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1.
Zhongguo Gu Shang ; 33(8): 745-9, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875766

RESUMO

OBJECTIVE: To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome. METHODS: Twenty six adult specimens (15 males and 11 females), aged 60 to 95(82.54±6.94) years old, were selected from 10% formalin antiseptic fixation. There were 52 sides(two of them could not be tested). The study period was from November 2017 to May 2018. The specimens were collected from the body donation center of the school of basic medicine, Peking University. The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy, and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels, and the shortest distance between the acupotomy and the nerve and blood vessels was defined as ≥2 mm as safety. RESULTS: In the experimental operation, the direct injury rate of nerve and blood vessel was 14% and 12% respectively. There was significant difference in the rate of direct nerve injury between the four injection points (P<0.05). There was no significant difference in the rate of direct vascular injury between the four injection points (P>0.05). Among the four points, there was a statistically significant difference in the safety of nerves(P<0.05), and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(P<0.05). There was significant difference in the safety of blood vessels between the four points(P<0.05), and the safety of radial point 1 was higher than that of ulnar point 2 and point 4 (P<0.05). CONCLUSION: The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point, and the safety of theradial proximal end of the needle is the highest.


Assuntos
Terapia por Acupuntura , Síndrome do Túnel Carpal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligamentos Articulares , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Agulhas , Articulação do Punho
2.
Med Probl Perform Art ; 35(3): 138-144, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32870965

RESUMO

AIMS: Musicians spend numerous hours perfecting their skills and art, often leading to overuse injuries of the hand; of specific concern to musicians is carpal tunnel syndrome (CTS). This study evaluated the median nerve cross-sectional area and hand function of musicians and made comparisons to non-musicians. METHODS: Seventy-six participants took part in the study, 38 music students and professors in the musician group and 38 participants in the control group. Participants completed patient-reported questionnaires to assess the level of pain and hand function. Ultrasound images were collected at the carpal tunnel inlet and outlet. The median nerve cross-sectional area and the depth of the carpal tunnel were measured on ultrasound images using software imbedded in the ultrasound unit. RESULTS: Musicians showed higher levels of hand dysfunction and CTS symptoms than the non-musicians. The median nerve cross-sectional area was greater in musicians than in the non-musician group on both the right (mean difference 1.5 mm2, p=0.002) and left sides (mean difference 0.9 mm2, p=0.036). The depth of the carpal tunnel at the carpal tunnel inlet and outlet did not differ between the groups (p>0.05). CONCLUSION: The current research identified between-group differences in median nerve cross-sectional area and the level of hand dysfunction. Understanding the interaction between the anatomy of the wrist and wrist and hand dysfunction will benefit clinicians when evaluating and treating musicians.


Assuntos
Síndrome do Túnel Carpal , Nervo Mediano , Música , Síndrome do Túnel Carpal/etiologia , Humanos , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Ultrassonografia , Punho
3.
Oral Health Prev Dent ; 18(2): 277-285, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618451

RESUMO

PURPOSE: Ergonomics in dentistry poses some challenges to dentists and may require considerable concentration and attention to detail. This research enables early recognition and prevention of common ergonomic-related conditions, such as carpel tunnel syndrome, back pain and neck pain. The purpose of this study was to determine the prevalence of ergonomic-related problems concerning carpel tunnel syndrome (CTS) and to know the efficacy of independent and combined clinical tests used in diagnosing it. MATERIALS AND METHODS: Initially the participants were instructed to complete a self-administered questionnaire regarding the severity of symptoms of their hands on a hand-wrist diagram and a visual analogue scale. The principle investigator evaluated all questionnaires independently and four clinical tests were used on both hands in a systematic (non-randomised) order for subjects who had symptoms. Those with residual symptoms that exceeded beyond 1 min interval were identified and controlled for the statistical analyses. RESULTS: The most common symptom noted in the study group was tingling and numbness of fingers (66.46%) followed by neck pain (66.34%). 29.26% of subjects reported moderate difficulty in typing and driving vehicles, whereas 26.82% subjects felt moderate difficulty in grasping and carrying shopping bags. 61.94% of subjects with symptoms spent more than 1 h daily of their free time on mobile phones or other smart devices. Individually, in our study the Tinsel's sign stood out as ineffective in ruling out CTS when compared with Phalen's test. Combination tests like Phalen's test and compression tests are confirmatory to CTS diagnosis and 66.34 % of the research group were hence diagnosed for CTS. CONCLUSIONS: A positive criteria for CTS, neck and shoulder pain is identified in our study as being due to long-term use of mobile devices. Further, combination tests like Phalen's with pressure provocation tests proved accurate in conforming CTS. Future research is needed to confirm the diagnostic utility of these independent and combined clinical tests in less prevalent settings, including general dental practitioners and occupational worksites. TRIAL REGISTRATION: The current study is registered in King Khalid University, College of dentistry ethical committee SRC/REG/2016-17/107.


Assuntos
Síndrome do Túnel Carpal , Odontólogos , Ergonomia , Universidades , Odontologia , Humanos , Incidência , Papel Profissional , Arábia Saudita
4.
Zhongguo Gu Shang ; 33(7): 659-61, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32700491

RESUMO

OBJECTIVE: To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome. METHODS: From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function. RESULTS: Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair. CONCLUSION: Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.


Assuntos
Síndrome do Túnel Carpal , Adulto , Anestesia Local , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória , Vigília
5.
Nat Commun ; 11(1): 3642, 2020 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-32686688

RESUMO

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, affecting a large proportion of the general population. Genetic susceptibility has been implicated in CTS, but the causative genes remain elusive. Here, we report the identification of two mutations in cartilage oligomeric matrix protein (COMP) that segregate with CTS in two large families with or without multiple epiphyseal dysplasia (MED). Both mutations impair the secretion of COMP by tenocytes, but the mutation associated with MED also perturbs its secretion in chondrocytes. Further functional characterization of the CTS-specific mutation reveals similar histological and molecular changes of tendons/ligaments in patients' biopsies and the mouse models. The mutant COMP fails to oligomerize properly and is trapped in the ER, resulting in ER stress-induced unfolded protein response and cell death, leading to inflammation, progressive fibrosis and cell composition change in tendons/ligaments. The extracellular matrix (ECM) organization is also altered. Our studies uncover a previously unrecognized mechanism in CTS pathogenesis.


Assuntos
Síndrome do Túnel Carpal , Proteína de Matriz Oligomérica de Cartilagem , Animais , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/genética , Síndrome do Túnel Carpal/metabolismo , Síndrome do Túnel Carpal/patologia , Proteína de Matriz Oligomérica de Cartilagem/genética , Proteína de Matriz Oligomérica de Cartilagem/metabolismo , Condrócitos/patologia , Estresse do Retículo Endoplasmático/fisiologia , Matriz Extracelular/patologia , Humanos , Inflamação , Ligamentos/citologia , Ligamentos/patologia , Mutação , Osteocondrodisplasias/genética , Osteocondrodisplasias/patologia , Tendões/citologia , Tendões/patologia , Tenócitos/patologia
6.
Medicine (Baltimore) ; 99(29): e20903, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702832

RESUMO

We analyze the effectiveness of ultrasonography in diagnosing carpal tunnel syndrome (CTS) and propose the use of sonographic index of median nerve (MN) in carpal tunnel (SIMNCT) in a diagnostic algorithm and in establishing a scale of severity.We studied a group of 344 patients with CTS symptoms, examining them by ultrasound. We measured in all patients, on the affected hand: the size of the cross-sectional area of the MN at carpal tunnel (CT) inlet and outlet, nerve morphology at passage through CT, the vertical thickness of the MN entering into the CT - G1, the lowest vertical thickness into the CT or leaving the CT - G2, the thickness of the MN in the transversal plane as entering in the CT - L. Normal values were considered the similar measurements taken on the healthy hand and we established as normal SIMNCT = 16%. We proposed the formula SIMNCT = 100% (1-G2/G1) in order to calculate the index.Statistics show a significant sensitivity of SIMNCT (P < .0001) compared with cross-sectional area (CSA) and flattening ratio in the diagnosis of CTS. Analyzing the SIMNCT developed by us, we demonstrated a sensitivity of 94.81% and a specificity of 99.66% in CTS diagnosis. Thereby, we propose a CTS severity classification: normal = 16%, mild = 16-19%, moderate = 19% to 28%, severe = 28% to 50%, very severe > 50%.Ultrasonography is an effective method of studying the morphology of the tunnel and compressed nerve at various CTS stages and determining the cause of compression. The SIMNCT is a valuable and practical indicator and it can be used in the CTS diagnosis.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Nervo Mediano/diagnóstico por imagem , Ultrassonografia , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
7.
Orthop Clin North Am ; 51(3): 361-368, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498954

RESUMO

Carpal tunnel is the most common peripheral compressive neuropathy. Nonoperative management may provide temporary alleviation of symptoms, but in most cases surgical decompression is warranted. There are a multitude of approaches ranging from open release under general anesthesia to wide awake in-office endoscopic carpal tunnel release. The present article describes the technical considerations for the single incision, antegrade approach to endoscopic carpal tunnel release using the SEGWay system and technique.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Nervo Mediano/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Descompressão Cirúrgica/efeitos adversos , Endoscopia/efeitos adversos , Humanos , Resultado do Tratamento
8.
PLoS One ; 15(6): e0235051, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584856

RESUMO

OBJECTIVE: To investigate the effects of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS in a large cohort of French workers. METHODS: Prospective study using the data collected at baseline and at the first 12 month-follow-up for the 18,018 participants included in the population-based Constances cohort between 2012 and 2015. CTS at follow-up and exposure to biomechanical wrist stressors and chemicals at baseline were assessed using a self-administered questionnaire. Associations between CTS and co-exposure to biomechanical wrist stressors and chemicals were studied using multivariate logistic regression models, adjusted for personal/medical factors. RESULTS: 184 men (2.1%, 95%CI 1.8-2.4) and 331 women (3.6%, 3.2-3.9) free from chronic hand symptoms at baseline declared suffering from unilateral/bilateral CTS at follow-up. A potentiating effect of co-exposure to biomechanical wrist stressors and chemicals on the risk of CTS was found for both genders, with higher OR in the co-exposure group (OR = 3.38 [2.29-5.01] in men and OR = 4.12 [2.73-6.21] in women) than in the biomechanical exposure group (OR = 2.14 [1.51-3.03] in men and OR = 2.19 [1.72-2.78] in women) compared to no exposure group. CONCLUSIONS: The study showed an association between CTS and co-exposure to biomechanical wrist stressors and chemicals, after adjustment for the main personal and medical factors. This finding should be confirmed using more objective case definition of CTS and assessment of the chemical exposure before drawing conclusions on the possible synergistic effects of mechanical stressors and chemical on the median nerve.


Assuntos
Síndrome do Túnel Carpal , Doenças Profissionais , Exposição Ocupacional/efeitos adversos , Estresse Fisiológico , Inquéritos e Questionários , Adulto , Síndrome do Túnel Carpal/epidemiologia , Síndrome do Túnel Carpal/etiologia , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia
9.
Ideggyogy Sz ; 73(05-06): 185-188, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579308

RESUMO

Background and purpose: After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose - The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Methods: Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. Results: A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Conclusion: Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Síndrome do Túnel Carpal/cirurgia , Resposta Galvânica da Pele/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Complicações Pós-Operatórias , Resultado do Tratamento , Nervo Ulnar/fisiologia , Nervo Ulnar/fisiopatologia
10.
Fisioterapia (Madr., Ed. impr.) ; 42(3): 161-164, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191006

RESUMO

OBJETIVO: Describir la presencia de síndrome de dolor miofascial en un paciente diagnosticado de síndrome de túnel carpiano, así como la propuesta de un abordaje fisioterapéutico. MATERIAL Y MÉTODOS: Varón de 42 años diagnosticado de síndrome de túnel carpiano. Presenta un cuadro de dolor, alteraciones sensitivo-motoras y autonómicas tanto en cuello como en el miembro superior derecho. Se exploran 17 músculos en estas zonas para diagnosticar el síndrome de dolor miofascial y tratar los puntos gatillo musculares con punción seca y la técnica suiza. RESULTADOS: Se confirma el diagnóstico de síndrome de dolor miofascial por la presencia de 7 puntos gatillo musculares activos. Tras 4 semanas de tratamiento se evidencia disminución de la severidad clínica, con remisión del dolor e hiperhidrosis palmar, recuperación del rango de movimiento, del control motor y disminución de las parestesias en la mano. CONCLUSIONES: El diagnóstico y el abordaje del síndrome de dolor miofascial debe ser considerado en pacientes con síndrome de túnel carpiano


OBJECTIVE: To describe the presence of myofascial pain syndrome in a patient diagnosed with carpal tunnel syndrome, as well as the proposal of a physiotherapy approach. MATERIAL AND METHODS: A 42-year-old male diagnosed with carpal tunnel syndrome, with pain, sensory-motor, and autonomic alterations in the neck, as well as in the upper right limb. Seventeen muscles were explored in these areas to diagnose myofascial pain syndrome and treat trigger points with dry needling and the Swiss technique. RESULTS: The diagnosis of myofascial pain syndrome was confirmed by the presence of 7 active trigger points. After 4 weeks of treatment there was a decrease in clinical severity, with remission of pain and palmar hyperhidrosis, recovery of the range of motion, motor control, and decrease of paraesthesias in the hand. CONCLUSIONS: The diagnosis and approach of myofascial pain syndrome should be considered in patients with carpal tunnel síndrome


Assuntos
Humanos , Masculino , Adulto , Síndromes da Dor Miofascial/terapia , Síndrome do Túnel Carpal/diagnóstico , Modalidades de Fisioterapia/instrumentação , Manejo da Dor , Pontos de Acupuntura , Hiperidrose/terapia , Parestesia/terapia , Traumatismos do Punho/terapia , Medição da Dor/instrumentação
12.
Medicine (Baltimore) ; 99(20): e20313, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443382

RESUMO

Carpal tunnel syndrome (CTS) is the most common mononeuropathy in clinical practice. Some patients with end-stage renal disease (ESRD) often associate with tertiary hyperparathyroidism, and ultimately need parathyroidectomy (PTX). However, no studies have definitively demonstrated an effect of PTX on ESRD patients' quality of life. We selected 1686 patients who underwent PTX and 1686 patients who did not receive PTX between 2000 and 2010. These patients were propensity-matched with others by age, sex, and comorbidities at a ratio of 1:1. We used single and multivariable cox proportional hazard models to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). In this study, 116 ESRD patients developed CTS, and the CTS incidences were 7.33 and 12.5 per 1000 person-years for the non-PTX and PTX group. The results reveal that the incidence curve for the PTX group was significantly higher than that for the non-PTX group (log-rank test, P = .004). After adjustments were made for sex, age, and baseline comorbidities, the PTX group had a 1.70-fold higher risk of CTS (hazard ratio (HR) = 1.70, 95% confidence intervals (CI) = 1.17-2.47) than the non-PTX group. The results also demonstrated that female patients (HR = 1.60, 95% CI = 1.06-2.42) and patients with one or more comorbidities (HR = 1.79, 95% CI = 1.23-2.60) might have an increased risk of CTS. The subhazard ratio for CTS risk was 1.62 (95% CI = 1.12-2.36) for the PTX group compared with the non-PTX group in the competing risk of death. In conclusion, we revealed that ESRD patients who had undergone PTX may have an increased risk of CTS.


Assuntos
Síndrome do Túnel Carpal/epidemiologia , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/cirurgia , Falência Renal Crônica/complicações , Paratireoidectomia/estatística & dados numéricos , Fatores Etários , Comorbidade , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Qualidade de Vida , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
13.
Medicine (Baltimore) ; 99(16): e19791, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311991

RESUMO

RATIONALE: In the medical field, the use of 3-dimensional (3D) printing is increasing explosively and it is especially widespread in the clinical application of fabricating orthosis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. The 3D-printing technique makes it possible for physicians to easily create individual-tailored products. Recently, many kinds of orthosis through 3D printing have been studied and used. The knee orthosis, ankle-foot orthosis, wrist orthosis, hand orthosis, and foot orthotics are examples used in the rehabilitation fields of orthotics. We reported 3 cases of 3D-printed orthoses in patients with peripheral nerve injuries. PATIENTS CONCERNS: In spite of the rapid development of the clinical use of 3D printing, to our knowledge, its application to patients with peripheral nerve injuries has not yet been reported. Two patients suffered from upper limb problems and 1 patient had a foot drop associated with peripheral nerve injury. DIAGNOSIS: Three patients diagnosed with median neuropathy, ulnar neuropathy, and right lower lumbar radiculopathy, respectively, by electromyography. INTERVENTIONS: Herein we present 3 case reports of patients with peripheral nerve injuries whose orthotic needs were fulfilled with the application of 3D-printed wrist orthosis and ankle-foot orthosis. OUTCOMES: For hand function evaluation, we assessed the Jebsen-Taylor hand function test. Grasp and pinch powers were assessed by a hand dynamometer before and after orthosis application. For lower limb functional evaluation, we used a 6-minute walking test and modified Emory Functional Ambulation Profile for ambulatory function. LESSONS: The 3D-printed orthosis could help functional improvement in patients with peripheral nerve injuries.


Assuntos
Síndrome do Túnel Carpal/terapia , Aparelhos Ortopédicos , Impressão Tridimensional , Radiculopatia/terapia , Neuropatias Ulnares/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Arq Neuropsiquiatr ; 78(4): 224-229, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32294751

RESUMO

OBJECTIVE: The effects of vitamin D on the central and peripheral nervous system continue to be investigated today. In the present study, we aimed to evaluate pain and electrophysiologic response in patients with carpal tunnel syndrome (CTS) who have undergone replacement therapy due to vitamin D deficiency. METHODS: Fifty female patients diagnosed with mild and moderate CTS and accompanied by vitamin D deficiency were included in this study. Nerve conduction study (NCS) was performed before and after vitamin D replacement, and the patient's pain was evaluated with Visual Analogue Scale (VAS). RESULTS: When NCS were compared before and after treatment, there was a statistically significant improvement in the median distal sensory onset latency (DSOL) and sensory conduction velocity (CV) and motor distal latencies (DML) values (p=0.001; p<0.001; p=0.001, respectively). At the same time, there was a decrease in the VAS values in patients (p<0.001). When the two groups were compared there was an improvement in DSOL and sensory CV in both groups, but in DML only in moderate CTS group. CONCLUSION: In this study, it was shown that mild and moderate CTS patients had an improvement in pain and electrophysiological parameters after vitamin D replacement. Replacing vitamin D in early stages of CTS may be beneficial.


Assuntos
Síndrome do Túnel Carpal , Deficiência de Vitamina D , Feminino , Humanos , Nervo Mediano , Condução Nervosa , Dor , Vitamina D , Vitaminas
16.
PLoS One ; 15(4): e0231502, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32282809

RESUMO

PURPOSE: To assess whether there is a measurable impairment of median nerve conduction study parameters with uncomplicated distal radius fracture. METHODS: Patients were assessed prospectively at the time of cast removal (visit 1) after a standard 6-8 week immobilization for uncomplicated distal radius fracture. Patients with prior entrapment neuropathy or polyneuropathy were excluded. Patients were asked to report sensory symptoms. Median and ulnar motor and sensory conduction studies were performed bilaterally, as well as transcarpal stimulation. All electrophysiologic studies were repeated at a follow-up visit 2, on average 7.8 weeks later. RESULTS: 39 patients were assessed at visit 1 and 30 (77%) were available for follow-up visit 2. Paresthesia in the median territory on the fractured side were reported in 20% at visit 1 and 26% at visit 2. Electrophysiological evidence of only mild carpal tunnel syndrome was found on the fractured side in 4/39 at visit 1 and 6/30 at visit 2. There were only 2 cases of moderate-marked median neuropathy, both asymptomatic and on the unfractured side. Median motor and sensory latencies and amplitudes did not show statistically significant differences between fractured and unfractured sides with the single exception of median distal motor latency at visit 1. CONCLUSIONS: Median territory paresthesia at the time of cast removal following distal radius fracture are often not associated with electrophysiologic evidence of median neuropathy. Most median nerve electrophysiologic parameters do not significantly differ between the fractured and uninjured sides. Significant traumatic median neuropathy is not likely to be a frequent manifestation of uncomplicated distal radius fracture. LEVEL OF EVIDENCE: Diagnostic analysis, Level III.


Assuntos
Fenômenos Eletrofisiológicos/fisiologia , Nervo Mediano/fisiopatologia , Fraturas do Rádio/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Exame Neurológico/métodos , Estudos Prospectivos , Tempo de Reação/fisiologia , Nervo Ulnar/fisiopatologia , Adulto Jovem
17.
Artigo em Chinês | MEDLINE | ID: mdl-32306692

RESUMO

Objective: To investigate the occurrence of pain symptoms and risk factors of carpal tunnel syndrome (CTS) in automobile manufacturing workers and provide theoretical basis for the prevention of CTS. Methods: From Nov.5th to Nov.19th, 2017, 446 workers in an automobile factory whose work age was above one year participate in questionnaires by cluster sampling. Chi square test and multifactor logistics regression analysis were used to analyze the factors related to the occurrence of CTS pain symptoms in workers. Results: The incidence of CTS pain among workers in this automobile factory was 20.8%. Working in the same position for a long time (OR=2.137, 95% CI:1.183-3.862) and unable to work reasonably because of uncomfortable posture (OR =2.067, 95% CI: 1.075-3.974) were identified as the risk factors of CTS pain symptoms by multifactor logistics regression analysis. Working age (OR=0.537, 95%CI:0.311-0.926) and work break (OR= 0.489, 95% CI: 0.282-0.849) were identified as the benefit factors of CTS pain symptoms. Conclusion: The incidence of CTS pain in automobile manufacturing workers is related to the posture in the process of labor . Effective ergonomic interventions should be carried out to prevent the occurrence of CTS pain in automobile manufacturing workers.


Assuntos
Automóveis , Síndrome do Túnel Carpal/epidemiologia , Ergonomia , Indústria Manufatureira , Doenças Profissionais/epidemiologia , Humanos , Fatores de Risco
18.
Plast Reconstr Surg ; 145(5): 1197-1203, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332539

RESUMO

BACKGROUND: The authors conducted a prospective study to compare patients' intraoperative experience of open carpal tunnel release under "wide awake, local anesthesia, no tourniquet" (WALANT) on the one hand and intravenous regional anesthesia on the other. The authors hypothesized that WALANT would offer a better intraoperative experience than intravenous regional anesthesia. METHODS: Twenty-four patients with bilateral carpal tunnel syndrome had one hand operated on using WALANT and the contralateral hand with the intravenous regional anesthesia method. At the postoperative second hour, patients completed a questionnaire to quantify their pain levels on a numerical rating scale and compare the operation with dental procedures. They were also asked about their expectations and feelings about reoperation with the anesthesia methods. The results were compared for the two anesthesia methods. RESULTS: There were no significant differences between numerical rating scale pain values during anesthetic administration or for surgical site pain on the WALANT and intravenous regional anesthesia sides. Patients reported moderate tourniquet pain for intravenous regional anesthesia sides. For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than dental procedures (91.6 percent WALANT and 37.5 percent intravenous regional anesthesia). For WALANT sides, a significantly higher number of patients reported carpal tunnel release to be an easier procedure than they expected (91.6 percent WALANT and 50 percent intravenous regional anesthesia). For the reoperation, 83.3 percent of patients preferred WALANT, 8.3 percent preferred intravenous regional anesthesia, and 8.3 percent reported no preference. CONCLUSIONS: WALANT offered a better intraoperative experience. Tourniquet pain, preoperative preparation basics, and the extended anesthesia duration are likely the major drawbacks of the intravenous regional anesthesia method.


Assuntos
Anestesia Intravenosa/métodos , Anestesia Local/métodos , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/efeitos adversos , Dor Pós-Operatória/diagnóstico , Adulto , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Preferência do Paciente , Estudos Prospectivos , Torniquetes/efeitos adversos , Vigília
19.
Plast Reconstr Surg ; 145(5): 1204-1214, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332540

RESUMO

BACKGROUND: The first aim of this study was to determine the rate of revision carpal tunnel release in five urban hospitals over a period of 14 years. The secondary aim was to assess what demographic, condition-related, and treatment-related factors are associated with revision carpal tunnel release. METHODS: Between 2002 and 2015, 7464 patients underwent carpal tunnel release. After manually reviewing the medical records, the authors identified 113 patients who underwent revision surgery. Multivariable logistic regression analysis was performed to study association with demographics (age, sex, and race), unilateral or bilateral treated wrist(s) (including carpal tunnel release performed simultaneously and separately), and type of surgery (open or endoscopic). To gain further insight into these factors, a matched case-control analysis in a 1:3 ratio was performed. RESULTS: One hundred thirteen of 7464 patients (1.5 percent) underwent revision carpal tunnel surgery. The median (interquartile range) time to revision surgery was 1.23 years (0.47 to 3.89 years). In multivariable logistic regression analysis, older age, male sex, bilateral carpal tunnel release, and endoscopic carpal tunnel release were independently associated with higher odds for revision surgery. Multivariable conditional logistic regression of the matched case-control cohort showed that smoking and rheumatoid arthritis were independently associated with revision carpal tunnel release. Splint treatment before the initial surgery was independently associated with single carpal tunnel release. CONCLUSION: Endoscopic release, male sex, smoking, rheumatoid arthritis, and undergoing staged or simultaneous bilateral carpal tunnel release are risk factors for revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Síndrome do Túnel Carpal/epidemiologia , Estudos de Casos e Controles , Feminino , Hospitais Urbanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 139: 548, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32348893

RESUMO

Carpal tunnel syndrome represents compression of the median nerve in the carpal tunnel, which is defined by the carpal bones on the lateral, medial, and dorsal aspects and the transverse carpal ligament on the anterior aspect.1 Symptoms of carpal tunnel syndrome include paresthesia, anesthesia, paresis, and pain located in the median nerve distribution. In severe cases, there may be atrophy of median nerve-innervated thenar muscles. In the United States, carpal tunnel syndrome affects approximately 3.72% of the population.2 Conservative measures, such as bracing, steroid injections, and physical and occupational therapy, are commonly employed.1 However, many patients still require more definitive surgical management, which may be in the form of open or endoscopic procedures. Regardless of surgical approach, the clinical success rates of carpal tunnel release have been reported to be 75%-90%.3 Recurrence rates are 8.4%-15% over 4-5 years,4,5 with the lower end of this range representing the Agee single-portal technique. Endoscopic carpal tunnel release leads to reduced postoperative pain and an increase in transient neurologic deficits; however, no improvements have been reported in overall complication rate, subjective satisfaction, return to work, postoperative grip and pinch strength, and operative time.6 In this technical video, we present a case of single-incision endoscopic carpal tunnel release in a patient with severe symptoms after conservative measures failed. The patient experienced a noncomplicated postoperative course and demonstrated an excellent recovery at follow-up visits. Surgical decompression is an important treatment for refractory carpal tunnel syndrome, and videos such as this provide guidance for safe and effective treatment (Video 1).


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Endoscopia/métodos , Cirurgia Vídeoassistida/métodos , Eletromiografia/métodos , Feminino , Humanos , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade
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