Hour glass constriction in advanced carpal tunnel syndrome

Compressive neuropathy of median nerve is relatively common but development of an hourglass like constriction is a rare phenomenon. The purpose of this study is to show morphologic changes of median nerve in advances carpal tunnel syndrome. Eighty patients with thenar atrophy, anesthesia and paresthesia of first, second and third finger and severe changes of EMG-NCV were chosen for surgery. All the cases were operated by classic approach. At ten cases, nerve was constricted in point and in six patients' area constriction was seen. Internal and external neurolysis was performed in all the cases. In two of them because of the wide and severe constriction, resection and end-to-end repair was performed. All the patients have been examined periodically. Mean follow-up was 12 month [8-40]. According to grading, pain degree [from 8-9 pre operation to 3-4 post operation] and two point discrimination [from the mean of 14 mm [13-20 mm] to 8 mm [6-10 mm]] decreased. Grip power was increased from the mean of 10 kg to 21 kg. In 15 cases return of sensation, and in 13 cases improvement of opposition power was seen. We recommend epineurolysis for mild to moderate constriction and also end-to-end repair may be needed if extensive and severe constriction was found. It means that if we manage mild to moderate constriction sooner, it can prevent the need for further surgical procedure because of sever constriction

Translation and cultural adaptation of the oxford hip score for Iranian population

In recent years, outcome assessment related to orthopedic surgeries has increasingly focused on patient reported questionnaires. The Oxford Hip Score [OHS], self administered questionnaire, is a reliable, valid, and responsive instrument for assessing hip in patients undergoing Arthroplasty. The study involved 105 adult Persian speaking patients admitted for primary Total Hip Arthroplasty in two hospitals in Isfahan in Iran from September 2009 until April 2011. All of them filled out their scales [Persian OHS, WOMAC, and SF12] in preoperative examination. Mean scores of OHS in first administrations was 42.7 +/- 12.7. The Persian OHS overall score demonstrated high reproducibility [ICC,0.93, P < 0.001] and internal consistency [CA, 0.94]. Persian OHS had high correlations with WOMAC total score [r = 0.86], function score [r = 0.86], and pain score [r = 0.79], the relationship between the Persian OHS and the WOMAC stiffness subscale was somewhat lower [r = 0.69]. The correlation coefficient between the Persian OHS and the PCS of the SF-12 in our study was moderate [r = 0.58]. Persian OHS had low correlation with MCS of the SF-12 [r = 0.40]. Persian OHS had high correlations with WOMAC total score, function score, and pain score. It had moderate correlation with PCS of the SF-12 and low correlation with MCS of the SF-12. Our study demonstrated the trans-cultural adaptation and validation of the Persian OHS is a reliable and practicable instrument for assessment of function and pain in Iranian patients with hip osteoarthritis