Outcomes of bilateral carpal tunnel syndrome treatment - A systematic review and meta-analysis.

Carpal tunnel syndrome (CTS) is the predominant compressive neuropathy among adults worldwide. However, evidence regarding treatment alternatives and their outcomes, especially with bilateral carpus involvement, is inconclusive. To analyze the clinical and surgical outcomes of bilateral CTS treatment using the visual analog scale (VAS) and Boston questionnaire, a systematic review was conducted according to PRISMA guidelines. After evaluating 129 articles from different databases, nine papers with low bias risk were included in the study. These studies were assessed for methodological quality, both in scale and degree, ensuring bias identification and independence of data extraction. Eligible articles were those in Portuguese, Spanish, and English, with no publication time limit. The outcomes assessed were the standardized mean differences (SMDs) on the symptom severity scale (SSS), functional state scale (FSS), and VAS. In the clinical treatment group, a positive effect was observed on the SSS (SMD: 0.53), FSS (SMD: 0.47), and VAS (SMD decrease: 2.52) at the one-month follow-up. In the surgical-treatment group, a positive effect was observed on the SSS (SMDs: 1.97 for endoscopic and 1.55 for open surgery), FSS (SMDs: 1.52 for endoscopic and 1.77 for open surgery), and VAS (SMDs: 2.19 for endoscopic and 2.59 for open surgery) at the one-month follow-up. Significant improvements in VAS, SSS, and FSS were observed at the three-month follow-up. Current evidence in both clinical and surgical treatments demonstrates their effectiveness, as they potentially improve symptom severity, functional status, and pain intensity in patients with bilateral CTS during one- and three-month follow-up periods.

Influence of the amount of use on hand motor cortex representation: effects of immobilization and motor training.

Converging evidence from animal and human studies has revealed that increased or decreased use of an extremity can lead to changes in cortical representation of the involved muscles. However, opposite experimental manipulations such as immobilization and motor training have sometimes been associated with similar cortical changes. Therefore, the behavioral relevance of these changes remains unclear. The purpose of this study was to observe the effect of the amount of use on hand muscle motor cortex representation by contrasting the effect of unspecific motor training and immobilization. Nine healthy volunteers were tested prior and after a 4-day exposure to two experimental conditions using a randomized cross-over design: a motor training condition (to play Guitar Hero 2h/day with the tested (nondominant) hand on the fret board) and an immobilization condition (to wear an immobilization splint 24h/day). Before and after each condition, motor cortex representation of the nondominant first dorsal interosseous (FDI) muscle was mapped using image-guided transcranial magnetic stimulation (TMS). At the behavioral level, results show that the training condition led to a 20% improvement in the trained task, while the immobilization condition resulted in a 36% decrease in the FDI maximal voluntary contraction. At the neurophysiological level, corticospinal excitability (e.g. Motor-evoked potential amplitude) was found to be decreased in response to immobilization, while no change was observed in response to motor training. No change was found for other TMS variables (motor thresholds or map location/volume/area) in either condition. In conclusion, our results indicate that a 4-day decrease, but not increase, in the amount of use of nondominant hand muscles is sufficient to induce a change in corticospinal excitability. The lack of a training effect might be explained by the use of an unspecific task (that is nevertheless representative of "real-life" training situations) and/or by insufficient duration/intensity to induce long-lasting changes.

Margin of manoeuvre indicators in the workplace during the rehabilitation process: a qualitative analysis.

INTRODUCTION: The task of evaluating workers' capacity to return to their pre-injury employment or other jobs continues to pose a daily challenge for clinicians. In this study, a concept frequently used in the field of ergonomics, the margin of manoeuvre (MM), was applied during the rehabilitation process. The study identified the indicators of the MM taken into account during the return to work of workers with musculoskeletal disorders. METHODS: This study used a multiple-case design. A case was defined as a dyad comprising a worker admitted to a work rehabilitation program and the clinician who was managing the return-to-work process. The results were then validated with investigators and expert ergonomists, through group interviews. Content analyses were performed using the conceptual framework for the work activity model adapted from Vézina and the procedures recommended by Miles and Huberman. RESULTS: A total of 11 workers, five clinicians, two experts and two investigators participated in this study. The interview analysis process resulted in a more detailed definition of the MM and the identification of 50 indicators. The indicators were classified according to six dimensions: (1) work context; (2) employer's requirements and expectations; (3) means and tools; (4) worker's personal parameters; (5) work activity; and (6) impacts of the work situation. CONCLUSIONS: The more specific indicators identified in this study will allow for more systematic observation of the MM. Subsequent studies will seek to link each indicator described in the model with a specific method of observation.

Indicators for choosing an optimal mix of major working postures.

North American workers usually stand while working, and prolonged standing is associated with discomfort and cardiovascular problems. Since prolonged sitting is also associated with health problems, and standing postures differ as to mobility and access to seating, it is desirable to identify an optimal mix of postures. As a step towards this identification, it is desirable to develop indicators of potential health effects that respond to changes in work requirements. We observed 65 subjects who usually stood at work, in four types of workplaces. Pressure-pain threshold (PPT) recorded on the plantar surface was used as an indicator of discomfort and arterial blood pressure was used as an indicator of cardiovascular effects. PPT after work was significantly lower than that before work. Sitting for even a small part of the day appeared to be protective. The effects of static vs. dynamic work on PPT and arterial blood pressure may differ.