Análisis de los parámetros ecográficos descritos en el estudio del síndrome del túnel del carpo. Una revisión sistemática / Analysis of the echographic parameters described in the study of carpal tunnel syndrome: A systematic review

El síndrome del túnel del carpo (STC) es la mononeuropatía por atrapamiento más frecuente; el diagnóstico se establece mediante pruebas electrodiagnósticas con un número sustancial de falsos positivos/negativos. Presentamos la siguiente revisión sistemática, cuyo objetivo es analizar la literatura más reciente en relación con los parámetros ecográficos descritos para estudiar el STC. Seleccionamos estudios que evaluasen parámetros ecográficos en pacientes con sospecha clínica, siguiendo las recomendaciones del manual Cochrane; incluimos revisiones sistemáticas, metaanálisis, estudios caso-control y de pruebas diagnósticas, valorando estudios retrospectivos y revisiones bibliográficas con buena calidad metodológica. La revisión se hizo de artículos publicados entre 2005-2019. Incluimos 8 artículos (2 revisiones sistemáticas/metaanálisis, 2 estudios caso-control, un estudio de pruebas diagnósticas, 2 revisiones literarias y un estudio retrospectivo). Los parámetros analizados fueron el área de sección transversa del nervio mediano, el índice muñeca-antebrazo, el índice entrada-salida, el rango de adelgazamiento del nervio mediano, el abombamiento del retináculo flexor y la vascularización/movilidad. La evidencia actual permite afirmar que la ecografía tiene utilidad en el cribado del STC.(AU)

Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy; the diagnosis is established by electrodiagnostic tests with until 34% of false positives/negatives. We present the following systematic review which objective is to analyze the most recent literature related to the ultrasound parameters described to study CTS. We selected studies that evaluated ultrasound parameters in patients with clinical suspicion following the Cochrane manual's recommendations. We include systematic reviews, meta-analyses, case–control studies and diagnostic tests, evaluating retrospective studies and bibliographic reviews with proper methodological quality. Articles published between 2005 and 2019. We included eight articles (two systematic reviews/meta-analyses, two case–control studies, one diagnostic test study, two literature reviews, and one retrospective). The parameters analyzed were cross-sectional area, wrist–forearm index, entry–exit index, thinning range, palmar bowing of the flexor retinaculum, and vascularity/mobility. Current evidence allows us to affirm that ultrasound is useful in screening for CTS.(AU)

[Analysis of the echographic parameters described in the study of carpal tunnel syndrome: A systematic review]. / Análisis de los parámetros ecográficos descritos en el estudio del síndrome del túnel del carpo. Una revisión sistemática.

Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy; the diagnosis is established by electrodiagnostic tests with until 34% of false positives/negatives. We present the following systematic review which objective is to analyze the most recent literature related to the ultrasound parameters described to study CTS. We selected studies that evaluated ultrasound parameters in patients with clinical suspicion following the Cochrane manual's recommendations. We include systematic reviews, meta-analyses, case-control studies and diagnostic tests, evaluating retrospective studies and bibliographic reviews with proper methodological quality. Articles published between 2005 and 2019. We included eight articles (two systematic reviews/meta-analyses, two case-control studies, one diagnostic test study, two literature reviews, and one retrospective). The parameters analyzed were cross-sectional area, wrist-forearm index, entry-exit index, thinning range, palmar bowing of the flexor retinaculum, and vascularity/mobility. Current evidence allows us to affirm that ultrasound is useful in screening for CTS.

Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior / Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients

El perfil del paciente que más frecuentemente sufre amputaciones de miembro inferior suele ser uno de edad avanzada y alta comorbilidad. Los médicos rehabilitadores precisamos en la valoración de estos pacientes de herramientas objetivas que predigan los resultados de los programas de protetización para aumentar la seguridad del paciente y eficiencia de los programas de rehabilitación protésica. Dada la necesidad de actualizar el conocimiento científico en este campo hemos realizado una revisión de la literatura con el objetivo de definir una propuesta de herramientas que faciliten la toma de decisiones en la indicación de rehabilitación protésica en estos pacientes. Para la realización de este trabajo se ha realizado una estrategia de búsqueda bibliográfica utilizando las bases de datos científicas PubMed, Web of Science, Scopus y Cochrane Library. La calidad de los artículos seleccionados se ha valorado según las herramientas propuestas por CASPe.(AU)

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.(AU)

[Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients]. / Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior.

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.

Nervio mediano trífido. Una variante anatómica infrecuente en la exploración ecográfica del túnel del carpo / Trifid median nerve. A rare anatomical variant in sonographic evaluation of carpal tunnel

El estudio ecográfico para el diagnóstico del síndrome del túnel del carpo puede ponernos de manifiesto distintas variantes anatómicas. Una variante poco común es la presencia de un nervio mediano trífido, que puede ser de importancia en una posterior planificación quirúrgica. Varón de 52 años, con clínica compatible con síndrome del túnel del carpo bilateral. Se realiza una evaluación ecográfica, visualizándose un nervio mediano bífido en la muñeca derecha y un nervio mediano trífido en la izquierda como variantes de la normalidad. La aparición de un tercer elemento nervioso en el túnel del carpo debe ser diferenciado de una persistencia de la arteria mediana a nivel del túnel del carpo junto a un nervio mediano bífido, mucho más habitual. Para ello, es fundamental la visualización ecográfica de la zona de estudio mediante la utilización de la función Doppler, como vemos en el caso clínico que presentamos.(AU)

The ultrasound study for the diagnosis of carpal tunnel syndrome can reveal different anatomical variants. A rare variant is the presence of a trifid median nerve. The visualization of this anatomical variant may be of importance in the surgical planning of carpal tunnel syndrome. Fifty-two-year-old male, with a clinic compatible with bilateral carpal tunnel syndrome. In the ultrasound examination, a bifid median nerve appears as a finding in the right wrist and a trifid median nerve in the left wrist as anatomical variants. It is important to distinguish a trifid median nerve from a persistent median artery at the level of the carpal tunnel, much more frequent than the first. For this, the ultrasound visualization of the study area using the Doppler function is essential.(AU)

[Trifid median nerve. A rare anatomical variant in sonographic evaluation of carpal tunnel]. / Nervio mediano trífido. Una variante anatómica infrecuente en la exploración ecográfica del túnel del carpo.

The ultrasound study for the diagnosis of carpal tunnel syndrome can reveal different anatomical variants. A rare variant is the presence of a trifid median nerve. The visualization of this anatomical variant may be of importance in the surgical planning of carpal tunnel syndrome. Fifty-two-year-old male, with a clinic compatible with bilateral carpal tunnel syndrome. In the ultrasound examination, a bifid median nerve appears as a finding in the right wrist and a trifid median nerve in the left wrist as anatomical variants. It is important to distinguish a trifid median nerve from a persistent median artery at the level of the carpal tunnel, much more frequent than the first. For this, the ultrasound visualization of the study area using the Doppler function is essential.

[Implementation of a new referral model for the musculoskeletal care pathway: Does it improve healthcare outcomes?] / Implantación de un nuevo modelo organizativo en la atención al proceso musculoesquelético: ¿mejora la capacidad de resolución de los procesos?

OBJECTIVE: To evaluate the impact of an organisational change in the musculoskeletal referral pathway in our health management area (HMA) by identifying changes in the ability to improve healthcare outcomes by facilitating referral to the most suitable specialty. DESIGN: This prospective descriptive study aimed to evaluate referral trends from primary care services (PCS) and hospital care (PHS) to musculoskeletal services from 2012 to 2018. MATERIALS AND METHODS: We included all patients who were referred to any of the 3 musculoskeletal services from our HMA catchment area, without specifying sample size. The variables studied were PCS, PHS, service of origin and destination. We used the SPSS programme for the statistical analysis and obtained absolute frequency data. RESULTS: The total number of referrals from PCS increased from 25,575 in 2012 to 24,871 in 2018. PHS referrals decreased from 17,207 in 2012 to 9,803 in 2018. With regards to PCS referrals, the service most increasing the number of referrals to the musculoskeletal team was the Rehabilitation Service, from 8.2% in 2012 to 47% in 2018. Regarding PHSs referrals by specialty, the service that most reduced the number of referrals to the musculoskeletal team was the Traumatology Service, from 10,587 in 2012 to 3,911 in 2018. CONCLUSIONS: The redesign of the musculoskeletal referral pathway improved healthcare outcomes by improving the quality of the referral process. In this organisational change, the Rehabilitation Service took the leadership from the point of view of healthcare and management of the musculoskeletal process, collaborating in the improvement of the healthcare outcomes of these processes.

Ortesis pasiva tobillo-pie de uso nocturno en la prevención del pie equino en la parálisis cerebral / Nocturnal use of an ankle-foot orthosis in the prevention of equinuus in cerebral palsy

Introducción. El equinismo, que es la deformidad más frecuente en los pacientes con parálisis cerebral, aumenta la inestabilidad, dificulta la marcha y la adaptación a la silla de ruedas. La corrección del equinismo beneficia al niño deambulador, facilita la adecuada colocación del pie en el reposapiés de la silla de ruedas y la posibilidad de usar un calzado convencional en el niño que no tiene capacidad de marcha. El objetivo de este estudio es valorar si el uso nocturno de ortesis de tobillo-pie en ortoposición permite prevenir o diferir la aparición de equinismo y así evitar o retrasar la cirugía de alargamiento tendinoso. Material y método. Se ha realizado un estudio observacional descriptivo retrospectivo, revisando el historial clínico de pacientes diagnosticados de parálisis cerebral, tratados mediante ortesis de tobillo-pie nocturnas en la Unidad de Rehabilitación Infantil del Hospital Virgen Macarena. Resultados. De los 90 pacientes tratados con la ortesis de tobillo-pie nocturna, el 88,9% consiguió el rango de flexión dorsal necesario para la deambulación (≥ 10°) o la correcta adaptación a la silla de ruedas y al calzado (≥ 0°). Únicamente en 9 pacientes (10% de los casos) no se alcanzaron los objetivos pretendidos. Conclusión. El tratamiento preventivo con ortesis rígidas constituye una opción de primera línea en el tratamiento de la parálisis cerebral. El uso reglado y mantenido de las ortesis de tobillo-pie nocturnas puede retrasar la aparición del equinismo en la parálisis cerebral y permite diferir o evitar la cirugía con un beneficio funcional evidente (AU)

Introduction. Equinus, the most common deformity in patients with cerebral palsy, increases instability and impairs gait and adaptation to a wheelchair. Correction of equinus benefits walking children and aids proper placement of the foot on the footrest of a wheelchair. It also allows the possibility of using conventional footwear in children with no ability to walk. The aim of this study was to assess whether the use of an ankle-foot orthosis at night, keeping the foot in orthoposition, can prevent or delay the onset of equinus and thus prevent or delay tendon lengthening surgery. Material and methods. We performed a retrospective observational study based on a chart review of 90 patients diagnosed with cerebral palsy treated with a nocturnal ankle-foot orthosis in the Children's Rehabilitation Unit at Hospital Virgen Macarena in Spain. Results. Of the 90 patients treated with nocturnal ankle-foot orthosis, 88.9% achieved the dorsiflexion necessary for ambulation (≥ 10°) or adequate adaptation to a wheelchair and footwear (≥ 0°). Only 9 patients (10%) did not achieve the intended objectives with the use of the splint. Conclusion. Preventive treatment with a rigid ankle-foot orthosis is a widely accepted practice that constitutes a first-line option in the treatment of cerebral palsy. Systematic and persistent use of a nocturnal ankle-foot orthosis can delay the onset of equinus in cerebral palsy and can delay or avoid surgery, with a clear functional benefit (AU)

[A study of the quality of life in cases of multiple sclerosis]. / Estudio de la calidad de vida en la esclerosis múltiple.

AIMS: Our objective was to study the quality of life (QoL) in a sample of patients with multiple sclerosis (MS) as measured by their scores on the QoL questionnaire SF-36 (Short Form 36 Health Survey) and its relationship with the extent of deterioration of the disease according to the EDSS (Expanded Disability Status Scale). PATIENTS AND METHODS: The QoL SF-36 scale was administered to 78 patients with defined MS. Those who had suffered outbreaks or whose condition had clearly deteriorated in the past 6 months were excluded, and variables such as age, sex and gait disorders, among others, were analysed. Patients were divided into three groups according to their degree of disability on the EDSS scale: group 1 (EDSS 0-3), group 2 (EDSS 3.5-5.5) and group 3 (EDSS > 6). RESULTS: There were significant differences in the mean scores of groups 1 and 3 in several dimensions of the QoL questionnaire (p < 0.05): general state of health, emotional role, physical functioning, physical role and body pain. Differences were also observed in physical functioning and physical role in groups 1 and 2. In group 1, the dimensions with the lowest mean score were body pain and vitality. In group 3, the dimension with the lowest score was physical functioning. The health dimensions belonging to the realm of mental health were the ones that reflected the smallest difference according to the stage, since no statistical significance existed for dimensions such as vitality, social functioning or mental health. Body pain and vitality were more affected at an early stage (group 1) and the effects on physical functioning were stronger at a later stage (group 3). CONCLUSIONS: As the disease progresses (EDSS > 6), the dimensions of the QoL SF-36 questionnaire concerning physical health (physical functioning) become affected. Body pain and vitality are the most strongly affected dimensions in the early stages of the disease. These findings should be confirmed in a larger sample in order to provide them with a higher degree of validity.

Estudio de la calidad de vida en la esclerosis múltiple / A study of the quality of life in cases of multiple sclerosis

Objetivo. Estudiar la calidad de vida (CdV) de una muestra de pacientes con esclerosis múltiple (EM) en función de su puntuación en el cuestionario de CdV SF-36 (del inglés Short Form 36 Health Survey) y su relación con el grado de deterioro de la enfermedad según la escala EDSS (del inglés Expanded Disability Status Scale). Pacientes y métodos. Se cuantificó la escala de CdV SF-36 en 78 pacientes con EM definida. Se excluyeron a aquellos que sufrieron brotes o claro empeoramiento los últimos 6 meses, y se analizaron variables de edad, sexo, alteraciones de la marcha, entre otros. Se establecieron tres grupos, sobre la base de los grados de discapacidad en la escala EDSS: grupo 1 (EDSS 0-3), grupo 2 (EDSS 3,5-5,5) y grupo 3 (EDSS > 6). Resultados. Existen diferencias significativas en las puntuaciones medias de los grupos 1 y 3 en varias dimensiones del cuestionario de CdV (p < 0,05): salud general, rol emocional, función física, rol físico, y dolor corporal. También se encontraron diferencias para los grupos 1 y 2 en la función física y rol físico. En el grupo 1, las dimensiones con menor puntuación media fueron: dolor corporal y vitalidad. En el grupo 3, la de menor puntuación fue la función física. Las dimensiones de salud pertenecientes al ámbito de la salud mental fueron las que reflejaron una menor diferencia en función del estadio, puesto que no existe significación estadística para dimensiones como vitalidad, función social o salud mental. El dolor corporal y la vitalidad estarían más afectadas en un estadio temprano (grupo 1), y la función física en un estadio tardío (grupo 3). Conclusiones. A medida que progresa la enfermedad (EDSS > 6), se afectan las dimensiones del cuestionario de CdV SF-36 relacionadas con la salud física (función física). Dolor corporal y vitalidad serían las dimensiones más afectadas en un estadio temprano de la enfermedad. Estos resultados se deberían confirmar en una muestra más amplia para adquirir mayor validez (AU)

Aims. Our objective was to study the quality of life (QoL) in a sample of patients with multiple sclerosis (MS) as measured by their scores on the QoL questionnaire SF-36 (Short Form 36 Health Survey) and its relationship with the extent of deterioration of the disease according to the EDSS (Expanded Disability Status Scale). Patients and methods. The QoL SF-36 scale was administered to 78 patients with defined MS. Those who had suffered outbreaks or whose condition had clearly deteriorated in the past 6 months were excluded, and variables such as age, sex and gait disorders, among others, were analysed. Patients were divided into three groups according to their degree of disability on the EDSS scale: group 1 (EDSS 0-3), group 2 (EDSS 3.5-5.5) and group 3 (EDSS > 6). Results. There were significant differences in the mean scores of groups 1 and 3 in several dimensions of the QoL questionnaire (p < 0.05): general state of health, emotional role, physical functioning, physical role and body pain. Differences were also observed in physical functioning and physical role in groups 1 and 2. In group 1, the dimensions with the lowest mean score were body pain and vitality. In group 3, the dimension with the lowest score was physical functioning. The health dimensions belonging to the realm of mental health were the ones that reflected the smallest difference according to the stage, since no statistical significance existed for dimensions such as vitality, social functioning or mental health. Body pain and vitality were more affected at an early stage (group 1) and the effects on physical functioning were stronger at a later stage (group 3). Conclusions. As the disease progresses (EDSS > 6), the dimensions of the QoL SF-36 questionnaire concerning physical health (physical functioning) become affected. Body pain and vitality are the most strongly affected dimensions in the early stages of the disease. These findings should be confirmed in a larger sample in order to provide them with a higher degree of validity (AU)