Diagnostic Contradictions in Carpal Tunnel Syndrome / Contradições diagnósticas na síndrome do túnel do carpo

Abstract Objective Given the divergence of opinions on the need for complementary tests such as ultrasonography (US) and electroneuromyography (ENMG) for the diagnosis of carpal tunnel syndrome (CTS), we aimed to elucidate which of them presents greater accuracy for the confirmation of the presence or not of this condition. Methods A total of 175 patients from a hand surgery outpatient clinic were clinically evaluated, and the results of clinical trials (Tinel, Phalen and Durkan), US (normal or altered), and ENMG (normal, mild, moderate and severe) were noted, crossed, and submitted to a statistical analysis to verify the agreement between them. Results with the sample had a mean age of 53 years, with a prevalence of female patients (159 cases). Of the patients with positive clinical test, 43.7% had normal US and 41.7% had no alterations on the ENMG. Negative results were found on the Tinel in 46.9%, on the Phalen in 47.4%, and on the Durkan in 39.7%. In the crossing between the results of the ENMG and those of the other diagnostic methods, there was little statistical agreement between them. Conclusion There was no agreement between the results of the clinical examinations, the US and the ENMG in the diagnosis of CTS, and there is no clinical or complementary examination for CTS that accurately determines the therapeutic approach. Level of Evidence IV, Case Series.

Resumo Objetivo Diante da divergência sobre a necessidade de exames complementares, como ultrassonografia (US) e eletroneuromiografia (ENMG) para o diagnóstico da síndrome do túnel do carpo (STC), objetivamos elucidar qual deles apresenta maior precisão na confirmação da presença ou não desta afecção. Métodos Um total de 175 pacientes de um ambulatório de cirurgia da mão foram avaliados clinicamente, e os resultados dos testes clínicos (Tinel, Phalen e Durkan), da US (normal ou alterada) e da ENMG (normal, leve, moderada e grave) foram anotados, cruzados, e submetidos a análise estatística para verificar a concordância entre eles. Resultados A idade média da amostra era de 53 anos, sendo prevalente o sexo feminino (159 casos). Dos pacientes com teste clínico positivo, 43,7% apresentavam US normal, e 41,7%, ENMG sem alterações. Foram encontrados resultados negativos no Tinel em 46,9% no Phalen em 47,4%, e no Durkan em 39,7%. No cruzamento entre a ENMG e os demais métodos diagnósticos, houve pouca concordância estatística. Conclusão Não houve concordância entre os resultados dos exames clínicos, da US e da ENMG no diagnóstico da STC, e não há exame clínico ou complementar para STC que determine a conduta terapêutica com precisão. Nível de Evidência IV, Série de Casos.

Clinical and electrophysiological efficacy of extracorporeal shock-wave therapy in carpal tunnel syndrome: a placebo-controlled, double-blind clinical trial

SUMMARY OBJECTIVE: The aim of this study was to evaluate the efficacy of radial extracorporeal shock wave therapy on pain, functionality, and electrophysiological measurements in carpal tunnel syndrome. METHODS: Between June 2021 and January 2022, a total of 66 wrists in 45 participants with mild-to-moderate carpal tunnel syndrome were included in this double-blind, prospective, randomized, placebo-controlled study. Patients were randomized into two groups, namely, the radial extracorporeal shock wave therapy (group 1, n=33) and the sham radial extracorporeal shock wave therapy (group 2, n=33). Night splints and tendon nerve gliding exercises were given to all participants. The participants were evaluated at baseline and the first month after treatment. Participants were evaluated using a visual analog scale, the Boston Carpal Tunnel Questionnaire, Leeds Neuropathic Symptom and Symptom Assessment, and electrophysiological examinations. RESULTS: A total of 37 participants (a total of 55 wrists, radial extracorporeal shock wave therapy n=27, and sham radial extracorporeal shock wave therapy n=28) completed the study. After the intervention, there was a significant decrease in visual analog scale values (p<0.001) and a significant increase in Boston Carpal Tunnel Questionnaire scores (p<0.001) and Leeds Neuropathic Symptom and Symptom Assessment scores (p<0.001). In electrophysiological measurements, there was a significant decrease in median nerve sensory (p=0.002) and motor (p=0.003) distal latency, and a significant increase in median nerve sensory conduction velocity (p=0.026) was found in the radial extracorporeal shock wave therapy group. CONCLUSION: This study shows that radial extracorporeal shock wave therapy has positive effects on pain, functionality, and electrophysiological measurements for mild-to-moderate carpal tunnel syndrome 1 month after application.

Results of surgical treatment of carpal tunnel syndrome using two variations of open technique / Resultados do tratamento cirúrgico da síndrome do túnel do carpo por meio de duas variações da técnica aberta

ABSTRACT Transverse carpal ligament (TCL) opening is the treatment of choice for carpal tunnel syndrome. However, complications such as loss of grip strength and anterior displacement of the median nerve are described as common complications associated with this technique. Thus, techniques that reconstruct or extend TCL are described to reduce the incidence of these complications. Objective: To evaluate the effectiveness of TCL enlargement through Z-plasty and the reduction of complications by comparing it with the complete opening of the ligament. Materials and Methods: A prospective and randomized intervention study was conducted in 56 patients. They were divided into 2 groups: 1) complete opening of TCL 2) TCL enlargement via Z-plasty. We evaluated grip strength, sensitivity, and functional evaluation using the QuickDASH questionnaire. Results: There was no statistically significant difference in the improvement of scores with QuickDASH between the two techniques. The sensitivity test was better in patients subjected to TCL enlargement, whereas grip strength increased in the group subjected to complete TCL opening. Conclusion: According to the results of this study, the complete opening of the TCL showed no reduction in grip strength, although it showed inferior recovery to postoperative sensitivity. Both techniques were equivalent in functional improvement. Thus, Z-plasty showed no identifiable benefits for TCL enlargement. Level of Evidence III, Randomized Clinical Trial.

RESUMO A abertura completa do ligamento transverso do carpo (LTC) é o tratamento de escolha para a síndrome do túnel do carpo. No entanto, complicações como perda de força de preensão e deslocamento anterior do nervo mediano são complicações comuns associadas a essa técnica. Assim, descrevem-se técnicas que reconstroem ou alargam o LTC visando reduzir a incidência dessas complicações. Objetivo: Avaliar a efetividade do alargamento do LTC através de Z-plastia e a diminuição das complicações, comparando a técnica com a abertura completa do ligamento. Métodos: Realizou-se um estudo de intervenção, prospectivo e randomizado com 56 pacientes. Estes foram divididos em dois grupos: 1) abertura completa do LTC e 2) alargamento do LTC através de Z-plastia. Avaliamos força de preensão e sensibilidade e realizamos avalição funcional por meio do questionário Quick Disabilities of Arm, Shoulder and Hand (QuickDASH). Resultados: Não houve diferença estatisticamente significante na melhora dos escores entre as duas técnicas. O teste de sensibilidade teve melhores resultados nos pacientes submetidos ao alargamento do LTC, enquanto a força de preensão teve maior acréscimo no grupo submetido à abertura completa do LTC. Conclusão: A abertura completa do LTC não levou à redução da força de preensão, apesar de ter se mostrado inferior na recuperação da sensibilidade no pós-operatório. As duas técnicas foram equivalentes na melhora funcional. Dessa forma, não encontramos benefícios identificáveis na realização da Z-plastia para alargamento do LTC. Nível de Evidência III, Ensaio Clínico Randomizado.

Uso da técnica WALANT para tratamento cirúrgico da síndrome do túnel do carpo: revisão da literatura / Use of WALANT technique for surgical treatment of carpal tunnel syndrome: literature review

A síndrome do túnel do carpo é uma das patologias mais incidentes no membro superior; é a neuropatia compressiva mais comum, acarretando importante morbidade. Grande parcela dos acometidos necessitam de tratamento cirúrgico; desse modo, a técnica WALANT seria uma excelente opção para permitir maior celeridade do tratamento desses pacientes que o aguardam. Este estudo visa realizar uma revisão integrativa sobre a aplicação da técnica WALANT para tratamento cirúrgico da síndrome do túnel do carpo, ressaltando a eficácia e a segurança do procedimento. Foi realizada uma revisão integrativa na literatura, utilizando o descritor "Wide Awake Local Anestesia No Tourniquet". Aplicando os critérios de elegibilidade, foram selecionados 16 estudos nas bases de dados PubMed e BVS. Os estudos selecionados não relatam complicações associadas à aplicação da técnica WALANT. A técnica WALANT apresenta evidente eficácia e segurança para o tratamento cirúrgico da síndrome do túnel do carpo, sem relatos de complicações.

Carpal tunnel syndrome is one of the most common pathologies in the upper limb; it is the most common compressive neuropathy, causing significant morbidity. Many of those affected need surgical treatment; thus, the WALANT technique would be an excellent option to allow faster treatment of patients waiting for it. This study aims to carry out an integrative review on applying the WALANT technique for the surgical treatment of carpal tunnel syndrome, emphasizing the efficacy and safety of the procedure. An integrative literature review was performed using the "Wide Awake Local Anesthesia No Tourniquet" descriptor. Sixteen studies were selected from the PubMed and VHL databases, applying the eligibility criteria. The selected studies do not report complications associated with applying the WALANT technique. The WALANT technique has evident efficacy and safety for the surgical treatment of carpal tunnel syndrome, with no reports of complications.

Electrodiagnostic Testing Characteristics of Diabetic People with Carpal Tunnel Syndrome / Características eletrofisiológicas das pessoas diabéticas com síndrome do túnel do carpo

Abstract Objective The present study aimed to correlate electroneuromyography (ENMG) findings in diabetic and nondiabetic subjects with carpal tunnel syndrome (CTS). Methods In total, 154 patients were evaluated in a hand surgery outpatient clinic. All ENMG tests were bilaterally performed by a single neurologist. Qualitative variables were described for all patients with CTS according to their diabetic status, and the chi-squared test was used to reveal any association. A joint model was adjusted to determine the influence of diabetes on ENMG severity in CTS patients. Results The sample consisted of 117 women and 37 men, with an average age of 56.9 years old. Electroneuromyography demonstrated bilateral CTS in 82.5% of the patients. Diabetes was identified in 21.4% of the cases. Severe ENMG was prevalent. Conclusion There was no association between diabetes and ENMG severity in patients with CTS. Level of evidence IV, case series.

Resumo Objetivo O presente trabalho teve por objetivo verificar se existe correlação entre a síndrome do túnel do carpo (STC) e eletroneuromiografia (ENMG) de pacientes diabéticos e não diabéticos. Métodos Foram avaliados 154 pacientes em um ambulatório de cirurgia da mão. Todas as ENMGs avaliadas foram realizadas por um único neurologista, bilateralmente. As variáveis qualitativas foram descritas para todas as pessoas em acompanhamento devido à STC segundo a presença de diabetes e foi verificada a associação com uso do teste qui-quadrado. Foi ajustado o modelo conjunto para verificar a influência da diabetes na gravidade da ENMG em pacientes com STC. Resultados Foram incluídos no presente estudo 117 mulheres e 37 homens, com média de idade de 56,9 anos. Eletroneuromiografia demonstrando STC bilateral foi observada em 82,5% das pessoas. Pessoas diabéticas foram identificadas em 21,4% dos casos. Eletroneuromiografia com padrão grave foi prevalente. Conclusão Não houve associação entre a presença de diabetes e a gravidade da ENMG em pessoas com STC. Nível de evidência IV, série de casos.

Is there an association between the Hand Diagram and Electrodiagnostic Testing for Carpal Tunnel Syndrome? / Existe associação entre o diagrama da parestesia da mão e a eletroneuromiografia no diagnóstico da Síndrome do Túnel do Carpo?

Abstract Objective Verify if there is an association between the hand diagram of paresthesia (HDP) and the results of electroneuromyography (ENMG) in the diagnosis of carpal tunnel syndrome. Methods A total of 92 people filled in a schematic drawing of the hand with the exact location of the paresthesia (167 hands). The main author classified the diagrams according to the criteria of Katz et al.5 The results of the HDP were crossed with the positive results of ENMG for the diagnosis of carpal tunnel syndrome. Results The possible pattern of the HDP was prevalent both in isolation and after crossing with the degrees of ENMG. Conclusion There was no association between the HDP and ENMG in the diagnosis of carpal tunnel syndrome.

Resumo Objetivo Verificar se existe associação entre o diagrama da parestesia da mão (DPM) e os resultados da eletroneuromiografia (ENMG) no diagnóstico da síndrome do túnel do carpo. Métodos Um total de 92 pessoas preencheram um desenho esquemático da mão com o local exato da parestesia (167 mãos). O autor principal classificou os diagramas de acordo com os critérios de Katz et al. Os resultados do DPM foram cruzados com os resultados positivos da ENMG para o diagnóstico da síndrome do túnel do carpo. Resultados O padrão possível do DPM foi prevalente tanto isoladamente quanto após o cruzamento com os graus da ENMG. Conclusão Não houve associação entre o DPM e a ENMG no diagnóstico da síndrome do túnel do carpo.

Profile of patients with carpal tunnel syndrome treated at a referral service / Perfil de pacientes com síndrome do túnel do carpo atendidos em um serviço de referência

ABSTRACT Objective: To describe the clinical and epidemiological characteristics of people diagnosed with carpal tunnel syndrome (CTS) treated at a hand surgery outpatient clinic of a regional referral service. Methods: Interview and specific medical examination of 150 people diagnosed with CTS underwent, and statistical analysis of the results obtained. Results: Women smokers, in the fifth decade of life, married, overweight and educated until the elementary level prevailed in our study. Arterial hypertension and diabetes were the most reported comorbidities, and Durkan's test was the most prevalent. Conclusion: CTS is prevalent in women in their fifth decade of life, with bilateral involvement and high school. The hypertension and diabetes are the most common diseases in people with CTS. Level of evidence IV, Case series.

RESUMO Objetivo: descrever as características clínicas e epidemiológicas das pessoas diagnosticadas com síndrome do túnel carpal (STC) atendidas em um ambulatório de cirurgia da mão de um serviço de referência regional. Métodos: Entrevista e exame médico específico de 150 pessoas diagnosticadas com STC e análise estatística dos resultados obtidos. Resultados: Houve prevalência de mulheres tabagistas, na quinta década de vida, casadas, com nível de instrução até o nível fundamental. Hipertensão arterial sistêmica e diabetes foram as comorbidades mais relatadas e o teste de Durkan foi o mais prevalente. Conclusão: A STC é prevalente em mulheres na quinta década de vida, com acometimento bilateral e nível de escolaridade até o ensino médio. Hipertensão e diabetes são as comorbidades mais frequentes em pessoas com STC. Nível de evidência IV, Série de casos.

Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome / Responsividade eletrofisiológica e desfechos clínicos da injeção local de corticosteroide no tratamento da síndrome do túnel do carpo

ABSTRACT Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. Objective: The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. Methods: Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. Results: A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). Conclusion: Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.

RESUMO A síndrome do túnel do carpo (STC) é a mononeuropatia mais comum causada pelo aprisionamento do nervo mediano no punho. Opções comuns de tratamento para STC incluem analgésicos orais, splinting, terapia de mão, injeções locais com esteroides ou cirurgia. Objetivo: O objetivo do presente estudo foi avaliar os resultados clínicos e eletrofisiológicos de curto prazo da injeção de corticosteroide local (ICL) em pacientes com STC sintomática. Métodos: Os parâmetros eletrofisiológicos foram avaliados antes e três meses após a ICL. Além disso, a Escala Numérica de Avaliação (NRS), a Escala de Gravidade de Sintomas de Boston (BSS) e a Escala de Status Funcional (FSS) foram administradas antes e após a injeção. Uma mistura de 1 ml (40 mg) de metilprednisolona e 1 ml de bupivacaína a 0,5% foi injetada cegamente no lado do antebraço entre os tendões do músculo flexor radial do carpo e o músculo palmar longo. Resultados: Um total de 25 pacientes (45 mãos) foi incluído no estudo. Vinte mulheres e cinco homens com idade média de 49,28 ± 11,37 anos foram incluídos. Foi observada diferença estatisticamente significante para melhora das velocidades de condução sensitiva, latência de pico sensorial, latência motora distal (p = 0,001) após a ICL. Uma diferença significativa foi registrada entre pré e pós-injeção para os escores NRS, BSS e FSS (p = 0,000). Conclusão: A ICL para STC fornece uma melhoria a curto prazo em resultados neurofisiológicos e clínicos, tais como intensidade da dor, gravidade dos sintomas e capacidade funcional.

Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.

A correlation between clinical severity and functional state with nerve conduction studies findings in patients with carpal tunnel syndrome: a systematic review / Correlação entre gravidade clínica e estado funcional com achados eletroneuromiograficos, em pacientes com síndrome do túnel do carpo: uma revisão sistemática

Carpal Tunnel Syndrome is the most common compressive neuropathy in the general population, and it may lead to disabling symptoms and significant functional limitation. This systematic review covered Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS, and SCIELO databases, with no time or language delimitations. The PICO strategy defined the search strategy with keywords extracted from the Medical Subjects Headings, and the quality of the studies was evaluated by the Agency for Healthcare Research and Quality (AHRQ) scale. Overall, 857 studies were identified, of which only 10 fulfilled the inclusion criteria. Despite the good results shown, a noticeable heterogeneity was observed among the studies included, associated with methodological discrepancy and to limited sample size in a few of them. Four studies showed no correlation between electrophysiological findings and clinical symptoms and signs, whereas three could demonstrate such association and other three studies had equivocal results. Other studies are necessary, with better methodological standards and more homogeneous and precise evaluations, so as to improve the level of scientific evidence

A síndrome do Túnel do Carpo é a neuropatia compressiva mais frequente na população geral que pode levar a sintomas incapacitantes e significativa limitação funcional. Uma revisão sistemática foi realizada nas bases de dados Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS e SCIELO, sem delimitação de tempo ou idioma. Utilizou-se da estratégia PICO para a pesquisa, palavras-chave extraídas dos Descritores de Ciências da Saúde (Decs) e a qualidade dos estudos foi avaliada através da escala Agency for Healthcare Research and Quality (AHRQ). Identificaram-se 857 estudos dos quais, somente 10 obedeceram aos critérios de inclusão. Apesar dos bons resultados apresentados, verificou-se uma expressiva heterogeneidade existente entre os estudos incluídos, associado à discrepância metodológica, e um limitado tamanho amostral em alguns deles. São necessários estudos com melhor padrão metodológico, bem como avaliações mais homogêneas e precisas, a fim de melhorar o nível de evidência científica

Descripción electrofisiològica del síndrome de túnel carpiano según edad en pacientes adultos / Electrophysiological severity of carpal tunnel syndrome according to age in adult patients

Background: Carpal tunnel syndrome (CTS) represents 90% of entrapment neuropathies. Severity may be greater in older patients. Aim: To describe the electrophysiological findings in adult patients with CTS and determine if severity is related to age. Material and Methods: Descriptive and retrospective study of electrophysiological findings in patients over 18 years of age with clinical suspicion of CTS, studied between January 2011 and December 2015. Neurophysiological severity was classified in 3 grades, comparing them by age, gender and laterality. Results: Of 1156 patients subjected to electrophysiological studies due to a clinical suspicion of CTS, 690 (60%) had electrophysiological features of the disease. In 274 patients (24%) the compromise was mild, in 162 (14%) it was moderate and in 254 (22%) it was severe. There was a positive association between age and CTS severity (p < 0.01). Severity was significantly greater in males than females (p < 0.01). Bilateral CTS was present in 471 patients (68%), which was associated with increased age and severity (p < 0.01). Conclusions: Electrophysiological severity in CTS increases with age. Other factors associated with higher severity are male gender and bilateral disease.

Upper limb nerve injuries caused by intramuscular injection or routine venipuncture

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection or routine venipuncture are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery. Recognizing competent level of anatomy and adept skill of needle placement are crucial in order to prevent this complication. If a patient notices any experience of abnormal pain or paresthesia during the needle procedures, an administrator should be alert to the possibility of nerve injury and should withdraw the needle immediately. Careful monitoring of the injection site for hours is required for early detection of nerve injury.

Proximal Median Neuropathy Caused by Axillary Brachial Plexus Block

An axillary brachial plexus block (BPB) is commonly used in local anesthesia, especially for hand surgery. Infraclavicular brachial plexopathy is a potential complication of axillary BPB. A 44-year-old man with an injury to his left third fingertip presented with weakness of the left thumb and index finger flexion after orthopedic surgery under axillary BPB. This was a rare case of proximal median neuropathy caused by axillary BPB. The diagnosis was confirmed by a detailed neurological examination and electrodiagnostic studies.

A Patient With Focal Dystonia That Occurred Secondary to a Peripheral Neurogenic Tumor: A Case Report

Dystonia is a movement disorder characterized by involuntary muscle contractions. Patients with dystonia may experience uncontrollable twisting, repetitive movements, or abnormal posture. A 55-year-old man presented with an involuntary left forearm supination, which he had experienced for five years. There was no history of antecedent trauma to the wrist or elbow. Although conventional therapeutic modalities had been performed, the symptoms persisted. When he visited our hospital, electromyography was performed. Reduced conduction velocity was evident at the elbow-axilla segment of the left median nerve. We suspected that there was a problem on the median nerve between the elbow and the axilla. For this reason, we performed an ultrasonography and magnetic resonance imaging study. A spindle-shaped soft tissue mass was observed at the left median nerve that suggested the possibility of neurofibroma. Dystonia caused by traumatic or compressive peripheral nerve injury has often been reported, but focal dystonia due to a neurogenic tumor is extremely rare. Here, we report our case with a review of the literature.

Estudo prospectivo da sensibilidade tátil em mãos de uma população brasileira usando pressure-specified sensory device / Prospective study on tactile sensitivity in the hands of a brazilian population using the pressure-specified sensory device

OBJETIVO: Avaliar os limiares de percepção da pressão em polpas de dois dedos (indicador e mínimo), em uma população brasileira, sem lesão nervosa ou neuropatia. MÉTODOS: Usamos Pressure-Specified Sensory Device, um equipamento computadorizado para obter limiares de percepção da pressão normal, tanto estáticos quanto dinâmicos, e discriminação de dois pontos. RESULTADOS: Testamos a sensibilidade nos dedos, em 30 voluntários. Os testes de significância foram realizados utilizando o teste t de Student. Os valores médios (g/mm²) para os limiares de pressão estática de um e dois pontos (s1PD, s2PD) e discriminação dinâmica de um e dois pontos (m1PD, m2PD) no dedo indicador dominante foram: s1PD = 0,4, m1PD = 0,4, s2PD = 0,48, m2PD = 0,51. CONCLUSÃO: Não há diferença significativa na sensibilidade entre as mãos dominante e não dominante.

OBJECTIVE: To evaluate the pressure perception thresholds on the pulp of two fingers (index and little fingers), among a Brazilian population with no nerve injury or neuropathy. METHODS: We used the Pressure-Specified Sensory Device (a computerized device) to derive static and dynamic normal pressure perception thresholds and two-point discrimination distances. RESULTS: We tested finger sensitivity on 30 volunteers. Significance analyses were performed using the Student t test. The mean values (g/mm²) for static one and two-point pressure thresholds (s1PD, s2PD) and dynamic one and two-point discrimination (m1PD, m2PD) in the dominant index finger were: s1PD = 0.4, m1PD = 0.4, s2PD = 0.48, m2PD = 0.51. CONCLUSION: There was no significant difference in sensitivity between the dominant and nondominant hands.

Clinical Applications of Neural Stem Cells for the Treatment of Peripheral Neuropathy / 한양의대학술지

Extraordinary advances in stem cell research have initiated an era of hope for strategies to treat intractable human diseases. Personalized regenerative treatment using stem cells is expected to accelerate continuous investment and research efforts throughout the world. Despite of their constraints, adult stem cells and embryonic stem cells have been used for cell transplantation for several intractable diseases. Besides adult and embryonic stem cells, the recent studies of induced pluripotent stem cells widened the possibility of patient-specific cell therapy, drug discovery, and disease modeling. This review focuses on the developments and potential applications of the stem cells for the treatment of peripheral neuropathy.

Laserterapia de baixa intensidade no pós-operatório da síndrome do túnel do carpo / Low-level laser therapy after carpal tunnel release

OBJETIVO: Avaliar o tratamento pós-operatório da síndrome do túnel do carpo (STC), utilizando-se a laserterapia de baixa intensidade (LBI). MÉTODO: Foram avaliados prospectivamente 58 pacientes portadores de STC, divididos aleatoriamente em dois grupos: tratamento com LBI (grupo 1) e placebo (grupo 2). Foi utilizado laser de 830nm, de gálio-alumínio-arsênico, e potência de 30mW. RESULTADOS: Houve predominância do sexo feminino, em ambos os grupos. A média de idade dos pacientes do grupo 1 foi de 44,3 anos e do grupo 2, de 51,9 anos. A média do tempo de evolução da doença foi aproximadamente dois anos em ambos os grupos. A média do tempo decorrido para alta do tratamento foi de 3,6 meses, em ambos os grupos, com menor número de pacientes queixosos no pós-operatório do grupo 1 do que do grupo 2. Ao fim do tratamento, no grupo 1, 29,41 por cento dos pacientes apresentavam eletroneuromiografia alterada, enquanto que, no grupo 2, foram 63,64 por cento dos pacientes após seis meses. CONCLUSÕES: Trata-se de estudo inicial sobre a terapêutica adjuvante utilizando LBI no pós-operatório da STC. A metodologia apresentada foi suficiente para a avaliação pós-operatória dos pacientes do estudo. Os pacientes submetidos à LBI após a cirurgia para STC foram beneficiados e obtiveram melhores resultados funcionais quando comparados ao grupo controle. A técnica foi eficaz e sem efeitos adversos nos pacientes estudados.

OBJECTIVE: Evaluate the post-operative treatment of CTS, using the LLLT. METHOD: We prospectively evaluated 58 patients with CTS, randomly divided into two groups: treatment with LLLT (Group 1) and placebo (Group 2). A 830 nm gallium-aluminum-arsenic laser was used, with a power of 30 mW. RESULTS: There was female predominance in both groups. The mean age of the patients in Group 1 was 44.3 years and in Group 2, 51.9 years. The average duration of disease progression was around two years in both groups. The average time elapsed since discharge from treatment was 3.6 months in both groups, and fewer patients had postoperative complaints in Group 1 than in Group 2. At the end of the treatment, in Group 1, 29.41 percent of the patients presented electromyographic abnormalities, while in Group 2, 63.64 percent of the patients had abnormalities, after six months. CONCLUSION: This was an initial study on adjuvant therapy using postoperative LLLT on CTS. The method presented was sufficient for postoperative evaluation of the patients in this study. Patients undergoing LLLT after surgery for CTS were benefited and had better functional outcomes than shown by the control group. The technique was effective and did not have any adverse effects on the patients studied.

Median Nerve Injury after Liposuction of Upper Arm

Liposuction of upper arm is often performed to attain muscular definition of arms and correct lipodystrophy, referred to as the "Bat-wing deformity", with scarless results compared to brachyplasty. Many complications, however, have been reported with this procedure, including hematoma, irregularity, inadequate skin retraction, and so on. Authors hereby report one of serious complications, which is a median nerve injury after liposuction of upper arm. A 51 years old woman underwent liposuction on both arms at a private clinic. Immediately after procedure, the patient complained bullae formation and color change on medial side of left arm, and tingling sensation on left hand. She was transferred to our hospital with necrotic wounds, swelling on left arm, and severe pain. Several evaluations were made, resulting in diagnosis of median nerve injury and CRPS(complex regional pain syndrome). Necrotic wound was treated by debridement and primary closure. Prednisolon(60mg; Kukje Pharm, Korea) was used for median nerve injury, and pain was managed by PCA(patient controlled analgesia). We should be aware of such complications that can occur during the liposuction on upper arm. Through this experience, we must pay attention to important structures, especially the medial bicipital groove, and avoid the injury of median nerve.

Nerve Conduction Study of Electrophysiologically Defined Severe Carpal Tunnel Syndrome Before and After Surgical Release

BACKGROUND: A nerve conduction study (NCS) is a useful method to diagnose and evaluate the therapeutic effect of carpal tunnel syndrome (CTS). Severe CTS often shows evidence of axonal injury, which may lead to incomplete recovery of symptoms or NCS abnormalities. To evaluate the degree of NCS recovery after decompression in patients with severe CTS, we studied NCS before and after surgical release in severe CTS with electrophysiological evidence of axonal injury. METHODS: We analyzed the NCS changes in 17 patients (21 hands) with severe CTS just before and 1 year after CTS release. The severe CTS was electrophysiologically defined with the following criteria; 1) prolonged median sensory and motor distal latencies, 2) either an absent SNAP or low amplitude/absent thenar CMAP, and 3) abnormal needle EMG findings. The patients averaged 53.3 years of age and all were females. RESULTS: The mean interval between the first and second NCS was 20.5 months and post-operation symptoms were free in 8 hands, markedly (>50%) improved in 11 hands, and symptoms remained (< 50%) in 2 hands. In 13 hands, SNAPs were not elicitable before surgery, but all were obtainable after surgery. One patient who had no CMAP did not show recovery after surgery. The mean median sensory latency, SNAP amplitude, and sensory NCV over the finger-wrist segment improved significantly (P < 0.05). The mean median motor latency and CMAP amplitude also improved significantly (P < 0.05). The parameters of NCS, however, showed incomplete and subnormal recovery after decompression except for sensory latency, amplitudes of SNAP and CMAP which recovered to the normal range. CONCLUSIONS: After CTS release even with electrophysiologically defined severe CTS patients, there were significant improvements of clinical symptoms and electrophysiological parameters. However, only some parameters(median sensory latency, SNAP amplitude and CMAP amplitude) were restored to the normal range.