The assessment of cervical myelopathy.

The assessment of cervical myelopathy can be challenging, especially early in the course of the disease. Typical symptoms, including pain, neck stiffness, paresthesias, weakness, clumsiness, disequilibrium, difficulty with bladder control and functional deficits, and signs, including decreased cervical range of motion, sensory abnormalities, weakness, spasticity, and gait disturbance, become more obvious as the disease progresses. Disease specific functional assessments can aid in the diagnosis. A detailed clinical assessment should always be interpreted in conjunction with supplemental assessment tools, including imaging and electrodiagnostic studies. This article will review typical clinical findings, the differential diagnosis, and the utilization of supplemental assessment tools for the evaluation of cervical myelopathy.

A simple device to monitor flexion and lateral bending of the lumbar spine.

Monitoring compliance with exercise and motivating patients with lower back pain to perform prescribed exercise regimens are considerable tasks. The objective of this study was to develop and test a low-cost device that can be used by a patient at home to both record and provide real-time biofeedback of lumbar position in the midsagittal and frontal planes during exercises. Our device utilizes strain gages on a thin stainless steel beam to measure lumbar flexion-extension and an optical mouse sensor attached to the end of the blade to measure lateral bending. In comparison tests with a standard electrogoniometer, our device was shown to be accurate within 3 degrees in both the sagittal and frontal planes in healthy subjects. Furthermore, users were capable of reapplying the device themselves and obtaining measurements that were repeatable within 4 degrees in both planes. The capability of this simple device to accurately measure lumbar spine position in a nonlaboratory setting makes it well suited as a tool for providing feedback on exercise performance to both patients and clinicians.

Functional deficits in carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a major occupational illness in the US. The Wisconsin Test is a quantitative computer-controlled test battery designed for measuring sensory and psychomotor function. Subjects were recruited from industrial jobs at high-risk for CTS to determine if subtle sensory and motor deficits were observable in a working population. Outcomes were studied for potential use as an injury surveillance instrument. METHODS: A total of 208 subjects participated (72 males and 136 females). Participants completed a symptom survey, were given a physical examination, administered nerve conduction tests, and were tested using the Wisconsin Test battery. RESULTS: The greatest functional deficits were observed when nerve conduction findings were positive and were accompanied by either positive symptom survey outcomes or positive physical exam findings. The presence of symptoms alone were not significantly associated with motor deficits and no significant sensory threshold differences were observed among subjects categorized using any single criterion (i.e., nerve conduction, symptom reports, or examination). CONCLUSIONS: Measurable and quantifiable sensory and psychomotor deficits were observed in a working industrial population, and were greatest when positive symptoms or physical exam was accompanied by positive nerve conduction test findings. These data show that clinical criteria used in the diagnosis of CTS corresponds with functional psychomotor and sensory impairments measured in these tests.