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1.
Article in English | LILACS, BBO | ID: biblio-1365230

ABSTRACT

ABSTRACT Over the past year and a half dental education has been conducted primarily online due to the SARS-CoV-2 pandemic. During the pandemic, we have spent many hours a day on our computers, mobile phones, and tablets to gather information and participate in online seminars and classrooms. Health consequences resulting from the overuse of these devices include carpal tunnel syndrome as well as computer vision syndrome (CVS). Computer vision syndrome, also known as digital eye strain, has several associated features such as eye burning, strained vision, dry eye, blurred vision, and associated neck and shoulder pain. Several predisposing factors have been linked with CVS, but often this problem gets ignored. The management of this syndrome is aimed at educating dentists on computer use, position, and the surrounding environment. Considering all this, we must ensure that we spend some time away from these devices every day to avoid any significant vision problems. The objective of preparing this manuscript was to provide a brief overview of the increased prevalence of computer vision syndrome and its associated features.


Subject(s)
Vision Disorders/prevention & control , Artificial Intelligence , Dentists , Eye Diseases/prevention & control , COVID-19/complications , Microcomputers , Carpal Tunnel Syndrome , Prevalence , Risk Factors , Education, Dental , Screen Time , India
2.
Prensa méd. argent ; 107(7): 381-392, 20210000. fig, tab
Article in English | LILACS, BINACIS | ID: biblio-1358982

ABSTRACT

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluían el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas para los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides. Los datos clínicos, las puntuaciones de CSA-MN antes de la inyección en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejora en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa


The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of preinjection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1-, 3-, and 6-months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections The clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury


Subject(s)
Humans , Steroids/therapeutic use , Carpal Tunnel Syndrome/therapy , Ultrasonography , Controlled Clinical Trial , Saline Solution/therapeutic use , Injections
3.
Medicina (B.Aires) ; 81(3): 318-322, jun. 2021. graf
Article in English | LILACS | ID: biblio-1346465

ABSTRACT

Abstract Carpal tunnel syndrome is median nerve symptomatic compression at the level of the wrist, characterized by increased pressure within the carpal tunnel and decreased nerve function at the level. Carpal tunnel release decreases pressure in Guyon's canal, via open techniques, with symptom and two-point discrimination improvement in the ulnar nerve distribution. We hypothesize that endoscopic carpal tunnel release improves two-point discrimination in the ulnar nerve distribution as well. This study includes 143 patients who underwent endoscopic carpal tunnel release between April 2016 to June 2019 in a single, community-based teaching hospital. A comprehensive retrospective chart review was performed on patient demographics, preand post-operative two-point discrimination test results, and complications. The effects of sex, age, and diabetes mellitus in the ulnar and median nerve territories with two-point discrimination tests were analyzed. As well as the differences in two-point discrimination among patient's based on their smoking status. There were significant post operative improvements in both the median (7.7 vs 4.4 mm, p < 0.001) and ulnar (5.7 vs 4.1 mm, p < 0.001) nerve territories. Smoking status, sex, age and diabetes did not significantly affect two-point discrimination outcomes. In conclusion the endoscopic release of the transverse carpal ligament decompresses the carpal tunnel and Guyon's canal, demonstrating improvement in two-point discrimination in both the ulnar and median nerve distributions.


Resumen El síndrome de túnel carpiano es la compresión sintomática del nervio mediano al nivel de la muñeca. Se caracteriza por un aumento de presión dentro del túnel y una disminución de la función del nervio a ese nivel. La liberación del túnel carpiano descomprime el canal de Guyon, con mejoría sintomática y en la prueba de discriminación de dos puntos en la distribución del nervio cubital. Hipotetizamos que la liberación endoscópica mejora de la misma manera en la distribución del nervio cubital. Este trabajo incluye 143 pacientes que tuvieron liberación endoscópica del túnel carpiano entre abril del 2016 y junio del 2019 en un hospital Universitario de la comunidad. Se evaluaron retrospectivamente las historias clínicas para los datos demográficos, los resultados pre y post quirúrgicos en la prueba de discriminación de dos puntos y complicaciones. Se analizaron los efectos del sexo, edad, tabaco y diabetes en los resultados de la prueba de discriminación de dos puntos para los nervios cubital y mediano. Hubo mejoría significativa post quirúrgica en la prueba de discriminación de dos puntos para los nervios mediano (7.7 vs 4.4 mm, p < 0.001) y cubital (5.7 vs 4.1 mm, p < 0.001). Fumadores, sexo, edad, y diabetes no afectaron de forma significativa. Concluimos que la liberación endoscópica del ligamento transverso del carpo descomprime el túnel carpiano y el canal de Guyon con mejoría en la prueba de discriminación de dos puntos para los nervios cubital y mediano.


Subject(s)
Humans , Carpal Tunnel Syndrome/surgery , Median Nerve , Ulnar Nerve , Wrist , Retrospective Studies
4.
Rev. bras. ortop ; 56(3): 346-350, May-June 2021. tab
Article in English | LILACS | ID: biblio-1288666

ABSTRACT

Abstract Objective The present study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure (n = 34). These findings were compared with a retrospective cohort submitted to ET (n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.


Resumo Objetivo Determinar a frequência do aparecimento de dedo em gatilho (DG) no pós-operatório da síndrome do túnel do carpo (STC) em duas técnicas: aberta (TA) e endoscópica (TE). Como desfecho secundário, comparar as taxas de remissão da parestesia e dor residual entre as duas técnicas. Métodos De forma prospectiva, verificamos o aparecimento de dedo em gatilho e taxa de remissão da parestesia e dor no território do nervo mediano em série de pacientes adultos operados pela TA (n = 34). Comparamos com coorte retrospectiva operada pela TE (n = 33), pela mesma equipe de cirurgiões. A avaliação dos pacientes ocorreu por meio de questionário estruturado em consulta de retorno, com mínimo de 6 meses de pós-operatório. Resultados Sessenta e sete pacientes foram avaliados. Não houve diferença quanto ao aparecimento de dedo em gatilho (TA, 26,5% versus TE, 27,3%; p = 0,94) e dor (TA, 76,5% versus TE, 84.8%; p = 0,38). Os pacientes operados pela TA apresentaram menos queixas de parestesia do que os operados pela TE (TA 5,9% versus TE 24,2%; p = 0,03). Conclusões Em nossa série, a técnica cirúrgica não influenciou o aparecimento de dedos em gatilho e dor residual. Os pacientes operados pela técnica aberta apresentaram menos queixa de parestesia residual pós-operatória.


Subject(s)
Humans , Male , Female , Adult , Paresthesia , Comparative Study , Carpal Tunnel Syndrome , Surveys and Questionnaires , Endoscopy , Trigger Finger Disorder , Median Nerve
5.
Rev. bras. ortop ; 56(3): 356-359, May-June 2021. tab
Article in English | LILACS | ID: biblio-1288663

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Paresthesia , Carpal Tunnel Syndrome , Median Neuropathy , Diabetes Mellitus , Electromyography
6.
Prensa méd. argent ; 107(2): 118-128, 20210000. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1361454

ABSTRACT

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después 21. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve 2017 June 16. doi: 10.1002/mus.25723. 22. Smith J, Wisniewski S, J, Finnoff JT, Payne JM. Sonographically Guided Carpal Tunnel Injections. J Ultrasound Med 2008;27:1485-1490. 23. Trescott AME. Peripheral Nerve Entrapments: Clinical Diagnosis and Management. Switzerland: Springer International Publishing; 2016 24. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2002(4). 25. Atroshi I, Flondell M, Hofer M, Ranstam J. Methyprednisolone Injections for the Carpal Tunnel Syndrome: A randomized Placebo-Controlled Trial. Ann Int Med 2013;159:309-317. 26. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC family practice 2010;11:54. 27. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlledtrial. Mayo Clinic proceedings 2017;92:1179-1189. 28. Kirwan J. Is there a place for intra-articular hyaluronate in osteoarthritis of the knee? The Knee 2001;8:93-101. 29. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Jr., et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: Ameta-analysis of evidence level 1 studies. The American journal of sports medicine 2017;45:2647-2653. 30. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56(11):1459­ 66 31. Ortiz-Corredor F, Enriquez F, Diaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 2008;119:1373-1378 32. Gordon T, Brushart TM, Chan KM. Augmenting nerve regeneration with electrical stimulation. Neurol Res 2008; 30:1012- 1022. 33. Aulisa L, Tamburrelli F, Padua R, Romanini E, Lo Monaco M, Padua L. Carpal tunnel syndrome: Indication for surgical treatment based on electrophysiologic study. J Hand Surg Am 1998; 23:687-691. 34. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom- de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54. 35. Girlanda P, Dattola R, Venuto C, Mangiapane R, Nicolosi C, Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and longterm efficacy. J Neurol. 1993; 240(3):187- 190. 36. Karadas¸ Ö, Tok F, Ulas¸ UH, Odabas¸i Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double blind randomized clinical trial. Am J Phys Med Rehabil. 2011; 90(4):287-292. 128 LA PRENSA MÉDICA ARGENTINA Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome V.107/Nº 2 de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluyen el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas de los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides; los datos clínicos, la preinyección de CSA-MN en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejoría en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa.


The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of pre-injection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1, 3, and 6 months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections the clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury.


Subject(s)
Humans , Steroids/therapeutic use , Carpal Tunnel Syndrome/therapy , Ultrasonography , Treatment Outcome , Adrenal Cortex Hormones/therapeutic use , Minimally Invasive Surgical Procedures , Dissection , Saline Solution/therapeutic use , Injections
7.
Rev. bras. ortop ; 56(1): 74-77, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288644

ABSTRACT

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.


Subject(s)
Humans , Carpal Tunnel Syndrome , Median Neuropathy , Electromyography
8.
Rev. bras. ortop ; 56(1): 69-73, Jan.-Feb. 2021. tab
Article in English | LILACS | ID: biblio-1288659

ABSTRACT

Abstract Objective To verify whether there is an association between the results of the severity in electroneuromyography and the positivity in ultrasound in the diagnosis of carpal tunnel syndrome. Methods Sixty-eight patients were included in the study, 61 women and 7 men, with a mean age of 54.4 years. The ultrasound results (positive or negative) were crossed with the results of electroneuromyography (mild, moderate or severe), and the existence of association was verified. Results One hundred and thirty-six hands with suspicion or symptoms of carpal tunnel syndrome were evaluated. Positive ultrasound diagnosis was observed in 72 hands and negative in 64; 123 hands presented positive electroneuromyography for carpal tunnel syndrome, and there were 13 negative results. The severe degree in electroneuromyography was prevalent. Conclusion There was a statistically significant association between electroneuromyography and ultrasonography (p < 0.05), and ultrasound positivity was higher for more severe levels of carpal tunnel syndrome given by electroneuromyography.


Resumo Objetivo Verificar se existe associação entre os resultados da gravidade da eletroneuromiografia e a positividade da ultrassonografia no diagnóstico da síndrome do túnel do carpo. Métodos Sessenta e oito pacientes foram incluídos no estudo, sendo 61 mulheres e 7 homens, com média de idade de 54,4 anos. Os resultados da ultrassonografia (positivo ou negativo) foram cruzados com os resultados da eletroneuromiografia (leve, moderado ou grave) e verificada a existência de associação. Resultados Cento e trinta e seis mãos com suspeita ou sintomas de síndrome do túnel do carpo foram avaliadas. O diagnóstico ultrassonográfico positivo foi observado em 72 mãos e negativo em 64; 123 mãos apresentaram eletroneuromiografia positiva para síndrome do túnel do carpo e 13 apresentaram resultado negativo. O grau grave da eletroneuromiografia foi prevalente. Conclusão Houve associação estatisticamente significativa entre eletroneuromiografia e ultrassonografia (p < 0,05), sendo que a positividade da ultrassonografia foi maior para níveis mais graves de síndrome do túnel do carpo dados pela eletroneuromiografia.


Subject(s)
Humans , Male , Female , Middle Aged , Signs and Symptoms , Carpal Tunnel Syndrome , Ultrasonography , Negative Results
9.
Article in Chinese | WPRIM | ID: wpr-921935

ABSTRACT

OBJECTIVE@#To investigate the efficacy of self-made arthroscopic single channel in the treatment of carpal tunnel syndrome.@*METHODS@#Sixty patients with primary carpal tunnel syndrome treated from January 2014 to December 2019 were divided into arthroscopic group and traditional open operation group. There were 30 cases in arthroscopic group, including 12 males and 18 females, aged (47.5±4.5) years and the course of disease was (6.6±4.2) months. There were 30 cases in the traditional operation group, including 10 males and 20 females, aged (48.5±3.5) years, and the course of disease was (5.6±4.4) months. Both groups were unilateral. According to the anatomy of wrist joint and the characteristics of transverse carpal ligament and arthroscopy, the instruments including cannula, inner heart and hook knife were designed. The patients in two groups were treated with decompression of transverse carpal ligament using arthroscopy combined with self-made instruments and traditional open sergery. The incision length, operation time, intraoperative bleeding, hospitalization cost, hospitalization time and recovery time of the two groups were observed and compared. Boston Carpal Tunnel Questionnaire (BCTQ) score was used to evaluate the clinical efficacy of arthroscopy combined with self made instruments in the treatment of carpal tunnel syndrome.@*RESULTS@#Compared with the traditional group, the arthroscopic group had significant advantages in incision length, operation time, intraoperative bleeding and hospital stay, but the total cost of hospitalization was increased. The Boston score was significantly higher in the arthroscopic group than that in the traditional group at 1 month after operation, but not at 3 and 6 months after operation.@*CONCLUSION@#Arthroscopy combined with self-made instruments in the treatment of carpal tunnel syndrome is more reliable, minimally invasive and simplified than open surgery, but the patients should be clearly diagnosed and appropriately selected before operation to achieve satisfactory clinical effect.


Subject(s)
Carpal Tunnel Syndrome/surgery , Decompression, Surgical , Female , Humans , Ligaments, Articular , Male , Treatment Outcome , Wrist/surgery , Wrist Joint/surgery
10.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 601-612, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353966

ABSTRACT

Introducción: El síndrome del túnel carpiano es la neuropatía por atrapamiento más común que genera compresión del nervio mediano. La cirugía de liberación abierta del nervio mediano tiene un papel importante, especialmente, en pacientes que no responden al manejo conservador o con diagnóstico de síndrome del túnel carpiano con criterios de gravedad. El propósito de este estudio fue describir los resultados funcionales, la satisfacción y la fuerza objetiva a mediano (6-24 meses) y largo plazo (>24 meses) con la técnica abierta convencional en la población local. Materiales y métodos: Estudio observacional descriptivo con datos retrospectivos de resultados clínicos funcionales a mediano y largo plazo en pacientes sometidos a cirugía de liberación abierta del nervio mediano como tratamiento del síndrome del túnel carpiano. Se determinaron el nivel funcional según el BCTQ y la FSS, la fuerza de agarre con un dinamómetro electrónico y la satisfacción. Resultados: Se realizaron 100 procedimientos entre mayo de 2012 y septiembre de 2018, con un seguimiento posoperatorio >6 meses. La mayoría eran mujeres (83%) con una mediana de la edad de 59 años. El 97% obtuvo resultados buenos y excelentes a mediano plazo y el 90%, a largo plazo, con una mediana de fuerza de 17 kg (RIC 7,4) y una satisfacción de 90 (RIC 20) a mediano y largo plazo. Conclusiones: La cirugía abierta de liberación del nervio mediano en pacientes con síndrome del túnel carpiano logra resultados buenos y excelentes a mediano y largo plazo en cuanto a funcionalidad, fuerza y satisfacción. Nivel de Evidencia: IV


Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that causes compression of the median nerve. Open median nerve release surgery plays an important role, especially in patients with failed conservative management or with a diagnosis of severe CTS. The purpose of the following study is to describe the functional outcomes, satisfaction, and objective strength in the medium (6 to 24 months) and long term (greater than 24 months) with the conventional open technique in the local population. Materials and methods: Descriptive observational study based on retrospective data of functional clinical outcomes in the medium and long term in patients undergoing open release surgery of the median nerve as a treatment for CTS. Functional level according to the BCTQ and FSS, grip strength with an electronic dynamometer, and satisfaction were determined. Results: 100 procedures were performed between May 2012 and September 2018, with a follow-up of more than 6 months. The majority were women (83%) with a total median age of 59 years showing good to excellent results in the 97% in the medium term and 90% in the long term, with a median strength of 17 kg (Interquartile range: 7.4) and satisfaction of 90 (Interquartile range: 20). Conclusions: Open surgery to release the median nerve in patients with CTS shows good to excellent functional outcomes, satisfaction, and strength in the medium and long term. Level of Evidence: IV


Subject(s)
Adult , Carpal Tunnel Syndrome/surgery , Treatment Outcome , Patient Satisfaction , Electromyography , Muscle Strength , Hand
11.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 613-620, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353967

ABSTRACT

Introducción: Los pacientes con síndrome del túnel carpiano suelen tener síntomas nocturnos que alteran la calidad del sueño y, muchas veces, son el motivo de consulta. Se estudiaron en profundidad los cambios objetivos luego de la liberación del túnel carpiano. Sin embargo, la evidencia sobre la mejoría del sueño tras la cirugía es escasa. Consideramos que la mejoría de la calidad del sueño está directamente relacionada con el procedimiento; nuestro objetivo primario fue comprobarlo. Como objetivo secundario se evaluó si los cambios en el sueño varían según factores constitucionales o de severidad del síndrome del túnel carpiano. Materiales y métodos: Serie prospectiva de 67 casos con síndrome del túnel carpiano e indicación de cirugía. Se dividieron grupos según edad, sexo y severidad del síndrome por electrodiagnóstico. Se evaluó la calidad del sueño con la Escala de Insomnio de Atenas antes de la cirugía y cuatro días después. Resultados: El 74,62% de los pacientes tenía alteraciones de la calidad del sueño antes de la cirugía. Se comprobó una mejoría significativa en la calidad del sueño después de la operación, en todos los casos (p <0,05). No hubo diferencias significativas en los resultados entre los grupos. Conclusiones: Clásicamente el éxito de la liberación del túnel carpiano se resume en los cambios sensitivo-motores. Sin embargo, no se apunta a la mejoría de la calidad del sueño, aunque sea el generador de la consulta. La descompresión del túnel carpiano mejora el sueño, independientemente de la edad, el sexo o la gravedad del cuadro. Nivel de Evidencia: II


Introduction: Sleep disturbances caused by night pain and paresthesia are usual symptoms in carpal tunnel syndrome (CTS), and are often the cause of medical consultation. Objective changes following the Carpal Tunnel Release (CTR) have been tho-roughly analyzed. However, evidence related to improvement in sleep quality is lacking. We consider that the immediate improvement in sleep quality is directly related to CTR. The main purpose of this study is to assess these changes following this procedure. The secondary objective is to evaluate if the severity of the median nerve compression or patient-related factors could have an impact on sleep quality. Materials and methods: Prospective case study of 67 patients diagnosed with CTS who underwent CTR procedure. We grouped all cases based on age, sex, and nerve conduction study (NCS) results. Sleep quality was evaluated with the Athens Insomnia Score before surgery and in the fourth follow-up day, asking specifically about symptoms from the first night after the procedure. Results: Sleep disorders were found in 74.62% of cases before surgery. After CTR, sleep quality improved in all cases (p<0.05). We found no relation between sleep quality improvement and sex, age, or NCS severity. Conclusions: CTR is commonly indicated to stop nerve damage, and to improve sensitive and motor symptoms. However, sleep disturbances are not the main indication for it, even if it is a frequent reason for medical consultation. Sleep quality improves from the first night after CTR, and this outcome is independent of age, sex, or severity of CTS. Level of Evidence: II


Subject(s)
Adult , Middle Aged , Sleep Wake Disorders , Carpal Tunnel Syndrome/surgery , Treatment Outcome
12.
Rev. bras. ortop ; 55(6): 755-758, Nov.-Dec. 2020.
Article in English | LILACS | ID: biblio-1156208

ABSTRACT

Abstract Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.


Resumo Objetivo Examinar a prevalência da síndrome do túnel do carpo em atletas do halterofilismo do esporte adaptado. Métodos Este estudo avaliou a presença e a intensidade da dor (escala numérica), a parestesia noturna (autorrelato), e a compressão nervosa (sinais de Tinel e de Phalen) em atletas do halterofilismo do esporte adaptado em cadeira de rodas e sem cadeira de rodas. O diagnóstico clínico da síndrome do túnel do carpo foi confirmado pela presença de dois ou mais sinais/sintomas. Resultados Vinte e nove atletas de halterofilismo de esporte adaptado foram avaliados. Nenhum dos atletas relatou a presença de dor ou parestesia noturna. O sinal de Tinel estava presente em 1 (3,45%) atleta de cadeira de rodas. O teste de Phalen positivo estava presente em 3 (10,35%) atletas (1 em cadeira de rodas e 2 sem cadeira de rodas). Testes positivos de sinais de Tinel e de Phalen foram encontrados concomitantemente em 2 (6,89%) atletas (1 em cadeira de rodas e 1 sem cadeira de rodas). Conclusão A síndrome do túnel do carpo foi diagnosticada clinicamente em 2 (6,89%) dos 29 atletas com deficiência física.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Pain , Athletic Injuries , Wheelchairs , Carpal Tunnel Syndrome , Disabled Persons , Athletes , Hand , Nerve Crush
13.
Rev. méd. Maule ; 36(2): 34-43, dic. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1344612

ABSTRACT

Pain located in the lateral aspect of the elbow is a common cause of consultation in the trauma consultation. The most common cause is "lateral epicondylitis," however there are several differential diagnoses that may require different management. There is a case of radial tunnel syndrome secondary to extrinsic compression, with an emphasis on its diagnosis and surgical technique.


Subject(s)
Humans , Male , Middle Aged , Carpal Tunnel Syndrome/diagnosis , Radial Neuropathy/surgery , Radial Neuropathy/diagnosis , Nerve Compression Syndromes , Radial Nerve , Synovial Cyst/surgery , Magnetic Resonance Imaging , Combined Modality Therapy , Elbow , Elbow Joint , Pain Management , Injections, Intra-Articular , Neurologic Examination/methods
14.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(4): 349-356, dic. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1351410

ABSTRACT

NiResumen Objetivo: Evaluar los resultados de la retinaculotomía endoscópica para tratar el síndrome del túnel carpiano mediante la técnica de doble portal de Chow, entre enero de 2006 y diciembre de 2015. Materiales y Métodos: Estudio de 179 pacientes (edad promedio 48.2 años [rango 32-68]), con 217 casos de síndrome del túnel carpiano idiopático y un seguimiento promedio de 97.9 meses. Los pacientes eran 145 mujeres (81%) (31 bilaterales) y 34 hombres (19%) (7 bilaterales) y fueron evaluados con la Symptom Severity Scale (SSS) y la Functional Status Scale (FSS) del Boston Carpal Tunnel Questionnaire (BCTQ). Resultados: El puntaje medio de la SSS-BCTQ fue de 3,20 + 0,26 antes de la cirugía, mejoró a 1,30 + 0,12 a los 6 meses y se mantuvo en 1,25 + 0,11 a largo plazo. El puntaje medio de la FSS-BCTQ fue de 2,57 + 0,29 antes de la cirugía, mejoró a 1,28 + 0,18 a los 6 meses y se mantuvo en 1,20 + 0,09 a largo plazo. Hubo 7 casos (3,2%) de neuropraxia posquirúrgica transitoria. No hubo conversiones a técnica abierta. Conclusión: La liberación endoscópica del túnel carpiano con la técnica de Chow es un método quirúrgico eficaz y seguro para tratar el síndrome del túnel carpiano idiopático. Nivel de Evidencia; III


Objective: To evaluate the outcomes of endoscopic release of the transverse carpal ligament (TCL) in carpal tunnel syndrome (CTS) using the Chow dual-portal technique between January 2006 and December 2015. Materials and Methods: Study population consisted of 217 cases of idiopathic CTS, in 179 patients, 145 females (81%) (31 bilateral cases) and 34 males (19%) (7 bilateral cases), with an average age of 48.2 years (range, 32-68) and an average follow-up of 97.9 months. The symptom severity and functional evaluations were performed using the Boston Carpal Tunnel Questionnaire Symptoms Severity Scale (BCTQ-SSS) and the Functional Status Scale (BCTQ-FSS). Results: The average BCTQ-SSS was 3.20±0.26 in the preoperative period, which improved to 1.30±0.12 at the 6-month postoperative follow-up and remained at 1.25±0.11 in the long-term. The average BCTQ-FSS was 2.57±0.29 in the preoperative period, which improved to 1.28±0.12 at the 6-month postoperative follow-up and remained at 1.20±0.09 in the long-term. There were 7 cases (3.2%) of transient postoperative neurapraxia. No patient required to be converted to open technique. Conclusion: The endoscopic carpal tunnel release with Chow technique is an effective and safe surgical method for the treatment of idiopathic CTS. Level of Evidence; III


Subject(s)
Adult , Middle Aged , Carpal Tunnel Syndrome , Median Nerve , Nerve Crush
15.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(4): 357-368, dic. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1351411

ABSTRACT

Objetivo: Comparar la eficacia de la inmovilización nocturna de la muñeca con una férula cubital en ángulo neutro junto con la aplicación de ultrasonido en pacientes con síndrome del túnel carpiano leve y moderado. Materiales y Métodos: Entre octubre de 2007 y marzo de 2010, se incluyó a pacientes >18 años con síndrome del túnel carpiano confirmado por electromiografía en un hospital de Buenos Aires. Se realizó una aleatorización estratificada, con bloques permutados aleatorios, y apareamiento por sexo y edad. Los pacientes fueron asignados al grupo experimental (GE) o al grupo de control (GC). Ambos grupos recibieron ultrasonido de 1 MHz pulsante por 15 min, 3 veces por semana, durante 6 semanas. Los pacientes del GE, además, utilizaron una férula nocturna. Se evaluaron el dolor y la parestesia con la escala analógica visual de 100 mm, la PSFS y el test de Moberg, al comenzar, a las 3 semanas y, al finalizar, a las 6 semanas, y durante el seguimiento, al mes, y a los 3 y 6 meses, con evaluador a ciego. Resultados: Se analizó a 32 pacientes del GC y a 33 del GE. Al finalizar el tratamiento, todas las variables habían mejorado en ambos grupos, con diferencia de medias estadísticamente significativa para el dolor a favor del GE a las 3 semanas de tratamiento 1,64 (IC95% 0,38-2,91; p = 0,012), pero sin diferencia clínica significativa. No se informaron efectos adversos. Conclusión: El tratamiento con una férula nocturna y ultrasonido no es superior al ultrasonido solo en pacientes con STC. Nivel de Evidencia; II


Objective: To compare the effectiveness of night wrist immobilization using an ulnar splint in neutral angle versus the use of ultrasound (US) in patients with Carpal Tunnel Syndrome (CTS). Materials and Methods: Study population included over 18 years of age that were treated for electromyography-confirmed CTS between October 2007 and March 2010 at a Buenos Aires hospital. A sex- and age-stratified randomization was performed by using randomly permuted blocks, allocating patients into the experimental group (EG) and control group (CG). Pulsed US therapy was administered for 15 minutes to all patients three times a week for six weeks at a frequency of 1 MHz. In addition, EG patients were also prescribed night splint. Pain and paresthesia were evaluated using a 100mm Visual Analogue Scale (VAS), the Patient Specific Functional Scale (PSFS), and the Moberg pickup test (MPUT) at baseline, at 3 and 6 weeks, and at 3 and 6 months after treatment institution by a blinded investigator. Results: Study population consisted of 85 cases (65 patients) that were randomly allocated to CG (n=42) or EG (n=43). Improvement of all the variables was observed at the end of treatment in both groups, with a 1.64 (95% CI: 0.38-2.91, P=0.012) statistically significant difference in means for pain in favor of the EG at 3 weeks of treatment, but without a significant clinical difference. No adverse effects were observed. Conclusion: The effectiveness of combined night splint and US therapy is not superior to the US alone treatment in CTS patients. Level of Evidence; II


Subject(s)
Adult , Middle Aged , Ultrasonic Therapy , Carpal Tunnel Syndrome , Ferula
16.
Rev. bras. ortop ; 55(4): 438-444, Jul.-Aug. 2020. tab
Article in English | LILACS | ID: biblio-1138058

ABSTRACT

Abstract Objectives To demonstrate the prevalence of depression and anxiety symptoms in patients with carpal tunnel syndrome treated at a hand surgery outpatient clinic and to describe the clinical and epidemiological characteristics of this population. Methods People diagnosed with carpal tunnel syndrome at the initial visit were evaluated over a 6-month period for data collection. Clinical and epidemiological characteristics were noted, and patients diagnosed with anxiety and/or depression were evaluated. Results In total, 101 people had carpal tunnel syndrome, including 38 diagnosed with depression and 29 with anxiety. Most patients were low-income women, with elementary school-level education. More than half of the patients had at least one associated systemic comorbidity. Conclusion Independent characteristics that statistically influenced anxiety and depression symptoms in patients with carpal tunnel syndrome were gender, smoking, and family income (p< 0.05).


Resumo Objetivos Demonstrar a prevalência de sintomas de depressão e ansiedade em pessoas com a síndrome do túnel do carpo atendidas em um ambulatório de cirurgia da mão e descrever as características clínicas e epidemiológicas dessa população. Métodos Foram avaliadas pessoas com o diagnóstico de síndrome do túnel do carpo na consulta inicial em um período de coleta de dados de 6 meses. Características clínicas e epidemiológicas foram anotadas, e as pessoas que possuíam diagnóstico de ansiedade e/ou depressão foram avaliadas. Resultados Um total de 101 pessoas apresentavam síndrome do túnel do carpo e destas, 38 apresentavam diagnóstico de depressão e 29 de ansiedade. Houve prevalência de mulheres de baixa renda, com predominância do nível de escolaridade fundamental. Mais da metade dos pacientes apresentava pelo menos uma comorbidade sistêmica associada. Conclusão Tanto para ansiedade como para depressão, as características que influenciaram estatisticamente nos sintomas em pacientes com síndrome do túnel do carpo independente das demais características avaliadas foram gênero, tabagismo, e renda familiar (p< 0,05).


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Anxiety , Referral and Consultation , Signs and Symptoms , Carpal Tunnel Syndrome , Comorbidity , Depression
17.
Arq. neuropsiquiatr ; 78(4): 224-229, Apr. 2020. tab
Article in English | LILACS | ID: biblio-1098085

ABSTRACT

Abstract 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.


Resumo Objetivo: Os efeitos da vitamina D no sistema nervoso central e periférico continuam sendo investigados atualmente. Neste estudo, objetivamos avaliar a dor e a resposta eletrofisiológica em pacientes com síndrome do túnel do carpo (STC) submetidos a terapia de reposição devido à deficiência de vitamina D. Métodos: Cinquenta pacientes do sexo feminino diagnosticadas com STC leve e moderada e acompanhadas de deficiência de vitamina D foram incluídas neste estudo. O estudo da condução nervosa (ECN) foi realizado antes e após a reposição da vitamina D, e a dor do paciente foi avaliada com a Escala Visual Analógica (EVA). Resultados: Quando a ECN foi comparada antes e após o tratamento, houve uma melhora estatisticamente significativa na latência mediana do início sensorial distal (DSOL) e nos valores de velocidade de condução sensorial (VC) e latência distal motora (LDM) (p=0,001; p<0,001; p=0,001, respectivamente). Ao mesmo tempo, houve uma diminuição dos valores da EVA nos pacientes (p<0,001). Quando os dois grupos foram comparados, houve uma melhora no DSOL e no VC sensorial em ambos, mas no LDM apenas no grupo STC moderado. Conclusão: Neste estudo, foi demonstrado que pacientes com STC leve e moderada apresentaram melhora da dor e parâmetros eletrofisiológicos após a reposição de vitamina D. A substituição da vitamina D nos estágios iniciais da STC pode ser benéfica.


Subject(s)
Humans , Female , Vitamin D Deficiency , Carpal Tunnel Syndrome , Pain , Vitamin D , Vitamins , Median Nerve , Neural Conduction
18.
Acta ortop. mex ; 34(1): 31-37, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1345082

ABSTRACT

Resumen: Introducción: Actualmente, no existe un estándar de referencia aceptado universalmente para el diagnóstico del síndrome de túnel carpiano, por lo que se le considera una patología de «clase latente¼, es decir, que carece de alguna prueba diagnóstica que dé certeza absoluta de la presencia de la enfermedad. Métodos: Estudio prospectivo, observacional y analítico en el cual se evaluaron los tres métodos diagnósticos utilizados para el síndrome de túnel carpiano (examen clínico, ecografía y electromiografía). En él, se establecieron valores de normalidad para cada método diagnóstico. Resultados: Se evaluó un total de 50 personas (14 hombres y 36 mujeres). El examen clínico presentó correlación positiva y significativa con el diámetro del nervio mediano afectado (ecografía) (R = 0.694 y p = 0.032). Los valores del área bajo la curva (AUC, por sus siglas en inglés) para la velocidad de conducción del nervio mediano (VCNM), velocidad de conducción de nervio cubital (VCNC) y latencia distal motora (LDM) por electromiografía fueron de 0.60, 0.519 y < 0.50, respectivamente, lo cual determinó que el valor diagnóstico de las características por electromiografía es malo. Conclusión: Nuestro trabajo establece al examen clínico como una herramienta de buena calidad, siendo el método más sensible para el diagnóstico de síndrome de túnel carpiano. Si existiera la necesidad de realizar una confirmación diagnóstica, la ecografía mostró ser un estudio altamente satisfactorio, el cual genera menos estrés, dolor e invasión al paciente, disminuyendo, a su vez, el gasto de salud y agilizando el proceso.


Abstract: Introduction: Currently there is no universally accepted standard of reference for the diagnosis of carpal tunnel syndrome so it is considered a «latent class¼ pathology, that is, it lacks any diagnostic tests that absolutely certain the presence of disease. Methods: Prospective, observational and analytical study evaluating the three diagnostic methods used for carpal tunnel syndrome (clinical examination, ultrasound and electromyography). Normality values were set for each diagnostic method. Results: 50 people (14 men and 36 women) were evaluated. The clinical examination showed a positive and significant correlation with the diameter of the affected median nerve (ecography) (R = 0.694, p = 0.032). The values of the under the curve area (UCA) for median nerve conduction speed (MNCS), cubital nerve conduction speed (CNCS), and distal latency (DL) by electromyography were 0.60, 0.519 and less than 0.50 respectively. This states that the diagnostic value of electromyography characteristics is bad. Conclusion: Our work establishes clinical examination as a good quality tool being the most sensitive method for diagnosing carpal tunnel syndrome. If there was a need for diagnostic confirmation, the ultrasound proved to be a highly satisfactory study generating less stress, pain and invasion to the patient, decreasing health expenditure and speeding up the process.


Subject(s)
Humans , Male , Female , Carpal Tunnel Syndrome/diagnostic imaging , Prospective Studies , Ultrasonography , Sensitivity and Specificity , Median Nerve/diagnostic imaging , Neural Conduction
19.
Autops. Case Rep ; 10(4): e2020209, 2020. graf
Article in English | LILACS | ID: biblio-1131865

ABSTRACT

The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.


Subject(s)
Humans , Male , Middle Aged , Carpal Tunnel Syndrome , Upper Extremity/anatomy & histology , Dissection , Biological Variation, Individual , Nerve Compression Syndromes
20.
Article in Chinese | WPRIM | ID: wpr-828232

ABSTRACT

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.


Subject(s)
Adult , Anesthesia, Local , Carpal Tunnel Syndrome , Female , Humans , Middle Aged , Pain, Postoperative , Wakefulness
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