Diffusion tensor imaging of the median nerve in healthy and carpal tunnel syndrome subjects.

PURPOSE: To determine if diffusion tensor imaging (DTI) of the median nerve could allow identification of patients with carpal tunnel syndrome (CTS). MATERIALS AND METHODS: A total of 13 healthy subjects and 9 CTS patients were scanned on a 3T magnetic resonance imaging (MRI) scanner. The MRI protocol included a DTI sequence from which the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and the parallel and radial diffusivities could be extracted. Those parameters were quantified at different locations along the median nerve (proximal to the carpal tunnel, within the carpal tunnel, and distal to the carpal tunnel). RESULTS: At the carpal tunnel, the FA, radial diffusivity, and ADC differed significantly between healthy subjects and CTS patients (P<0.0002). This highly significant difference between the two groups was due to an opposite trend of changes in the DTI indices between the proximal to the carpal tunnel and within the carpal tunnel locations. In healthy subjects the FA increased (+20%, P<0.001) and the radial diffusivity and ADC decreased (by -15% and -8%, respectively, P<0.05) between the proximal to the carpal tunnel and within the carpal tunnel locations. In CTS subjects the FA decreased (by -21%, P<0.05) and the radial diffusivity increased (by +23%, P<0.01) between the proximal to the carpal tunnel and within the carpal tunnel locations. CONCLUSION: DTI enables visualization and characterization of the median nerve in healthy subjects and CTS patients. DTI indices show clear-cut discrimination between the two groups and in fact enables the of use DTI in the diagnosis of CTS.

The effects of femoral derotation osteotomy in children with cerebral palsy: an evaluation using energy cost and functional mobility.

BACKGROUND: The effect of femoral derotation osteotomy (FDO) in children with cerebral palsy (CP) has hitherto been examined using various outcome measures including range of motion of lower extremity joints and gait parameters. However, functional ambulation following this procedure has been scarcely investigated. OBJECTIVE: To evaluate the effect of FDO on energy cost during stair climbing and functional mobility in children with CP. METHOD: A prospective case series study was conducted on 18 children with CP, 11 at Gross Motor Functional Classification System (GMFCS) II and 7 with GMFCS III, aged 8.5 +/- 1.24 years (range, 6.9-11 years) who underwent FDO to correct hip internal rotation. The energy cost was measured using the heart beat cost index (HBCI) during stair climbing test, whereas functional mobility was assessed using the Gillette Functional Assessment Questionnaire (FAQ). Tests were administered before surgery (P0), 6 months (P1), and at approximately a year postoperatively (P2). RESULTS: Compared with P0, significant changes in hip rotation were observed at P1 and P2. There was a significant improvement in HBCI from P0 to P2, whereas FAQ improved significantly from P1 to P2. A moderate correlation was found between HBCI and GMFCS at all times (r = 0.61-0.78). Negative correlations were found between the HBCI and FAQ and between GMFCS and FAQ at all times (r = -0.5). CONCLUSION: This study indicates that children with CP may benefit functionally from FDO as judged by HBCI and functional mobility rating.

Grip and pinch strength in healthy subjects and patients with primary osteoarthritis of the hand: a reproducibility study.

Grip, Key Pinch (KP), 3 Point Pinch (3PP) and 2 Point Pinch (2PP) strengths were measured twice weekly in 32 women with primary osteoarthritis of the hand (POAH) and 25 healthy women. Reproducibility was assessed by standard error of measurement (SEM) and the coefficient of variation (CV). Cutoff values for significant improvement or deterioration were determined and expressed, respectively, as either the smallest detectable difference (SDD) or critical difference (CD). The SDD and CD of grip and pinch strengths were higher in POAH patients than in the healthy group. Among the pinch tests the 2PP findings were least reproducible. The relatively high SDD and CD scores indicate that improvement may be detected only in patients with moderate to severe weakness of grip and pinch. Furthermore, in POAH patients, diagnosing strength changes using the 2PP test is invalid due to low reproducibility.

The aging hand.

Hand function decreases with age in both men and women, especially after the age of 65 years. A review is presented of anatomical and physiological changes in the aging hand. The age-related changes in prehension patterns (grip and pinch strength) and hand dexterity in the elderly population are considered. Deterioration in hand function in the elderly population is, to a large degree, secondary to age-related degenerative changes in the musculoskeletal, vascular, and nervous systems. Deterioration of hand function in elderly adults is a combination of local structural changes (joints, muscle, tendon, bone, nerve and receptors, blood supply, skin, and fingernails) and more distant changes in neural control. These age-related changes are often accompanied by underlying pathological conditions (osteoporosis, osteoarthritis, rheumatic arthritis, and Parkinson's disease) that are common in the elderly population. Assessment of hand function and prehension patterns is needed in order to determine specific treatment approaches.