region were 3.6 N/mm (±2.7) and 28.0 N/mm (±20.2), respectively. The average stiffness values at compression sites with muscle attachments were notably lower, with low-strain and high-strain stiffness values of 1.2 N/mm (±0.5) and 9.7 N/mm (±4.8), respectively. The average Ogden coefficients for the muscle attachment region were 51.6 kPa (±16.5) for μ and 16.5 (±2.0) for α, while coefficients for the non-muscle attachment region were 117.8 kPa (±86.8) for μ and 17.2 (±1.6) for α. These TCL compressive mechanical properties can help inprove computational models, which can be used to provide insight into the mechanisms of median nerve injury leading to the onset of carpal tunnel syndrome symptoms. PMID:22381735

  4. ANALYSIS OF TARSAL TUNNEL SYNDROME USING IMAGE CORRELATION

    OpenAIRE

    Amarjot Singh; S.N. Omkar

    2013-01-01

    Tarsal tunnel syndrome (TTS), also known as posterior tibial neuralgia is a painful disorder of the foot. It is a medical condition arising due to the compression of the tibial nerve in the tarsal tunnel, resulting in numbness, parenthesis and muscle weakness in foot. A number of imaging methodologies such as ultrasound as well as MRI imaging has been used in the past in order to analyze the strain pattern of gastrocnemius tendon and aponeurosis from the surface of the skin without analyzing ...

  5. 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.

  6. Needle electromyography in carpal tunnel syndrome: is it valuable or predictable?

    Directory of Open Access Journals (Sweden)

    Wafaa S El-Emary

    2016-01-01

    Conclusion It can be concluded that median nerve CMAP amplitudes are the most powerful predictors of the occurrence of spontaneous EMG activity. However, EMG examination is still valuable in some CTS patients and NCS cannot completely replace needle EMG examination in these patients.

  7. Importance of the ultrasound in cubital tunnel syndrome.

    Science.gov (United States)

    Draghi, Ferdinando; Bortolotto, Chandra

    2016-03-01

    We report a case of a patient with cubital tunnel syndrome caused by presence of a non-thrombotic vein in the cubital tunnel. Cubital tunnel syndrome is a symptom complex caused by the compression of the ulnar nerve at the elbow. It is the second most common peripheral compression neuropathy. Ulnar compression at the elbow can be clinically diagnosed; however, an electroneurographic examination is necessary to confirm the diagnosis. Sonography and MRI may be required to locate nerve lesions, but primarily to evaluate the causes of compression. We decided to report this case because it shows the importance of the ultrasound in the diagnosis of the cause of compressions, including those rare and unexpected. PMID:26246343

  8. Biomechanical properties of the transverse carpal ligament under biaxial strain.

    Science.gov (United States)

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

    2012-05-01

    The transverse carpal ligament (TCL) influences carpal stability and carpal tunnel mechanics, yet little is known about its mechanical properties. We investigated the tissue properties of TCLs extracted from eight cadaver arms and divided into six tissue samples from the distal radial, distal middle, distal ulnar, proximal radial, proximal middle, and proximal ulnar regions. The 5% and 15% strains were applied biaxially to each sample at rates of 0.1, 0.25, 0.5, and 1%/s. Ligament thickness ranged from 1.22 to 2.90 mm. Samples from the middle of the TCL were thicker proximally than distally (p carpal bone attachments. These properties contribute to the understanding of carpal tunnel mechanics that is critical to understanding disorders of the wrist. PMID:22042748

  9. [The anterior tarsal tunnel syndrome: a case report].

    Science.gov (United States)

    Milants, C; Wang, F C; Gomulinski, L; Ledon, F; Petrover, D; Bonnet, R; Crielaard, J M; Kaux, J F

    2015-01-01

    The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is frequently unrecognized and may lead to misdiagnosis and delayed treatment. We report the case of a 77 year old patient complaining of symptoms of an anterior tarsal tunnel syndrome with neuropathic pain located at the dorsal part of the foot, without any sensorimotor loss. The ENMG was in favour of a motor impairment of the deep peroneal nerve. MRI exploration of the ankle showed a millimetric bony overgrowth of the upper pole of the navicular bone, irritative to the deep peroneal nerve. Infiltration at overgrowth of the navicular provided a partial and temporary decrease in pain symptoms. Surgical nerve decompression was then considered. PMID:26376569

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

    Science.gov (United States)

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-06-01

    The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiologic factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measure the TCL thickness and to test the validity and reliability of this method. Three operators conducted two sessions of ultrasound examination on eight cadaveric specimens and eight healthy volunteers. A custom script was used to calculate TCL thickness along the TCL length from the ultrasound images. The ultrasound based TCL thickness of the cadaveric specimens was compared with the dissection based TCL thickness for validation. The results showed Pearson's correlation coefficients of 0.867-0.928, intraclass correlation coefficient (ICC) values of 0.726-0.865, a standard error of measurement of 0.02-0.07 mm and a minimal detectable difference of 0.05-0.15 mm. The high correlation coefficients and small errors indicate that the ultrasound based method is valid for measuring TCL thickness. Furthermore, ultrasound measurements showed excellent intraoperator and interoperator reliability with ICC values as 0.826-0.933 and 0.840-0.882, respectively. The ultrasound based TCL thickness was in the range of 0.93-2.34 (1.54 ± 0.33) mm and agreed well with previous studies. The ultrasound method developed in this study is a valuable tool to examine morphologic properties of healthy and pathologic TCLs. PMID:22502882

  11. Avaliação clínica a longo prazo - pelo sinal de Phalen, Tinel e parestesia noturna - dos pacientes submetidos a cirurgia de liberação do túnel do carpo com instrumento de Paine® Long-term clinical evaluation - by Phalen, Tinel sign and night paresthesia - of patients submitted to carpal tunnel release surgery with Paine® retinaculatome

    Directory of Open Access Journals (Sweden)

    Sergio Eiti Carbone de Paula

    2006-01-01

    Full Text Available A liberação do retináculo dos flexores para o tratamento da síndrome do túnel do carpo (STC é uma das cirurgias mais realizadas. Existem diversos métodos para a realização deste procedimento cirúrgico, como endoscópicos, via aberta clássica e mini-incisões. A longo prazo, poucos trabalhos mostram os resultados destas cirurgias. Este estudo tem como finalidade avaliar os pacientes submetidos à liberação do túnel do carpo com instrumento de Paine®, com no mínimo 84 meses de pós-operatório. Foram avaliados os parâmetros clínicos: teste de Phalen, sinal da percussão dolorosa e a queixa de parestesia noturna no pré e pós-operatório. Os resultados mostram que há significante melhora dos sinais avaliados (p....., quando comparados com a avaliação inicial, e que estes sinais clínicos permanecem negativos ao longo do tempo.The release of flexors retinaculum for carpal tunnel syndrome (CTS treatment is one of the most frequently performed surgeries. There are many methods for performing this surgical procedure, such as endoscopic, classical open port and mini-incisions. Few papers show the long-term results of those surgeries. This study is aimed to evaluate patients submitted to carpal tunnel syndrome release using the Paine® instrument, in at least 84 months postoperatively. The following clinical parameters were assessed: Phalen test, painful percussion sign, and complaints of nighttime paresthesia pre- and postoperatively. The results show that there is a significant improvement of the signs assessed (p....., when compared to baseline evaluation, and that those clinical signs remain negative with time.

  12. Guyon's tunnel syndrome during pregnancy with concomitant anomalous arch of the ulnar nerve: a case report.

    OpenAIRE

    Nasser Janmohammadi

    2014-01-01

    Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle). Symptoms of the patient appeared during the third trime...

  13. Estudo prospectivo comparativo entre a descompressão do canal do carpo pela mini-incisão transversa proximal e a incisão palmar longitudinal convencional Prospective comparative study between the proximal transverse incision and the conventional longitudinal incision for carpal tunnel release

    Directory of Open Access Journals (Sweden)

    Marcelo de Pinho Teixeira Alves

    2010-01-01

    Full Text Available A síndrome do túnel do carpo (STC é patologia frequente em consultório de ortopedia, sendo a neuropatia compressiva mais comum e também a mais tratada por cirurgia. O diagnóstico da STC é eminentemente clínico, através da história clínica, exame físico (testes de Tinel, Phalen, Durkan e exames complementares, mais especificamente estudos de neurocondução. Eventualmente, pode-se lançar mão de exames de ultrassonografia e ressonância magnética. O tratamento conservador é reservado para pacientes em que os sintomas são leves, pouco incapacitantes e melhoram com o uso de medicações anti-inflamatórias (esteroidais ou não esteroidais, fisioterapia e modificação dos hábitos de vida. O tratamento cirúrgico é o mais frequente, empregando diversas técnicas. O objetivo da cirurgia é descomprimir o canal do carpo e liberar o nervo mediano, por secção do ligamento transverso do carpo (LTC. O objetivo deste trabalho é comparar o tratamento cirúrgico da STC por mini-incisão transversa, proximal ao canal do carpo, com a incisão clássica, longitudinal, sobre o canal do carpo. A mini-incisão mostra-se uma opção menos invasiva e igualmente eficaz para o tratamento cirúrgico da STC, com menor morbidade do que a incisão longitudinal clássica.Carpal tunnel syndrome (CTS is the most common compressive neuropathy, a pathology frequently seen in orthopedic clinics and the neuropathy most often treated surgically. The diagnosis of CTS is made clinically, through a clinial history, physical examination (Tinel, Phalen, and Durkan tests and complementary exams, and more specifically nerve conduction studies. Eventually, ultrasound scans and magnetic resonance imaging may be used. Conservative treatment is reserved for patients presenting with light symptoms, mild impairment and showing a good response to non-steroidal or steroidal anti-inflammatory drugs, physical therapy, and lifestyle changes. Surgical treatment is the most

  14. Cubital tunnel syndrome caused by hypertrophic burn scarring: Sonographic envisage

    Directory of Open Access Journals (Sweden)

    Alparslan Bayram Carli

    2015-08-01

    Full Text Available In nerve entrapment syndromes, an electrodiagnostic study during physical examination would usually suffice to assess localization of injury. However, in daily clinical practice, sometimes it may be necessary to depict the insight; in other words to use an imaging tool. From this point of view, with its manifold advantages, ultrasound (US is superior to other imaging technologies such as magnetic resonance imaging (MRI. According to a study, US increased the sensitivity of electrodiagnostic studies from 78% to 98%. By presenting a patient with cubital tunnel syndrome caused by hypertrophic scarring, we wanted to highlight the complementary role of US in nerve entrapment syndromes in confirming the entrapment, as well as the usefulness of it in the follow-up period of burn patients. [Hand Microsurg 2015; 4(2.000: 44-46

  15. Medline Plus

    Full Text Available ... Hospital, Miami, FL, 10/21/2010) Carpal Tunnel Syndrome Carpal Tunnel Surgery (Broward Health Medical Center, Fort ... Hospital, Norfolk, VA, 5/08/2008) Carpal Tunnel Syndrome Carpal Tunnel Surgery (Broward Health Medical Center, Fort ...

  16. A Review Article: Diagnosis and Treatment of Radial Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Ebrahimzadeh Mohammad Hosein

    2015-04-01

    Full Text Available  Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show u muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.

  17. Ultrasonographic Findings of the Ulnar Nerves in Cubital Tunnel Syndrome

    International Nuclear Information System (INIS)

    To determine useful diagnostic criteria of cubital tunnel syndrome (CTS), using ultrasonographic ulnar nerve cross-sectional areas (UNCSA) measurements. The CTS group included 28 patients confirmed with nerve conduction study and the control group included 17 healthy adults. Ulnar nerve cross sectional areas (UNCSA) were measured at the distal 1/3 upper arm level and in the cubital tunnel (CTN). US findings of CTS were ulnar nerve dislocation (n = 2), ulnar nerve subluxation (n = 5), ganglion (n = 1), sever elbow joint osteoarthritis (n = 1) and elbow joint valgus deformity after fracture (n = 1). UNCSA, the ratio of UNCSA in CTN to distal 1/3 upper arm level (CH ratio), and the difference of UNCSA between CTN and distal 1/3 upper arm level (CH difference) were evaluated to obtain the optimal diagnostic cutoff value of CTS, using ROC curve. The mean UNCSA in CTN was 0.168 cm2 in the CTS and 0.067 cm2 in the control. The CTS could be diagnosed when UNCSA, the CH ratio and the CH difference are larger than 0.096 cm2, 1.371 and 0.036 cm2 respectively. The ROC curve area was largest and the sensitivity, specificity was respectively 82.4%, 95.8%, when the CH difference was used as cutoff value. Ultrasound is useful for the detection of CTS pathogenic lesions in CTN. The highest diagnostic accuracy was acquired when the CH difference is larger than 0.036 cm2

  18. Ultrasonographic Findings of the Ulnar Nerves in Cubital Tunnel Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Young Hwan; Chai, Jee Won; Chung, Se Yeong; Choi, Young Ho; Cha, Joo Hee [Seoul Municipal Boramae Hospital, Seoul (Korea, Republic of)

    2010-06-15

    To determine useful diagnostic criteria of cubital tunnel syndrome (CTS), using ultrasonographic ulnar nerve cross-sectional areas (UNCSA) measurements. The CTS group included 28 patients confirmed with nerve conduction study and the control group included 17 healthy adults. Ulnar nerve cross sectional areas (UNCSA) were measured at the distal 1/3 upper arm level and in the cubital tunnel (CTN). US findings of CTS were ulnar nerve dislocation (n = 2), ulnar nerve subluxation (n = 5), ganglion (n = 1), sever elbow joint osteoarthritis (n = 1) and elbow joint valgus deformity after fracture (n = 1). UNCSA, the ratio of UNCSA in CTN to distal 1/3 upper arm level (CH ratio), and the difference of UNCSA between CTN and distal 1/3 upper arm level (CH difference) were evaluated to obtain the optimal diagnostic cutoff value of CTS, using ROC curve. The mean UNCSA in CTN was 0.168 cm2 in the CTS and 0.067 cm2 in the control. The CTS could be diagnosed when UNCSA, the CH ratio and the CH difference are larger than 0.096 cm2, 1.371 and 0.036 cm2 respectively. The ROC curve area was largest and the sensitivity, specificity was respectively 82.4%, 95.8%, when the CH difference was used as cutoff value. Ultrasound is useful for the detection of CTS pathogenic lesions in CTN. The highest diagnostic accuracy was acquired when the CH difference is larger than 0.036 cm2

  19. ANALYSIS OF TARSAL TUNNEL SYNDROME USING IMAGE CORRELATION

    Directory of Open Access Journals (Sweden)

    Amarjot Singh

    2013-11-01

    Full Text Available Tarsal tunnel syndrome (TTS, also known as posterior tibial neuralgia is a painful disorder of the foot. It is a medical condition arising due to the compression of the tibial nerve in the tarsal tunnel, resulting in numbness, parenthesis and muscle weakness in foot. A number of imaging methodologies such as ultrasound as well as MRI imaging has been used in the past in order to analyze the strain pattern of gastrocnemius tendon and aponeurosis from the surface of the skin without analyzing the internal tendons. The DIC code developed, computes the in-plane strain with a correlation function using pictures taken before and after stretching, using a CCD camera. The shift between the initial picture and subsequent one is evaluated by cross-correlation using FFT. This paper gives in detail description of the preprocessing steps necessary to extract Zone of Interest from the two images. The effects of stretching on the superficial components of the tibial nerve, the posterior tibial artery and vein, and the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons in the calf and foot are studied.

  20. Case Study of Oriental Medicine Treatment with acupotomy Therpy of the Tarsal tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Lim Na-ra

    2009-03-01

    Full Text Available Purpose : In order to estimate clinical effects of Oriental Medicine Treatment with acupotomy therapy of Tarsal tunnel Syndrome Methods : From 5th November, 2008 to 8th November, 2008, 1 male patient diagnosed as Tarsal tunnel syndrome(clinical diagnosed was treated with general oriental medicine therapy (acupuncture, moxibustion, cupping, physical therapy, herbal medication and acupotomy. Results : The patient's Rt foot paresthesia, pain were remarkably improved. Conclusions : This study demonstrates that oriental medical treatment with acuputomy therapy has notable effect in improving symptoms of tarsal tunnel syndrome. as though we had not wide experience in this treatment, more research is needed.

  1. Bilateral Tarsal Tunnel Syndrome Due To Bilateral Lipoma: A Case Report

    Directory of Open Access Journals (Sweden)

    C. Eren CANSÜ, İstemi YÜCEL, Kutay ÖZTURAN

    2010-11-01

    Full Text Available Tarsal tunnel syndrome is an entrapment neuropathy of posterior tibial nerve under the flexorretinaculum. Patients generally present with paresthesias on the plantar side of foot and fingersand in the distal kruris.The causes of tarsal tunnel syndrome are space occupying lesions within or around the tunnelwhich exert pressure to the nerve, ankle deformities, systemic illnesses, trauma or lesions ofthe nerve itself.In this study a case of tarsal tunnel syndrome due to bilateral lipoma which was treated surgicallyis presented.

  2. Lumbosacral radiculopathy, reflex sympathetic dystrophy and tarsal tunnel syndrome: an unusual presentation.

    Science.gov (United States)

    Chodoroff, B; Ball, R D

    1985-03-01

    This case documents a patient with lumbosacral radiculopathy, reflex sympathetic dystrophy, and tarsal tunnel syndrome affecting one extremity. After lumbar laminectomy for L5-S1 radiculopathy, the patient developed foot pain diagnosed as secondary to reflex sympathetic dystrophy. Because of increasing foot pain despite long-term conservative therapy, the patient underwent further evaluation, including electrodiagnostic studies leading to the diagnosis of a superimposed tarsal tunnel syndrome. Following surgical decompression, pain decreased. Because of the unusual presentation, diagnosis and treatment of the tarsal tunnel syndrome was significantly delayed. To help understand the coexistence of these conditions, interrelating pathophysiologic mechanisms have been postulated, including the possibility that a "double-crush" phenomenon may have contributed to the development of tarsal tunnel syndrome. Earlier diagnosis and definitive treatment of the foot pain may have been possible had these mechanisms been better understood. PMID:2983640

  3. Anterior Tarsal Tunnel Syndrome: Electrophysiological and Clinical Evaluation of Five Cases

    OpenAIRE

    Yaprak SEÇİL; Figen TOKUÇOĞLU; Yeşim BECKMANN; Şehnaz ARICI; Gaye ERYAŞAR

    2012-01-01

    Anterior tarsal tunnel syndrome is entrapment of deep peroneal nerve between the inferior extensor retinaculum and fascia overlying the talus and navicular bones that is an infrequent and probabaly overlooked condition. We report five cases which were referred to EMG laboratory with different diagnosis other than anterior tarsal tunnel syndrome. In our cases, ground sitting habits such as legs crossed position and practising “namaz” is thought to be etiological factors. As our opinion, hand d...

  4. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    International Nuclear Information System (INIS)

    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.

  5. 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.

  6. ′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.

  7. Chronic pain syndrome at tunnel neuropathies of peripheral nerves. integrative approaches to therapy

    Directory of Open Access Journals (Sweden)

    Yemelyanov A. Y.

    2012-06-01

    Full Text Available

    Painful chronic tunnel syndrome is almost always connected with asthenia and a various degree of anxiety and depressive syndrome. The goal of the research is to investigate prevalence and expressiveness of depressive and astheniс disorders in patients with chronic tunnel pain syndrome and to fnd accommodation of choice. 54 patients with chronic painful tunnel syndrome (35 (64,8 % male, 19 (35,2 % female, mean age 39,7+10,9 years have been examined and treated. Different acupuncture methods in complex treatment were accompanied by a positive dynamics of both subjective and objective clinical neurological and psychological symptoms. Anxiety have been revealed in 79,6 % of patients, depressive syndrome — in 57,3 % of patients, asthenia — in 85,2 % of patients. Acupuncture is tolerable, compare and have not got backside effects. Inclusion of acupuncture in complex treatment chronic tunnel pain syndrome allows to reduce a pain syndrome and asthenia, to normalize psychological condition of the patient.

  8. 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. PMID:23083195

  9. 手掌侧单孔入路微创治疗腕管综合征的解剖学研究%Anatomic study of the volar single-aperture approach of endoscopic carpal tunnel release

    Institute of Scientific and Technical Information of China (English)

    魏瑞鸿; 庄永青; 叶凤清; 姜浩力; 熊洪涛; 方锡池; 张轩

    2015-01-01

    Objective To report the palmar approach and surgical method for the view to provide anatomical data for the volar single-aperture approach of endoscopic carpal tunnel release(ECTR). Methods 16 specimens of fresh adult upper limb were used to observe and measure the anatomical structures in the carpal tunnel and palm. 6 specimens of fresh adult upper limb were used randomly to simulate the operation that divided the flexor retinaculum and released the median nerve of ECTR by one-point technique in palm. Results The best entrance point in palm of ECTR: Draw a parallel line along the thumb in the maximal abduction position to the ulnar side, and draw a axis between the middle finger and the ring finger;Mark the intersection of the lines, and then take an incision in the ulnar aspect about 1cm away from the intersection. Surgical plane was the lacunar space between the superficial fascia and palmar aponeursis. Conclusion Our study confirms that ECTR by one-point technique in palm is safe and feasible. It’s practical for surgeons to adopt the surgical approach of ECTR and avoid damage during severance offlexor retinaculum and relief of the median nerve under endoscope.%目的:报道手掌侧单孔入路微创治疗腕管综合征的解剖入路及手术方法,为手掌侧入路微创治疗腕管综合征手术提供解剖学基础。方法选取16例新鲜成人上肢标本,解剖观测腕管及手掌的相关解剖结构。选取6例新鲜成人上肢标本进行模拟手术,镜视下切开屈肌支持带并进行神经外膜松解。结果手术入路点为拇指呈最大外展位,沿掌指关节尺侧取一平行线,与中、环指间的长轴线交叉点处向尺侧1cm处,操作层面为浅筋膜层与掌腱膜间的腔隙。结论手掌侧单孔入路微创治疗腕管综合征是安全可行的,在镜视下可彻底切开屈肌支持带并进行神经外膜松解,有利于术者进行操作及减轻术中损伤。

  10. The value of MRI iniIdiopathic tarsal tunnel syndrome by measuring the cross-sectional area of tarsal tunnel

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Jung; Jeong, Yu Mi; Lee, Sheen Woo; Choi Seung; Kim, Jeong Ho; Park, Hong Gi [Gachon University, Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The purpose of this study was to evaluate the use of MRI as a diagnostic test in tarsal tunnel syndrome. There are no published reports with this aim and no diagnostic standard for idiopathic tarsal tunnel syndrome (TTS) using imaging modalities. We retrospectively searched our Picture Archiving and Communication System data and medical records to identify patients who were clinically and electomyographically diagnosed with idiopathic TTS without space-occupying lesion on MRI. Twenty five patients were included in the patient group. Another twenty-five patients who underwent ankle MRI for Achilles tendon disease were selected and included in the control group. Cross-sectional areas (CSA) of tarsal tunnel were manually measured independently by two radiologists who were blinded to clinical and surgical results, using three-dimensional reconstruction software in our hospital. Measurements were done on axial images at three levels (level 1, tibiotalar joint level; level 2, medial malleolar tip level; level 3, sustentaculum tali level). Patient and control group data were statistically analyzed by the Mann-Whitney test. The mean values of CSA at levels 1, 2, and 3 of the tarsal tunnel were 87.8 mm2, 98.2 mm2, and 105.2 mm2, respectively in the patient group; and 100.0 mm2, 113.8 mm2, and 127.9 mm2 in the control group, respectively, in reader 1; and 86.2 mm2, 97.6 mm2, 105.2 mm2, respectively in the patient group; and 99.7 mm2, 112.3 mm2, 124.4 mm2, respectively, in the control group, in reader 2. The mean CSA in the patient group was significantly less than that of the control group at all three levels (p < 0.05). Intra-class correlation coefficient value between reader 1 and reader 2 were 0.98 in group 1, and 0.97 in group 2, respectively. MRI can be helpful in the assessment of idiopathic tarsal tunnel syndrome. CSA measurements of tarsal tunnel at each level may predict TTS even though there are no space occupying lesions in the tarsal tunnel on MRI.

  11. CUBITAL TUNNEL SYNDROME: REVIEW OF 14 ANTERIOR SUBCUTANEOUS TRANSPOSITIONS OF THE VASCULARIZED ULNAR NERVE

    Directory of Open Access Journals (Sweden)

    M. Farzan

    2005-06-01

    Full Text Available Anterior transposition of the ulnar nerve is widely implemented for treatment of cubital tunnelsyndrome. However, preservation of the extrinsic blood supply of the ‎ulnar nerve may result in better clinical outcomes. Fourteen patients with cubital tunnelsyndrome, 11 ‎men and 3 women, were treated by anterior subcutaneous transposition of the ulnar nerve. The extrinsic blood supply of the ulnar nerve was ‎preserved. The average age at the time of operation was 33 years. The average follow-up period was 44 months. Post-operative outcome assessment by an independent examiner was based on the modified Bishop rating system. Nine patients had excellent or good outcomes. Five patients had a fair outcome. There ‎were no complications or recurrence of symptoms. Anterior subcutaneous ‎transposition of the vascularized ulnar nerve is an effective method of surgical ‎treatment for patients with cubital tunnel syndrome.

  12. Three-dimensional stiffness of the carpal arch.

    Science.gov (United States)

    Gabra, Joseph N; Li, Zong-Ming

    2016-01-01

    The carpal arch of the wrist is formed by irregularly shaped carpal bones interconnected by numerous ligaments, resulting in complex structural mechanics. The purpose of this study was to determine the three-dimensional stiffness characteristics of the carpal arch using displacement perturbations. It was hypothesized that the carpal arch would exhibit an anisotropic stiffness behavior with principal directions that are oblique to the conventional anatomical axes. Eight (n=8) cadavers were used in this study. For each specimen, the hamate was fixed to a custom stationary apparatus. An instrumented robot arm applied three-dimensional displacement perturbations to the ridge of trapezium and corresponding reaction forces were collected. The displacement-force data were used to determine a three-dimensional stiffness matrix using least squares fitting. Eigendecomposition of the stiffness matrix was used to identify the magnitudes and directions of the principal stiffness components. The carpal arch structure exhibited anisotropic stiffness behaviors with a maximum principal stiffness of 16.4±4.6N/mm that was significantly larger than the other principal components of 3.1±0.9 and 2.6±0.5N/mm (p<0.001). The principal direction of the maximum stiffness was pronated within the cross section of the carpal tunnel which is accounted for by the stiff transverse ligaments that tightly bind distal carpal arch. The minimal principal stiffness is attributed to the less constraining articulation between the trapezium and scaphoid. This study provides advanced characterization of the wrist׳s three-dimensional structural stiffness for improved insight into wrist biomechanics, stability, and function. PMID:26617368

  13. CUBITAL TUNNEL SYNDROME: REVIEW OF 14 ANTERIOR SUBCUTANEOUS TRANSPOSITIONS OF THE VASCULARIZED ULNAR NERVE

    OpenAIRE

    M. Farzan; S. M. J. Mortazavi S. Asadollahi

    2005-01-01

    Anterior transposition of the ulnar nerve is widely implemented for treatment of cubital tunnelsyndrome. However, preservation of the extrinsic blood supply of the ‎ulnar nerve may result in better clinical outcomes. Fourteen patients with cubital tunnelsyndrome, 11 ‎men and 3 women, were treated by anterior subcutaneous transposition of the ulnar nerve. The extrinsic blood supply of the ulnar nerve was ‎preserved. The average age at the time of operation was 33 years. The average follow-...

  14. Hand-arm vibration syndrome.

    Science.gov (United States)

    Pelmear, P L; Taylor, W

    1994-02-01

    The hand-arm vibration syndrome affects workers who perform tasks that generate vibration. Raynaud's phenomenon and sensory impairment of the fingers are the predominant effects. A history of hand-arm vibration (HAV) exposure in a patient with these symptoms should alert the physician to the diagnosis. Referral to a special clinic or hospital department for multiple clinical tests is required to confirm the diagnosis and, using the Stockholm classification, to grade the severity in each hand. The assessment permits the patient to be monitored either for progression of or recovery from the syndrome. Avoidance of further vibration exposure is recommended, together with the prescription of a slow-release calcium channel blocker to improve peripheral circulation. Hand-arm vibration syndrome should be distinguished from carpal tunnel syndrome (CTS), which may have similar symptomatology but requires different treatments. Surgery is contraindicated in the former and should be the last resort for carpal tunnel syndrome in a worker requiring good grip-strength in future employment. PMID:8185734

  15. Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Wei Huang

    2015-01-01

    Full Text Available Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28% had grade IIA neuropathy, 20 (31% had grade IIB, and 27 (42% had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%, good in 16 (25%, fair in 7 (11%, and poor in 4 (6%, with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

  16. Radial tunnel syndrome caused by ganglion cyst: treatment by arthroscopic cyst decompression.

    Science.gov (United States)

    Mileti, Joseph; Largacha, Mauricio; O'Driscoll, Shawn W

    2004-05-01

    Compressive neuropathies of the radial nerve at the elbow can lead to one of 2 clinical entities. Posterior interosseous syndrome is primarily a motor deficiency of the posterior interosseous nerve, and radial tunnel syndrome presents as pain along the radial tunnel and extensor muscle mass. The radial nerve can be compressed at a number of sites around the elbow. In addition, numerous mass lesions reported in the literature can cause compressive neuropathy of the radial nerve at the elbow. Standard surgical management for persistent radial tunnel syndrome that is refractory to nonsurgical treatment is open decompression of the radial nerve. Cysts occurring in other joints are commonly treated arthroscopically. Supraglenoid cysts of the shoulder, meniscal cysts in the knee, and dorsal wrist ganglia are routinely treated with arthroscopic decompression or excision with management of the underlying etiology of the cyst. We present a case of radial tunnel syndrome caused by a ganglion cyst of the proximal radioulnar joint that was treated using arthroscopic excision of the cyst and decompression of the radial nerve. PMID:15122155

  17. Wrist pain

    Science.gov (United States)

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  18. Carpal Ligament Anatomy and Biomechanics.

    Science.gov (United States)

    Pulos, Nicholas; Bozentka, David J

    2015-08-01

    A fundamental understanding of the ligamentous anatomy of the wrist is critical for any physician attempting to treat carpal instability. The anatomy of the wrist is complex, not only because of the number of named structures and their geometry but also because of the inconsistencies in describing these ligaments. The complex anatomy of the wrist is described through a review of the carpal ligaments and their effect on normal carpal motion. Mastery of this topic facilitates the physician's understanding of the patterns of instability that are seen clinically. PMID:26205699

  19. Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study

    OpenAIRE

    Kang, Ho Jung; Oh, Won Taek; Koh, Il Hyun; Kim, Sungmin; Choi, Yun Rak

    2016-01-01

    Purpose Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. Materials and Methods Forty-o...

  20. Carpal fractures in athletes.

    Science.gov (United States)

    Geissler, W B

    2001-01-01

    A review of the literature shows that 3% to 9% of all athletic injuries occur to the hand or wrist. Also, hand and wrist injuries are more common in pubescent and adolescent athletes than adults. Although knee and shoulder injuries are more common athletic injuries, an injury to the hand or wrist significantly can impair the athlete's ability to throw or catch a ball, or swing a bat or racquet. A college football player trains year round for just 11 or 12 hours of playing time. An athletic injury that occurs during the season can have profound consequences for the athlete's career and emotions. When defining a management plan for a particular wrist athletic injury, the time to heal the injury and the time to rehabilitate fully must be considered. The athlete must be informed fully of the length of recovery. The continued advancement of fixation methods and techniques are diminishing fracture morbidity considerably. Small-cannulated compression screws that provide rigid fixation can be inserted with decreased surgical dissection, thus preserving critical vascular supply and promoting accelerated healing and earlier rehabilitation. The arthroscope as a valuable adjunct in the management of wrist fractures was virtually unheard of years ago, but is now common. The ability to arthroscopically guide a cannulated compression screw to stabilize a scaphoid fracture without a formal open volar approach can reduce surgical morbidity significantly and allow the athlete to return to competition more quickly. Mechanisms of injury that cause osseous fractures of the wrist are fairly high energy. A high index of suspicion for associated soft tissue injuries should be kept in mind when fractures of the wrist are identified. The wrist is composed of eight carpal bones tightly interwoven with each other by intrinsic and extrinsic wrist ligaments. The management of carpal fractures depends on prompt diagnosis, stable and anatomic alignment of the involved carpal bone, protective

  1. [The terminal latency quotient in patients with compressive syndromes].

    Science.gov (United States)

    Bedenić, B; Jusić, A

    1989-01-01

    In our investigation 119 patients suffering from carpal tunnel syndrome, and 45 suffering from cubital tunnel syndrome have been analyzed. The above mentioned syndromes belong to compressive mononeuropathies and are the result of the narrowing of the anatomical channel, through which the nerve passes, causing direct or indirect pressure on the nerve and difficulties in the flow of particles and nerve impulses towards the periphery. The aim of our work was to study the influence of the compressive lesion, primarily on the distal motor and sensory latencies. To achieve a better precision, the distal motor latency is expressed as a quotient of terminal latency. It is obtained by dividing the distance between the stimulation and the recording point in centimeters with the latency of response expressed in miliseconds. Sensory latencies are obtained by orthodromic stimulation of the finger and the detection of the neural potential at the wrist. According to our results, the proximal pathological process, besides causing the localized slowing down of conduction velocity, affects the conduction velocity of the distal sensory fibers in a higher degree than of the distal motor fibers. In any case the distal motor latencies are in a higher percentage prolonged by the distal lesion, such as carpal channel syndrome, in comparison with the proximal lesion (cubital tunnel syndrome). The less pronounced prolongation of the distal latencies, especially of sensory ones, must not be proclaimed as a consequence of a local compression without additional plurisegmental analysis. PMID:2702327

  2. Tarsal Tunnel Syndrome Secondary to an Unreported Ossicle of the Talus: A Case Report.

    Science.gov (United States)

    Sweed, Tamer Ahmed; Ali, Seyed Asghar; Choudhary, Surabhi

    2016-01-01

    Tarsal tunnel syndrome (TTS) is a compression neuropathy of the posterior tibial nerve in the tarsal tunnel. In about 80% of patients, a specific cause can be identified for TTS. We present a case of TTS secondary to an ossicle in close relation to the talus that, to our knowledge, has not previously been reported. A 26-year-old male presented with left ankle and foot pain that increased with activity and playing football. He had a tingling sensation and paresthesia in the sole and medial border of the foot along the distribution of the medial and lateral plantar nerves. Clinically, he had hard swelling at the floor of the tarsal tunnel, and Tinel's sign was positive. Computed tomography showed an accessory ossicle articulating with the posteromedial aspect of the talus, separating the flexor digitorum longus and flexor hallucis longus tendons, with tenosynovitis of the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons. Surgical release of the tarsal tunnel and excision of the ossicle were performed. Postoperatively, the patient showed dramatic improvement and had no complications or recurrence of symptoms after 8 months of follow-up. More interestingly, to the best of our knowledge, this ossicle has not been previously reported to cause TTS. PMID:25441278

  3. Bilateral Second Carpal Row Duplication Associated with Multiple Epiphyseal Dysplasia.

    Science.gov (United States)

    Cladiere-Nassif, Victoire; Delaroche, Caroline; Pottier, Edwige; Feron, Jean-Marc

    2015-11-01

    We report a case of a 75-year-old woman presenting a hitherto undescribed condition of bilateral second carpal row duplication. She was diagnosed in childhood with both Marfan and Ehlers-Danlos syndromes, with no clear evidence and no further medical follow-up. She presented throughout her life with various articular symptoms, which appeared to be compatible with a diagnosis of multiple epiphyseal dysplasia, and underwent several surgical procedures on her knees and hips. Most recently, she was reporting pain at the base of the fifth metacarpal bone of the left hand. X-ray images and computed tomography (CT) were obtained for exploration and showed a total second row duplication in both carpi, with a total number of 18 carpal bones in each wrist. PMID:26649258

  4. Current diagnostics and treatment of the cubital tunnel syndrome in Austria.

    Science.gov (United States)

    Harder, Kristina; Diehm, Jens; Fassola, Isabella; Al Khaled, Nesrin; Doll, Dietrich; Dunda, Sebastian E; Krapohl, Björn Dirk

    2016-01-01

    According to the vote of the Austrian Society for Surgery of the Hand (ÖGH) an investigation to collect data on the current state of the treatment of cubital tunnel syndrome was initiated. Over one year a total of 875 patients with cubital tunnel syndrome were operated in Austria, this means an incidence of this nerve entrapment of 0.011%. Most of the operations were done by trauma surgeons (287; 33%). For diagnosis most of the centers rely on clinical symptoms, electroneurophysiology, and elbow X-ray. 40% of the institutions regard conservative therapy as useless and not indicated. If conservative treatment modalities are applied, physiotherapy (97%), non-steroidal anti-inflammatory medication (77%), and glucocorticoid injections (30%) are primarily used. In case of simple nerve entrapment most of the surgeons (72%) prefer simple nerve decompression. If there is additional pathology subcutaneous cubital nerve transposition is recommended (62%). Endoscopic techniques are only use by 3% of the surgeons. In the postoperative care, physiotherapy is favored in 51%, whereas 24% do not judge any postoperative care as beneficial. The three most often encountered complications were incomplete remission, scar contracture and hypertrophy, and postoperative bleeding. PMID:26816669

  5. Carpal conformation in relation to carpal chip fracture

    International Nuclear Information System (INIS)

    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

  6. Wrist and palm indexes in carpal tunnel syndrome Índices de palma/punho e síndrome do túnel do carpo

    Directory of Open Access Journals (Sweden)

    JOAO ARIS KOUYOUMDJIAN

    2000-09-01

    Full Text Available According to median sensory latency > or = 3.7 ms (wrist-index finger [WIF], 14 cm, median/ulnar sensory latency difference to ring finger > or = 0.5 ms (14 cm or median midpalm (8 cm latency > or = 2.3 ms (all peak-measured, 141 Brazilian symptomatic patients (238 hands have CTS confirmation. Wrist ratio (depth divided by width, WR and a new wrist/palm ratio (wrist depth divided by the distance between distal wrist crease to the third digit metacarpophalangeal crease, WPR were measured in all cases. Previous surgery/peripheral neuropathy were excluded; mean age 50.3 years; 90.8% female. Control subjects (486 hands have mean age 43.0 years; 96.7% female. The mean WR in controls was 0.694 against 0.699, 0.703, 0.707 and 0.721 in CTS groups of progressive WIF severity. The mean WPR in controls was 0.374 against 0.376, 0.382, 0.387 and 0.403 in CTS groups of WIF progressive severity. Both were statistically significant for the last two groups (WIF > 4.4 ms, moderate, and, WIF unrecordable, severe. BMI increases togetherwith CTS severity and WR. It was concluded that both WR/WPR have a progressive correlation with the severity of CTS but with statistically significance only in groups moderate and severe. In these groups both WR and BMI have progressive increase and we believe that the latter could be a risk factor as important as important WR/WPR.Um grupo de 141 pacientes (238 mãos com síndrome do túnel do carpo (STC sintomático foi estudado após confirmação por condução nervosa: latência distal sensitiva do nervo mediano (LDS-M > ou = 3,7 ms (punho -- II dedo, 14 cm, diferença de latência sensitiva mediano-ulnar > ou = 0,5 ms (punho -- IV dedo, 14 cm e/ou latência palma-punho do nervo mediano > ou = 2,3 ms (8 cm; as latências foram medidas no pico do potencial. Todos os casos tiveram as seguintes medidas calculadas: 1. Índice do punho (IP, espessura dividido pela largura do punho; 2. Índice punho-palma (IPP, espessura do punho dividido pela distância entre a prega distal do punho e a prega mais proximal do III dedo; a média de idade foi de 50,3 anos com 90,8% do gênero feminino. Foram realizadas mesmas medidas em 486 mãos do grupo controle (GC cuja idade média foi 43,0 anos e 96,7% do gênero feminino. O IP médio do GC foi de 0,694 contra 0,699/0,703/0,707/0,721 do grupo STC (valores relativos a casos incipiente/leve/moderado/grave. O IPP médio do GC foi de 0,374 contra 0,376/0,382/0,387/0,403 do grupo STC. Ambos os índices apresentaram significância estatística na comparação com STC mais grave (moderado: LDS-M > 4,4 ms e grave: LDS-M não obtida. O índice de massa corporal aumentou de acordo com a gravidade do STC e o IP. Conclui-se que tanto o IP como o IPP apresentam correlação progressiva com a gravidade do STC porém com significância estatística apenas nos grupos moderado e grave. Neste grupos tanto o IP como o índice de massa corporal tiveram aumento progressivo e acreditamos que o último possa representar risco tão importante quanto IP/IPP.

  7. Ulnar nerve stability-based surgery for cubital tunnel syndrome via a small incision: a comparison with classic anterior nerve transposition

    OpenAIRE

    Kang, Ho-Jung; Koh, Il-Hyun; Chun, Yong-Min; Oh, Won-Taek; Chung, Kwang-Ho; Choi, Yun-Rak

    2015-01-01

    Objective The purpose of this study was to compare the clinical outcomes of ulnar nerve stability-based surgery via a small incision with those of classic anterior transposition of the ulnar nerve for cubital tunnel syndrome. Methods From March 2008 to December 2013, 107 patients with cubital tunnel syndrome underwent simple decompression or anterior transposition via a small incision, according to an ulnar nerve stability-based decision based on an assessment of intraoperative ulnar nerve st...

  8. The role of the transverse carpal ligament in carpal stability: an in vitro study.

    Science.gov (United States)

    Tengrootenhuysen, Mike; van Riet, Roger; Pimontel, Paul; Bortier, Hilde; Van Glabbeek, Francis

    2009-08-01

    A biomechanical in vitro study was performed on 16 fresh frozen cadaver forearms to investigate the role of the transverse carpal ligament (TCL) in carpal stability. The distance between the scaphoid and hamate was measured, as a reference for the length of the TCL. Distances were recorded in both loaded and unloaded conditions after gradual sectioning of the transverse carpal ligament, the palmar scapholunate, long radiolunate ligament and radioscapholunate ligament. The largest increase in spread of the carpal bones (55.3% of total spread) was noted after loading with the ligament intact. Thereafter, sectioning of the TCL resulted in a further 32.9% increase in the distance between the scaphoid and the hamate. We conclude that the intact carpal bones-ligament complex displays some elasticity. Progressive sectioning of the TCL ligament under loading further opens the palmar arch. Nevertheless it appears that the carpal arch will still retain reasonable intrinsic stability even without an intact TCL. PMID:19774812

  9. Dry Endoscopic-Assisted Mini-Open Approach With Neuromonitoring for Chronic Hamstring Avulsions and Ischial Tunnel Syndrome

    Science.gov (United States)

    Gómez-Hoyos, Juan; Reddy, Manoj; Martin, Hal D.

    2015-01-01

    Chronic hamstring origin avulsions and ischial tunnel syndrome are common causes of posterior hip pain. Although physical therapy has shown benefits in some cases, recent evidence has reported better outcomes with surgical treatment in appropriately selected patients. The full-open approach has been the classic procedure to address this problem. However, the complications related to extensive tissue exposure and the proximity of the incision to the perianal zone have led to the description of full-endoscopic techniques. Achieving an accurate hamstring repair could be technically demanding with a full-endoscopic procedure. Accurate reattachment is crucial in hamstring repair because of the functional demand of the muscles crossing of 2 major joints (hip and knee). This surgical note describes a mixed technique including a mini-open approach, neuromonitoring, and dry endoscopic-assisted repair of the hamstring origin as an alternative for treating patients with chronic hamstring avulsions and ischial tunnel syndrome that remain symptomatic despite nonoperative treatment. PMID:26258031

  10. Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region

    OpenAIRE

    Mei-xiu-li Li; Qiong He; Zhong-lin Hu; Sheng-hua Chen; Yun-cheng Lv; Zheng-hai Liu; Yong Wen; Tian-hong Peng

    2015-01-01

    Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of ...

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

    International Nuclear Information System (INIS)

    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

  12. [Hand-arm vibration syndrome and upper limbs diseases in the forest workers of Italia meridionale].

    Science.gov (United States)

    Fenga, C; Rapisarda, V; Valentino, M; Cacciola, A; Deboli, R; Calvo, A; Germanò, D

    2007-01-01

    Vibration exposure of the hand-arm system is associated with an increased risk of upper-limb vascular, neurological and musculoskeletal lesions, or hand-arm vibration syndrome (HAVS). The prevalence of occupational HAVS and upper-limb disorders was studied among 278 Forestry Service workers in Sicily and Calabria. Subjects who used chain-saws (18 weeks/year) had a greater prevalence of peripheral sensory-neural disturbances (28%), upper-limb musculoskeletal disorders (33%) and carpal tunnel syndrome (19%) compared with 260 manual workers from the same Corps not exposed to hand-transmitted vibration. Raynaud's phenomenon was comparable in exposed and control subjects (5.3% vs. 4.7%.) Upper-limb neuropathies were significantly associated with energy-equivalent frequency-weighted acceleration; exposure duration; and cumulative vibration dose (m2/s4h). The variable "years of work with vibrating tools" was strongly associated with peripheral neuropathies; carpal tunnel syndrome; and upper-limb musculotendinous syndromes. Data suggest that in Sicily and Calabria, where the climate is milder than in other areas of Italy, forestry work with hand-held vibrating tools does not entail a greater prevalence of peripheral vascular disorders (Raynaud's phenomenon), while the prevalence of occupational upper-limb neurological and musculoskeletal disorders, in which combined ergonomic and mechanical risk factors have a large pathogenic role, is significantly increased. PMID:18409849

  13. Disease: H00798 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H00798 Familial carpal tunnel syndrome Carpal tunnel syndrome is an entrapment neur...opathy of the median nerve characterized by paresthesias in the district of the median nerve. Familial carpal tunnel...Epstein LG, Lou JS Familial autosomal-dominant carpal tunnel syndrome presenting in a 5-year-old-case report...tion) Stoll C, Maitrot D Autosomal dominant carpal tunnel syndrome. Clin Genet 54:345-8 (1998) PMID:19756731... (description) Senel S, Ceylaner G, Yuksel D, Erkek N, Karacan C Familial primary carpal tunnel syndrome wit

  14. Diagnostic Usefulness of Ultrasonographic Examination of Cubital Tunnel Syndrome: Analysis of Ulnar Nerve Cross-sectional Area

    International Nuclear Information System (INIS)

    To prospectively evaluate the accuracy of sonography for diagnosis of cubital tunnel syndrome (CUTS) confirmed by electrodiagnostic study. From February 2004 to March 2005, we prospectively analyzed 24 elbows in 19 patients (8 women, 11 men: mean age, 49.2 years: range 23-65 years) with cubital tunnel syndrome, including 5 bilateral cases. Diagnoses of CUTS were confirmed by both clinical symptom and electrodiagnostic study. Sonographic findings of 20 asymptomatic cases served as controls. In sonographic examination, the cross sectional area of the ulnar nerve was measured at the inlet (at the level of medial epicondyle) and outlet (at the level of convergence of flexor carpi ulnaris tendons) of the cubital tunnel. The shape and echogenicity of the ulnar nerve were also evaluated, as were possible causes of entrapment. The accuracy of using ultrasonographic cross sectional area to diagnose CUTS was evaluated with receiver operating characteristic (ROC) analysis. The cross sectional area of the ulnar nerve at the inlet and outlet levels in CUTS patients was increased much more than in the asymptomatic cases. Decreased echogenicity and distortion of normal parallel echotexture of the ulnar nerve were observed in all CUTS patients. At the inlet level, the area under the ROC curve (AUC) was 0.816, and the ideal cut-off value for CUTS diagnosis was 0.08 cm2 with a sensitivity of 58.3%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 66.7%. At the distal outlet level, the AUC was 0.785, and the cut-off value was 0.06 cm2 with a sensitivity of 79.2%, specificity of 70%, PPV of 76%, and NPV of 73.7%. When the summation value of inlet and outlet cross sectional areas was used, the AUC was 0.853, and cut-off value was 0.14 cm2 with a sensitivity of 70.8%, specificity of 85%, PPV of 85%, and NPV of 70.8%. Measurement of the cross sectional area of the ulnar nerve at the inlet and outlet of the cubital tunnel can aid in the

  15. Diagnostic Usefulness of Ultrasonographic Examination of Cubital Tunnel Syndrome: Analysis of Ulnar Nerve Cross-sectional Area

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Yu Mee; Hong, Suk Joo; Yoon, Joon Shik; Park, Cheol Min [Korea University Guro Hospital, Seoul (Korea, Republic of); Kim, Jung Hyuk [Korea University Auam Hospital, Seoul (Korea, Republic of)

    2006-06-15

    To prospectively evaluate the accuracy of sonography for diagnosis of cubital tunnel syndrome (CUTS) confirmed by electrodiagnostic study. From February 2004 to March 2005, we prospectively analyzed 24 elbows in 19 patients (8 women, 11 men: mean age, 49.2 years: range 23-65 years) with cubital tunnel syndrome, including 5 bilateral cases. Diagnoses of CUTS were confirmed by both clinical symptom and electrodiagnostic study. Sonographic findings of 20 asymptomatic cases served as controls. In sonographic examination, the cross sectional area of the ulnar nerve was measured at the inlet (at the level of medial epicondyle) and outlet (at the level of convergence of flexor carpi ulnaris tendons) of the cubital tunnel. The shape and echogenicity of the ulnar nerve were also evaluated, as were possible causes of entrapment. The accuracy of using ultrasonographic cross sectional area to diagnose CUTS was evaluated with receiver operating characteristic (ROC) analysis. The cross sectional area of the ulnar nerve at the inlet and outlet levels in CUTS patients was increased much more than in the asymptomatic cases. Decreased echogenicity and distortion of normal parallel echotexture of the ulnar nerve were observed in all CUTS patients. At the inlet level, the area under the ROC curve (AUC) was 0.816, and the ideal cut-off value for CUTS diagnosis was 0.08 cm{sup 2} with a sensitivity of 58.3%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 66.7%. At the distal outlet level, the AUC was 0.785, and the cut-off value was 0.06 cm{sup 2} with a sensitivity of 79.2%, specificity of 70%, PPV of 76%, and NPV of 73.7%. When the summation value of inlet and outlet cross sectional areas was used, the AUC was 0.853, and cut-off value was 0.14 cm{sup 2} with a sensitivity of 70.8%, specificity of 85%, PPV of 85%, and NPV of 70.8%. Measurement of the cross sectional area of the ulnar nerve at the inlet and outlet of the cubital

  16. Carpal ligamentous disruptions and negative ulnar variance

    International Nuclear Information System (INIS)

    Negative ulnar variance is a condition in which the ulna is relatively shorter than the radius at the carpus. It was found in 21% of 203 normal wrists. We have observed an increased incidence (49%) of this anomaly in patients with carpal ligamentous instabilities (dorsiflexion instability, palmar flexion instability, scapholunate dissociation with rotary luxation of the scaphoid, and lunate and perilunate dislocations). While the reasons for this association have yet to be adequately delineated, the presence of a negative ulnar variant may serve as an impartial clue to the presence of ligamentous instability. Many carpal instabilities present with subtle radiographic findings requiring careful evaluation of radiographs. Patients with negative ulnar variance and histories suggestive of ligamentous instability should undergo careful radiologic evaluation to assure early diagnosis of carpal disruption. (orig.)

  17. Effect of Elbow Position on Short-segment Nerve Conduction Study in Cubital Tunnel Syndrome

    Science.gov (United States)

    Liu, Zhu; Jia, Zhi-Rong; Wang, Ting-Ting; Shi, Xin; Liang, Wei

    2016-01-01

    Background: The appropriate elbow position of short-segment nerve conduction study (SSNCS) to diagnose cubital tunnel syndrome (CubTS) is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods: In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow full extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland–Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results: Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group's latency and compound muscle action potential (CMAP) of each segment at 70° elbow flexion by SSNCS was compared with full extension position, no statistically significant difference were found (all P > 0.05). Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated (all P elbow (P = 0.43), and the latency (P = 0.15) and the CMAP (P = 0.06) of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland–Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow (2 cm above the elbow and 2 cm below it), latency at elbow full extension and 70° flexion were strong direct associated (r = 0.83, P 0.05, respectively). Conclusions: There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS. PMID:27098786

  18. Effect of Elbow Position on Short-segment Nerve Conduction Study in Cubital Tunnel Syndrome

    Institute of Scientific and Technical Information of China (English)

    Zhu Liu; Zhi-Rong Jia; Ting-Ting Wang; Xin Shi; Wei Liang

    2016-01-01

    Background:The appropriate elbow position of short-segment nerve conduction study (SSNCS) to diagnose cubital tunnel syndrome (CubTS) is still controversial.The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS.Methods:In this cross-sectional study,the clinical data of seventy elbows from 59 CubTS patients between September,2011 and December,2014 in the Peking University First Hospital were included as CubTS group.Moreover,thirty healthy volunteers were included as the healthy group.SSNCS were conducted in all subjects at elbow lull extension and 70° elbow flexion.Paired nonparametric test,bivariate correlation,Bland-Altman,and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients.Results:Data of upper limit was calculated from healthy group,and abnormal latency was judged accordingly.CubTS group's latency and compound muscle action potential (CMAP) of each segment at 70° elbow flexion by SSNCS was compared with full extension position,no statistically significant difference were found (all P > 0.05).Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated (all P < 0.01),except the latency of segment of 4 cm to 6 cm above elbow (P =0.43),and the latency (P =0.15) and the CMAP (P =0.06) of segment of 2 cm to 4 cm below elbow.Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion.Especially in segments across the elbow (2 cm above the elbow and 2 cm below it),latency at elbow full extension and 70° flexion were strong direct associated (r =0.83,P < 0.01; r =0.55,P < 0.01),and so did the CMAP (r =0.49,P < 0.01; r =0.72,P < 0.01).There was no statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion (P > 0

  19. Understanding carpal instability: a radiographic perspective.

    Science.gov (United States)

    Kani, Kimia Khalatbari; Mulcahy, Hyojeong; Chew, Felix S

    2016-08-01

    The wrist is disposed to a variety of instability patterns owing to its complex anatomical and biomechanical properties. Various classification schemes have been proposed to describe the different patterns of carpal instability, of which the Mayo classification is the most commonly used. Understanding the concepts and pertinent terminology of this classification scheme is important for the correct interpretation of images and optimal communication with referring physicians. Standard wrist radiographs are the first line of imaging in carpal instability. Additional information may be obtained with the use of stress radiographs and other imaging modalities. PMID:27085694

  20. Dorsal wrist mass: the carpal boss

    OpenAIRE

    Boggess, Blake; Berkoff, David

    2011-01-01

    The carpal boss is an osseous overgrowth that is occasionally mistaken for a ganglion cyst. This report highlights the case a 36-year-old patient who was originally diagnosed by his primary care physician with a ganglion cyst and was sent to an orthopaedist for aspiration. Upon further evaluation with a plain radiograph, the dorsal wrist mass was found to be a carpal boss. The patient was treated with rest and a wrist brace, and was informed that a corticosteroid injection or surgical excisio...

  1. Dorsal wrist mass: the carpal boss.

    Science.gov (United States)

    Boggess, Blake; Berkoff, David

    2011-01-01

    The carpal boss is an osseous overgrowth that is occasionally mistaken for a ganglion cyst. This report highlights the case a 36-year-old patient who was originally diagnosed by his primary care physician with a ganglion cyst and was sent to an orthopaedist for aspiration. Upon further evaluation with a plain radiograph, the dorsal wrist mass was found to be a carpal boss. The patient was treated with rest and a wrist brace, and was informed that a corticosteroid injection or surgical excision would be necessary if conservative treatment failed. The patient was asymptomatic on follow-up and invasive procedures were not necessary. PMID:22707539

  2. ASCITES SYNDROME (PULMONARY HYPERTENSION SYNDROME) IN BROILER CHICKENS: ARE WE SEEING THE LIGHT AT THE END OF THE TUNNEL?

    Science.gov (United States)

    Ascites syndrome in broilers is a cascade of events that result in cardiac anomalies including an enlarged, flaccid heart, and right ventricular hypertrophy, as well as an accumulation of fluid in the abdominal cavity. Ascites was first noticed as a problem for commercial poultry producers, at farm...

  3. Carpal arthrodesis in cats. Long-term functional outcome.

    Science.gov (United States)

    Calvo, I; Farrell, M; Chase, D; Aisa, J; Rayward, R; Carmichael, S

    2009-01-01

    Pancarpal and partial carpal arthrodesis were performed in 22 carpi (20 cats) using various surgical methods. Short and long-term outcomes were assessed using a retrospective review of the case notes and via owner questionnaires. Carpal arthrodesis was associated with complications that did not affect the functional outcome, and in most cases, did not necessitate major revision surgery. Following arthrodesis, the cats did not jump as high, and showed a reduction in their willingness to jump and climb. Based on our results, carpal arthrodesis is a suitable salvage surgery to treat severe carpal injuries in the cat. PMID:19876518

  4. LOW-LEVEL LASER THERAPY AFTER CARPAL TUNNEL RELEASE

    OpenAIRE

    Alves, Marcelo de Pinho Teixeira; de Araújo, Gabriel Costa Serrão

    2015-01-01

    Objective: Evaluate the post-operative treatment of CTS, using the LLLT. Method: We prospectively evaluated 58 patients with CTS, randomly divided into two groups: treatment with LLLT (Group 1) and placebo (Group 2). A 830 nm gallium-aluminum-arsenic laser was used, with a power of 30 mW. Results: There was female predominance in both groups. The mean age of the patients in Group 1 was 44.3 years and in Group 2, 51.9 years. The average duration of disease progression was around two years in b...

  5. Factors Affecting the Outcomes of Carpal Tunnel Surgery: A Review.

    Science.gov (United States)

    Zyluk-Gadowska, P; Zyluk, A

    2016-08-01

    Ziel der vorliegenden Arbeit war es, unter Berücksichtigung der in Pubmed und Medline veröffentlichten Ergebnisse nach Eingriffen am Karpalkanal zu ermitteln, inwieweit ausgewählte Faktoren wie das Patientenalter, die Dauer der Symptome, die Ausprägung der klinischen und elektrophysiologischen Befunde, das Vorliegen von Begleiterkrankungen und medikolegale Momente die Ergebnisse beeinflussen. Letztlich konnte für keinen der zahlreichen untersuchten Faktoren ein signifikanter Einfluss auf das Langzeitergebnis nachgewiesen werden. Bestehen die Beschwerden länger, sind die klinischen und elektrophysiologischen Befunde ausgeprägter und liegen Begleiterkrankungen vor, so fallen die Ergebnisse weniger gut aus, was darauf hindeutet, dass die betroffenen Patienten etwas weniger von der Operation profitieren. Nur bei Vorliegen von medikolegalen Faktoren wie Rechtsstreit oder Schadenersatzansprüchen lässt sich definitiv ein schlechtes Ergebnis voraussagen. PMID:27580438

  6. RARE PRESENTATION OF MELORHEOSTEOSIS INVOLVING CARPAL BONES

    Directory of Open Access Journals (Sweden)

    Ramana

    2014-02-01

    Full Text Available Melorheostosis is a rare sclerosing bone dysplasia, known as Leri disease characterized by a “flowing” hyperostosis of the cortex. Classically, melorheostosis affects the long bones of the skeleton, especially those in the lower extremities . Involvement of wrist is rare. The radiographic appearance has been likened to “dripping wax down the side of a candle.” The clinical and the radiographic manifestations of melorheostosis have been encountered in a 12 - year - old male child. Examination revealed limitation of movements of right wrist. Conventional radiographs of right hand showed increase in density of scaphoid, lunate, Triquetrum and Pisiform, skeletal survey showed isolated carpal involvement, 3D CT s canning showed patchy increase of density with cortical dripping appearance of carpal bones

  7. Nutrient vessel canals. Differential diagnosis of zystoid carpal lesions on MRI?

    International Nuclear Information System (INIS)

    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.)

  8. Anterior Subcutaneous versus Submuscular Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Chun-Hua Liu

    Full Text Available To pool reliable evidences for the optimum anterior transposition technique in the treatment of cubital tunnel syndrome by comparing the clinical efficacy of subcutaneous and submuscular anterior ulnar nerve transposition.A comprehensive search was conducted in PubMed MEDLINE, Cochrane Library, EMBASE, Web of Science, OVID AMED, EBSCO and potentially relevant surgical archives. Risk of bias of each included studies was evaluated according to Cochrane Handbook for Systematic Reviews of Interventions. The risk ratio (RR and 95% confidence intervals (CI were calculated for the clinical improvement in function compared to baseline. Heterogeneity was assessed across studies, and subgroup analysis was also performed based on the study type and follow-up duration.Three studies with a total of 352 participants were identified, and the clinically relevant improvement was used as the primary outcomes. Our meta-analysis revealed that no significant difference was observed between two comparison groups in terms of postoperative clinical improvement in those studies (RR 1.04, 95% CI 0.86 to 1.25, P = 0.72. Meanwhile, subgroup analyses by study type and follow-up duration revealed the consistent results with the overall estimate. Additionally, the pre- and postoperative motor nerve conduction velocities were reported in two studies with a total of 326 patients, but we could not perform a meta-analysis because of the lack of concrete numerical value in one study. The quality of evidence for clinical improvement was 'low' or 'moderate' on the basis of GRADE approach.Based on small numbers of studies with relatively poor methodological quality, the limited evidence is insufficient to identify the optimum anterior transposition technique in the treatment of cubital tunnel syndrome. The results of the present study suggest that anterior subcutaneous and submuscular transposition might be equally effective in patients with ulnar neuropathy at the elbow. Therefore

  9. Spondylocarpotarsal synostosis syndrome (not rare but infrequently recognised syndrome)

    International Nuclear Information System (INIS)

    Spondylocarpotarsal synostosis syndrome - a rarely recognised entity - is characterised by malsegmentation of the spine and carpal/tarsal fusions. The main reason for the rarity of its diagnosis is that radiographs of the hands and feet are not routinely performed in children with scoliosis and/or kyphoscoliosis, and fusion of the carpal/tarsal bones may not be evident in preschool children. We report four patients with spondylocarpotarsal synostosis syndrome; the diagnosis in three of these was not made until radiographs of the hands were performed. The amount of scoliosis was much less evident in two of these patients (sibs) than in the others. (author)

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

    International Nuclear Information System (INIS)

    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

  11. [Treatment of pseudoarthrosis of the carpal scaphoid with fibrin glue].

    Science.gov (United States)

    Carozzi, S

    1983-08-01

    The author think that "Fibrin Seal Glue" and mechanical syntesis is an opimal method for osteosintesis of the Carpal scaphoid. He speaks about 5 patients treated with optimal results in 50 days mean. PMID:6395974

  12. Karpal tünel Sendromunda Klinik ve Elektrofizyolojik Bulgular

    OpenAIRE

    TUNALI, G.

    2009-01-01

    SUMMARY Clinical and Electrophysiological Findings In Carpal Tunel Syndrome Carpal tunnel syndrome is the most common entrapment neuropathy due to compression of the median nerve beneath the transverse carpal liga¬ment in the wrist. Clinical and electophysiological findings of 79 cases with carpal tunnel syndrome were discussed in this paper. 73 of our cases were women and 6 of them were men. CTS was bilateral in 20 and unilateral in 59. In cases of unilateral involement, 37 right an...

  13. Computer and visual display terminals (VDT) vision syndrome (CVDTS).

    Science.gov (United States)

    Parihar, J K S; Jain, Vaibhav Kumar; Chaturvedi, Piyush; Kaushik, Jaya; Jain, Gunjan; Parihar, Ashwini K S

    2016-07-01

    Computer and visual display terminals have become an essential part of modern lifestyle. The use of these devices has made our life simple in household work as well as in offices. However the prolonged use of these devices is not without any complication. Computer and visual display terminals syndrome is a constellation of symptoms ocular as well as extraocular associated with prolonged use of visual display terminals. This syndrome is gaining importance in this modern era because of the widespread use of technologies in day-to-day life. It is associated with asthenopic symptoms, visual blurring, dry eyes, musculoskeletal symptoms such as neck pain, back pain, shoulder pain, carpal tunnel syndrome, psychosocial factors, venous thromboembolism, shoulder tendonitis, and elbow epicondylitis. Proper identification of symptoms and causative factors are necessary for the accurate diagnosis and management. This article focuses on the various aspects of the computer vision display terminals syndrome described in the previous literature. Further research is needed for the better understanding of the complex pathophysiology and management. PMID:27546968

  14. Traumatic Carpal Axial Instability in a Professional Football Player: A Case Report.

    Science.gov (United States)

    Rettig, Lance; Rettig, Arthur; Cleland, Kirk

    2016-05-01

    This is a case of traumatic carpal axial instability in a professional football player. Traumatic carpal axial instability characteristically involves longitudinal separation of the ulnar or radial distal carpal row along with intermetacarpal injury. Rarely, pancarpal ligament disruption occurs, as in this case. Early diagnosis and treatment of unstable wrist injuries is important in achieving a satisfactory outcome. PMID:26502186

  15. [The pararheumatic syndrome in thyroid diseases].

    Science.gov (United States)

    Rössner, B; Schambach, H; Görlitz, N; Schäfer, W

    1977-10-01

    25 patients with hypothyroidism and 100 patients with hyperthyroidism were anamnestically, clinically, serologically and radiologically examined for the presence of a para- or pseudorheumatic symptomatology. The evaluation was carried out in comparison to the control groups of the same sex and age distribution. In nearly half the cases in hypothyroidism a symptomatology with polyarthralgias, myalgias, weakness of the muscles, acroparaesthesias, rigidity, swelling of the fingers and thickenings of the synovial membrane which are to be classified as "myxoedematous pseudorheumatism" stood in the foreground, which for the largest part were concomitant with a polyarthrosis. Furthermore a syntropy with the cervicobrachial syndrome, the humeroscapular periarthritis, calcifications of bursa and insertions of the sinews, the gout and the carpal tunnel syndrome were found. In the not infrequently prevailing pararheumatic symptomatology differential-diagnostic difficulties may develop within the total clinical picture. The patients with hyperthyroidism showed a symptomatology of the joints and tissues of the upper extremities which above all had the character of trifles. PMID:304281

  16. Global point signature for shape analysis of carpal bones

    OpenAIRE

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

    2014-01-01

    We present a method based on spectral theory for the shape analysis of carpal bones of the human wrist. We represent the cortical surface of the carpal bone in a coordinate system based on the eigensystem of the two-dimensional Helmholtz equation. We employ a metric—global point signature (GPS)—that exploits the scale and isometric invariance of eigenfunctions to quantify overall bone shape. We use a fast finite-element-method to compute the GPS metric. We capitalize upon the properties of GP...

  17. The carpal boss: a review of different sonographic findings*

    Science.gov (United States)

    Arend, Carlos Frederico

    2014-01-01

    Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss. PMID:25741059

  18. The carpal boss: a review of different sonographic findings.

    Science.gov (United States)

    Arend, Carlos Frederico

    2014-01-01

    Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss. PMID:25741059

  19. New mini-invasive decompression for pronator teres syndrome.

    Science.gov (United States)

    Zancolli, Eduardo R; Zancolli, Eduardo P; Perrotto, Christian Jorge

    2012-08-01

    The pronator teres syndrome is a set of signs and symptoms that result from compression of the median nerve in the upper forearm. It is a dynamic syndrome that is frequently associated with compression of the same nerve at the carpal tunnel. The literature describes different anatomic structures that can cause this syndrome. Experience showed us that the deep fascia of the superficial head of the pronator teres is the only anatomic structure that causes compression of the median nerve in the upper forearm. If the flexor digitorum test is negative, selective release of the deep fascia of the superficial head of the pronator teres ends the symptoms. Our surgical technique uses a mini-invasive approach that takes into account the anatomic knowledge of this region. A 3.5-cm oblique skin incision is done 6 cm distal to the medial epicondyle, over the flexor/pronator muscle mass. The medial cutaneous nerve is atraumatically retracted. The superficial fascia of the flexor/pronator muscles is opened transversely. With the section of the septum between the pronator teres and the flexor carpi radialis, access to the deep fascia of the superficial head of the pronator teres is obtained. This structure is released. The median nerve is now easily visualized, and other types of possible compression causes are excluded. The same surgeon treated 44 cases with this technique. Two assistants were always needed for this mini-invasive approach. Pronator teres symptoms disappeared in 93% of cases. PMID:22835590

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  1. [Arthroscopic distal ulna resection after post traumatic ulno carpal abutment].

    Science.gov (United States)

    Mathoulin, C; Pagnotta, A

    2006-11-01

    Ulno carpal abutments secondary to the sequels of a fracture of the radius are often due to the inversion of the distal radio ulnar index by shortening relative to the radius. This positive ulnar variance eventually leads to an abutment between the head of the ulnar and the proximal articular face of the lunate with alteration of the cartilaginous carpal surfaces. The wrist arthroscopy makes diagnosis and treatment possible in a less invasive way. The patients are operated on as outpatients under local regional anaesthetic using a pneumatic tourniquet. The arthroscope is positioned using the 3-4 radio carpal opening permitting exploration of the joint. The surgical treatment is performed by arthroscopy using a burr and going in through the 6R radio carpal opening. In this way we use the technique of partial resection of the distal ulna. We have a series of 62 patients who have benefited from the technique of partial resection of the ulnar head by arthroscopy. There were 30 men and 32 women. The average age was 66 years old (between 45 and 82). Our average follow-up is 32 months (between 12 and 60 months). Recovery of mobility was immediate in all cases with persistent pain in the radio ulnar joint in 8 cases. Arthroscopic treatment of ulno carpal abutment has proved itself effective and innocuous. It should nevertheless be reserved for operations on small sized inversions of the distal radio ulnar index (less than 5 mm). In the event of larger ulnar variances we prefer ulnar shortening osteotomy. The other techniques will be restricted to cases where the distal radio ulnar joint has been impaired. PMID:17361890

  2. 创伤性腕部轴向骨折与脱位的治疗%Treatment of traumatic axial carpal fracture and dislocation

    Institute of Scientific and Technical Information of China (English)

    刘峰; 李占雨; 刘浩宇; 魏壮

    2015-01-01

    cases of open injury underwent debridement, open reduction, internal fixation, one-stage repair of ligaments and nerves, 2 of whom needed an abdominal pedicle flap to resurface their defective skin;the other 2 cases of severe open injury had to receive secondary amputation due to complications after debridement, open reduction, internal fixation, one-stage repair of ligaments and nerves.Results Postoperative follow-ups ranged from 7 to 113 months (average, 77 months).According to the criteria proposed by the Hand Surgery Society of the Chinese Medical Association, functional recovery of the hand was rated as excellent in one case, good in 2 cases, moderate in one and poor in 3 cases.Conclusions Severity of soft tissue injury is much greater than that of bone and joint injury in traumatic axial carpal fracture and dislocation, a special type of wrist injury.Prevention of Osteofascial Compartment Syndrome and Carpal Tunnel Syndrome should be our first concern in the treatment of closed axial injury while our first attention should be paid to soft tissue injury in the treatment of open axial injury.

  3. Orthopedic Health: Healthy Joints for a Lifetime / Keep Your Moving Parts Moving

    Science.gov (United States)

    ... Common problems: Arthritis (osteoarthritis, rheumatoid arthritis), bursitis, osteoporosis, fracture, tendinitis, sprains, carpal tunnel syndrome. Knee Common problems: Osteoarthritis, sprains and strains, rheumatoid arthritis, ...

  4. The study of work behaviours and risks for occupational overuse syndrome.

    Science.gov (United States)

    Laoopugsin, Niyom; Laoopugsin, Suwannee

    2012-01-01

    "Occupational overuse syndrome" is defined as the syndrome of work-related musculoskeletal disorders resulting from repetitive hand posture and motion. We looked at 867 employees in seven different factories to determine the groups suffering from trigger fingers, de Quervain's disease and carpal tunnel syndrome (CTS) from the period of January 2009 to November 2010. The inclusion and exclusion criteria were designated for the subjects in each group. We found the highest prevalence of the syndrome in the rate of CTS development. The differences in the hand spans and the grip strengths between the normal versus the diseased groups were statistically significant. The most common work patterns were a repetitive workload with the hand in a posture of a contracted grasping position. This accounted for 43.1% of the cases of trigger fingers, 38.1% in cases of CTS and this position with a contributing increased speed in the work pattern at 29.8% in the de Quervain's disease patients. PMID:22745084

  5. Epilepsy in Muenke Syndrome: FGFR3-Related Craniosynostosis

    OpenAIRE

    Agochukwu, Nneamaka B.; Solomon, Benjamin D.; Gropman, Andrea L.; Muenke, Maximilian

    2012-01-01

    Epilepsy, a neurologic disorder characterized by the predisposition to recurrent unprovoked seizures, is reported in more than 300 genetic syndromes. Muenke syndrome is an autosomal-dominant craniosynostosis syndrome characterized by unilateral or bilateral coronal craniosynostosis, hearing loss, intellectual disability, and relatively subtle limb findings such as carpal bone fusion and tarsal bone fusion. Muenke syndrome is caused by a single defining point mutation in the fibroblast growth ...

  6. A Study of Ossification of Carpal and Tarsal Bones in Normal and Hypothyroid Foals

    OpenAIRE

    McLaughlin, B. G.; Doige, C E

    1982-01-01

    The degree of ossification of carpal and tarsal bones was determined in normal foals of various ages and in hypothyroid and thyroidectomized foals. In normal foals ossification occurred very rapidly in the last few weeks of gestation and less rapidly from birth to 33 days. The ulnar carpal bone was consistently less ossified than other carpal or tarsal bones. Foals with congenital hyperplastic goitre had retarded ossification of the cuboidal bones, especially the central and third tarsal bone...

  7. The carpal boss: a review of different sonographic findings

    Directory of Open Access Journals (Sweden)

    Carlos Frederico Arend

    2014-04-01

    Full Text Available Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss.

  8. EVALUASI MODEL PENYULUHAN DALAM PENINGKATAN PENGETAHUAN, SIKAP DAN PRAKTEK MENGENAI SINDROM TEROWONGAN KARPAL PADA PEKERJA BEBERAPA PERUSAHAAN GARMEN DI JAKARTA, TAHUN 2004

    OpenAIRE

    Lusianawaty Tana; Delima Delima; Woro Riyadina

    2012-01-01

    Carpal tunnel syndrome (CTS) is a disorder caused of medianus nerve entrapment in carpal tunnel in the wrist and give many symptoms as pain, numbness, and hyperesthesia at nerve medianus area. CTS is related to repetitive biomechanical movement in hand at work. The scope of this study was development of an educational model to prevent carpal tunnel syndrome among workers at several garment factories in Jakarta. The objectives were to identify effects and the best model of 4 intervention model...

  9. Luxation of the radial carpal bone in a cat

    International Nuclear Information System (INIS)

    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

  10. Prevalence and distribution of the first and fifth carpal bones in Standardbred horses as determined by radiography

    International Nuclear Information System (INIS)

    In a radiographic study of 200 Standardbred horses, a first carpal bone was observed unilaterally in 21 (10.5%) horses and bilaterally in 45 (22.5%) horses. There was no significant effect of sex on the absence or presence of the first carpal bone. No fifth carpal bone was seen in this study

  11. Guidelines for diagnosis and treatment of Hunter Syndrome for clinicians in Latin America

    Directory of Open Access Journals (Sweden)

    Roberto Giugliani

    2014-06-01

    Full Text Available This review aims to provide clinicians in Latin America with the most current information on the clinical aspects, diagnosis, and management of Hunter syndrome, a serious and progressive disease for which specific treatment is available. Hunter syndrome is a genetic disorder where iduronate-2-sulfatase (I2S, an enzyme that degrades glycosaminoglycans, is absent or deficient. Clinical manifestations vary widely in severity and involve multiple organs and tissues. An attenuated and a severe phenotype are recognized depending on the degree of cognitive impairment. Early diagnosis is vital for disease management. Clinical signs common to children with Hunter syndrome include inguinal hernia, frequent ear and respiratory infections, facial dysmorphisms, macrocephaly, bone dysplasia, short stature, sleep apnea, and behavior problems. Diagnosis is based on screening urinary glycosaminoglycans and confirmation by measuring I2S activity and analyzing I2S gene mutations. Idursulfase (recombinant I2S (Elaprase®, Shire enzyme replacement therapy (ERT, designed to address the underlying enzyme deficiency, is approved treatment and improves walking capacity and respiratory function, and reduces spleen and liver size and urinary glycosaminoglycan levels. Additional measures, responding to the multi-organ manifestations, such as abdominal/inguinal hernia repair, carpal tunnel surgery, and cardiac valve replacement, should also be considered. Investigational treatment options such as intrathecal ERT are active areas of research, and bone marrow transplantation is in clinical practice. Communication among care providers, social workers, patients and families is essential to inform and guide their decisions, establish realistic expectations, and assess patients' responses.

  12. Guidelines for diagnosis and treatment of Hunter Syndrome for clinicians in Latin America.

    Science.gov (United States)

    Giugliani, Roberto; Villarreal, Martha Luz Solano; Valdez, C Araceli Arellano; Hawilou, Antonieta Mahfoud; Guelbert, Norberto; Garzón, Luz Norela Correa; Martins, Ana Maria; Acosta, Angelina; Cabello, Juan Francisco; Lemes, Aída; Santos, Mara Lucia Schmitz Ferreira; Amartino, Hernán

    2014-06-01

    This review aims to provide clinicians in Latin America with the most current information on the clinical aspects, diagnosis, and management of Hunter syndrome, a serious and progressive disease for which specific treatment is available. Hunter syndrome is a genetic disorder where iduronate-2-sulfatase (I2S), an enzyme that degrades glycosaminoglycans, is absent or deficient. Clinical manifestations vary widely in severity and involve multiple organs and tissues. An attenuated and a severe phenotype are recognized depending on the degree of cognitive impairment. Early diagnosis is vital for disease management. Clinical signs common to children with Hunter syndrome include inguinal hernia, frequent ear and respiratory infections, facial dysmorphisms, macrocephaly, bone dysplasia, short stature, sleep apnea, and behavior problems. Diagnosis is based on screening urinary glycosaminoglycans and confirmation by measuring I2S activity and analyzing I2S gene mutations. Idursulfase (recombinant I2S) (Elaprase(®), Shire) enzyme replacement therapy (ERT), designed to address the underlying enzyme deficiency, is approved treatment and improves walking capacity and respiratory function, and reduces spleen and liver size and urinary glycosaminoglycan levels. Additional measures, responding to the multi-organ manifestations, such as abdominal/inguinal hernia repair, carpal tunnel surgery, and cardiac valve replacement, should also be considered. Investigational treatment options such as intrathecal ERT are active areas of research, and bone marrow transplantation is in clinical practice. Communication among care providers, social workers, patients and families is essential to inform and guide their decisions, establish realistic expectations, and assess patients' responses. PMID:25071396

  13. 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...

  14. 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...

  15. 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...

  16. Condroblastoma de escafoides carpiano Chondroblastoma of the carpal scaphoids

    Directory of Open Access Journals (Sweden)

    F.J. Repáraz

    2008-12-01

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

  17. Radiographic imaging and possible causes of a carpal varus deformity in an Asian elephant (Elephas maximus).

    Science.gov (United States)

    Kaulfers, Carola; Geburek, Florian; Feige, Karsten; Knieriem, Andreas

    2010-12-01

    The carpal region of an Asian elephant (Elephas maximus) with a clinically obvious varus deformity of the carpus was examined radiographically with a standard portable x-ray unit. Several dorsopalmar radiographs were taken at a short source-to-image distance, moving the beam center along the carpus. To obtain a single image of the carpal region, radiographs were assembled digitally using a composite technique. Radiographs revealed a deviation of the limb's axis of approximately 25 degrees in the region of distal physis of the radius and ulna and a wedge-shaped epiphysis of the ulna. Healed physitis due to trauma and subluxation of the middle carpal joint are discussed as possible causes of the deformity. The radiographic technique described proved to be helpful to evaluate a relatively large anatomic area in the carpal region of an adult Asian elephant with a varus deformity and may be an alternative tool to previously described single image radiography. PMID:21370652

  18. 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

  19. Distal Row Carpectomy—A Possible Salvage Procedure of Severe Carpal Trauma

    OpenAIRE

    Brodbeck, Rebekka; Horch, Raymund E.; Arkudas, Andreas

    2015-01-01

    Summary: Complex fracture dislocations of the wrist often result in posttraumatic arthrosis. In trying to avoid total arthrodesis, alternative treatment strategies have been investigated. For this purpose, we present the case of a 56-year-old male patient who sustained a direct trauma during a circular saw accident, resulting in the destruction of the distal carpal row among other things. However, the proximal carpal row was found completely intact. We indicated an emergency distal row carpec...

  20. Distal Row Carpectomy—A Possible Salvage Procedure of Severe Carpal Trauma

    OpenAIRE

    Brodbeck, Rebekka; Horch, Raymund E.; Arkudas, Andreas

    2015-01-01

    Complex fracture dislocations of the wrist often result in posttraumatic arthrosis. In trying to avoid total arthrodesis, alternative treatment strategies have been investigated. For this purpose, we present the case of a 56-year-old male patient who sustained a direct trauma during a circular saw accident, resulting in the destruction of the distal carpal row among other things. However, the proximal carpal row was found completely intact. We indicated an emergency distal row carpectomy. Eig...

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

    OpenAIRE

    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 suc...

  2. Three-dimensional computed tomography of the carpal ligaments.

    Science.gov (United States)

    Nanno, Mitsuhiko; Viegas, Steven F

    2009-03-01

    This article details a current perspective and accurate anatomical three-dimensional descriptions of the ligaments of the wrist. The carpometacarpal ligaments, the intercarpal ligaments, and the radiocarpal ligaments are described and illustrated using a unique combination of detailed dissection, computed tomography, and a three-dimensional digitization technique. Detailed information is also provided about the ligamentous attachments of the carpometacarpal joints, the carpal bones, and the distal radius. This study improves knowledge and understanding of the normal anatomy and mechanics of the radiocarpal and intercarpal ligaments and the carpometacarpal joints, and it should help in the assessment of radiographic images and treatment of various injuries and degenerative changes seen in the wrist. The knowledge of the ligaments will further serve as a foundation for understanding the anatomy of the ligaments, the biomechanics of the wrist, and the function of the individual ligaments and their roles in joint motion and stability. PMID:19235667

  3. Three-dimensional imaging of the carpal ligaments.

    Science.gov (United States)

    Nanno, Mitsuhiko; Patterson, Rita M; Viegas, Steven F

    2006-11-01

    This article provides a new perspective and detailed anatomic description of the attachments of the carpometacarpal (CMC) ligaments, intercarpal ligaments, and radiocarpal ligaments, which are described and illustrated using a unique combination of detailed dissection, CT imaging, and three-dimensional digitization. Detailed information is also provided about the ligamentous attachments of the CMC joints, carpal bones, and distal radius. This information advances the current knowledge and understanding of the normal anatomy and its impact on the mechanics of the radiocarpal intercarpal ligaments and the CMC joints, and should help surgeons to assess and treat injuries and degenerative changes seen in the wrist and CMC joints. Furthermore, this additional knowledge of the ligaments will help to further understand wrist kinematics and, more precisely, the function of the individual ligaments and their roles in joint motion and stability and injuries. PMID:17097462

  4. INTRAVENOUS MIDAZOLAM - ROLE IN THE TREATMENT OF HYPERVENTILATION SYNDROME

    OpenAIRE

    Jyoti V.; Anil S; Kanchan

    2013-01-01

    ABSTRACT: BACKGROUND: Hyperventilation syndrome (HVS) also known as irrit able Heart, Da Costas syndrome or soldier’s heart is induced by stress. It comprises various symptoms like hyperventilation, breathlessness, Light-headedness, dizziness carpal-pedal spasm, tachycardia and numbness or paraesthesia and unconsciousness1. MATERIAL AND METHOD: Twenty seven years man, driver by occupation was posted for surgical extraction of impacted lower right third m...

  5. Semisimple tunnels

    CERN Document Server

    Cho, Sangbum

    2010-01-01

    A knot in the 3-sphere in (1,1)-position (that is, in 1-bridge position with respect to a Heegaard torus) can be described by an element of the braid group of two points in the torus. Our main results tell how to translate between a braid group element and the sequence of slope invariants of the upper tunnel (or lower tunnel) associated to the corresponding (1,1)-position. This enables us to calculate the slope invariants of the four tunnels of the (-2,3,7)-pretzel knot, and to verify previous calculations of the slope invariants for all tunnels of 2-bridge knots and (1,1)-tunnels of torus knots. We also characterize a class of (1,1)-positions that we call toroidal, in terms of the slope invariants of the associated upper tunnel. Finally, we develop a general algorithm to calculate the slope invariants of the associated tunnels, given a braid description. We have implemented the algorithm and other results as software, and we give some sample computations.

  6. Talocalcaneal Coalition in Muenke Syndrome: Report of a patient, review of the literature in FGFR-related craniosynostoses, and consideration of mechanism

    OpenAIRE

    Agochukwu, Nneamaka B.; Solomon, Benjamin D.; Benson, Laurel J.; Muenke, Maximilian

    2013-01-01

    Muenke syndrome is an autosomal dominant craniosynostosis syndrome resulting from a defining point mutation in the FGFR3 gene. Muenke syndrome is characterized by coronal craniosynostosis (bilateral more often than unilateral), hearing loss, developmental delay and carpal and/or tarsal bone coalition. Tarsal coalition is a distinct feature of Muenke syndrome and has been reported since the initial description of the disorder in the 1990s. Although talocalcaneal coalition is the most common ta...

  7. [A woman with acute pain and swelling of her wrist

    NARCIS (Netherlands)

    Ridder, J.A. de; Koning, G.G.

    2015-01-01

    After hyperextension of both her wrists, a 39-year-old woman, who used coumarin derivatives for a known antiphospholipid syndrome, had acute pain and swelling of the left wrist. She had symptoms of an acute carpal tunnel syndrome. MRI revealed a hematoma compressing the median nerve in the carpal tu

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

    Science.gov (United States)

    Zilch, H

    1985-01-01

    There is given a survey of recent findings of the biomechanics of the carpal bones of which the complex of the os scaphoideum, lunatum and capitatum has the key role. The mechanism of injury and posttraumatic instability of the wrist are presented. Rare injuries like subluxation of the os scaphoideum with DISI instability, "scapho-capitate fracture" syndrome, and perilunar dislocation associated with scaphoid fracture (de Quervain) with a proximal fragment of the scaphoid which is turned over about 180 and 90 degrees, are reported in form of clinical cases. In case of subluxation of the os scaphoideum the operation described by Dobyns is recommended, using a split of ECRB tendon for dorsal ligament reconstruction. PMID:3984469

  9. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  11. The value of SPECT/CT in carpal boss

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

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

  12. Applied anatomy of endoscopic decompression and anterior transposition for cubital tunnel syndrome in cadavers%内窥镜辅助下肘管减压尺神经前置术的应用解剖

    Institute of Scientific and Technical Information of China (English)

    丁健; 高伟阳; 郑鑫

    2013-01-01

    目的 在尸体上模拟内窥镜辅助下肘管减压及尺神经前置术,探讨该术式的注意事项.方法 在8具上肢标本上模拟内窥镜辅助下肘管减压及尺神经前置术,再对尸体进行解剖,观察尺神经松解、前置效果及有无前臂内侧皮神经损伤.结果 8侧标本均顺利去除肘部尺神经卡压的因素,前置尺神经充分,固定牢靠,未形成继发卡压.在肘管减压及尺神经松解过程中前臂内侧皮神经后支均未损伤.皮下筋膜与屈肌旋前圆肌肌膜缝合固定法缝扎前臂内侧皮神经后支2例,筋膜瓣法固定未对前臂内侧皮神经造成损伤.结论 在内窥镜辅助下能切除肘部尺神经卡压的常见因素,前置尺神经充分,并能有效降低前臂内侧皮神经后支的损伤,但需注意皮下筋膜与屈肌旋前圆肌肌膜缝合固定法易缝扎前臂内侧皮神经后支,而筋膜瓣法固定相对安全.%Objective To simulate endoscopic decompression and anterior transposition of the ulnar nerve for treatment of cubital tunnel syndrome in cadavers and explore the technical details of this approach.Methods Simulation of endoscopic decompression of the cubital tunnel and anterior transposition of the ulnar nerve was carried out in 8 upper limb cadaver specimens.The cubital tunnel was then opened to explore the effectiveness of decompression and transposition and any signs of medial antebrachial cutaneous nerve (MACN) damage.Results Nerve decompression was sufficient with all the constrictions released.The ulnar nerve was properly anterior transposed and secured.There was no sign of secondary compression to the ulnar nerve.There was no MACN injury during cubital tunnel release and ulnar nerve decompression.MACN posterior branch was caught in 2 specimens when the superficial fascia and pronator teres sarcolemma were sutured together to make transposition tunnel.Creating a fascia tunnel did not cause MACN injury.Conclusion Endoscopic release can

  13. Computer users at risk: Health disorders associated with prolonged computer use

    OpenAIRE

    Abida Ellahi; M. Shahid Khalil; Fouzia Akram

    2011-01-01

    By keeping in view the ISO standards which emphasize the assessment of use of a product, this research aims to assess the prolonged use of computers and their effects on human health. The objective of this study was to investigate the association between extent of computer use (per day) and carpal tunnel syndrome, computer stress syndrome, computer vision syndrome and musculoskeletal problems. The second objective was to investigate the extent of simultaneous occurrence of carpal tunnel syndr...

  14. Classical Tunneling

    CERN Document Server

    Cohn, A G; Rabinowitz, Mario

    2003-01-01

    A classical representation of an extended body over barriers of height greater than the energy of the incident body is shown to have many features in common with quantum tunneling as the center-of-mass literally goes through the barrier. It is even classically possible to penetrate any finite barrier with a body of arbitrarily low energy if the body is sufficiently long. A distribution of body lengths around the de Broglie wavelength leads to reasonable agreement with the quantum transmission coefficient.

  15. Classical Tunneling

    OpenAIRE

    Cohn, Arthur; Rabinowitz, Mario

    2003-01-01

    A classical representation of an extended body over barriers of height greater than the energy of the incident body is shown to have many features in common with quantum tunneling as the center-of-mass literally goes through the barrier. It is even classically possible to penetrate any finite barrier with a body of arbitrarily low energy if the body is sufficiently long. A distribution of body lengths around the de Broglie wavelength leads to reasonable agreement with the quantum transmission...

  16. Soliton tunneling

    OpenAIRE

    Kälbermann, G.

    1997-01-01

    We present a numerical simulation of the scattering of a topological soliton off finite size attractive impurities, repulsive impurities and a combination of both. The attractive and attractive-repulsive cases show similar features to those found for $\\delta$ function type of impurities. For the repulsive case, corresponding to a finite width barrier, the soliton behaves completely classically. No tunneling occurs for sub-barrier kinetic energies despite the extended nature of the soliton.

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

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

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

    2010-04-01

    The functional morphology of the wrist pertains to a number of important questions in primate evolutionary biology, including that of hominins. Reconstructing locomotor and manipulative capabilities of the wrist in extinct species requires a detailed understanding of wrist biomechanics in extant primates and the relationship between carpal form and function. The kinematics of carpal movement, and the role individual joints play in providing mobility and stability of the wrist, is central to such efforts. However, there have been few detailed biomechanical studies of the nonhuman primate wrist. This is largely because of the complexity of wrist morphology and the considerable technical challenges involved in tracking the movements of the many small bones that compose the carpus. The purpose of this article is to introduce and outline a method adapted from human clinical studies of three-dimensional (3D) carpal kinematics for use in a comparative context. The method employs computed tomography of primate cadaver forelimbs in increments throughout the wrist's range of motion, coupled with markerless registration of 3D polygon models based on inertial properties of each bone. The 3D kinematic principles involved in extracting motion axis parameters that describe bone movement are reviewed. In addition, a set of anatomically based coordinate systems embedded in the radius, capitate, hamate, lunate, and scaphoid is presented for the benefit of other primate functional morphologists interested in studying carpal kinematics. Finally, a brief demonstration of how the application of these methods can elucidate the mechanics of the wrist in primates illustrates the closer-packing of carpals in chimpanzees than in orangutans, which may help to stabilize the midcarpus and produce a more rigid wrist beneficial for efficient hand posturing during knuckle-walking locomotion. PMID:20235325

  19. Tunneling technologies for the collider ring tunnels

    International Nuclear Information System (INIS)

    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

  20. Sclerosis of the third carpal bone: a prospective study of its significance in a group of young standardbred trotters

    International Nuclear Information System (INIS)

    To assess the significance of radiographic signs of sclerosis of the third carpal bone (C3) in young Standardbred trotters in relation to performance, lameness and bone turnover both carpi in 14 Standardbred trotters were radiographically and scintigraphically examined 6 times, from the beginning of speed training until the beginning of racing, between the mean ages of 20 and 42 months. At the end of the study 8 horses had raced in official qualifying races and 14 limbs in 11 horses had been diagnosed with carpal lameness. All horses but 2 developed sclerosis and all but one had increased bone turnover in the C3 area by scintigraphy. C3 sclerosis increased continuously over time and with increased performance. Carpal lameness was significantly associated with progression of sclerosis but in most cases sclerosis developed without concomitant signs of carpal lameness. No association between carpal lameness and increased scintigraphic uptake was found, but horses that had qualified for racing had significantly higher C3 to carpus ratio of radiopharmaceutical uptake. We conclude that there is a continuous increase in C3 radiographic sclerosis with time in young Standardbred trotters in professional training, but radiographic sclerosis appears to be of limited value as an indicator of clinical carpal disease or level of performance in Standardbred trotters

  1. Clinical observation on peripheral neurodynamic technique combined with compound vitamin B1, B2, B12 in treatment of carpal tunnel syndrome%周围神经松解术联合复方三维B治疗腕管综合征的临床观察

    Institute of Scientific and Technical Information of China (English)

    齐丹; 戴艳萍; 陈晓光; 田春光; 靳美; 张春媛

    2014-01-01

    目的 观察周围神经松解术联合营养神经药物复方三维B对腕管综合征的临床疗效.方法 收集本门诊60例腕管综合征患者,经知情同意后随机分为2组,治疗组采用周围神经松解术联合复方三维B,对照组单纯使用复方三维B药物治疗.使用视觉模拟评分法(VAS)和整体症状分数表(GSS)分别于治疗后1个月和6个月对患者进行评价.结果 治疗组在VAS及症状积分等指标方面均优于单纯药物对照组.另外,治疗后6个月的随访表明,2组与发病前比较差异有统计学意义,且治疗组优于对照组.结论 周围神经松解术联合药物复方三维B对腕管综合征治疗效果肯定,临床疗效明显优于单纯药物组,远期疗效好,值得推广与进一步研究.

  2. The Advantage of Throwing the First Stone: How Understanding the Evolutionary Demands of Homo sapiens Is Helping Us Understand Carpal Motion

    OpenAIRE

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

    2010-01-01

    Unlike any other diarthrodial joint in the human body, the “wrist joint” is composed of numerous articulations between eight carpal bones, the distal radius, the distal ulna, and five metacarpal bones. The carpal bones articulate with each other as well as with the distal radius, distal ulna, and the metacarpal bases. Multiple theories explaining intercarpal motion have been proposed; however, controversy exists concerning the degree and direction of motion of the individual carpal bones with...

  3. Ways to Prevent Percussion Overuse Injuries

    Science.gov (United States)

    Fidyk, Steve

    2009-01-01

    It is a proven fact that the repetitive nature of percussion playing can cause carpal tunnel syndrome, bursitis, and tendinitis. This paper offers ways to prevent percussion overuse injuries, particularly by developing a healthy warmup routine.

  4. Tratamento da síndrome do túnel ulnar pela técnica da epicondilectomia parcial medial do cotovelo Treatment of cubital tunnel syndrome using the technique of medial partial epicondylectomy of the elbow

    Directory of Open Access Journals (Sweden)

    Marcio Eduardo de Melo Viveiros

    2008-12-01

    Full Text Available OBJETIVO: Analisamos retrospectivamente os resultados de 21 casos de síndrome cubital tratados cirurgicamente com a técnica da epicondilectomia parcial medial. MÉTODOS: No período de fevereiro de 2001 a outubro de 2006, 21 pacientes com síndrome do canal cubital foram tratados pela técnica da epicondilectomia parcial medial do cotovelo associada à neurólise do nervo ulnar. Destes, 12 (57,1% eram do sexo masculino. O lado direito foi o acometido em 15 (71,4% pacientes. A média da idade dos pacientes foi de 51,6 anos. Pela graduação de McGowan, seis (28,6% pacientes encontravam-se no grau I, 11 (52,3%, no grau II e quatro (19,1%, no grau III do período pré-operatório. RESULTADOS: O tempo médio de acompanhamento pós-operatório foi de 25,7 meses. No pós-operatório, os pacientes foram avaliados conforme a escala de pontos de Bishop, sendo que nove (42,8% apresentavam resultados excelentes, sete (33,3%, bons, três (14,2%, regulares e dois (9,5%, ruins. Nesta série, não se encontraram como complicações a instabilidade em valgo residual, a lesão permanente do nervo ulnar, a recidiva da compressão ou a subluxação do nervo ulnar. As complicações encontradas foram perda do arco de movimento em um (4,7% caso, infecção superficial em um (4,7% e um (4,7% com dor residual. CONCLUSÃO: Os resultados apresentados permitem concluir que a epicondilectomia parcial medial do cotovelo associada à neurólise do nervo ulnar é eficiente e segura para o tratamento da síndrome do canal cubital.OBJECTIVE: The authors made a retrospective analysis of the results of 21 cases of cubital syndrome that were surgically treated with the partial medial epicondylectomy. METHODS: From February 2001 to October 2006, 21 patients with cubital tunnel syndrome were treated with the technique of elbow partial medial epicondylectomy associated to neurolysis of the ulnar nerve. Of these patients, 12 (57.1% were male. The right side was involved in 15 (71

  5. Application of multiple magnification roentgenography for the control of reparative process in carpal bones

    International Nuclear Information System (INIS)

    Consideration is given to the first experience in using direct magnification roentgenography for diagnosis of navicular bone fracture and for evaluation of dynamics of reparative processes in carpal bones. Roentgenograms were made by portable X-ray apparatus REIS-D with 9-fold direct magnification. The use of the given type of roentgenography demonstrated its ample scope for both diagnosis of navicular bone fractures and for evaluation of the process of their adhesion

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

    OpenAIRE

    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 includin...

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

    International Nuclear Information System (INIS)

    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

  8. Musculoskeletal lesions and lameness in 121 horses with carpal sheath effusion (1999-2010).

    Science.gov (United States)

    Jorgensen, Joan S; Genovese, Ronald L; Döpfer, Dörte; Stewart, Matthew C

    2015-01-01

    Equine carpal sheath effusion has multiple etiologies. The purpose of this retrospective study was to describe the prevalence of distinct musculoskeletal lesions lameness in a sample of horses with a clinical diagnosis of carpal sheath effusion. A total of 121 horses met inclusion criteria. Seventy-four percent (89/121) of horses were lame at presentation; middle-aged (9-18 years, 80%) and older (> 18 years, 85%) horses were lame more frequently than young horses (horses, 10 exhibited osseous abnormalities, whereas 111 were diagnosed with soft tissue lesions. Eighty-four percent (93/111) of the soft tissue injuries extended from the caudodistal antebrachium to the palmar metacarpus. The superficial digital flexor tendon (98/111; 88%) and accessory ligament of the superficial digital flexor tendon (64/111; 58%) were the most commonly injured structures, with both structures affected in 41 (41/111; 37%) horses. Injuries within the caudodistal antebrachium included the superficial digital flexor musculotendinous junction (66), the accessory ligament of the superficial digital flexor tendon (64), and deep digital flexor muscle (21), in isolation or in combination with other structures. Increased echogenicity in the medial superficial digital flexor musculotendinous junction was detected in 40 horses and was significantly associated with increasing age (middle-aged, 19/40; old, 18/40). Findings from this study indicated that age should be taken into consideration for horses presented with carpal sheath effusion and that adjacent structures within the caudodistal antebrachium should be included in evaluations. PMID:25572121

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

    International Nuclear Information System (INIS)

    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.

  10. 术中神经电生理监测和刺激尺神经治疗肘管综合征%Intraoperative monitoring and supramaximal stimulation on ulnar nerve for the treatment of cubital tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    赵睿; 丛锐; 罗卓荆; 黄景辉; 张航; 臧成五; 鲜航

    2012-01-01

    Objective To evaluate the therapeutic effect of decompression and anterior transposition of ulnar nerve combined with intraoperative supramaximal stimulation. Methods A total of 30 patients diagnosed as cubital tunnel syndrome with moderate to severe damage were performed decompression and anterior transposition of ulnar nerve. The amplitude and latency period of compound muscle action potential ( CMAP) of abductor digiti minimi muscle after decompression were measured and recorded. Then the ulnar nerve was treated with intraoperative supramaximal stimulation (80 mA, 2 Hz, 10 min). The amplitude and latency period of CMAP of abductor digiti minimi muscle were also measured and recorded. The data before and after stimulation were analyzed by statistics. Results The amplitude of CMAP of abductor digiti minimi muscle after decompression and after supramaximal stimulation was (2.5 ±0.4) mV and (6.2 ±0.8) mV, respectively, while the latency period of CMAP was (12.0 ±0.6) ms and (10.3 ±0.3) ms, respectively. There was significant difference in amplitude and latency period before and after stimulation (P<0.05). The latency period of the CMAP of abductor digiti minimi muscle was shortened by 15. 7% and the amplitude was doubled in average. Conclusion The use of intraoperative monitoring and supramaximal stirmlation has the auxiliary therapeutic effect on the recovery of ulnar nerve in cubital tunnel syndrome.%目的 评估尺神经松解前置术结合术中超强电刺激治疗肘管综合征的治疗效果.方法 30例中重度肘管综合征患者首先进行尺神经松解前置术,测定并记录松解后小指展肌复合肌肉动作电位(CMAP)的潜伏期及波幅;然后给予尺神经超强电刺激治疗(80 mA,2Hz,10 min),按照同样的方法再次记录小指展肌CMAP的潜伏期及波幅,并将刺激前后的数据进行统计学分析.结果 患者尺神经外膜松解后与超强电刺激后小指展肌CMAP的波幅分别为(2.5±0.4) mV和(6.2±0.8)m

  11. 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. PMID:27117123

  12. 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...

  13. 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,...

  14. Magnetic tunnel junctions (MTJs)

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    We review the giant tunnel magnetoresistance (TMR) in ferromagnetic-insulator-ferromagnetic junctions discovered in recent years, which is the magnetoresistance (MR) associated with the spin-dependent tunneling between two ferromagnetic metal films separated by an insulating thin tunnel barrier. The theoretical and experimental results including junction conductance, magnetoresistance and their temperature and bias dependences are described.

  15. 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)

  16. Middle tunnels by splitting

    CERN Document Server

    Cho, Sangbum

    2011-01-01

    For a genus-1 1-bridge knot in the 3-sphere, that is, a (1,1)-knot, a middle tunnel is a tunnel that is not an upper or lower tunnel for some (1,1)-position. Most torus knots have a middle tunnel, and non-torus-knot examples were obtained by Goda, Hayashi, and Ishihara. We generalize their construction and calculate the slope invariants for the resulting middle tunnels. In particular, we obtain the slope sequence of the original example of Goda, Hayashi, and Ishihara.

  17. Epilepsy in Muenke syndrome: FGFR3-related craniosynostosis.

    Science.gov (United States)

    Agochukwu, Nneamaka B; Solomon, Benjamin D; Gropman, Andrea L; Muenke, Maximilian

    2012-11-01

    Epilepsy, a neurologic disorder characterized by the predisposition to recurrent unprovoked seizures, is reported in more than 300 genetic syndromes. Muenke syndrome is an autosomal-dominant craniosynostosis syndrome characterized by unilateral or bilateral coronal craniosynostosis, hearing loss, intellectual disability, and relatively subtle limb findings such as carpal bone fusion and tarsal bone fusion. Muenke syndrome is caused by a single defining point mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. Epilepsy rarely occurs in individuals with Muenke syndrome, and little detail is reported on types of epilepsy, patient characteristics, and long-term outcomes. We present seven patients with Muenke syndrome and seizures. A review of 789 published cases of Muenke syndrome, with a focus on epilepsy and intracranial anomalies in Muenke syndrome, revealed epilepsy in six patients, with intracranial anomalies in five. The occurrence of epilepsy in Muenke syndrome within our cohort of 58 patients, of whom seven manifested epilepsy, and the intracranial anomalies and epilepsy reported in the literature, suggest that patients with Muenke syndrome may be at risk for epilepsy and intracranial anomalies. Furthermore, the impact of Muenke syndrome on the central nervous system may be greater than previously thought. PMID:23044018

  18. The MR trainer. Upper extremities. 2. rev. and enl. ed.; Der MR-Trainer. Obere Extremitaet

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, Martin [Landesklinikum Waldviertel Horn (Austria). Inst. fuer Radiologie und Interventionelle Radiologie

    2016-05-01

    The MR (magnetic resonance) trainer covers the indications in NMR images of hands, elbows and shoulder, including fractures and instabilities at the wrist, tendon and ligament lesions, carpal tunnel syndrome, ulnar tunnel syndrome, scaphoid bone fracture, (posttraumatic) osteonecrosis, synovial lesions, luxations, osteocondrosis, soft tissue rumors and bone tumors. The book includes training tasks for each issue.

  19. The MR trainer. Upper extremities. 2. rev. and enl. ed.

    International Nuclear Information System (INIS)

    The MR (magnetic resonance) trainer covers the indications in NMR images of hands, elbows and shoulder, including fractures and instabilities at the wrist, tendon and ligament lesions, carpal tunnel syndrome, ulnar tunnel syndrome, scaphoid bone fracture, (posttraumatic) osteonecrosis, synovial lesions, luxations, osteocondrosis, soft tissue rumors and bone tumors. The book includes training tasks for each issue.

  20. Unusual presentation of multiple nerve entrapment: a case report

    OpenAIRE

    Citisli, Veli; Kocaoglu, Murat; Göcmen, Selcuk; Korucu, Mustafa

    2014-01-01

    Cubital tunnel syndrome is the most common form of ulnar nerve entrapment and the second most common entrapment neuropathy of the upper extremity after carpal tunnel syndrome. However, bilateral compressive ulnar neuropathy is a rare condition. Electro diagnostic studies are a valid and reliable means of confirming the diagnosis.

  1. The Response of the Rabbit Subsynovial Connective Tissue to a Stress-Relaxation Test

    OpenAIRE

    Morizaki, Yutaka; Vanhees, Matthias; Thoreson, Andrew R.; Larson, Dirk; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C.

    2011-01-01

    The subsynovial connective tissue (SSCT) in the carpal tunnel may play a role in the etiology of carpal tunnel syndrome (CTS), yet the material properties of the SSCT remain unclear. Thus, we investigated the mechanical response of the SSCT in a rabbit model. Twenty-four rabbit cadaver paws were used for mechanical testing; two paws were used for scanning electron microscopy (SEM) imaging. After testing normal tendon excursion, the divided third digit flexor digitorum superficialis (FDS) tend...

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

    OpenAIRE

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

    2010-01-01

    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 te...

  3. T1-nerve root neuroma presenting with apical mass and Horner's syndrome

    Directory of Open Access Journals (Sweden)

    Podnar Simon

    2007-03-01

    Full Text Available Abstract Background The appearance of dumbbell neuroma of the first thoracic root is extremely rare. The extradural component of a T1-dumbbell neuroma may present as an apical mass. The diagnosis of hand weakness is complex and may be delayed in T1-neuroma because of absence of the palpable cervical mass. One-stage removal of a T1-root neuroma and its intrathoracic extension demanded an extended posterior midline approach in the sitting position. Case presentation A 51-year old man had suffered a traumatic partial tendon rupture of his wrist flexor muscles 6 years ago. Since the incident he occasionally felt fullness and tenderness in the affected forearm with some tingling in his fingers bilaterally. During the last two years the hand weakness was continuous and hypotrophy of the medial flexor and intrinsic hand muscles had become apparent. Electrophysiological studies revealed an ulnar neuropathy in addition to mild median and radial nerve dysfunction, including a mild contralateral carpal tunnel syndrome. The diagnostic work-up for multiple mononeuropathy in the upper extremity was negative. Repeated electrophysiological studies revealed fibrillations in the C7 paravertebral muscles on the affected side. Chest x-ray revealed a large round apical mass on the affected side. A Horner's syndrome was noted at this point of diagnostic work-up. MRI of the cervical and thoracic spine revealed a dumbbell T1 neuroma enlarging the intervertebral foramen at T1-2 and a 5 cm large extradural tumor with extension into the apex of the ipsilateral lung. The patient underwent surgery in sitting position using a left dorsal midline approach. Although the T1 root could not be preserved, the patient's neurological condition was unchanged after the surgery. Conclusion Extended posterior midline exposure described here using hemilaminectomy, unilateral facetectomy and costo-transversectomy is efficient and safe for one-stage removal of dumbbell tumors at the T1

  4. Complex tunneling dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Yang, C.-D. [Department of Aeronautics and Astronautics, National Cheng Kung University, Tainan 701, Taiwan (China)]. E-mail: cdyang@mail.ncku.edu.tw

    2007-04-15

    Tunneling dynamics and tunneling trajectories are modeled exactly by complex-extended Hamilton-Jacobi formulation in this paper. It is found that the wave-like properties of tunneling particles, such as reflection, refraction, and transmission resonance, can be identified and explained in terms of particle's motion in complex space with the tunneling time defined as the usual sense of classical time. Following the complex trajectories determined by the complex Hamilton equations of motion, we can connect classical trajectories smoothly with tunneling trajectories using position and velocity continuity at the interface of the media, locate the particle's position at any instant, and find the time spent by a particle within the potential. A microscopic tunneling model is also developed to explain the probabilistic nature why a particle with the same incident conditions sometimes transmits the potential and sometimes is reflected from the potential.

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

    Science.gov (United States)

    Van Overstraeten, Luc; Camus, Emmanuel J

    2016-02-01

    Several biomechanical studies have shown that the scapholunate (SL) and lunotriquetral (LT) ligaments are not the only stabilizers of the proximal carpal row. However, no study has yet analyzed the range of ligament lesions leading to instability in vivo. Arthroscopy has been used to assess the condition of the wrist's extrinsic ligaments by palpating and tensioning the various ligament and capsule structures. In this prospective study, this arthroscopic method was used in 85 cases of wrist sprain without static instability to evaluate the correlation between lesions of the intrinsic and extrinsic carpal ligaments and carpal instability. In SL instability, a scapholunate interosseous ligament (SLIL) lesion was statistically correlated with lesions of the long radiolunate ligament (P<0.05). There also was a statistically significant correlation between lesions of the SLIL and the radioscaphocapitate, scaphotrapezial and dorsal intercarpal ligaments. There was a correlation between the stage of SL instability and the number of lax extrinsic ligaments (P<0.05) but not with the severity of the extrinsic ligament lesions. In LT instability, a LT interosseous ligament lesion was statistically correlated with lesions of the dorsal intercarpal ligament (P<0.05). There also was a correlation between the stage of LT instability and the number (P<0.005) and severity (P<0.001) of the extrinsic ligament lesions. Arthroscopy can reveal hidden radiographic instability and can also be used to define the number and severity of injured ligaments. In carpal instability, a lesion of one intrinsic carpal ligament was associated with a lesion of one or more extrinsic ligaments. PMID:27117018

  6. Diagnostic comparison of X-ray plain film and 40-multidetector CT in dislocation of carpal bones

    International Nuclear Information System (INIS)

    Objective: To study the imaging manifestations and detecting rates of dislocation of carpal bones on X- ray plain film and 40-multidetector CT (MDCT), to improve the diagnostic accuracy and to reduce the missed diagnosis and misdiagnosis. Materials and Methods: The X -ray plain films, MDCT, volume rendering (VR) and multiplanar reconstruction (MPR) of 21 patients with dislocation of carpal bones were retrospectively studied. 19 cases were male and two were female, mean age 31±7 years old (19-45 years). Dislocation was in left side in 14 cases, in right in seven cases. Result: Eight cases of lunate dislocation, 13 cases of perilunar dislocation, three cases of simple perilunar dislocation, four cases of perilunar dislocation per navicular bone. One case of perilunar dislocation per navicular and triangular bones, three cases of perilunar dislocation per triangular bones, two cases of perilunar dislocation per styloid process of radius. Among the cases with fracture of other carpal bones, the diagnosis of fractures of radial styloid process and navicular bones were correctly detected on X-ray plain film. But in three cases with fracture of triangular bone, the fractures were indetectable or the original place of the bone fragments were unable to determine on X-ray plain film, but could be correctly detected with MDCT and reconstruct technology. Conclusion: Diagnosis of dislocation of carpal bones can be correctly made with X-ray plain film in the most cases. But for the cases with fracture of carpal bones, especially with tiny fracture, X-ray plain film produces high rate of missed diagnosis. MDCT, VR and MPR can accurately show dislocations and fractures in three-dimension having high clinical value. (authors)

  7. Resonance Enhanced Tunneling

    CERN Document Server

    Matsumoto, S; Matsumoto, Sh.

    2000-01-01

    Time evolution of tunneling in thermal medium is examined using the real-time semiclassical formalism previously developed. Effect of anharmonic terms in the potential well is shown to give a new mechanism of resonance enhanced tunneling. If the friction from environment is small enough, this mechanism may give a very large enhancement for the tunneling rate. The case of the asymmetric wine bottle potential is worked out in detail.

  8. 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...

  9. Gadolinium-enhanced MRI for evaluation of peripheral nerve neuropathy

    International Nuclear Information System (INIS)

    We carried out enhanced MRI for the carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel syndrome and anterior interosseous nerve palsy that is entrapment neuropathy. The affected nerve was enhanced in entrapment point. Carpal tunnel syndrome: The enhancement of affected nerve was apparent in 41 of 52 cases (79%). Cubital tunnel syndrome: The enhancement of affected nerve was apparent in 4 of 5 cases (80%). Tarsal tunnel syndrome: The enhancement of affected nerve was apparent in 1 of 1 case. Anterior interosseous nerve palsy: The enhancement of affected nerve was apparent in 3 of 4 cases (75%). The affected nerve was strongly enhanced by Gd-DTPA, indicating the blood-nerve barrier in the affected nerve to be broken and intraneural edema to be produced, e.i., the ability of Gd-DTPA to selectively contrast-enhance a pathologic focus within the peripheral nerve is perhaps its most important clinical applications. (author)

  10. Carpal boss in chronic wrist pain and its association with partial osseous coalition and osteoarthritis - A case report with focus on MRI findings

    Directory of Open Access Journals (Sweden)

    Feng Poh

    2015-01-01

    Full Text Available The carpal boss is a bony prominence at the dorsal aspect of the 2 nd and/or 3 rd carpometacarpal joint, which has been linked to various etiologies, including trauma, os styloideum, osteophyte formation, and partial osseous coalition. It may result in symptoms through secondary degeneration, ganglion formation, bursitis, or extensor tendon abnormalities by altered biomechanics of wrist motion. We present a case of symptomatic carpal boss with the finding of a partial osseous coalition at the 2 nd carpometacarpal (metacarpal-trapezoid joint and highlight the magnetic resonance imaging (MRI findings of carpal boss impingement and secondary osteoarthritis. To the best of our knowledge, there is no report in the literature describing the imaging findings of partial osseous coalition and degenerative osteoarthritis in relation to carpal boss.

  11. Spondylocarpotarsal synostosis syndrome (with a posterior midline unsegmented bar)

    International Nuclear Information System (INIS)

    Spondylocarpotarsal synostosis syndrome (SSS) is characterised by malsegmentation of the thoracic spine and carpal/tarsal fusions. A unilateral or bilateral unsegmented bar may be present in the thoracic spine. Presenting clinical signs are congenital scoliosis early in life, and shortening of the trunk with scoliosis and/or lordosis in older children. We report a 13-year-old girl with SSS and a midline unsegmented bar running along the spinal processes of T3 to L2 and extending into the posterior vertebral elements. (orig.)

  12. Spondylocarpotarsal synostosis syndrome (with a posterior midline unsegmented bar)

    Energy Technology Data Exchange (ETDEWEB)

    Kaissi, A. Al; Ghachem, M. Ben; Nassib, N.; Chehida, F. Ben [Hospital d' Enfants, Service d' orthopedie infantile, Tunis (Tunisia); Kozlowski, K. [Department of Medical Imaging, Sydney (Australia)

    2005-06-01

    Spondylocarpotarsal synostosis syndrome (SSS) is characterised by malsegmentation of the thoracic spine and carpal/tarsal fusions. A unilateral or bilateral unsegmented bar may be present in the thoracic spine. Presenting clinical signs are congenital scoliosis early in life, and shortening of the trunk with scoliosis and/or lordosis in older children. We report a 13-year-old girl with SSS and a midline unsegmented bar running along the spinal processes of T3 to L2 and extending into the posterior vertebral elements. (orig.)

  13. Tunnel modeling with BIM tools

    OpenAIRE

    Saje, Samo

    2014-01-01

    Graduation thesis deals with the process of tunnel modeling with the use of BIM tools and shows the development of libraries and families for tunnels for Revit software environment. In the first part of the thesis the process of design and construction of tunnels is presented, various tunnel construction methods and typical structure of road tunnels are described with an emphasis on the new Austrian method (NATM). The tunnel design process is broken down into individual phases, while the ...

  14. Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria.

    Science.gov (United States)

    Alvarez-Nemegyei, José; Peláez-Ballestas, Ingris; Goñi, Mario; Julián-Santiago, Flor; García-García, Conrado; Quintana, Rosana; Silvestre, Adriana M R; García-Olivera, Imelda; Mathern, Nora A; Loyola-Sanchez, Adalberto; Conti, Silvana; Sanabria, Alvaro J; Pons-Estel, Bernardo A

    2016-07-01

    This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98-6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03-22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37-12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19-3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36-1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60-2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59-1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52-1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50-1.01); anserine syndrome: 0.64 % (95 % CI: 0.44-0.92); inferior heel pain: 0.61 % (95 % CI: 0.42-0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25-0.64); de Quervain's tendinopathy: 0.45 % (95 % CI: 0.29-0.70); trigger finger: 0.42 % (95 % CI: 0.27-0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16-0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05-0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02-0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in

  15. Coherent revival of tunneling

    Science.gov (United States)

    Hsu, Liang-Yan; Rabitz, Herschel

    2015-07-01

    We introduce a tunneling effect by a driving field, referred to as coherent revival of tunneling (CRT), corresponding to complete tunneling (transmission coefficient =1 ) that is revived from the circumstance of total reflection (transmission coefficient ≈0 ) through application of an appropriate perpendicular high-frequency ac field. To illustrate CRT, we simulate electron transport through fish-bone-like quantum-dot arrays by using single-particle Green's functions along with Floquet theory, and we explore the corresponding current-field amplitude characteristics as well as current-polarization characteristics. In regard to the two characteristics, we show that CRT exhibits entirely different features than coherent destruction of tunneling and photon-assisted tunneling. We also discuss two practical conditions for experimental realization of CRT.

  16. 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.

  17. Lumbar radiculopathy caused by a tunneling transvertebral Schmorl's node

    International Nuclear Information System (INIS)

    We report a rare case of lumbar spinal radiculopathy caused by a tunneling Schmorl's node originating from the superior endplate of the L3 vertebra of a 75-year-old patient and penetrating the spinal canal through the posterior wall of this vertebra. This case highlights recent reports emphasizing the clinical pain syndromes possibly associated with Schmorl's nodes. (orig.)

  18. Poland综合征常见的上肢及手畸形的临床特征%Clinical features of common deformities of the upper limb and hand in Poland syndrome

    Institute of Scientific and Technical Information of China (English)

    于龙彪; 田文; 张国安

    2014-01-01

    Poland syndrome ( PS ), also called pectoralis major muscle defect, brachydactyly and syndactylia syndrome, is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral upper limb and hand abnormalities in different degrees. The clinical manifestations are various, especially the upper limb and hand deformities, with great individual differences. This article reviewed the domestic and foreign literatures in recent years and summarized the various deformities of the upper limb and hand in the PS patients. ( 1 ) The PS patients with upper limb deformities may have the following symptoms, including various degrees of short or even defected upper limb, congenital radioulnar synostosis, congenital high scapula, ulnar longitudinal dysplasia, posterior dislocation of the radial head and so on. ( 2 ) The PS patients with wrist deformities may have the following symptoms, including one or more pairs of intercarpal fusion, delay of carpal ossiifcation, disharmonious ossiifcation between the carpal and tubular bone, abnormal carpal morphology, absence of carpal bones and so on. ( 3 ) The PS patients with hand deformities may have the following symptoms, including volume decrease of the ipsilateral hand such as brachydactyly, ectrodactyly, split hand and acheiria, partially or completely soft tissue syndactyly, dysplasia or absence of the middle phalanx, contracture of the metacarpophalangeal joint and the interphalangeal joint, finger lateral deformity, congenital constriction band deformity and so on.

  19. Beals Syndrome

    Science.gov (United States)

    ... Boards & Staff Annual Report & Financials Contact Us Donate Marfan & Related Disorders What is Marfan Syndrome? What are ... the syndrome. How does Beals syndrome compare with Marfan syndrome? People with Beals syndrome have many of ...

  20. The aeolian wind tunnel

    Science.gov (United States)

    Iversen, J. D.

    1991-01-01

    The aeolian wind tunnel is a special case of a larger subset of the wind tunnel family which is designed to simulate the atmospheric surface layer winds to small scale (a member of this larger subset is usually called an atmospheric boundary layer wind tunnel or environmental wind tunnel). The atmospheric boundary layer wind tunnel is designed to simulate, as closely as possible, the mean velocity and turbulence that occur naturally in the atmospheric boundary layer (defined as the lowest portion of the atmosphere, of the order of 500 m, in which the winds are most greatly affected by surface roughness and topography). The aeolian wind tunnel is used for two purposes: to simulate the physics of the saltation process and to model at small scale the erosional and depositional processes associated with topographic surface features. For purposes of studying aeolian effects on the surface of Mars and Venus as well as on Earth, the aeolian wind tunnel continues to prove to be a useful tool for estimating wind speeds necessary to move small particles on the three planets as well as to determine the effects of topography on the evolution of aeolian features such as wind streaks and dune patterns.

  1. Biomechanical analysis of load transmission characteristics of limited carpal fusions used to treat Kienböck’s disease

    OpenAIRE

    Gunal, Izge; Ozcan, Ozal; Uyulgan, Bahadir; Baran, Onder; Arman, Candan; Karatosun, Vasfi

    2004-01-01

    Objectives: Although limited carpal fusions used in the treatment of Kienböck’s disease are thought to act by decreasing the loads on the lunate, biomechanical studies show that capitohamate fusion acts oppositely to what is expected. This experimental study was designed to resolve this paradox, Methods: In a biomechanical cadaveric study, load transmissions at the radioulnacarpal joint were investigated under 140 and 210 newtons of load with three wrist postures, namely, neutral, ulnar an...

  2. 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.)

  3. Galloping exercise induces regional changes in bone density within the third and radial carpal bones of Thoroughbred horses

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2001-07-01

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

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

    International Nuclear Information System (INIS)

    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.)

  6. Spin Tunneling in Conducting Oxides

    OpenAIRE

    Bratkovsky, Alexander

    1997-01-01

    Direct tunneling in ferromagnetic junctions is compared with impurity-assisted, surface state assisted, and inelastic contributions to a tunneling magnetoresistance (TMR). Theoretically calculated direct tunneling in iron group systems leads to about a 30% change in resistance, which is close to experimentally observed values. It is shown that the larger observed values of the TMR might be a result of tunneling involving surface polarized states. We find that tunneling via resonant defect sta...

  7. 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...

  8. 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.

  9. 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...

  10. Tunnelling in organic superconductors

    OpenAIRE

    Bolech, C. J.; Giamarchi, T.

    2005-01-01

    We discuss the possibility of deciding on the symmetry of the superconducting phase in the organic superconductors (Bechgaard salts), using tunnelling experiments. We first briefly review the properties of organic superconductors, and the possibility to have unconventional (triplet) superconductivity in these systems. We then present a simple scheme for computing the full current-voltage characteristics for tunnelling experiments within the framework of the non-equilibrium Keldysh Green funct...

  11. On tunneling across horizons

    OpenAIRE

    Vanzo, Luciano

    2011-01-01

    The tunneling method for stationary black holes in the Hamilton-Jacobi variant is reconsidered in the light of various critiques that have been moved against. It is shown that once the tunneling trajectories have been correctly identified the method isfree from internal inconsistencies, it is manifestly covariant, it allows for the extension to spinning particles and it can even be used without solving the Hamilton-Jacobi equation. These conclusions borrow support on a simple analytic continu...

  12. Temperature stratification in tunnels

    OpenAIRE

    Nyman, Hans; Ingason, Haukur

    2012-01-01

    An investigation of previously established correlations between gas temperature distribution and smoke stratification in mines has been carried out for tunnel applications. The investigated correlations are based on excess gas temperature ratios and Froude number scaling. This paper describes a comparison between two large scale tests carried out in a road tunnel and two well defined model scale tests. In each of the tests, a longitudinal flow was maintained. The temperature data obtained at ...

  13. Gravity Tunnel Drag

    CERN Document Server

    Concannon, Thomas

    2016-01-01

    The time it takes to fall down a tunnel through the center of the Earth to the other side takes approximately 42 minutes, but only when given several simplifying assumptions: a uniform density Earth; a gravitational field that varies linearly with radial position; a non-rotating Earth; a tunnel evacuated of air; and zero friction along the sides of the tunnel. Though several papers have singularly relaxed the first three assumptions, in this paper we relax the final two assumptions and analyze the motion of a body experiencing these types of drag forces in the tunnel. Under such drag forces, we calculate the motion of a transport vehicle through a tunnel of the Earth under uniform density, under constant gravitational acceleration, and finally under the more realistic Preliminary Reference Earth Model (PREM) density data. We find the density profile corresponding to a constant gravitational acceleration better models the motion through the tunnel compared to the PREM density profile, and the uniform density m...

  14. Tunnelling of a molecule

    International Nuclear Information System (INIS)

    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 tH and tBL, with the time dependence of the coherent state parameter for the tunnelled state given by α(t) = α e-iω(t+Δt) , Δt = tH - itBL. 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

  15. Numerical wind tunnels

    CERN Document Server

    Souza, Paulo Victor Santos

    2015-01-01

    Flow of viscous fluids are not usually discussed in detail in general and basic courses of physics. This is due in part to the fact that the Navier-Stokes equation has analytical solution only for a few restricted cases, while more sophisticated problems can only be solved by numerical methods. In this text, we present a computer simulation of wind tunnel, i.e., we present a set of programs to solve the Navier-Stokes equation for an arbitrary object inserted in a wind tunnel. The tunnel enables us to visualize the formation of vortices behind object, the so-called von K\\'arm\\'an vortices, and calculate the drag force on the object. We believe that this numerical wind tunnel can support the teacher and allow a more elaborate discussion of viscous flow. The potential of the tunnel is exemplified by the study of the drag on a simplified model of wing whose angle of attack can be controlled. A link to download the programs that make up the tunnel appears at the end.

  16. 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.

  17. Antiphospholipid Syndrome

    Science.gov (United States)

    ... Awards Enhancing Diversity Find People About NINDS NINDS Antiphospholipid Syndrome Information Page Synonym(s): Hughes Syndrome Table of Contents ( ... research is being done? Clinical Trials What is Antiphospholipid Syndrome? Antiphospholipid syndrome (APS) is an autoimmune disorder caused ...

  18. Shot Noise in Magnetic Tunnel Junctions: Evidence for Sequential Tunneling

    OpenAIRE

    Guerrero, R.; Aliev, F. G.; Tserkovnyak, Y.; Santos, T. S.; Moodera, J.S.

    2006-01-01

    We report the experimental observation of sub-Poissonian shot noise in single magnetic tunnel junctions, indicating the importance of tunneling via impurity levels inside the tunnel barrier. For junctions with weak zero-bias anomaly in conductance, the Fano factor (normalized shot noise) depends on the magnetic configuration being enhanced for antiparallel alignment of the ferromagnetic electrodes. We propose a model of sequential tunneling through nonmagnetic and paramagnetic impurity levels...

  19. 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...

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

    Science.gov (United States)

    Ferretti, Roberta; Dellepiane, Silvana

    2016-03-01

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

  1. Tunneling Through Black Rings

    Institute of Scientific and Technical Information of China (English)

    ZHAO Liu

    2007-01-01

    Hawking radiation of black ring solutions to 5-dimensional Einstein-Maxwell-dilaton theory is analyzed by use of the Parikh-Wilczek tunneling method. To get the correct tunneling amplitude and emission rate, we adopt and develop the Angheben-Nadalini-Vanzo-Zerbini covariant approach to cover the effects of rotation and electronic discharge all at once, and the effect of back reaction is also taken into account. This constitutes a unified approach to the tunneling problem. Provided the first law of thermodynamics for black rings holds, the emission rate is proportional to the exponential of the change of Bekenstein-Hawking entropy. Explicit calculation for black ring temperatures agrees exactly with the results obtained via the classical surface gravity method and the quasi-local formalism.

  2. Tunneling with negative tension

    CERN Document Server

    Marvel, Kate

    2008-01-01

    We describe a new family of thin-wall instantons, with negative tension bubble walls, that mediate tunneling between Minkowski or de Sitter vacua. Some of these instantons can have exponentially enhanced tunneling rates, and would dominate the Euclidean path integral, representing a severe non-perturbative instability in any theory which supports them. We give two constructions of these instantons in theories which are perturbatively stable, but violate the null energy condition. One construction uses a scalar field theory with higher-derivative kinetic term, and is similar to the Coleman-de Luccia positive tension instanton. The other construction employs a negative-tension boundary arising from Z_2 orbifolding: it resembles a "bubble of nothing" which nucleates and grows, consuming the surrounding de Sitter or Minkowski spacetime. We explain how the spectral flow for fluctutations about the thin-wall tunneling solutions automatically protects causality, for both positive and negative tension instantons. We ...

  3. Den Trygge Tunnel

    OpenAIRE

    Jensen, Claus Bach; Hertz, Thea Stine Lund; Loose, Mikkel Thybo; Carlsson, Katrine; Høg, Lasse Noe; Andersen, Ea Leighton

    2013-01-01

    Abstract Pedestrian tunnels in Denmark has for a long time just been something that is solely there to transport the pedestrians away and in safety from car or train traffic, from one point to another, and it still is in many cases. There has been no focus on making it an experience in itself, actively including the pedestrians, which could promote comfort, pleasure and a feeling of safety when using the tunnels. They are left as they were build; creepy, dark, humid, wet and often vandali...

  4. Tunneling in Axion Monodromy

    CERN Document Server

    Brown, Jon; Shiu, Gary; Soler, Pablo

    2016-01-01

    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.

  5. Programmable ferroelectric tunnel memristor

    OpenAIRE

    Andy eQuindeau; Dietrich eHesse; Marin eAlexe

    2014-01-01

    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...

  6. INCAS SUBSONIC WIND TUNNEL

    OpenAIRE

    Corneliu STOICA; Corneliu OPREAN; Florin MUNTEANU

    2009-01-01

    The INCAS Subsonic Wind Tunnel is a closed circuit, continuous, atmospheric pressure facility with a maximum speed of 110 m/s. The test section is octagonal ,of 2.5 m wide, 2.0 m high and 4 m long. The tunnel is powered by a 1200 kW, air cooled variable speed DC motor which drives a 12 blade, 3.5 m diameter fan and is equipped with a six component pyramidal type external mechanical balance with a 700 Kgf maximum lift capacity.The angle of attack range is between -45º and +45º while the yaw an...

  7. 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...

  8. Subcutaneous anterior transposition of the lunar nerve joint absorbable membrane for cubical tunnel syndrome%尺神经肌膜瓣下前置联合可吸收医用膜包裹治疗肘管综合征疗效分析

    Institute of Scientific and Technical Information of China (English)

    李伟

    2014-01-01

    Objective To investigate clinical efficacy of subcutaneous anterior transposition of the lunar nerve joint ab-sorbable membrane in the treatment of cubical tunnel syndrome. Methods From February 2010 to January 2013 in our hospi-tal ,60 cases of cubical tunnel syndrome patients were randomly divided into two groups. The preoperative and postoperative efficacy and little finger abductor muscle leads CMAP amplitude were compared. Results The total efficiency of experimental group was 93.3% ,which was 80.0% in control group. The total efficiency of the two groups were significantly different ,with statistical significance (P0.05) ,the difference was statistically significant between the two groups after operation (P<0.05).Conclusion The subcutaneous anterior transposition of the lunar nerve joint absorbable membrane can improve patients ’ neurological function , and has obvious advantages in the treatment of cubical tunnel syndrome.%目的:探讨尺神经肌膜瓣下前置联合可吸收医用膜包裹治疗肘管综合征的临床疗效。方法选取2010-02-2013-01我院收治的60例肘管综合征患者,随机分为2组。比较2组疗效及术前、术后小指展肌引出CMAP波幅。结果实验组总有效率93.3%,对照组为80.0%,2组比较差异有统计学意义(P<0.05)。实验组术前小指展肌引出CMAP波幅为3.9±2.7,术后为5.3±3.4;对照组术前为4.1±2.9,术后为4.6±3.2。2组术前小指展肌引出CMAP波幅差异无统计学意义(P>0.05),术后组间比较差异有统计学意义(P<0.05)。结论尺神经肌膜瓣下前置联合可吸收医用膜包裹术能够有效改善患者神经功能,在肘管综合征的治疗上具有明显优势。

  9. Tunnelling with wormhole creation

    Energy Technology Data Exchange (ETDEWEB)

    Ansoldi, S. [National Institute of Nuclear Physics (INFN) (Italy); Tanaka, T., E-mail: tanaka@yukawa.kyoto-u.ac.jp [Kyoto University, Department of Physics (Japan)

    2015-03-15

    The description of quantum tunnelling in the presence of gravity shows subtleties in some cases. We discuss wormhole production in the context of the spherically symmetric thin-shell approximation. By presenting a fully consistent treatment based on canonical quantization, we solve a controversy present in the literature.

  10. Tunnelling with wormhole creation

    OpenAIRE

    Ansoldi, Stefano; Tanaka, Takahiro

    2014-01-01

    The description of quantum tunnelling in the presence of gravity shows subtleties in some cases. Here we discuss wormhole production in the context of the spherically symmetric thin-shell approximation. By presenting a fully consistent treatment based on canonical quantization, we solve a controversy present in literature.

  11. Environmental Wind Tunnels

    Czech Academy of Sciences Publication Activity Database

    Jaňour, Zbyněk; Jurčáková, Klára

    New York : Nova Science Publishers, Inc., 2013 - (Chaplin, S.), s. 105-124 ISBN 978-1-62618-396-4 R&D Projects: GA MŠk(CZ) OC 113 Institutional support: RVO:61388998 Keywords : wind tunnel * air pollution * atmospheric boundary layer Subject RIV: BK - Fluid Dynamics

  12. Tunneling path toward spintronics

    International Nuclear Information System (INIS)

    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.

  13. INCAS SUBSONIC WIND TUNNEL

    Directory of Open Access Journals (Sweden)

    Corneliu STOICA

    2009-09-01

    Full Text Available The INCAS Subsonic Wind Tunnel is a closed circuit, continuous, atmospheric pressure facility with a maximum speed of 110 m/s. The test section is octagonal ,of 2.5 m wide, 2.0 m high and 4 m long. The tunnel is powered by a 1200 kW, air cooled variable speed DC motor which drives a 12 blade, 3.5 m diameter fan and is equipped with a six component pyramidal type external mechanical balance with a 700 Kgf maximum lift capacity.The angle of attack range is between -45º and +45º while the yaw angle range is between -140º and +216º .The data acquisition system has been modified recently to allow the recording of all test data on a PC - type computer using LABVIEW and a PXI – type chassis containing specialized data acquisition modules.The tunnel is equipped with a variable frequency electrical supply system for powered models and a 10 bar compressed air supply for pneumatic flow control applications.In the recent years the subsonic wind tunnel has been intensively used for tests within several European projects (AVERT, CESAR and others.

  14. 99mTc-MDP combined blood pool and bone phase radionuclide imaging in papain-injected carpal joints

    International Nuclear Information System (INIS)

    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

  15. High resolution imaging of tunnels by magnetic resonance neurography

    Energy Technology Data Exchange (ETDEWEB)

    Subhawong, Ty K.; Thawait, Shrey K.; Machado, Antonio J.; Carrino, John A.; Chhabra, Avneesh [Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Wang, Kenneth C. [Baltimore VA Medical Center, Department of Radiology, Baltimore, MD (United States); Williams, Eric H. [Dellon Institute for Peripheral Nerve Surgery, Towson, MD (United States); Hashemi, Shahreyar Shar [Johns Hopkins Hospital, Division of Plastic and Reconstructive Surgery, Baltimore, MD (United States)

    2012-01-15

    Peripheral nerves often traverse confined fibro-osseous and fibro-muscular tunnels in the extremities, where they are particularly vulnerable to entrapment and compressive neuropathy. This gives rise to various tunnel syndromes, characterized by distinct patterns of muscular weakness and sensory deficits. This article focuses on several upper and lower extremity tunnels, in which direct visualization of the normal and abnormal nerve in question is possible with high resolution 3T MR neurography (MRN). MRN can also serve as a useful adjunct to clinical and electrophysiologic exams by discriminating adhesive lesions (perineural scar) from compressive lesions (such as tumor, ganglion, hypertrophic callous, or anomalous muscles) responsible for symptoms, thereby guiding appropriate treatment. (orig.)

  16. High resolution imaging of tunnels by magnetic resonance neurography

    International Nuclear Information System (INIS)

    Peripheral nerves often traverse confined fibro-osseous and fibro-muscular tunnels in the extremities, where they are particularly vulnerable to entrapment and compressive neuropathy. This gives rise to various tunnel syndromes, characterized by distinct patterns of muscular weakness and sensory deficits. This article focuses on several upper and lower extremity tunnels, in which direct visualization of the normal and abnormal nerve in question is possible with high resolution 3T MR neurography (MRN). MRN can also serve as a useful adjunct to clinical and electrophysiologic exams by discriminating adhesive lesions (perineural scar) from compressive lesions (such as tumor, ganglion, hypertrophic callous, or anomalous muscles) responsible for symptoms, thereby guiding appropriate treatment. (orig.)

  17. 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

  18. A Study to Develop a New Clinical Measure to Assess Visual Awareness in Tunnel Vision

    OpenAIRE

    Al Shaghthrah, Ali

    2014-01-01

    AbstractVisual conditions such as retinitis pigmentosa and Usher syndrome can gradually cause tunnel vision. Patients with these conditions usually face difficulties with navigation, avoiding obstacles, and performing visual search. Loss of mobility can affect patients' independence and quality of life. One of the rehabilitation strategies for patients with tunnel vision is the use of optical aids to enhance mobility performance. The main method used to evaluate the usefulness of optical aid...

  19. 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.)

  20. Carpal angles as measured on CT and MRI: can we simply translate radiographic measurements?

    International Nuclear Information System (INIS)

    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.)

  1. Diagnostic imaging of the hand. 3. rev. and enl. ed.

    International Nuclear Information System (INIS)

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  2. Diagnostic imaging of the hand. 3. rev. and enl. ed.; Bildgebende Diagnostik der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Herz und Gefaessklinik GmbH, Bad Neustadt (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Lanz, Ulrich

    2015-07-01

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  3. Orthopaedic problems in pregnancy

    OpenAIRE

    Yurdoglu, Cihangir; Turker, Ervan; Orsel, Selcuk

    2004-01-01

    During the nine months of pregnancy, the female body undergoes a number of changes. Many of these changes cause musculoskeletal conditions such as low back pain, carpal tunnel syndrome, de Quervain tenosynovitis and other painful conditions. In a retrospective study, 105 postpartum women were seen and detailed history was obtained. Seventy-two (68.5 per cent) of the 105 postpartum women had low-back pain, twelve (11 per cent) had carpal tunnel syndrome, nine (8.5 per cent) had de Quervain ten...

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

    International Nuclear Information System (INIS)

    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.)

  5. On tunneling across horizons

    Science.gov (United States)

    Vanzo, L.

    2011-07-01

    The tunneling method for stationary black holes in the Hamilton-Jacobi variant is reconsidered in the light of some critiques that have been moved against. It is shown that once the tunneling trajectories have been correctly identified the method is free from internal inconsistencies, it is manifestly covariant, it allows for the extension to spinning particles and it can even be used without solving the Hamilton-Jacobi equation. These conclusions borrow support on a simple analytic continuation of the classical action of a pointlike particle, made possible by the unique assumption that it should be analytic in the complexified Schwarzschild or Kerr-Newman space-time. A more general version of the Parikh-Wilczek method will also be proposed along these lines.

  6. Magnetic flux tube tunneling

    International Nuclear Information System (INIS)

    We present numerical simulations of the collision and subsequent interaction of orthogonal magnetic flux tubes. The simulations were carried out using a parallelized spectral algorithm for compressible magnetohydrodynamics. It is found that, under a wide range of conditions, the flux tubes can open-quotes tunnelclose quotes through each other, a behavior not previously seen in studies of either vortex tube or magnetic flux tube interactions. Two conditions must be satisfied for tunneling to occur: the magnetic field must be highly twisted with a field line pitch >1, and the Lundquist number must be somewhat large, ≥2880. An examination of magnetic field lines suggests that tunneling is due to a double-reconnection mechanism. Initially orthogonal field lines reconnect at two specific locations, exchange interacting sections, and open-quotes passclose quotes through each other. The implications of these results for solar and space plasmas are discussed. copyright 1997 The American Physical Society

  7. Possibility of hyperbolic tunneling

    International Nuclear Information System (INIS)

    Traversable wormholes are primarily useful as 'gedanken experiments' and as a theoretician's probe of the foundations of general relativity. In this work, we analyze the possibility of having tunnels in a hyperbolic spacetime. We obtain exact solutions of static and pseudo-spherically symmetric spacetime tunnels by adding exotic matter to a vacuum solution referred to as a degenerate solution of class A. The physical properties and characteristics of these intriguing solutions are explored, and through the mathematics of embedding it is shown that particular constraints are placed on the shape function, that differ significantly from the Morris-Thorne wormhole. In particular, it is shown that the energy density is always negative, and the radial pressure is positive, at the throat, contrary to the Morris-Thorne counterpart. Specific solutions are also presented by considering several equations of state, and by imposing restricted choices for the shape function or the redshift function.

  8. 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.

  9. Tunnel boring machine applications

    International Nuclear Information System (INIS)

    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

  10. 弥可宝对肘管综合征致肘、腕、环指功能障碍恢复的作用%The recovery function of Mikebao on elbow, twist and finger functional disorder caused by cubital tunnel syndrome

    Institute of Scientific and Technical Information of China (English)

    陈越林; 刘淑贞; 管廷进; 王宝滨

    2002-01-01

    @@ 1 Subject and method 1.1 Subject 60 cases of middle and severe cubital tunnel syndrome from 1992 to 2000 were divided into three groups randomly: Group A was the Mikebao group: 20 cases including 17 male cases and 3 female cases, their ages were from 22~ 45 with the average one as 25; Group B was the vitamin B12 group: 19 cases including 17 male cases and 2 female cases, their ages were from 24~ 50 with the average one as 27; Group C was the control group: 21 cases including 19 male cases and 2 female cases, their ages were from 23~ 60 with the average one as 26. all the patients were sick at single sides, 42 cases were on the right side and 18 cases were on the left side. Causes: 15 cases were with elbow injury history and limited elbow movement, others were of no obvious causes. Courses: 5~ 72 months with the average one as 15 months. Clinical manifestation and signs: 49 cases were with elbow sour and swelling, 58 cases were with adductor pollicis muscle atrophy and 54 cases were with claw hand.Electromyography examination: ulnar nerve movement of the 60 cases at the elbows were obviously slow and CMAP (compound muscle active potential) latent periods were prolonged. All the Tinel sign of ulnar nerves were positive, one cases was with muscle paralysis and partial functional disorder at the median nerve domain, it was proven to be CTS after operation.

  11. Fire Size in Tunnels

    OpenAIRE

    Carvel, Ricky O

    2004-01-01

    In recent years, a number of high profile accidental fires have occurred in several road and rail tunnels throughout the world. Many of these fires grew rapidly to catastrophic size and claimed many lives. The processes involved in the rapid growth and extremely severe of these fires are not adequately understood as yet. The introduction to this thesis reviews a number of these accidental fires and describes much of the previous experimental research which has brought about the...

  12. 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.

  13. Small Icing Wind Tunnel

    Czech Academy of Sciences Publication Activity Database

    Horák, V.; Hoření, Bohumír; Rozehnal, D.; Svoboda, E.

    Brno: University of Defence, 2007, s. 91-98. ISBN 978-80-7231-238-2. [ICMT'07, The international conference on military technologies. Brno (CZ), 02.05.2007-04.05.2007] R&D Projects: GA MPO FT-TA/026 Institutional research plan: CEZ:AV0Z20600510 Keywords : aircraft icing * icing wind tunnel * ice accretion Subject RIV: JR - Other Machinery

  14. Holt-Oram syndrome: a rare case report

    Directory of Open Access Journals (Sweden)

    Parul Sinha

    2015-01-01

    Full Text Available Holt-Oram syndrome is an inherited disorder that causes abnormalities of the hands, arms and heart. The diagnosis can be established clinically. The diagnostic criteria have been validated with molecular testing. An upper-limb malformation involving the carpal bone(s and, variably, the radial and/or thenar bones-An abnormal carpal bone, present in all affected individuals and identified by performing a posterior-anterior hand x-ray, may be the only evidence of disease. 24 years unbooked Hindu female G2P1+0 presented in OPD at term. Her USG examination showed-small deformed upper limbs with poorly appreciable upper limb skeleton. Induction of labour was done and patient delivered vaginally a female baby with deformed upper limbs. This case emphasizes the importance of proper history taking (family history, early diagnosis of such anomalies and proper counseling the parents. [Int J Res Med Sci 2015; 3(1.000: 312-313

  15. 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.

  16. Tunnelling from black holes and tunnelling into white holes

    Science.gov (United States)

    Chatterjee, Bhramar; Ghosh, A.; Mitra, P.

    2008-03-01

    Hawking radiation is nowadays being understood as tunnelling through black hole horizons. Here, the extension of the Hamilton-Jacobi approach to tunnelling for non-rotating and rotating black holes in different non-singular coordinate systems not only confirms this quantum emission from black holes but also reveals the new phenomenon of absorption into white holes by quantum mechanical tunnelling. The rôle of a boundary condition of total absorption or emission is also clarified.

  17. Fluctuation Dominated Josephson Tunneling with a Scanning Tunneling Microscope

    OpenAIRE

    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 voltages. In the presence of microwave fields (f=15.0 GHz) the peak decreases in magnitude and shifts to higher voltages with increasing ...

  18. Joubert Syndrome

    Science.gov (United States)

    ... Awards Enhancing Diversity Find People About NINDS NINDS Joubert Syndrome Information Page Table of Contents (click to ... Organizations Related NINDS Publications and Information What is Joubert Syndrome? Joubert syndrome is a rare brain malformation ...

  19. Marfan Syndrome

    Science.gov (United States)

    Marfan syndrome is a disorder that affects connective tissue. Connective tissues are proteins that support skin, bones, ... fibrillin. A problem with the fibrillin gene causes Marfan syndrome. Marfan syndrome can be mild to severe, ...

  20. Quantum tunneling in thermal medium

    OpenAIRE

    Matsumoto, Sh.; Yoshimura, M.

    2000-01-01

    Time evolution of tunneling phenomena in medium is studied using a standard model of environment interaction. A semiclassical formula valid at low, but finite temperatures is derived in the form of integral transform for the reduced Wigner function, and the tunneling probability in thermal medium is calculated for a general tunneling potential of one dimensional system. Effect of dissipation, its time evolution in particular, depends on the behavior of the potential far beyond the barrier.