Minimally invasive ultrasound-guided vs open release for carpal tunnel syndrome in working population: A randomized controlled trial.

PURPOSE: To compare the clinical effectiveness of minimally invasive ultrasound (US)-guided vs open release for carpal tunnel syndrome. METHODS: In an open randomized controlled trial, 47 employed patients were allocated to US-guided carpal tunnel release (USCTR) and 42 to an open carpal tunnel release (OCTR) procedure. The main outcome was symptom severity measured by the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ-S). Secondary outcomes were hand functionality (BCTQ-F), nerve conduction, two-point discrimination, handgrip and pinch strength, pain (visual analog scale), work leave and complications. For BCTQ-S and BCTQ-F, minimal clinically important differences (MCID) were also considered. Follow-up duration was 12 months. RESULTS: Mixed model analyses detected no significant differences between the two treatment arms in BCTQ-S (P = .098) while BCTQ-F scores were significantly better in the USCTR group (P = .007). This benefit was, however, not supported by the MCID data. Remaining variables were similar in the two groups except pain which was lower in USCTR at 3 months follow-up. All variables but two-point discrimination showed significant improvement after 3 months. CONCLUSIONS: Our findings reveal similar symptom relief benefits following OCTR or USCTR in these patients. The patients in our USCTR group, however, reported better hand functional status and less pain.

Ultrasound classification of medial gastrocnemious injuries.

High-resolution ultrasound (US) has helped to characterize the "tennis leg injury" (TL). However, no specific classifications with prognostic value exist. This study proposes a medial head of the gastrocnemius injury classification based on sonographic findings and relates this to the time to return to work (RTW) and return to sports (RTS) to evaluate the prognostic value of the classification. 115 subjects (64 athletes and 51 workers) were retrospectively reviewed to asses specific injury location according to medial head of the gastrocnemius anatomy (myoaponeurotic junction; gastrocnemius aponeurosis (GA), free gastrocnemius aponeurosis (FGA)), presence of intermuscular hematoma, and presence of gastrocnemius-soleus asynchronous movement. Return to play (RTP; athletes) and return to work (RTW; occupational) days were recorded by the treating physician. This study proposes 5 injury types with a significant relation to RTP and RTW (P < .001): Type 1 (myoaponeurotic injury), type 2A (gastrocnemius aponeurosis injury with a <50% affected GA width), type 2B (gastrocnemius aponeurosis with >50% affected GA width), type 3 (free gastrocnemius aponeurosis (FGA) tendinous injury), and type 4 (mixed GA and FGA injury). The longest RTP/RTW periods were associated with injuries with FGA involvement. Intermuscular hematoma and Gastrocnemius-soleus asynchronous motion during dorsiflexion and plantarflexion were observed when the injury affected >50% of the GA width, with or without associated FGA involvement, and this correlated with a worse prognosis. The proposed classification can be readily applied in the clinical setting although further studies on treatment options are required.

Assessing Change of Direction Ability in a Spanish Elite Soccer Academy.

The aims of the study were: a) to analyze the reproducibility of the Modified Agility Test (MAT) according to two types of displacement (i.e. constrained [MATtop] vs. free [MATfree]), b) to examine the explanatory capacity of anthropometric characteristics and neuromuscular performance on the ability to change the direction (CODA), c) to look into the practical consequences of the types of displacement from the perspective of an elite soccer academy. 118 male soccer players (age: 16 (13-25) years old) from the same elite Spanish soccer academy (U13 to senior) were tested twice on two versions of the MAT (MATtop and MATfree), with 48 hours between testing sessions. Moreover, they were tested on linear-sprint performance, over 5 m (S5m) and 15 m (S15m), and the vertical jump (VJ) (countermovement jump with [ACMJ] and without an arm swing [CMJ]). The main findings were: a) the type of displacement did not affect the reliability of the CODA test; b) weight, S15m, ACMJ and CMJ variables explained close to 60% of CODA performance; c) MATtop (i.e. constrained displacement) and MATfree (i.e. free-displacement) CODA tests could show different profiles of development along the age groups; and d) the impact of the task's constraints was relatively higher in U16 and U17 groups. CODA seems to have a variable meaning depending on the characteristics of the test and the age of the participants.

Intra-rater reliability and agreement of various methods of measurement to assess dorsiflexion in the Weight Bearing Dorsiflexion Lunge Test (WBLT) among female athletes.

OBJECTIVES: To examine the intra-observer reliability and agreement between five methods of measurement for dorsiflexion during Weight Bearing Dorsiflexion Lunge Test and to assess the degree of agreement between three methods in female athletes. DESIGN: Repeated measurements study design. SETTING: Volleyball club. PARTICIPANTS: Twenty-five volleyball players. MAIN OUTCOME MEASUREMENTS: Dorsiflexion was evaluated using five methods: heel-wall distance, first toe-wall distance, inclinometer at tibia, inclinometer at Achilles tendon and the dorsiflexion angle obtained by a simple trigonometric function. For the statistical analysis, agreement was studied using the Bland-Altman method, the Standard Error of Measurement and the Minimum Detectable Change. Reliability analysis was performed using the Intraclass Correlation Coefficient. RESULTS: Measurement methods using the inclinometer had more than 6° of measurement error. The angle calculated by trigonometric function had 3.28° error. The reliability of inclinometer based methods had ICC values < 0.90. Distance based methods and trigonometric angle measurement had an ICC values > 0.90. Concerning the agreement between methods, there was from 1.93° to 14.42° bias, and from 4.24° to 7.96° random error. CONCLUSION: To assess DF angle in WBLT, the angle calculated by a trigonometric function is the most repeatable method. The methods of measurement cannot be used interchangeably.

Gas analyzer's drift leads to systematic error in maximal oxygen uptake and maximal respiratory exchange ratio determination.

The aim was to examine the drift in the measurements of fractional concentration of oxygen (FO2) and carbon dioxide (FCO2) of a Nafion-using metabolic cart during incremental maximal exercise in 18 young and 12 elderly males, and to propose a way in which the drift can be corrected. The drift was verified by comparing the pre-test calibration values with the immediate post-test verification values of the calibration gases. The system demonstrated an average downscale drift (P < 0.001) in FO2 and FCO2 of -0.18% and -0.05%, respectively. Compared with measured values, corrected average maximal oxygen uptakevalues were 5-6% lower (P < 0.001) whereas corrected maximal respiratory exchange ratio values were 8-9% higher (P < 0.001). The drift was not due to an electronic instability in the analyzers because it was reverted after 20 min of recovery from the end of the exercise. The drift may be related to an incomplete removal of water vapor from the expired gas during transit through the Nafion conducting tube. These data demonstrate the importance of checking FO2 and FCO2 values by regular pre-test calibrations and post-test verifications, and also the importance of correcting a possible shift immediately after exercise.

¿Cual es el "Draf factor" del concept 2 que mejor simula el remo en trainera? / Setting the concept 2 "Draf factor" for the simulation of fixed-thwart boat rowing?

Antecedentes: El remo ergómetro CONCEPT 2 (C2) es uno de los más utilizados en todo el mundo, tanto en la valoración funcional de los remeros, como en sus entrenamientos fuera del agua. Este ergómetro controla la resistencia del ventilador mediante una ventanilla que regula la entrada de aire al mismo. El fabricante denomina a esta resistencia drag factor (DF), y recomienda utilizar DF entre 115 y 140, debido a que son los que mejor simulan las sensaciones delos remeros de banco móvil en el agua. A pesar de que elC2 es también el remo ergómetro más utilizado en el remo de banco fijo (trainera), se desconoce cuál es el DF que mejor simula las condiciones de esta modalidad. Objetivo: Determinar cuál era el DF del C2 más adecuado al remo en la trainera. Diseño: Estudio transversal comparativo. Sujetos: 19 Remeros varones, edad de 26 ± 5 años, y un umbral anaeróbico (4 mmol/l) (W4) de 231 ± 26 W. Medidas: Se midió la frecuencia cardiaca (FC) en trainera y en el C2 con tres DF diferentes (140, 150 y 160). Se tomaron 34 muestras para cada DF. Para asegurar la similitud entre la remada del ergómetro y la de la trainera también se controló la cadencia de palada (R) y el tiempo de la fase de pasada (TP).Análisis: Método de Bland-Altman para comprobar la concordancia de la FC entre el C2 y la trainera para los diferentes DF. Resultados: La mejor concordancia se encontró para un DF de 160. Las diferencias de las FC de la trainera y el C2mostraron una dispersión importante, y unas diferencias significativas, de 7, 4 y 5 lat/min, para los DF de 140, 150 y160 respectivamente. Conclusiones: De los tres DF del C2 utilizados en este estudio (140, 150 y 160), el que mejor concordancia demostró con el remo de la trainera de banco fijo fue el de160. Sin embargo, se produjo un error sistemático en la medida de la FC entre ambas condiciones para todos los DF testados (AU)

Background: The CONCEPT 2 rowing ergometer (C2)is a world wide used device, both for rowers performance assessment and for indoor training. In order to regulate the resistance of the flywheel the C2 has a damper to control the air that can pass across the fan. This resistance is called drag factor (DF) and the manufacturer recommend to use the machine in the 115-140 range, because at this level the perception is closest to that of a racing boat. Although theC2 is also the most commonly used ergometer in fixed thwart rowing (trainer a), it is unknown which is the DF that better simulate the conditions of this rowing modality. Objective: To assess the most appropriate DF of the C2 to reflect fixed-thwart trainer a rowing. Design: Cross-sectional comparative study. Subjects: 19 Well trained male rowers, age 25 ± 5 year, anaerobic threshold (4 mmol/l) (W4) 231 ± 26 W. Measurements: The heart rate (FC) in trainer a and in C2was measured using three different DF (140, 150 and 160),34 samples at each DF were taken. To assure that the C2and the trainer a rowing was similar, the stroke rate (R) and the drive phase duration (TP) were controlled. Analysis: The Bland-Altman`s method was used to test the agreement of the FC between the C2 and the trainer a at the three different DF. Results: The best agreement was found at 160 DF of theC2. The differences between the FC of the trainer a and the C2 showed a great data dispersion in all the DF. The FC demonstrated a significant difference of 7, 4 and 5 lat/min, for the 140, 150 and 160 DF, respectively. Conclusions: Among the three DF of the C2 studied in this investigation (140, 150 and 160) the one that best reflect the trainer a rowing is 160. Although, a systematic error were found in the measurement of the FC at all of the three tested DF (AU)