ABSTRACT
A remarkable number of out patients referred to physical medicine, orthopedic, neurologic clinics are the ones with the chief complaint of sensory-motor dysfunction in the distribution of median nerve on hands and upper limbs. Usually, it is thought these symptoms and singns are due to carpal tunnel syndrome [CTS] existence. However, in the majority of cases symptoms are not eliminated in spite of the most invasive treatments [e.g. surgical release of median nerve at wrist]. Further studies such as electrodiagnosis confirm radiculopathy in these patients. Several studies in past years have estimated the synchronous prevalence of CTS and Radiculopathy to be 22 to 70 percent. On the basis of these the double crush syndrome theory has been suggested. Estimation of synchronous prevalence of CTS and radiculopathy is a way to confirm this theory. This study is a descriptive study. The patients studied were persons with the numerous complaints in the upper limb and cervical area that had existence of radiculopathy in them been confirmed by several means such as physical examination and Electrodiagnosis. 183 patients were entered in the study and they considered from the aspect of synchronous prevalence of CTS. From 183 patients entered in the study, due to bilateral radiculopathies in both upper limbs in some patients, the total number of upper limbs studied were 264. Among them the existence of synchronous CTS in 96 upper limbs was confirmed [36.6%]. Percentages of different roots radiculopthies prevalence were as following: [C6]; 75%, [C7]: 93.75% and [C8]: 3.12%. According to 36.6% prevalence of synchronous CTS in patients with cervical radiculopathy, this rate is less than that of previous studies but more than that of recent studies. Although frequency of involved roots in this study doesn't fit with previous studies but match with electrodiagnosis texts
Subject(s)
Humans , Prevalence , Radiculopathy , Electrodiagnosis , Upper ExtremityABSTRACT
Application of transcranial magnetic stimulation as a prognostic tool in stroke patients is a new method. in the present study, we used transcranial magnetic stimulation of the motor cortex to evaluate the functional state of corticospinal pathway innervated the first dorsal interosseous muscle and we have assessed the prognostic value of this study on prediction of motor function recovery. We have assessed 34 patients that experience first ever acute ischemic stroke in the middle cerebral artery territory and had complete hand palsy. All patients were clinically evaluated and tested with transcranial magnetic stimulation within the first 24 hours after onset of stroke. Patients were divided into three group, according to the amplitude of the motor evoked potential [MEP] at day1. These testes were repeated at day 14. Then, Correlation between clinical evaluation at day 14 and eleotrophysiologic results at day1 was investigated. After 2 weeks, all patients that their MEP were at the normal range, showed some hand muscle motor function recovery, whereas 25 of 27 patients with initially absent or small MEP were left with complete hand palsy. There was strong positive correlation between MEP amplitude at day1 and improvement of muscle strength at day 14 [P<0.001]. Also, measurement of central motor conduction time showed the same results [P=0.0001]. This study showed that transcranial magnetic stimulation of the motor cortex is a useful device for prediction of motor function recovery in patients with ischemic stroke