ABSTRACT
OBJECTIVES: To measure the changes in median nerve conduction parameters at various angles of wrist flexion and extension. DESIGN: We studied 8 patients with carpal tunnel syndrome (CTS) and 4 subjects (5 hands) without the condition (controls). Conduction parameters were measured with the wrist in neutral position and at different wrist angles. RESULTS: Onset motor latency increased in both groups with wrist extension and decreased with wrist flexion. Sensory onset latency decreased in both groups with wrist flexion. Compound Muscle Action Potential (CMAP) amplitude increased with wrist flexion for both groups. Wrist extension resulted in reduction of the CMAP amplitude in controls; however, for the CTS group it increased for the first 30 degrees and then decreased. Sensory Nerve Action Potential (SNAP) amplitude increased with wrist flexion and decreased with wrist extension in both groups. CONCLUSION: Median nerve conduction parameters improve with wrist flexion and generally worsen with extension.
Subject(s)
Carpal Tunnel Syndrome/physiopathology , Carpal Tunnel Syndrome/therapy , Median Nerve/physiology , Neural Conduction , Wrist , Adult , Aged , Biomechanical Phenomena , Female , Humans , Male , Middle Aged , Orthotic Devices , Wrist/physiologyABSTRACT
A review of the history and pharmacology of the botulinum neurotoxins is presented. Established mechanisms of action are discussed as well as preliminary evidence of other potential mechanisms, as related to botulinum toxins' antinociceptive properties. Methods of administration, including reconstitution, dilution, and basic injection techniques/principles are reviewed. Safety concerns are also addressed. Various applications relevant to the field of Physical Medicine & Rehabilitation are reviewed, specifically uses in the management of muscle over activity syndromes such as upper motor neuron-related spasticity, dystonias, and painful syndromes including Myofascial Pain Syndromes and headaches. Relevant literature related to these applications is reviewed and discussed. Botulinum toxin therapeutic efficacy and possible reasons for treatment failure (including development of antibody-mediated resistance) are discussed.