Effects of Diacutaneous Fibrolysis on Mechanosensitivity, Disability, and Nerve Conduction Studies in Mild to Moderate Carpal Tunnel Syndrome: Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: People diagnosed with carpal tunnel syndrome (CTS) have fibrosis between the soft, connective, and neural tissues that could worsen the compression of the median nerve. The diacutaneous fibrolysis (DF) technique may release tissue adhesions and increase the mobility of connective tissues. The purpose of this study was to compare the outcomes of DF in people with mild to moderate CTS on mechanosensitivity, disability, and nerve conduction studies. METHODS: This was a secondary analysis of a double-blinded, randomized, placebo-controlled trial. Patients were recruited between April and September 2016 from the Department of Neurophysiology at the Hospital Miguel Servet, Zaragoza, Spain. Thirty-nine people (52 wrists) diagnosed with mild to moderate CTS were included. Participants were randomly assigned to either the DF group (n = 26) or the sham group (n = 26). Both groups received 5 therapy sessions, 2 sessions per week. Mechanosensitivity with the Upper Limb Neurodynamic Test 1, symptom severity and functional status with the Boston Carpal Tunnel Questionnaire, and median nerve sensory conduction velocity with nerve conduction studies were the outcomes measured. Assessments were recorded at baseline and after the intervention. RESULTS: The DF group showed significant improvements in the following: mechanosensitivity, with 28.46 degrees of elbow extension range of motion (95% CI = 19.2-37.7); an increase of 1.0 point (95% CI = 0.7-1.4) for the Boston Carpal Tunnel Questionnaire symptom severity and functional status score; and sensory conduction velocity of median nerve, which improved to 5.8 m/s (95% CI = 2.5-9.2). CONCLUSION: Participants with mild to moderate CTS experienced improvements in symptom severity, functional status, mechanosensitivity, and nerve conduction studies after 5 sessions of DF. IMPACT: This study provides evidence of an approach based on soft and connective tissues around the median nerve in patients with CTS.

Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial.

OBJECTIVE:: To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome. DESIGN:: Double-blind (patient and evaluator) randomized controlled trial. SETTING:: Miguel Servet University Hospital, Zaragoza, Spain. SUBJECTS:: A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group. INTERVENTIONS:: Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand. MAIN MEASURES:: Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment. RESULTS:: Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: -0.26, 95% confidence interval (CI): -0.49/-0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: -2.24, 95% CI: -4.08/-2.04) and upper limb functional capacity (mean difference: -19, 95% CI: -26.1/-11.9) compared to the sham group (n = 30 wrists) ( P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group ( P < 0.01). CONCLUSION:: Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome.

Validity of the Upper Limb Neurodynamic Test 1 for the diagnosis of Carpal Tunnel Syndrome. The role of structural differentiation.

BACKGROUND: Several studies have analysed the use of the Upper Limb Neurodynamic Test 1 (ULNT1) for diagnosing Carpal Tunnel Syndrome (CTS) obtaining weak diagnostic accuracy, which could be related to the lack of consensus in the selected diagnostic criteria of ULNT1. OBJECTIVE: To determine the concurrent validity of ULNT1 in comparison to Nerve Conduction Studies (NCS) for the diagnosis of CTS, considering the structural differentiation (SD) as an essential part of the diagnosis. DESIGN: Prospective diagnostic test study. METHODS: Individuals with suspected CTS referred for NCS were invited to voluntarily participate in the study. Each participant was tested with NCS and ULNT1. ULNT1 result was considered positive when the patient's clinical symptoms were reproduced during the test and symptoms changed during contralateral neck side bending (SD). RESULTS: 58 Participants (17 men, 44 women) with suspected CTS and a total of 95 limbs were examined using the NCS and ULNT1. Sensitivity of the ULNT1 was 57.9%, specificity was 84.2%, and the positive and negative likelihood ratios were 3.67 and 0.50 respectively. CONCLUSION: Results obtained in the study may indicate the ability of the ULNT1 to generate small shifts from pre-test to post-test probability. However, imprecision in the CIs limits interpretation from the data. LEVEL OF EVIDENCE: 1b.

[Relationship between ultrasound measurements of the median nerve and electrophysiological severity in carpal tunnel syndrome]. / Relación entre las mediciones ecográfi cas del nervio mediano y la gravedad electrofi siológica en el syndrome del túnel carpiano.

INTRODUCTION: Ultrasonography is a tool that has advanced a great deal in the diagnosis of neural compressive pathologies, such as carpal tunnel syndrome (CTS). In order to plan the treatment it is important to establish the severity of the pathology, which means that it would be important to know the capacity of ultrasonography to determine the extent to which the median nerve is compromised at this level. AIM: To investigate the correlation between ultrasound measurements and electrophysiological severity in patients with CTS. PATIENTS AND METHODS: Ultrasound measurements were performed with 59 subjects (97 wrists) who were referred to have an electroneurogram (ENG) due to suspected CTS. According to the ENG, the subjects were classified as healthy, mild, moderate or severe CTS. The relationship between the ultrasound measurements and the results of the ENG were later analysed in terms of their severity. The ROC (receiver operating characteristic) curves were calculated for the optimal cut-off values in each group, taking into account their severity. RESULTS: Both ultrasound measurements showed a correlation with the severity of the CTS determined by ENG. The cross-sectional area of the median nerve in the wrist (CSA-W) showed the highest correlation (r = 0.613). CONCLUSIONS: There is a relation between the ultrasound measurements of the median nerve, especially in the CSA-W, and the severity of CTS in the clinical context. These measurements could be used as complementary data to diagnose CTS and to determine its severity.

TITLE: Relacion entre las mediciones ecograficas del nervio mediano y la gravedad electrofisiologica en el sindrome del tunel carpiano.Introduccion. La ecografia es una herramienta que ha experimentado un gran desarrollo en el diagnostico de patologias compresivas neurales, como el sindrome del tunel carpiano (STC). Para planificar el tratamiento es importante establecer la gravedad de la patologia, por lo que seria relevante conocer la capacidad de la ecografia para discriminar el grado de afectacion del nervio mediano a este nivel. Objetivo. Investigar la correlacion de las mediciones ecograficas con la gravedad electrofisiologica en pacientes con STC. Pacientes y metodos. Se realizaron mediciones ecograficas en 59 sujetos (97 muñecas) remitidos para recibir un electroneurograma (ENG) por sospecha de STC. Segun el ENG, los sujetos se clasificaron como sanos, STC leve, moderado o grave. Posteriormente, se analizo la relacion entre las mediciones ecograficas y los resultados del ENG segun su gravedad. Tambien se calcularon las curvas ROC (receiver operaing characteristic) para los valores de corte optimos en cada grupo atendiendo a su gravedad. Resultados. Ambas mediciones ecograficas mostraron correlacion con la gravedad del STC determinada por el ENG. El area de seccion transversal del nervio mediano en la muñeca (AST-M) mostro la mayor correlacion (r = 0,613). Conclusiones. Existe relacion entre las mediciones ecograficas del nervio mediano, especialmente en el AST-M, y la gravedad del STC en un contexto clinico. Dichas mediciones podrian ser complementarias para diagnosticar el STC y determinar su gravedad.

Relación entre las mediciones ecográficas del nervio mediano y la gravedad electrofisiológica en el síndrome del túnel carpiano / Relationship between ultrasound measurements of the median nerve and electrophysiological severity in carpal tunnel syndrome

Introducción. La ecografía es una herramienta que ha experimentado un gran desarrollo en el diagnóstico de patologías compresivas neurales, como el síndrome del túnel carpiano (STC). Para planificar el tratamiento es importante establecer la gravedad de la patología, por lo que sería relevante conocer la capacidad de la ecografía para discriminar el grado de afectación del nervio mediano a este nivel. Objetivo. Investigar la correlación de las mediciones ecográficas con la gravedad electrofisiológica en pacientes con STC. Pacientes y métodos. Se realizaron mediciones ecográficas en 59 sujetos (97 muñecas) remitidos para recibir un electroneurograma (ENG) por sospecha de STC. Según el ENG, los sujetos se clasificaron como sanos, STC leve, moderado o grave. Posteriormente, se analizó la relación entre las mediciones ecográficas y los resultados del ENG según su gravedad. También se calcularon las curvas ROC (receiver operating characteristic) para los valores de corte óptimos en cada grupo atendiendo a su gravedad. Resultados. Ambas mediciones ecográficas mostraron correlación con la gravedad del STC determinada por el ENG. El área de sección transversal del nervio mediano en la muñeca (AST-M) mostró la mayor correlación (r = 0,613). Conclusiones. Existe relación entre las mediciones ecográficas del nervio mediano, especialmente en el AST-M, y la gravedad del STC en un contexto clínico. Dichas mediciones podrían ser complementarias para diagnosticar el STC y determinar su gravedad (AU)

Introduction. Ultrasonography is a tool that has advanced a great deal in the diagnosis of neural compressive pathologies, such as carpal tunnel syndrome (CTS). In order to plan the treatment it is important to establish the severity of the pathology, which means that it would be important to know the capacity of ultrasonography to determine the extent to which the median nerve is compromised at this level. Aim. To investigate the correlation between ultrasound measurements and electrophysiological severity in patients with CTS. Patients and methods. Ultrasound measurements were performed with 59 subjects (97 wrists) who were referred to have an electroneurogram (ENG) due to suspected CTS. According to the ENG, the subjects were classified as healthy, mild, moderate or severe CTS. The relationship between the ultrasound measurements and the results of the ENG were later analysed in terms of their severity. The ROC (receiver operating characteristic) curves were calculated for the optimal cutoff values in each group, taking into account their severity. Results. Both ultrasound measurements showed a correlation with the severity of the CTS determined by ENG. The crosssectional area of the median nerve in the wrist (CSA-W) showed the highest correlation (r = 0.613). Conclusions. There is a relation between the ultrasound measurements of the median nerve, especially in the CSA-W, and the severity of CTS in the clinical context. These measurements could be used as complementary data to diagnose CTS and to determine its severity (AU)

Validez diagnóstica de la ecografía en el síndrome del túnel carpiano / Diagnostic validity of ultrasonography in carpal tunnel syndrome

Introducción. La ecografía ha emergido como una herramienta diagnóstica alternativa de las neuropatías periféricas, como el síndrome del túnel carpiano (STC). Sin embargo, faltan datos sobre la validez diagnóstica de las diferentes mediciones ecográficas para la detección del STC en entornos clínicos. Objetivo. Hallar la validez diagnóstica de las mediciones ecográficas del área de sección transversal del nervio mediano en la muñeca (AST-M) y de la ratio del área del nervio mediano entre la muñeca y el antebrazo (R-MA) en el diagnóstico del STC, utilizando como técnica de referencia el electroneurograma (ENG). Pacientes y métodos. Se realizaron mediciones ecográficas en 59 sujetos (97 muñecas) referidos para someterse a un ENG por sospecha de STC. Los examinadores que realizaron la ecografía desconocían los resultados del ENG. Posteriormente, se calcularon los puntos de corte mediante curvas ROC para cada una de las mediciones (AST-M y R-MA) y se analizó su validez diagnóstica. Resultados. Con un punto de corte de 9,15 mm2, la medición AST-M obtuvo una sensibilidad del 75,81%, una especificidad del 74,29%, una ratio de probabilidad positiva de 2,95 y una ratio de probabilidad negativa de 0,33. Para la medición R-MA y un punto de corte de 1,56, los valores de sensibilidad, especificidad y ratios de probabilidad positiva y negativa fueron 70,97%, 71,43%, 2,48 y 0,4, respectivamente. Conclusión. Tanto el AST-M como la R-MA parecen ser medidas útiles en el diagnóstico del STC tomando como prueba de referencia el ENG (AU)

Introduction. Ultrasonography has emerged as an alternative tool for diagnosing peripheral neuropathies, such as carpal tunnel syndrome (CTS). Yet, data are still lacking as regards the diagnostic validity of the different ultrasonography measurements for detecting CTS in clinical settings. Aims. To determine the diagnostic validity of ultrasound measurements of the cross-sectional area of the median nerve in the wrist (CSA-M) and of the ratio of the area of the median nerve between the wrist and the forearm (R-WF) in the diagnosis of CTS, using electroneuromyography (ENG) as the reference technique. Patients and methods. Ultrasound measurements were performed on 59 subjects (100 wrists) who were referred to have an ENG due to suspected CTS. The examiners that performed the ultrasonography scan did not know the results of the ENG. The cut-off points were later calculated by means of ROC curves for each of the measurements (CSA-M and R-WF) and their diagnostic validity was analysed. Results. With a cut-off point of 9.15 mm2, CSA-M measurement obtained a sensitivity of 75.81%, a specificity of 74.29%, a positive likelihood ratio of 2.95 and a negative likelihood ratio of 0.33. For the R-WF measurement and a cut-off point of 1.56, the values for sensitivity, specificity, and positive and negative likelihood ratios were 70.97%, 71.43%, 2.48 and 0.4, respectively. Conclusions. Both the CSA-M and R-WF appear to be useful measures in the diagnosis of CTS, taking the ENG as a reference test (AU)

[Diagnostic validity of ultrasonography in carpal tunnel syndrome]. / Validez diagnostica de la ecografia en el sindrome del tunel carpiano.

INTRODUCTION: Ultrasonography has emerged as an alternative tool for diagnosing peripheral neuropathies, such as carpal tunnel syndrome (CTS). Yet, data are still lacking as regards the diagnostic validity of the different ultrasonography measurements for detecting CTS in clinical settings. AIMS: To determine the diagnostic validity of ultrasound measurements of the cross-sectional area of the median nerve in the wrist (CSA-M) and of the ratio of the area of the median nerve between the wrist and the forearm (R-WF) in the diagnosis of CTS, using electroneuromyography (ENG) as the reference technique. PATIENTS AND METHODS: Ultrasound measurements were performed on 59 subjects (100 wrists) who were referred to have an ENG due to suspected CTS. The examiners that performed the ultrasonography scan did not know the results of the ENG. The cut-off points were later calculated by means of ROC curves for each of the measurements (CSA-M and R-WF) and their diagnostic validity was analysed. RESULTS: With a cut-off point of 9.15 mm2, CSA-M measurement obtained a sensitivity of 75.81%, a specificity of 74.29%, a positive likelihood ratio of 2.95 and a negative likelihood ratio of 0.33. For the R-WF measurement and a cut-off point of 1.56, the values for sensitivity, specificity, and positive and negative likelihood ratios were 70.97%, 71.43%, 2.48 and 0.4, respectively. CONCLUSIONS: Both the CSA-M and R-WF appear to be useful measures in the diagnosis of CTS, taking the ENG as a reference test.

TITLE: Validez diagnostica de la ecografia en el sindrome del tunel carpiano.Introduccion. La ecografia ha emergido como una herramienta diagnostica alternativa de las neuropatias perifericas, como el sindrome del tunel carpiano (STC). Sin embargo, faltan datos sobre la validez diagnostica de las diferentes mediciones ecograficas para la deteccion del STC en entornos clinicos. Objetivo. Hallar la validez diagnostica de las mediciones ecograficas del area de seccion transversal del nervio mediano en la muñeca (AST-M) y de la ratio del area del nervio mediano entre la muñeca y el antebrazo (R-MA) en el diagnostico del STC, utilizando como tecnica de referencia el electroneurograma (ENG). Pacientes y metodos. Se realizaron mediciones ecograficas en 59 sujetos (97 muñecas) referidos para someterse a un ENG por sospecha de STC. Los examinadores que realizaron la ecografia desconocian los resultados del ENG. Posteriormente, se calcularon los puntos de corte mediante curvas ROC para cada una de las mediciones (AST-M y R-MA) y se analizo su validez diagnostica. Resultados. Con un punto de corte de 9,15 mm2, la medicion AST-M obtuvo una sensibilidad del 75,81%, una especificidad del 74,29%, una ratio de probabilidad positiva de 2,95 y una ratio de probabilidad negativa de 0,33. Para la medicion R-MA y un punto de corte de 1,56, los valores de sensibilidad, especificidad y ratios de probabilidad positiva y negativa fueron 70,97%, 71,43%, 2,48 y 0,4, respectivamente. Conclusion. Tanto el AST-M como la R-MA parecen ser medidas utiles en el diagnostico del STC tomando como prueba de referencia el ENG.

Síndrome del túnel carpiano: comparación de resultados en el electroneurograma y en el cuestionario de Boston / Syndrome of the tunnel carpiano: comparison of results in the electroneurograma and in the questionnaire of Boston

El síndrome del túnel carpiano (STC) es un cuadro clínico que afecta al 5% de la población. El diagnóstico se basa en lahistoria clínica, uso de cuestionarios y electroneurograma-electromiograma. En este estudio se comparan las respuestas obtenidasen el autocuestionario de Boston (CB) que es reproducible, válido, con consistencia interna, capaz de responder a loscambios clínicos y transculturales, con los resultados del electroneurograma del nervio mediano (ENG), prueba suficientementevalidada para confirmación diagnóstica de STC, en 56 pacientes sin tratamiento. Los valores obtenidos en el ENG seclasificaron en seis niveles. Se encontró correlación positiva entre la velocidad de conducción sensitiva distal (VCSD) conlas preguntas 3, 4, 5 y 9 del CB, y entre la latencia distal motora (LDM) con la pregunta 9, cuestiones relacionadas principalmentecon la gravedad del dolor y de las parestesias nocturnas. Según estos resultados, podría ser de interés utilizar estecuestionario como método simple y válido para diagnosticar el STC (AU)

Carpal tunnel syndrome (CTS) affects approximately 5% of the population. The diagnosis is based on the clinical history,questionnaires and electromyogram-nerve conduction velocity studies (EMG-NCV). The Boston Questionnaire (BQ) hasbeen shown to be a repeatable, valid, and internally consistent tool for the diagnosis of CTS, able to adapt to clinical andtranscultural changes. We compared responses to the BQ with results of median NCV, a test that has been extensivelyvalidated for the diagnostic confirmation of CTS, in 56 untreated patients. NCV results were classified into six levels.Positive correlations were observed between the distal sensory NCV and questions 3, 4, 5 and 9 of the BQ, and betweendistal motor latency and question 9; these items are mainly related to the severity of pain and nocturnal paresthesias. Theseresults suggest that use of this simple and validated questionnaire may be useful in the diagnosis of CTS(AU)