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3.
Muscle Nerve ; 62(4): 462-473, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32557709

RESUMO

Persons with back, neck, and limb symptoms constitute a major referral population to specialists in electrodiagnostic (EDX) medicine. The evaluation of these patients involves consideration of both the common and less common disorders. The EDX examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and well complements imaging of the spine. Needle EMG in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy-conditions that frequently mimic radicular symptoms. In this first of a two-part review, the optimal EDX evaluation of persons with suspected radiculopathy is presented. In part two, the implications of EDX findings for diagnosis and clinical management of persons with radiculopathy are reviewed.


Assuntos
Técnicas de Diagnóstico Neurológico , Eletromiografia/métodos , Condução Nervosa , Radiculopatia/diagnóstico , Variação Anatômica , Vértebras Cervicais , Eletrodiagnóstico/métodos , Potencial Evocado Motor , Humanos , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Vértebras Lombares , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Agulhas , Exame Neurológico , Exame Físico , Radiculopatia/complicações , Radiculopatia/fisiopatologia , Reflexo Anormal , Sacro , Ciática/etiologia , Ciática/fisiopatologia , Raízes Nervosas Espinhais
4.
Muscle Nerve ; 62(4): 474-484, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32564381

RESUMO

The electrodiagnostic (EDX) examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and complements imaging of the spine. In this second of a two-part review, the implications of electrodiagnostic findings for diagnosis and clinical management of persons with radiculopathy are reviewed. An EMG confirmed lumbosacral radiculopathy is associated with better clinical outcomes for persons undergoing aggressive conservative management. A positive EMG test portends a better clinical response to epidural corticosteroid injections. If a person undergoes spine surgery, a positive pre-operative EMG for radiculopathy is also associated with better outcomes.


Assuntos
Técnicas de Diagnóstico Neurológico , Eletromiografia/métodos , Condução Nervosa , Músculos Paraespinais/fisiopatologia , Radiculopatia/diagnóstico , Corticosteroides/uso terapêutico , Vértebras Cervicais , Tratamento Conservador , Eletrodiagnóstico/métodos , Humanos , Injeções Epidurais , Vértebras Lombares , Agulhas , Exame Neurológico , Procedimentos Neurocirúrgicos , Exame Físico , Prognóstico , Radiculopatia/fisiopatologia , Radiculopatia/terapia , Sacro , Sensibilidade e Especificidade , Raízes Nervosas Espinhais , Fatores de Tempo
7.
Medicine (Baltimore) ; 99(22): e20506, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481471

RESUMO

RATIONALE: Supracondylar process is a rare bony anomaly that can cause neurovascular symptoms. Previous reports on supracondylar process syndrome mostly suspect the condition by physical examination and simple radiograph with little assistance of electrodiagnostic methods and report efficiency of surgical treatment. PATIENTS CONCERNS: A 45-year-old woman working at an assembly line packing boxes presented with tingling pain at her middle and ring fingers that started 2 months ago. She had positive Tinel sign at the medial side of the distal arm. DIAGNOSIS: Electrodiagnostic inching study on median nerve was conducted and the conduction velocity at the segment between 3 cm to 5 cm proximal to the elbow crease was decreased to 27m/s. Following imaging studies revealed supracondylar process at 4.2 cm proximal to the medial epicondyle. She was successfully treated with conservative treatment. INTERVENTIONS: Oral medications including Non-steroidal anti-inflammatory drug and pregabalin were prescribed along with superficial and deep heat modalities. The extent of manual labor was modified. Additionally, self-massage and stretching/nerve-gliding exercises were delivered. OUTCOMES: The symptoms substantially improved and she could sleep without trouble, however, complete resolution was not achieved. After a year, she was nearly symptom-free after changing occupations with only occasional tingling after manual labor of unusual intensity. LESSONS: This case report enlightens the versatility of electrodiagnostic inching study in localizing median neuropathy at the distal arm and the effectiveness of conservative treatment in supracondylar process syndrome.


Assuntos
Tratamento Conservador , Eletrodiagnóstico , Nervo Mediano/lesões , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Condução Nervosa , Síndrome
8.
Muscle Nerve ; 62(3): 386-389, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32511769

RESUMO

BACKGROUND: Changes in radiation therapy practice and cancer incidence bring into question prior evidence suggesting that radiation therapy predominantly injures the brachial plexus upper trunk, while tumor invasion typically injures the lower trunk. METHODS: We reviewed electrodiagnostic brachial plexopathy reports in cancer survivors for predominant trunk involvement, injury mechanism (tumor invasion vs radiation), and primary cancer location. RESULTS: Fifty-six cases of cancer-associated brachial plexopathy were identified. There was no relationship between injury mechanism and brachial plexus injury level. However, primary cancer location superior/inferior to the clavicle increased the odds of predominantly upper/lower trunk involvement by a factor of 60.0 (95% confidence interval: 7.9, 1401, respectively). CONCLUSIONS: Cancers superior/inferior to the clavicle increase the likelihood of predominantly upper/lower trunk plexopathy, respectively, regardless plexus injury mechanism. These findings contrast with older work, possibly due to more precise radiation therapy techniques and increased incidence of radiosensitive head and neck cancers.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Neoplasias/radioterapia , Lesões por Radiação/diagnóstico , Radioterapia/efeitos adversos , Idoso , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Eletrodiagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/fisiopatologia
9.
Muscle Nerve ; 62(3): 381-385, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32530515

RESUMO

INTRODUCTION: The sensitivity of repetitive nerve stimulation (RNS) in myasthenia gravis (MG) is dependent on the cutoff for abnormal decrement. METHODS: RNS data of adults with and without MG from 2014 to 2017 were reviewed retrospectively. The maximum reliable RNS amplitude/area decrement before and after exercise from facial, spinal accessory (SA), ulnar, and fibular nerves was recorded. Sensitivity/specificity using 5%, 7%, and 10% cutoffs were calculated. RESULTS: Seventy-nine of 141 patients had MG (46 generalized, 21 ocular, 12 bulbar). A total of 608 unique RNS recordings were analyzed. Overall RNS sensitivity/specificity at ≥5%, ≥7%, and ≥10% amplitude cutoffs were as follows: SA, 65.6%/86.3%, 49.2%/94.1%, and 29.5%/96.1%; facial, 51.0%/82.5%, 43.1%/95.0%, and 37.3%/100%; ulnar, 43.6%/100%, 41.0%/100%, and 41.0%/100%; and fibular, 52.6%/89.5%, 42.1%/94.7%, and 42.1%/100%. DISCUSSION: Lowering amplitude cutoff from 10% to 7% increased or maintained sensitivity with little loss in specificity. Post-exercise and area analysis resulted in increased sensitivity in some circumstances.


Assuntos
Nervo Acessório/fisiopatologia , Nervo Facial/fisiopatologia , Miastenia Gravis/diagnóstico , Nervo Fibular/fisiopatologia , Nervo Ulnar/fisiopatologia , Estimulação Elétrica , Eletrodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/fisiopatologia , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Bone Joint J ; 102-B(5): 556-567, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349600

RESUMO

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.


Assuntos
Síndrome do Músculo Piriforme/diagnóstico , Síndrome do Músculo Piriforme/terapia , Ciática/diagnóstico , Ciática/terapia , Terapia Combinada , Diagnóstico Diferencial , Diagnóstico por Imagem , Eletrodiagnóstico , Humanos , Anamnese , Exame Físico , Síndrome do Músculo Piriforme/fisiopatologia , Nervo Pudendo/fisiopatologia , Nervo Isquiático/fisiopatologia , Ciática/fisiopatologia
12.
Muscle Nerve ; 62(2): 176-181, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32462675

RESUMO

As the world accommodates to the coronavirus disease 2019 (COVID-19) pandemic, routine in-person medical services are resuming. The resumption of non urgent electrodiagnostic (EDX) testing faces unique challenges due to the long duration of the procedure and direct close contact with patients, including studies with risk of exposure to oropharyngeal secretions. We provide consensus guidance for resumption of EDX testing, addressing scheduling, patient arrival and registration, use of personal protective equipment, COVID-19 screening and testing, the performance of EDX testing in outpatient and inpatient settings, cleaning and maintenance of the EDX equipment and laboratory, balancing trainee safety and training requirements, and patient care issues. These are broad recommendations that need to be adapted to local COVID-19 risks, institutional guidelines and policies, and changing federal, state, and local regulations, and to changes in the pandemic over time.


Assuntos
Agendamento de Consultas , Infecções por Coronavirus/epidemiologia , Eletrodiagnóstico/métodos , Higiene das Mãos , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Descontaminação , Eletromiografia , Contaminação de Equipamentos , Humanos , Controle de Infecções , Máscaras , Programas de Rastreamento , Condução Nervosa , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Estados Unidos/epidemiologia
13.
Muscle Nerve ; 62(2): 219-225, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32362001

RESUMO

INTRODUCTION: In this study we collected reference values for the across-tarsal-tunnel conduction of the motor tibial nerve (mTN). METHODS: The mTN compound muscle action potentials (CMAPs) from the abductor hallucis muscle were obtained by stimulating below/above the malleolus and the popliteal fossa. The effect of weight, height, body mass index (BMI), foot and leg length, sex, and age were evaluated using univariate and multivariate correlation analyses, and predictive equations for each mTN conduction parameter were developed. RESULTS: On the basis of data from 185 subjects, there were differences between women and men in all anthropometric parameters and for some nerve conduction values. Through multivariate analysis, age, but not sex, was found to have a significant impact. Height affected both distal and proximal conduction velocity. BMI affected CMAP amplitude. DISCUSSION: mTN conduction is influenced by various demographic and anthropometric factors. For all intrinsic factors, height demonstrated the greatest effect on mTN conduction across the tarsal tunnel.


Assuntos
Potenciais de Ação/fisiologia , Estatura , Índice de Massa Corporal , Condução Nervosa/fisiologia , Nervo Tibial/fisiologia , Fatores Etários , Idoso , Peso Corporal , Eletrodiagnóstico , Feminino , Pé/anatomia & histologia , Humanos , Perna (Membro)/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valores de Referência , Fatores Sexuais
14.
Muscle Nerve ; 62(2): 214-218, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32367533

RESUMO

BACKGROUND: We assessed clinical predictors of mechanical ventilation in children with Guillain-Barré syndrome (GBS) to help identify patients who require mechanical ventilation. METHODS: We retrospectively collected the clinical, laboratory, and electrophysiological data of 103 children with GBS. Patients were categorized into two groups based on the requirement for mechanical ventilation. Variables that were significantly different between the two groups in univariate analysis were analyzed by multivariate logistic regression models. RESULTS: Time from symptom onset to admission (P = .002), facial or bulbar weakness (P = .001), and axonal type (P = .005) were associated with mechanical ventilation in univariate analysis. In multivariate analysis, facial or bulbar weakness (odds ratio [OR], 7.936; P = .013) and axonal type (OR, 4.582; P = .022) were independent predictors for mechanical ventilation. CONCLUSIONS: Facial or bulbar weakness and axonal type were associated with increased risk for mechanical ventilation in children with GBS.


Assuntos
Síndrome de Guillain-Barré/terapia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/terapia , Criança , Pré-Escolar , Eletrodiagnóstico , Músculos Faciais/fisiopatologia , Feminino , Síndrome de Guillain-Barré/fisiopatologia , Hospitalização , Humanos , Lactente , Masculino , Debilidade Muscular/fisiopatologia , Condução Nervosa , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
15.
Muscle Nerve ; 62(2): 239-246, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32415858

RESUMO

BACKGROUND: Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT). METHODS: Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls. RESULTS: CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups. CONCLUSIONS: MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS.


Assuntos
Potenciais de Ação/fisiologia , Nervo Mediano/fisiopatologia , Neurônios Motores/fisiologia , Condução Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Nervo Ulnar/fisiopatologia , Degeneração Walleriana/fisiopatologia , Adolescente , Adulto , Progressão da Doença , Eletrodiagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia , Adulto Jovem
16.
Muscle Nerve ; 62(2): 233-238, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32415859

RESUMO

INTRODUCTION: In contrast to needle electromyography (EMG), surface EMG recordings are painless. It is of interest to develop methods to analyze surface EMG for diagnostic purposes. METHODS: Surface EMG interference pattern (SIP) recordings from the abductor pollicis brevis muscle of healthy subjects and subjects with amyotrophic lateral sclerosis (ALS) were analyzed by measuring root-mean-square (RMS) voltage, mean rectified voltage, form factor (FF), and the clustering index (CI). The FF vs SIP area plot was used for analysis. RESULTS: The SIP FF was increased and abnormal in ALS subjects, especially when SIP area was less than 200 mVms. Power regression showed a faster FF decline with SIP area in ALS patients than in healthy subjects. The CI and FF showed a strong correlation. DISCUSSION: FF is easy to calculate and demonstrates abnormalities in ALS patients.


Assuntos
Potenciais de Ação/fisiologia , Esclerose Amiotrófica Lateral/fisiopatologia , Eletromiografia/métodos , Contração Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Eletrodiagnóstico/métodos , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Muscle Nerve ; 62(2): 247-253, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32369630

RESUMO

INTRODUCTION: The best treatment strategy for mild ulnar neuropathy at the elbow (UNE) is not known, due to lack of trials comparing surgery vs conservative treatment. METHODS: We recruited patients with clinical symptoms and signs of mild UNE and an electrophysiologically or sonographically confirmed diagnosis. Patients were randomly allocated to either in situ decompression or conservative treatment. The primary outcome was the proportion of patients with subjective symptom improvement at short-term (3 months) and long-term (6-12 months) follow-up. RESULTS: One hundred seventeen patients were included: 56 and 61 patients were allocated to surgery and conservative treatment, respectively. A larger proportion of surgically treated patients showed improvement at short-term follow-up (85% vs 50%; odds ratio, 5.6; P < .001), but no differences were observed at long-term follow-up. DISCUSSION: In situ decompression for mild UNE may result in faster relief of symptoms when compared with conservative treatment, but at long-term follow-up no differences were observed.


Assuntos
Tratamento Conservador/métodos , Descompressão Cirúrgica/métodos , Cotovelo , Neuropatias Ulnares/terapia , Potenciais de Ação , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrodiagnóstico , Feminino , Humanos , Hipestesia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , Condução Nervosa , Parestesia/fisiopatologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Neuropatias Ulnares/diagnóstico por imagem , Neuropatias Ulnares/fisiopatologia , Ultrassonografia
18.
Muscle Nerve ; 62(4): 430-444, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32270509

RESUMO

The nondystrophic myotonias are rare muscle hyperexcitability disorders caused by gain-of-function mutations in the SCN4A gene or loss-of-function mutations in the CLCN1 gene. Clinically, they are characterized by myotonia, defined as delayed muscle relaxation after voluntary contraction, which leads to symptoms of muscle stiffness, pain, fatigue, and weakness. Diagnosis is based on history and examination findings, the presence of electrical myotonia on electromyography, and genetic confirmation. In the absence of genetic confirmation, the diagnosis is supported by detailed electrophysiological testing, exclusion of other related disorders, and analysis of a variant of uncertain significance if present. Symptomatic treatment with a sodium channel blocker, such as mexiletine, is usually the first step in management, as well as educating patients about potential anesthetic complications.


Assuntos
Fadiga/fisiopatologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Mialgia/fisiopatologia , Transtornos Miotônicos/fisiopatologia , Acetazolamida/uso terapêutico , Idade de Início , Inibidores da Anidrase Carbônica/uso terapêutico , Canais de Cloreto/genética , Eletrodiagnóstico , Eletromiografia , Testes Genéticos , Humanos , Lamotrigina/uso terapêutico , Mexiletina/uso terapêutico , Miotonia Congênita/tratamento farmacológico , Miotonia Congênita/genética , Miotonia Congênita/fisiopatologia , Transtornos Miotônicos/genética , Canal de Sódio Disparado por Voltagem NAV1.4/genética , Guias de Prática Clínica como Assunto , Ranolazina/uso terapêutico , Bloqueadores dos Canais de Sódio/uso terapêutico , Bloqueadores do Canal de Sódio Disparado por Voltagem/uso terapêutico
19.
Muscle Nerve ; 62(1): 111-114, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32291768

RESUMO

BACKGROUND: Increment of compound muscle action potential amplitude is a diagnostic hallmark of Lambert-Eaton myasthenic syndrome (LEMS). Making a diagnosis can be challenging, therefore, a proper cutoff for abnormal increment is highly relevant for improved recognition of this rare disease. METHODS: We determined the sensitivity and specificity of 60% and 100% cutoff values in all consecutive patients who underwent increment testing in our hospital from 1999 to 2016. RESULTS: We included 156 patients, 63 with LEMS and 93 without LEMS. Sensitivity of a 60% cutoff for increment testing was 77.8% (95% confidence interval 65.5%-87.3%) and 58.7% (45.6%-71.0%) for 100%. Specificity was 98.9% (94.2%-100%) and 100% (96.1%-100%) using a threshold of 60% and 100%, respectively. CONCLUSIONS: Lowering the cutoff value for abnormal increment to 60% greatly increases sensitivity to diagnose LEMS without an overt loss in specificity.


Assuntos
Eletrodiagnóstico/métodos , Eletrodiagnóstico/normas , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Síndrome Miastênica de Lambert-Eaton/fisiopatologia , Potenciais de Ação/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Reflexo de Estiramento/fisiologia , Estudos Retrospectivos , Adulto Jovem
20.
Muscle Nerve ; 62(1): 60-69, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32304244

RESUMO

INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Eletrodiagnóstico/normas , Gastos em Saúde/normas , Serviços de Saúde do Trabalhador/normas , Medidas de Resultados Relatados pelo Paciente , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/economia , Eletrodiagnóstico/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Resultado do Tratamento
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