Síndrome do túnel do carpo: uma doença ocupacional? Revisão bibliográfica / Carpal tunnel syndrome: an occupational disease? Literature review

Introdução: A síndrome do túnel do carpo (STC) é uma neuropatia decorrente da compressão do nervo mediano em seu curso pelo túnel do carpo no punho. Os sintomas iniciais de STC incluem dor, dormência e parestesias, inicialmente localizados e posteriormente com irradiação. O trabalho, em função de esforços e movimentos repetitivos, demonstra ter alguma relação com o desenvolvimento da condição de forma muito comum entre trabalhadores. Objetivo: o objetivo foi de verificar a relação entre a síndrome do túnel do carpo e as atividades laborais de acordo com a literatura dos últimos 5 anos. Método: Os artigos foram coletados a partir de bases eletrônicas de dados, sendo selecionados apenas artigos publicados nos últimos 5 anos. Resultados: Foram selecionados 14 estudos que evidenciaram a relação entre STC e o trabalho. Discussão: Os dados coletados evidenciam que há uma estreita relação entre as atividades laborais e o desenvolvimento de STC. Conclusão: Ainda que algumas atividades representem um risco maior de adoecimento, mais estudos são necessários para avaliar em que proporção essas variadas atividades existentes podem contribuir para que os trabalhadores adoeçam e, com isso, estratégias de cuidados preventivos para esses trabalhadores possam ser desenvolvidas. Palavras-chave: Síndrome do túnel do carpo. Avaliação de sintomas. Trabalho. Doença laboral. Avaliação diagnóstica.

Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis.

BACKGROUND: Clinical trials have demonstrated some benefits of electromyogram-triggered/controlled neuromuscular electrical stimulation (EMG-NMES) on motor recovery of upper limb (UL) function in patients with stroke. However, EMG-NMES use in clinical practice is limited due to a lack of evidence supporting its effectiveness. OBJECTIVE: To perform a systematic review and meta-analysis to determine the effects of EMG-NMES on stroke UL recovery based on each of the International Classification of Functioning, Disability, and Health (ICF) domains. METHODS: Database searches identified clinical trials comparing the effect of EMG-NMES versus no treatment or another treatment on stroke upper extremity motor recovery. A meta-analysis was done for outcomes at each ICF domain (Body Structure and Function, Activity and Participation) at posttest (short-term) and follow-up periods. Subgroup analyses were conducted based on stroke chronicity (acute/subacute, chronic phases). Sensitivity analysis was done by removing studies rated as poor or fair quality (PEDro score <6). RESULTS: Twenty-six studies (782 patients) met the inclusion criteria. Fifty percent of them were considered to be of high quality. The meta-analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain. No evidence was found in favor of EMG-NMES for the Activity and Participation domain. EMG-NMES had a stronger effect for each ICF domain in chronic (≥3 months) compared to acute/subacute phases. CONCLUSION: EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke.

Design and development of a pool and billiards assistive device for the physically challenged.

This research entailed the development and prototyping of a bespoke assistive device for a subject who was a local pool and billiards championship player. The subject was diagnosed with a brain tumor and had to undergo surgery followed by chemotherapy to completely remove the mass in the brain. Following this, there was some loss in motor skills on the right side of his body affecting his gait and grip on objects and his ability to play pool and billiards. Concepts were developed to enable the subject to regain some form. A final design was made, with subsequent alterations for fit and comfort. Testing was done over a 7-day period and results using aid were compared without using any aid over a similar period. There was an 88% decrease in time taken to execute the shot, a 140% increase in strength of shot and a 75% increase in accuracy. The results suggest greater improvement in these performance characteristics with extended use of the device. The device also serves to improve the quality of life of the subject. Implications for Rehabilitation A subject lost some physical ability following the removal of a brain tumor. A bespoke design was found to significantly enhance the performance of the subject in pool and billiards, a game that the subject loved to play before loss of the physical ability. Of increasing importance to those that have lost physical ability is the aim to restore quality of life similar to before the loss of the physical ability, especially with respect to activities that a subject would have been motivated to do due to intrinsic love/interest of the activity.

Objective Assessment of Bradykinesia Estimated from the Wrist Extension in Older Adults and Patients with Parkinson's Disease.

Parkinson's disease (PD) presents several motor signs, including tremor and bradykinesia. However, these signs can also be found in other motor disorders and in neurologically healthy older adults. The incidence of bradykinesia in PD is relatively high in all stages of the disorder, even when compared to tremor. Thus, this research proposes an objective assessment of bradykinesia in patients with PD (G PD: 15 older adults with Parkinson's disease, 65.3 ± 9.1 years) and older adults (G HV: 12 healthy older adults, 60.1 ± 6.1 years). The severity of bradykinesia in the participants of G PD was assessed using the Unified Parkinson's Disease Rating Scale. Movement and muscular activity were detected by means of inertial (accelerometer, gyroscope, magnetometer) and electromyographic sensors while the participants performed wrist extension against gravity with the forearm on pronation. Mean and standard error of inertial and electromyographic signal parameters could discriminate PD patients from healthy older adults (p value <0.05). In discriminating patients with PD from healthy older adults, the mean sensitivity and specificity were respectively 86.67 and 83.33%. The discrimination between the groups, based on the objective evaluation of bradykinesia, may contribute to the accurate diagnosis of PD and to the monitoring of therapies to control parkinsonian bradykinesia, and opens the possibility for further comparative studies considering individuals suffering from other motor disorders.

A tribute to Wartenberg's refined neurological examination.

Robert Wartenberg was a renowned 20th century neurologist who contributed greatly to our understanding of the neurological examination. This article aims to illustrate his legacy by highlighting five seminal neurological signs.

A tribute to Wartenberg's refined neurological examination / Um tributo ao refinado exame neurológico de Wartenberg

ABSTRACT Robert Wartenberg was a renowned 20th century neurologist who contributed greatly to our understanding of the neurological examination. This article aims to illustrate his legacy by highlighting five seminal neurological signs.

RESUMO Robert Wartenberg foi um renomado neurologista do século XX que contribuíu enormemente para o entendimento do exame neurológico. Este artigo tem como objetivo principal ilustrar seu legado, ressaltando cinco sinais neurológicos seminais.

A Clinical Trial with Brazilian Arnica (Solidago chilensis Meyen) Glycolic Extract in the Treatment of Tendonitis of Flexor and Extensor Tendons of Wrist and Hand.

One of the Brazilian arnicas, Solidago chilensis Meyen, is a species of the Asteraceae family. This plant is known by this common name because it shares remarkably similar organoleptic properties with the genus Arnica L., also within the family Asteraceae. We examined the effectiveness of the S. chilensis fluid extract used externally for treating tendinitis of flexor and extensor tendons of wrist and hand in placebo-controlled double-blind clinical pharmacological studies. This study was approved by the Ethical Committee for Scientific Research in Human Beings at University Vila Velha-UVV. Two daily skin applications on the arm skin of a gel cream containing a 5% glycolic plant extract were administered to eight volunteers for 21 days. Among the volunteers, one of their arms was used as the placebo group, and the other one was used as a test group. Statistical data analyses demonstrated a significant reduction in the perception of pain in the arms in the test group, when it was compared to those receiving only the placebo.

Transfer of a flexor digitorum superficialis motor branch for wrist extension reconstruction in C5-C8 root injuries of the brachial plexus: a case series.

In brachial plexus injuries, though nerve transfers and root grafts have improved the results for shoulder and elbow reconstruction, wrist extension has received little attention. We operated on three young patients with C5-C8 root injuries of the left brachial plexus, each operated upon within 6 months of trauma. For wrist extension reconstruction, we transferred a proximal branch of the flexor digitorum superficialis to the motor branch of the extensor carpi radialis brevis. Twenty-four months after surgery, all patients recovered some degree of active wrist motion, from full flexion to near neutral. Independent control of finger flexion and wrist extension was not observed. In C5-C8 root injuries of the brachial plexus, transfer of a flexor digitorum superficialis motor branch to the extensor carpi radialis brevis produces limited recovery.

Biomechanical strain of goldsmiths.

The work of the goldsmiths consists in the manufacture of jewelry. The piece, be it an earring, bracelet or necklace, is hand-assembled. This task requires precision, skill, kindness and patience. In this work, we make use of tools such as cuticle clippers and rounded tip, beads or precious stones and also pieces of metal. This type of activity requires a biomechanical stress of hands and wrists. In order to quantify the biomechanical stress, we performed a case study to measure the movements performed by an assembly of pieces of jewelry. As method for research, filming was done during assembly of parts to a paste, using a Nikon digital camera, for 1 (one) hour. The film was edited by Kinovea software, and the task was divided into cycles, each cycle corresponds to a complete object. In one cycle, there are four two movements of supination and pronation movements of the forearm. The cycle lasts approximately sixteen seconds, totaling 1800 cycles in eight hours. Despite the effort required of the wrists, the activity shows no complaints from the employees, but this fact does not mischaracterizes the ability of employees to acquire repetitive strain injuries and work-related musculoskeletal disorders.

Botulinum toxin, physical and occupational therapy, and neuromuscular electrical stimulation to treat spastic upper limb of children with cerebral palsy: a pilot study.

Spasticity has been successfully managed with different treatment modalities or combinations. No information is available on the effectiveness or individual contribution of botulinum toxin type A (BTA) combined with physical and occupational therapy and neuromuscular electrical stimulation to treat spastic upper limb. The purpose of this study was to assess the effects of such treatment and to inform sample-size calculations for a randomized controlled trial. BTA was injected into spastic upper limb muscles of 10 children. They received 10 sessions of physical and occupational therapy followed by 10 sessions of neuromuscular electrical stimulation on the wrist extensors (antagonist muscles). Degree of spasticity using the Modified Ashworth scale, active range of motion, and manual function with the Jebsen hand test, were assessed. Meaningful improvement was observed in hand function posttreatment (P = 0.03). Median spasticity showed a reduction trend and median amplitude of wrist range of motion registered an increase; however, neither of these were significant (P > 0.05). There is evidence of a beneficial effect of the combined treatment. Adequate information has been obtained on main outcome-measurement variability for calculating sample size for a subsequent study to quantify the treatment effect precisely.

Effects of strength training aided by electrical stimulation on wrist muscle characteristics and hand function of children with hemiplegic cerebral palsy.

Nine children with spastic hemiplegic cerebral palsy underwent 24 sessions of wrist muscles strengthening in the extended wrist range aided by electrostimulation. Isometric strength of flexors and extensors was registered in three wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) to infer on angle-torque curves. Passive stiffness of wrist flexors and wrist flexion angle during manual tasks and hand function were also documented. Significant strength gains were observed at 30 degrees of wrist extension for flexors (p= 0.029) and extensors (p= 0.024). No gains were observed at 30 degrees of flexion. The difference in extensor strength between the three test positions changed after intervention (p< 0.034), suggesting a shift in the angle-torque curve. No changes were observed in passive stiffness (p= 0.506), wrist angle (p< 0.586), or hand function (p= 0.525). Strength training in specific joint ranges may alter angle-torque relationships. For functional gains to be observed, however, a more aggressive intervention and contextualized task training would probably be needed.

Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy.

This study compared the passive stiffness of wrist flexors and the strength of wrist flexors and extensors in three different wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) between children with cerebral palsy (CP) and typically developing (TD) comparison children. It also examined associations between these characteristics and manual function in children with CP. Eleven children with spastic hemiplegic CP (six females, five males; mean age 8y 5mo [SD 1y 8mo], range 6-11y) and 11 TD children, matched for age and sex, took part in this study. Passive stiffness of muscles was measured as the torque/angle relation during passive motion. Isometric strength tests were performed and the time needed to complete three tasks based on the Jebsen-Taylor Hand Function Test was recorded. Flexor stiffness was higher in the group with CP. Strength of flexors and extensors in the group with CP was lower with the wrist extended. No difference among test positions was found in the TD group. Moderate correlations were observed between manual function and variables related to strength and stiffness of wrist muscles in the group with CP. Children with CP showed muscle alterations coherent with the use of the wrist in flexion. Intervention on these characteristics could have a positive impact on manual function.

Evaluation of age, body mass index, and wrist index as risk factors for carpal tunnel syndrome severity.

To determine the role of personal variables as risk factors for carpal tunnel syndrome (CTS) and their relationship to severity of nerve conduction abnormality, we studied 210 consecutive symptomatic CTS patients and 320 controls subjects without CTS symptomatology or known systemic disorders. The CTS group was classified according to the severity of nerve conduction changes. The risk factors for CTS and its severity were assessed by means of univariate and multivariate analysis. Presence of CTS was significantly related to increase of body mass index (BMI) and wrist index. More severe nerve conduction abnormalities were associated with greater age and wrist index but not with higher BMI.

Wrist and palm indexes in carpal tunnel syndrome.

According to median sensory latency >/= 3.7 ms (wrist-index finger [WIF], 14 cm), median/ulnar sensory latency difference to ring finger >/= 0.5 ms (14 cm) or median midpalm (8 cm) latency >/= 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.

[Transfer of the pronator teres tendon to the extensor carp radialis tendon in wrist flexion deformity in cerebral palsy]. / Transferência tendínea do pronador redondo aos extensores radiais do carpo na deformidade em flexão do punho de pacientes portadores de paralisia cerebral.

The flexion deformity of the wrist in cerebral palsy is quite common, carrying disability to the effective use of the hands. From 1980 to 1990, 36 transferences of the pronator teres to the extensor carpi radialis were reviewed. The authors describe the operative technique by a unique incision, that may be used in cerebral palsy, and conclude that it is a good method for correction of deformity.

Músculo extensor anómalo que simula quiste sinovial dorsal de la muñeca / Anomalous extensor muscle that resembles dorsal synovial cist of the carpus

Se presentan en este informe dos casos de músculo anómalo extensor digitorum manus indicis que simulaban quiste sinovial en el dorso de la muñeca. Una prueba diagnóstica es la extensión de los dedos palpando la tumoración en la que puede percibirse contracción muscular. La tumuración se hace más prominente durante la dorsiflexión activa de la muñeca y extensión de los dedos en oposición al quiste sinoval que es más prominente en flexión palmar. El dolor que se presenta puede ser debido a la compresión del músculo bajo el ligamento dorsal del carpo o contra su borde distal en la dorsiflexión activa.