Effectiveness of carpal tunnel syndrome rehabilitation after endoscopic versus open surgical release.

BACKGROUND. Carpal tunnel syndrome is a common upper limb compression neuropathy. Postoperative rehabilitation improves the function of the limb. The aim of this study was to assess the effects of rehabilitation in patients who had undergone endoscopic vs. open surgical carpal tunnel release. MATERIAL AND METHODS. Twenty-six patients were divided into endoscopy (E) and open surgery (K) groups. The following parameters were assessed after rehabilitation: two-point discrimination by fingertips of the operated hand, ranges of motion of joints of the hand, circumferences of the radiocarpal and metacarpo pha langeal joints and the severity of pain and other symptoms. RESULTS. The groups differed regarding the severity of symptoms (numbness), joint circumferences and tactile sensation in fingertips I-IV. The mean values of these parameters were significantly higher in group K compared to group E. In group E, rehabilitation decreased severity of pain and other symptoms and increased the ranges of motion. Recovery of two-point discrimination by fingertips I-IV was also observed. Group K patients showed the greatest improvement in the range of motion. Pain intensity decrease did not reach statistical significance. The two-point discrimination test demonstrated better tactile sensation, but the mean distance between caliper points for particular fingers still showed reduced two-point discrimination ability. CONCLUSIONS. 1. Rehabilitation improved hand function in patients from groups that operated on using different techniques of median nerve release. 2. Rehabilitation resulted in improved innervation density, which was reflected by changes in two-point discrimination scores in fingertips in the operated hand of patients from both groups. 3. Great er improvement was achieved in the pa tients who had undergone an endoscopic procedure.

Assessment of muscle strength of hip joints in children with idiopathic scoliosis.

BACKGROUND: The choice of an appropriate approach to the treatment of idiopathic scoliosis is considerably complicated owing to the lack of a clear-cut aetiology of this condition. Idiopathic scoliosis impairs the body's biomechanical balance and adversely affects body statics. MATERIAL AND METHODS: The muscle torques of the flexor and extensor muscles of the hip joints were assessed in 123 children (96 girls and 27 boys) aged from 8 to 16 with the I degrees scoliosis. Statistically significant differences (p>0.05) were revealed. RESULTS: The primary lumbar scoliosis was to the left in 109 patients (Group 1) and to the right in 14 patients (Group 2). All children participated in a 6-month exercise programme to strengthen the weakened muscle groups. Torque measurements were performed twice: immediately after the child joined the rehabilitation programme and on completion of the programme. The strength of the weakened muscles was seen to increase to a statistically non-significant level (p>0.05). CONCLUSIONS: 1. Exercises strengthening weakened muscles of the hip joint improve the posture of scoliotic children and can be helpful in treating idiopathic scoliosis. 2. Differences in the strength of the flexors and extensors of the hop joint impair body statics and may constitute one of the causes of idiopathic scoliosis in children.

The value of synovectomy of the knee in the treatment of rheumatoid arthritis.

The goal of the present study is to evaluate the usefulness of synovectomy of the knee joint in patients with rheumatoid arthritis. Synovectomy of the knee is the most common lower limb operation performed in patients with rheumatoid arthritis. Depending on the stage of the disease, the symptoms, and the degree of intra-articular changes in the radiological image, there are indications for performing both early and late synovectomy. The progress of the disease is not dependent on its duration, but on the aggressiveness and dynamics of the rheumatoid process. The authors present the advantages of early synovectomy, which halts the progress of the disease and protects the joint from destruction. After early synovectomy one obtains an average of 75% good outcomes, while after late synovectomy the percentage of positive outcomes is about 70%. The authors point out the effectiveness and low level of invasiveness of arthroscopic synovectomy, thanks to which the progress of the disease can be checked and monitored. Another possible therapy is chemical synovectomy, with the specific action of radioisotopes: synoviorthosis with laser irradiation. The authors emphasize that an important factor in obtaining good outcome after every synovectomy is rehabilitation, during which the range, frequency of exercise, and physicotherapeutic procedures are established, depending on the stage of advancement of the rheumatoid process.