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1.
BMC Musculoskelet Disord ; 23(1): 971, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352375

RESUMO

Previous studies have shown radioulnar wrist compression augments carpal arch space. This study investigated the effects of radioulnar wrist compression on patient-reported outcomes associated with carpal tunnel syndrome. Subjects underwent thrice-daily (15 min each time 45 min daily) wrist compression over 4 weeks with an additional four weeks of follow-up without treatment. Primary outcomes included Boston Carpal Tunnel Questionnaire symptom and functional severity scales (SSS and FSS) and symptoms of numbness/tingling based on Visual Analog Scales. Our results showed that radioulnar wrist compression improved SSS by 0.55 points after 2 weeks (p < 0.001) and 0.51 points at 4 weeks (p < 0.006) compared to the baseline scale. At the four-week follow-up, SSS remined improved at 0.47 points (p < 0.05). Symptoms of numbness/tingling improved at two and 4 weeks, as well as the follow-up (p < 0.05). Hand motor impairment such as weakness had a lower frequency across carpal tunnel syndrome sufferers and does not significantly improve (p > 0.05). Radioulnar wrist compression might be an effective alternative treatment in improving sensory related symptoms in patients with mild to moderate carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal , Humanos , Síndrome do Túnel Carpal/complicações , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/terapia , Punho , Hipestesia/diagnóstico , Hipestesia/etiologia , Articulação do Punho , Medidas de Resultados Relatados pelo Paciente
2.
Hand (N Y) ; : 15589447221082163, 2022 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-35321574

RESUMO

BACKGROUND: The Orthopaedic Minimal Data Set (OrthoMiDaS) Episode of care (OME) is a prospectively collected database enabling capture of patient and surgeon-reported data in a more efficient, comprehensive, and dependable manner than electronic medical record (EMR) review. We aimed to assess and validate the OME as a data capture tool for carpometacarpal (CMC) arthroplasty compared to traditional EMR-based review. Specifically, we aimed to: (1) compare the completeness of the OME versus EMR data; and (2) evaluate the extent of agreement between the OME and EMR data-based datasets for carpometacarpal (CMC) arthroplasty. METHODS: The first 100 thumb CMC arthroplasties after OME inception (Febuary, 2015) were included. Blinded EMR-based review of the same cases was performedfor 48 perioperative variables and compared to their OME-sourced counterparts. Outcomes included completion rates and agreement measures in OME versus EMR-based control datasets. RESULTS: The OME demonstrated superior completion rates compared to EMR-based retrospective review. There was high agreement between both datasets where 75.6% (34/45) had an agreement proportion of >0.90% and 82.2% (37/45) had an agreement proportion of >0.80. Over 40% of the variables had almost perfect to substantial agreement (κ > 0.60). Among the 6 variables demonstrating poor agreement, the surgeon-inputted OME values were more accurate than the EMR-based review control. CONCLUSIONS: This study validates the use of the OME for CMC arthroplasty by illustrating that it is reliably able to match or supersede traditional chart review for data collection; thereby offering a high-quality tool for future CMC arthroplasty studies.

3.
J Shoulder Elbow Surg ; 31(6): 1215-1223, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35172209

RESUMO

BACKGROUND: There are various approaches to the distal humerus when managing a distal humeral fracture, and controversy exists regarding which approach is optimal. The purpose of this study was to report the outcomes of the triceps tongue (TT) approach when used for osteosynthesis of AO type 13-A, B, and C distal humeral fractures. Secondarily, we aimed to compare the outcomes of the TT approach vs. olecranon osteotomy (OO) when used for osteosynthesis of AO type 13-C distal humeral fractures. METHODS: We performed a retrospective review of patients with distal humeral fractures treated with open reduction-internal fixation by either a TT or OO approach between 2007 and 2019 at 2 separate institutions. TT patients with AO type 13-C fractures were matched to OO patients at a 1:1 ratio based on age, sex, and fracture characteristics. Surgical time, intraoperative blood loss, elbow motion, fracture union, complications, and Disabilities of the Arm, Shoulder and Hand scores were compared. RESULTS: A total of 28 patients treated with the TT approach were assessed, and the matched TT and OO cohorts each comprised 15 patients. The TT group showed less blood loss (119.3 mL vs. 268.5 mL, P = .03), had greater maximal flexion (126° vs. 116°, P = .03), and achieved a larger flexion-extension arc (108° vs. 93°, P = .05) than the OO group. In the OO cohort, 27% of patients had complications directly related to the OO, and OO patients had a higher rate of postoperative ulnar nerve neuritis (33% vs. 0%, P = .04). There was no difference in Disabilities of the Arm, Shoulder and Hand score (P = .08), procedure time (P = .2), total number of patients with ≥1 complication (P = .5), difficulty with union (P = .7), or number of patients requiring revision surgery (P = .7). CONCLUSIONS: The TT approach is a safe and effective approach for the treatment of distal humeral fractures. When compared with the OO approach for AO type 13-C fractures, the TT approach did not differ regarding functional outcomes but showed increased range of motion, decreased intraoperative blood loss, and a lower rate of postoperative ulnar nerve neuritis. The TT approach should be considered as a safe and reliable first-line approach for intra-articular distal humeral fractures because it allows adequate visualization of the articular surface, eliminates complications related to osteotomy including delayed union or nonunion and hardware failure or irritation, and allows for easy conversion to total elbow arthroplasty.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Fraturas Intra-Articulares , Olécrano , Osteotomia , Braço , Perda Sanguínea Cirúrgica , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/métodos , Humanos , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Neurite (Inflamação) , Olécrano/cirurgia , Osteotomia/métodos , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Neuropatias Ulnares
4.
J Shoulder Elbow Surg ; 31(3): 495-500, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34653613

RESUMO

BACKGROUND: Surgical management of the triceps during exposure for total elbow arthroplasty (TEA) is critical to a successful outcome. Previously described techniques include elevating the triceps insertion from one side or leaving the triceps insertion attached and dislocating the joint. Another approach to the elbow, first described in 1933 by Willis Campbell, MD, and subsequently modified by George Van Gorder, MD, involves turning down the triceps tendon without disrupting the triceps insertion. This approach offers complete visualization of the joint and provides excellent exposure for TEA. Only the original report of the technique and a small series of patients using this technique for TEA exist in the literature. The goal of this study was to evaluate outcomes of the Van Gorder approach in a large series of patients undergoing TEA. METHODS: All patients who underwent TEA from 2008 to 2016 were retrospectively reviewed. Only patients who underwent primary TEA performed through the Van Gorder approach with at least 6 months' follow-up were included for analysis. Patients with prior elbow surgery were excluded. Demographic data, indication for surgery, postoperative range of motion, triceps function, and need for additional surgery were recorded. Prospectively collected visual analog scale (VAS) and Global Health Quality of Life scores were also analyzed. RESULTS: A total of 53 patients met inclusion criteria. The mean age was 62 years, 81% were female, and the average follow-up was 30.2 months. The most common surgical indications included inflammatory arthritis (47%), osteoarthritis (24%), and fracture (19%). Postoperatively, average elbow arc of motion was an 8°-137°. There was 1 patient (1.89%) who developed failure of their triceps extension mechanism. A total of 10 patients (19%) underwent additional elbow surgery most commonly for superficial wound complications. Preoperative VAS scores decreased significantly, starting at 3 months postoperatively (6.76 to 3.37, P < .001), and remained constant at the 12- and 24-month postoperative visits. CONCLUSIONS: This is the largest study evaluating the Van Gorder surgical approach to the elbow for primary TEA with an average follow-up of 32 months. Overall rates of triceps failure and reoperation are consistent with other approaches for TEA.


Assuntos
Artroplastia de Substituição do Cotovelo , Articulação do Cotovelo , Osteoartrite , Artroplastia de Substituição do Cotovelo/métodos , Cotovelo/cirurgia , Articulação do Cotovelo/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
5.
Data Brief ; 40: 107674, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34917713

RESUMO

This Data-in-brief article includes datasets of electron microscopy, polarised neutron reflectometry and magnetometry for ultra-small cobalt particles formed in titania thin films via ion beam synthesis. Raw data for polarised neutron reflectometry, magnetometry and the particle size distribution are included and made available on a public repository. Additional elemental maps from scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) are also presented. Data were obtained using the following types of equipment: the NREX and PLATYPUS polarised neutron reflectometers; a Quantum Design Physical Property Measurement System (14 T); a JEOL JSM-6490LV SEM, and a JEOL ARM-200F scanning transmission electron microscope (STEM). The data is provided as supporting evidence for the article in Applied Surface Science (A. Bake et al., Appl. Surf. Sci., vol. 570, p. 151068, 2021, DOI 10.1016/j.apsusc.2021.151068), where a full discussion is given. The additional supplementary reflectometry and modelling datasets are intended to assist future scientific software development of advanced fitting algorithms for magnetization gradients in thin films.

6.
Ann Plast Surg ; 87(3): e1-e21, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833177

RESUMO

ABSTRACT: Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery. MEDLINE and EMBASE databases were systematically reviewed for clinical data on nerve repair and reconstruction to define the current understanding of timing and other factors affecting outcomes. Special attention was given to sensory, mixed/motor, nerve compression syndromes, and nerve pain. The data presented in this review may assist surgeons in making sound, evidence-based clinical decisions regarding timing of nerve surgery.


Assuntos
COVID-19 , Humanos , Procedimentos Neurocirúrgicos , Pandemias , SARS-CoV-2
7.
Am J Cardiol ; 160: 96-98, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34620488

RESUMO

Cardiac amyloidosis is often preceded by orthopedic manifestations such as carpal tunnel syndrome, and 10% of patients who underwent idiopathic carpal tunnel release surgery will have biopsy-confirmed amyloid deposits in the tenosynovial sheath. Trigger finger is also commonly reported in patients with amyloidosis and involves the same tendon sheath as carpal tunnel syndrome, but the prevalence of amyloid deposition is unclear. This prospective cross-sectional study enrolled 100 patients aged ≥50 years at the time of surgery for idiopathic trigger finger. Patients underwent release surgery, and a sample of the tenosynovium of the affected finger was excised, stained with Congo red, and subtyped with mass spectrometry if amyloid was demonstrated. Further cardiac evaluation was performed in patients with amyloid deposition. Of the 100 patients (mean age 65.5 ± 8.1 years) enrolled, only 2 demonstrated amyloid deposits on Congo red staining. One patient with previous proteinuric kidney disease had fibrinogen A α-chain amyloidosis, and the other patient had untyped amyloidosis. Neither patient had cardiac involvement. A total of 13 of the 100 patients underwent concomitant carpal tunnel release surgery, and 2 of these patients had amyloid deposits in the carpal tunnel with "false-negative" samples from the trigger finger tenosynovium. In conclusion, biopsy during trigger finger release surgery demonstrated a 2% yield for amyloidosis, which is significantly lower than the previously published yield of 10% during carpal tunnel release surgery. This observation has important implications for the development of diagnostic algorithms to screen patients for amyloidosis during orthopedic operations.


Assuntos
Amiloidose/diagnóstico , Cardiomiopatias/diagnóstico , Membrana Sinovial/patologia , Dedo em Gatilho/cirurgia , Idoso , Amiloidose/complicações , Amiloidose/metabolismo , Amiloidose/patologia , Cardiomiopatias/complicações , Cardiomiopatias/metabolismo , Cardiomiopatias/patologia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/metabolismo , Síndrome do Túnel Carpal/patologia , Síndrome do Túnel Carpal/cirurgia , Feminino , Fibrinogênio/metabolismo , Humanos , Masculino , Programas de Rastreamento , Espectrometria de Massas , Pessoa de Meia-Idade , Membrana Sinovial/metabolismo , Dedo em Gatilho/etiologia , Dedo em Gatilho/metabolismo , Dedo em Gatilho/patologia
8.
Bone Jt Open ; 1(6): 272-280, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33215114

RESUMO

Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve. Cite this article: Bone Joint Open 2020;1-6:272-280.

9.
Muscle Nerve ; 62(4): 522-527, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32644200

RESUMO

INTRODUCTION: The purpose of this study was to investigate in vivo median nerve longitudinal mobility in different segments of the carpal tunnel associated with active finger motion in carpal tunnel syndrome (CTS) patients in a comparison with healthy controls. METHODS: Eleven healthy volunteers and 11 CTS patients participated in this study. Dynamic ultrasound images captured location-dependent longitudinal median nerve mobility within the carpal tunnel during finger flexion at the metacarpophalangeal joints using a speckle cross-correlation algorithm. RESULTS: Median nerve longitudinal mobility in the carpal tunnel was significantly smaller in CTS patients (0.0037 ± 0.0011 mm/degree) compared with controls (0.0082 ± 0.0026 mm/degree) (P < .05), especially in the proximal (0.0064 vs 0.0132 mm/degree on average) and middle (0.0033 vs 0.0074 mm/degree on average) carpal tunnel sections. DISCUSSION: Median nerve mobility can potentially serve as a biomechanical marker when diagnosing CTS, or when assessing the effectiveness of surgical and conservative treatments.


Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Nervo Mediano/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Síndrome do Túnel Carpal/diagnóstico por imagem , Feminino , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Ultrassonografia
11.
Am J Sports Med ; 48(2): 432-443, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31851536

RESUMO

BACKGROUND: Shoulder pain and dysfunction are common indications for rotator cuff repair surgery, yet the factors that are associated with these symptoms are not fully understood. PURPOSE/HYPOTHESIS: This study aimed to investigate the associations of patient and disease-specific factors with baseline patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair. We hypothesized that tear size and mental health status, as assessed by the Veterans RAND 12-Item Health Survey mental component score (VR-12 MCS), would be associated with baseline total Penn Shoulder Score (PSS) and its pain, function, and satisfaction subscale scores. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We prospectively identified 12 patient factors and 12 disease-specific factors as possible statistical predictors for baseline PROMs in patients undergoing surgical repair of superior-posterior rotator cuff tears at a single institution over a 3-year period. Multivariable statistical modeling and Akaike information criterion comparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in baseline PSS and its subscale scores. RESULTS: A total of 1442 patients who had undergone surgery by 23 surgeons met inclusion criteria, with a baseline median total PSS of 38.5 (pain, 12; function, 24.2; satisfaction, 2). Adjusted R2 in multivariable models demonstrated that the 24 general patient and disease-specific factors accounted for 22% to 24% of the variability in total PSS and its pain and function subscale scores. Large/massive tear size was significantly associated with worse PSS total score and function score but not pain or satisfaction scores. Lower VR-12 MCS was significantly associated with worse total PSS and all 3 subscale scores. Among other factors significantly associated with baseline PROMs were sex, race, preoperative opioid use, years of education, employment status, acromion status, and adhesive capsulitis. Lower VR-12 MCS, preoperative opioid use, female sex, and black race were the factors most strongly associated with baseline PROMs. CONCLUSION: Large/massive tear size, lower VR-12 MCS, and several additional patient and disease-specific factors are associated with baseline PROMs in patients undergoing rotator cuff repair. Further studies are needed to investigate whether these factors will also predict poor postoperative PROMs.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Artroplastia , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Satisfação do Paciente , Dor de Ombro/cirurgia , Resultado do Tratamento
12.
J Hand Surg Glob Online ; 2(5): 312-315, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35415510

RESUMO

Total elbow arthroplasty (TEA) is a well-established treatment for end-stage rheumatoid arthritis of the elbow. With improved surgical techniques and implant designs, TEA is also effective in treating elbow osteoarthritis, posttraumatic arthritis, distal humerus nonunion, and comminuted distal humerus fractures in the elderly population. There have been multiple reports of greater than 90% survival rate, free of reoperation at 10 years. We present a case of early failure of TEA caused by coronoid impingement, to provide a surgical pearl for others to avoid this complication.

13.
J Orthop Translat ; 18: 13-19, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31508303

RESUMO

BACKGROUND: Owing to the compressive nature of the neuropathy, patients with carpal tunnel syndrome (CTS) have prolonged distal motor latency (DML), sensory nerve latency (SNL), median nerve swelling and restricted median nerve mobility. The purpose of this study was to noninvasively augment carpal tunnel space using radioulnar wrist compression (RWC) and evaluate its effects on median nerve pathological properties in patients with CTS. It was hypothesized that the RWC intervention would reduce the median nerve DML, SNL and cross-sectional area (CSA) and enhance longitudinal median nerve mobility in patients. with CTS. METHODS: Eleven patients diagnosed with CTS participated in this study. A portable RWC intervention splint was developed to apply 10 N of compressive force across the wrist. Three daily sessions of RWC were performed over 4 weeks of intervention (15 min per session, 45 min per day, 7 days per week). Each 15-min session consisted of three 5-min blocks of RWC, with a 1-min rest in between consecutive blocks. Patients were evaluated at Week 0 (baseline), Week 2 (mid-intervention) and Week 4 (end of intervention). DML and SNL of the median nerve were evaluated using established nerve conduction study techniques. Median nerve CSA at the distal wrist crease was obtained by ultrasound imaging. Median nerve motion associated with finger flexion/extension was captured by dynamic ultrasound imaging and quantified using a speckle cross-correlation algorithm. Finger flexion/extension was recorded using an electrogoniometer. The slope of the regressed linear equation of median nerve displacement as a function of finger flexion angle was used to quantify nerve mobility. RESULTS: Patients with CTS showed significantly decreased DML (p = 0.048) and median nerve CSA (p < 0.001) and increased nerve mobility (p < 0.001) at mid-intervention compared to baseline. However, DML, CSA and mobility of the median nerve did not differ significantly between Weeks 2 and 4 (p = 0.574, 1.00 and 0.139, respectively). Median nerve SNL was not significantly affected throughout the 4-week intervention (p = 0.330 for Week 0 vs. 2; p = 1.00 for Week 2 vs. 4). CONCLUSION: This study revealed that RWC intervention with 10-N force applied to the wrist in the radioulnar direction could restore impaired neurophysiological and biomechanical functions of the median nerve. The beneficial effects of RWC intervention for the median nerve were in evidence after a relatively short period of two weeks. These functional improvements could be explained by intermittent decompression of the median nerve via RWC-induced augmentation of the carpal arch. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Biomechanically manipulating the carpal tunnel by RWC decompresses the median nerve and has the potential to become an alternative treatment for CTS.

14.
J Am Coll Cardiol ; 72(17): 2040-2050, 2018 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-30336828

RESUMO

BACKGROUND: Patients with cardiac amyloidosis often have carpal tunnel syndrome that precedes cardiac manifestations by several years. However, the prevalence of cardiac involvement at the time of carpal tunnel surgery has not been established. OBJECTIVES: The authors sought to identify the prevalence and type of amyloid deposits in patients undergoing carpal tunnel surgery and evaluate for cardiac involvement. The authors also sought to determine if patients with soft tissue transthyretin (TTR) amyloid had abnormal TTR tetramer kinetic stability. METHODS: This was a prospective, cross-sectional, multidisciplinary study of consecutive men age ≥50 years and women ≥60 years undergoing carpal tunnel release surgery. Biopsy specimens of tenosynovial tissue were obtained and stained with Congo red; those with confirmed amyloid deposits were typed with mass spectrometry and further evaluated for cardiac involvement with biomarkers, electrocardiography, echocardiography with longitudinal strain, and technetium pyrophosphate scintigraphy. Additionally, serum TTR concentration and tetramer kinetic stability were examined. RESULTS: Of 98 patients enrolled (median age 68 years, 51% male), 10 (10.2%) had a positive biopsy for amyloid (7 ATTR, 2 light chain [AL], 1 untyped). Two patients were diagnosed with hereditary ATTR (Leu58His and Ala81Thr), 2 were found to have cardiac involvement (1 AL, 1 ATTR wild-type), and 3 were initiated on therapy. In those patients who had biopsy-diagnosed ATTR, there was no difference in plasma TTR concentration or tetramer kinetic stability. CONCLUSIONS: In a cohort of patients undergoing carpal tunnel release surgery, Congo red staining of tenosynovial tissue detected amyloid deposits in 10.2% of patients. Concomitant cardiac evaluation identified patients with involvement of the myocardium, allowing for implementation of disease-modifying therapy. (Carpal Tunnel Syndrome and Amyloid Cardiomyopathy; NCT02792790).


Assuntos
Amiloidose , Síndrome do Túnel Carpal , Cardiopatias , Pré-Albumina/metabolismo , Tendinopatia , Tenotomia/métodos , Idoso , Amiloidose/complicações , Amiloidose/metabolismo , Amiloidose/patologia , Biomarcadores/análise , Biópsia/métodos , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/metabolismo , Síndrome do Túnel Carpal/cirurgia , Estudos Transversais , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Masculino , Espectrometria de Massas/métodos , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Tendinopatia/epidemiologia , Tendinopatia/etiologia , Tendinopatia/patologia , Estados Unidos
15.
Clin Biomech (Bristol, Avon) ; 60: 83-88, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30336369

RESUMO

BACKGROUND: Carpal tunnel syndrome is a compression neuropathy at the wrist associated with compromised median nerve mobility. The purpose of this study was to investigate the effects of radioulnar wrist compression on median nerve longitudinal mobility within the carpal tunnel in carpal tunnel syndrome patients as well as healthy subjects. METHODS: Dynamic ultrasound images captured longitudinal median nerve motion in the carpal tunnel during radioulnar wrist compression force application in 11 healthy subjects and 11 carpal tunnel syndrome patients. FINDINGS: We found that median nerve mobility was not significantly affected by radioulnar wrist compression in healthy subjects (P = 0.34), but improved by 10 N radioulnar wrist compression in carpal tunnel syndrome patients (P < 0.05). Analysis of segmental median nerve mobility in carpal tunnel syndrome patients showed significantly improved mobility in the proximal tunnel section under 10 N radioulnar wrist compression force condition compared to the no compression condition (P < 0.05). INTERPRETATION: Moderate radioulnar wrist compression force application helps restore impaired median nerve mobility and may be effective in improve nerve function and symptoms associated with carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Feminino , Voluntários Saudáveis , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Pressão , Amplitude de Movimento Articular , Estresse Mecânico , Ultrassonografia , Punho/fisiopatologia , Articulação do Punho/fisiopatologia
17.
Tech Hand Up Extrem Surg ; 22(3): 99-103, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30048383

RESUMO

Restoration of longitudinal stability of the forearm continues to pose a difficult challenge for the hand surgeon, and no technique has demonstrated success above others. Longitudinal stability to the forearm is conferred by 3 structures: the radial head, which acts as a primary stabilizer, the interosseous membrane, more specifically, the central band and, the distal radioulnar ligaments which are part of the triangular fibrocartilage complex. A combination of techniques is described in this article to address chronic longitudinal instability of the forearm: (1) ulnar shortening osteotomy to restore ulnar variance, (2) pronator teres transfer was used to reconstruct the central band of the interosseous membrane, and (3) tightrope augmentation was used to prevent elongation during the healing process.


Assuntos
Antebraço/cirurgia , Dispositivos de Fixação Ortopédica , Osteotomia/métodos , Transferência Tendinosa/métodos , Ulna/cirurgia , Adulto , Feminino , Antebraço/fisiopatologia , Humanos , Complicações Intraoperatórias/prevenção & controle , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Traumatismos dos Nervos Periféricos/prevenção & controle , Articulação do Punho/fisiopatologia
18.
J Hand Surg Am ; 43(10): 933-940, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29891267

RESUMO

Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy in the upper extremity. There are considerable diagnostic and therapeutic challenges associated with treating patients after a failed primary procedure for CuTS. Distinguishing cases of recurrence versus persistence and identifying concomitant pathology can guide treatment. Conditions that mimic CuTS must be carefully ruled out and coexisting dysfunction of the medial antebrachial cutaneous nerve needs to be addressed. Results of revision procedures are not as reliable as primary procedures for CuTS; however, improvements in pain and paresthesias are noted in approximately 75% of patients. Nerve wraps represent a promising adjuvant treatment option, but long-term outcome data are lacking. External neurolysis and anterior transposition after failed CuTS procedures are supported by case series; multicenter, prospective randomized trials are needed to guide treatment further and improve outcomes.


Assuntos
Síndrome do Túnel Ulnar/terapia , Algoritmos , Síndrome do Túnel Ulnar/diagnóstico , Eletromiografia , Humanos , Bloqueio Nervoso , Condução Nervosa , Procedimentos Ortopédicos , Exame Físico , Recidiva , Reoperação , Nervo Ulnar/anatomia & histologia
19.
J Electromyogr Kinesiol ; 38: 197-202, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28343885

RESUMO

The fine-tuning of digit forces to object properties can be disrupted by carpal tunnel syndrome (CTS). CTS' effects on hand function have mainly been investigated using predictable manipulation tasks; however, unpredictable perturbations are commonly encountered during manual tasks, presenting situations which may be more challenging to CTS patients given their hand impairments. The purpose of this study was to investigate muscle and force responses of the index finger to unpredictable perturbations in patients with CTS. Nine CTS patients and nine asymptomatic controls were instructed to stop the movement of a sliding plate by increasing index finger force following an unexpected perturbation. The electrical activity of the first dorsal interosseous muscle and forces exerted by the index finger were recorded. CTS patients demonstrated 20.9% greater muscle response latency and 12.0% greater force response latency compared to controls (p<0.05). The duration of plate sliding was significantly different between groups (p<0.05); the CTS group's duration was 142.2±5.8ms compared to the control group's duration of 133.1±8.4ms. Although CTS patients had increased muscle and force response durations comparatively, these differences were not statistically significant. Findings from this study suggest CTS-induced sensorimotor deficits interfere with accurate detection, processing and response to unpredictable perturbations. These deficits could be accounted for at multiple levels of the peripheral and central nervous systems. Delayed and decreased responses may indicate inefficient object manipulation by CTS patients and may help to explain why CTS patients tend to drop objects.


Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Dedos/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Dedos/inervação , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Músculo Esquelético/fisiopatologia , Tempo de Reação
20.
Nanoscale ; 9(32): 11793-11805, 2017 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-28786471

RESUMO

Dye-sensitised solar cells (DSCs) have niche prospects for electricity-generating windows that could equip buildings for energy-sustainable future cities. However, this 'smart window' technology is being held back by a lack of understanding in how the dye interacts with its device environment at the molecular level. A better appreciation of the dyeTiO2 interfacial structure of the DSC working electrodes would be particularly valuable since associated structure-function relationships could be established; these rules would provide a 'toolkit' for the molecular engineering of more suitable DSC dyes via rational design. Previous materials characterisation efforts have been limited to determining this interfacial structure within an environment exposed to air or situated in a solvent medium. This study is the first to reveal the structure of this buried interface within the functional device environment, and represents the first application of in situ neutron reflectometry to DSC research. By incorporating the electrolyte into the structural model of this buried interface, we reveal how lithium cations from the electrolyte constituents influence the dyeTiO2 binding configuration of an organic sensitiser, MK-44, via Li+ complexation to the cyanoacrylate group. This dye is the molecular congener of the high-performance MK-2 DSC dye, whose hexa-alkyl chains appear to stabilise it from Li+ complexation. Our in situ neutron reflectometry findings are built up from auxiliary structural models derived from ex situ X-ray reflectometry and corroborated via density functional theory and UV/vis absorption spectroscopy. Significant differences between the in situ and ex situ dyeTiO2 interfacial structures are found, highlighting the need to characterise the molecular structure of DSC working electrodes while in a fully assembled device.

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