Nervio mediano trífido. Una variante anatómica infrecuente en la exploración ecográfica del túnel del carpo / Trifid median nerve. A rare anatomical variant in sonographic evaluation of carpal tunnel

El estudio ecográfico para el diagnóstico del síndrome del túnel del carpo puede ponernos de manifiesto distintas variantes anatómicas. Una variante poco común es la presencia de un nervio mediano trífido, que puede ser de importancia en una posterior planificación quirúrgica. Varón de 52 años, con clínica compatible con síndrome del túnel del carpo bilateral. Se realiza una evaluación ecográfica, visualizándose un nervio mediano bífido en la muñeca derecha y un nervio mediano trífido en la izquierda como variantes de la normalidad. La aparición de un tercer elemento nervioso en el túnel del carpo debe ser diferenciado de una persistencia de la arteria mediana a nivel del túnel del carpo junto a un nervio mediano bífido, mucho más habitual. Para ello, es fundamental la visualización ecográfica de la zona de estudio mediante la utilización de la función Doppler, como vemos en el caso clínico que presentamos.(AU)

The ultrasound study for the diagnosis of carpal tunnel syndrome can reveal different anatomical variants. A rare variant is the presence of a trifid median nerve. The visualization of this anatomical variant may be of importance in the surgical planning of carpal tunnel syndrome. Fifty-two-year-old male, with a clinic compatible with bilateral carpal tunnel syndrome. In the ultrasound examination, a bifid median nerve appears as a finding in the right wrist and a trifid median nerve in the left wrist as anatomical variants. It is important to distinguish a trifid median nerve from a persistent median artery at the level of the carpal tunnel, much more frequent than the first. For this, the ultrasound visualization of the study area using the Doppler function is essential.(AU)

[Trifid median nerve. A rare anatomical variant in sonographic evaluation of carpal tunnel]. / Nervio mediano trífido. Una variante anatómica infrecuente en la exploración ecográfica del túnel del carpo.

The ultrasound study for the diagnosis of carpal tunnel syndrome can reveal different anatomical variants. A rare variant is the presence of a trifid median nerve. The visualization of this anatomical variant may be of importance in the surgical planning of carpal tunnel syndrome. Fifty-two-year-old male, with a clinic compatible with bilateral carpal tunnel syndrome. In the ultrasound examination, a bifid median nerve appears as a finding in the right wrist and a trifid median nerve in the left wrist as anatomical variants. It is important to distinguish a trifid median nerve from a persistent median artery at the level of the carpal tunnel, much more frequent than the first. For this, the ultrasound visualization of the study area using the Doppler function is essential.

Estrategias biomecánicas conservadoras para la gonartrosis mediante ortesis plantares / Conservative biomechanical strategies for knee osteoarthritis through plantar orthoses

Introducción: La gonartrosis representa un importante problema de salud, cuya prevalencia aumenta acorde con el envejecimiento de la población y las crecientes tasas de sobrepeso y obesidad. Asocia dolor, discapacidad funcional y un alto coste económico. Objetivo: Determinar la eficacia del uso de cuñas pronadoras en las plantillas para disminuir los síntomas, la discapacidad y retrasar la cirugía artroplástica. Diseño: Ensayo clínico aleatorizado no cegado. Pacientes con gonartrosis grado 2-4 de Kellgren y Lawrence atendidos en la Unidad de Aparato Locomotor y Rehabilitación del Hospital Infanta Margarita. Se hizo un seguimiento de 9 meses. Material y método: Cincuenta y seis pacientes sin tratamiento ortésico o quirúrgico previo. Valoramos el grado de severidad mediante radiología, el dolor mediante la escala visual analógica pre- y postintervención, y la funcionalidad mediante el índice de artrosis de la Western Ontario and McMaster Universities. Se incluyó a los pacientes de forma aleatoria en uno de los grupos: cuñas pronadoras retropié, cuñas pronadoras con prolongación a cabeza de 5.o metatarsiano o ciclo de infiltraciones corticoideas intraarticulares en rodilla. Resultados: Obtenemos diferencias estadísticamente significativas en las dimensiones del índice de artrosis de la Western Ontario and McMaster Universities. Dolor: mejoría en el grupo 2 (p < 0,001); capacidad funcional: niveles inferiores en el grupo 3 respecto a los otros grupos (p < 0,001). No existieron diferencias en la escala visual analógica (p = 0,927) ni en la dimensión rigidez del índice de artrosis de la Western Ontario and McMaster Universities (p = 0,072). El 12,5% de los pacientes fueron derivados a cirugía. Conclusión: Las ortesis plantares modificadas producen mejoría sintomática y funcional en pacientes con gonartrosis. Se precisan estudios con mayor muestra y a más largo plazo para verificar si este beneficio se mantiene en el tiempo (AU)

Introduction: Knee osteoarthritis is a major health problem whose prevalence increases in line with the aging population and rising rates of overweight and obesity. Associated factors are pain, functional disability, and high economic cost. Objective: To determine the efficacy of using wedge insoles to reduce symptoms, disability and delay arthroplasty surgery. Design: A randomized unblinded study was performed in patients with Kellgren and Lawrence grade 2-4 knee osteoarthritis treated in the Locomotive and Rehabilitation Unit of the Infanta Margarita Hospital. A 9-month follow-up was performed. Material and method: Fifty-six patients received no orthotic or surgical treatment. Severity was assessed by radiological study, pain by visual analog scale pre- and post-intervention, and functionality by the Western Ontario and McMaster Universities osteoarthritis index. We randomly included the patients into one of three groups: pronator rearfoot wedges, pronator wedges with extension to the 5th metatarsal head or three intraarticular corticosteroid infiltrations in the knee. Results: Statistically significant differences were found in Western Ontario and McMaster Universities osteoarthritis index dimensions: pain improved in group 2 (P < .001). Functional capacity was lower in group 3 than in the other groups (P < .001). There were no differences in visual analog scale (P = .927) or the Western Ontario and McMaster Universities osteoarthritis index stiffness scale (P = .072). A total of 12.5% were referred to surgery. Conclusion: The use of modified foot orthoses produces symptomatic and functional improvements in patients with knee osteoarthritis. Long-term studies with a larger sample are needed to verify whether this benefit is maintained over time (AU)

Incidence of hypercalcemia, hypercalciuria and related factors in patients treated with recombinant human parathyroid hormone (1-84).

AIM: The aim of this paper was to determine the incidence of hypercalcemia and hypercalciuria (and related factors) in 22 postmenopausal women with osteoporosis treated with PTH (1-84) in daily practice. METHODS: Osteoporosis was defined as history of osteoporotic fracture or a T score less than -3 SD on bone densitometry. Patients were treated with PTH (1-84), 100 mcg/daily, for 12 months. Clinical and laboratory data at baseline and after 6 months of treatment were assessed. RESULTS: The mean age was 71.9 years. The incidence of hypercalcemia and the hypercalciuria were 6 events. Increase in serum calcium levels showed a statistically significant correlation with 24-hour urinary calcium (rho [ρ]=0.83, P<0.001), serum alkaline phosphatase (ρ=0.76, P=0.001), total proteins (ρ=0.77, P=0.005), and ß-CTx (ρ=0.82, P=0.002). On the other hand, 24-hour urinary calcium excretion correlated significantly with ß-CTx (ρ=0.83, P=0.002), alkaline phosphatase (ρ=0.73, P=0.005), total proteins (ρ=0.73, P=0.02), and serum phosphate (ρ=0.58, P=0.04). When the group of patients with and without hypercalcemia were compared, there were statistically significant differences in increases of ß-CTx and baseline ß-CTx values, whereas the group of patients with and without hypercalciuria showed significant differences in serum calcium increases and baseline values of T score at the femoral neck. CONCLUSION: The incidence of hypercalcemia and hypercalciuria after treatment with PTH (1-84) is similar to that expected according to the product's technical specifications. There was a significant correlation between increases of serum calcium, urinary calcium excretion, serum alkaline phosphatase, and ß-CTx after treatment with PTH (1-84). Baseline ß-CTx values were significantly lower in patients who developed hypercalcemia than in those with normal serum calcium levels.

Rehabilitación en atención primaria: mejorando la accesibilidad en una unidad de gestión clínica internivel / Rehabilitation in primary care: improving accessibility in an interlevel clinical management unit

El origen de la gestión clínica en Andalucía hay que situarlo a partir de las estrategias del I Plan de Calidad que, acogiéndose a los principios de efectividad, eficacia y eficiencia en la práctica clínica, tienen como objetivo mantener y mejorar la atención sanitaria. Uno de los indicadores de calidad en las unidades de gestión clínica (UGC) es la accesibilidad, siendo fundamental el trabajo realizado en atención primaria (AP). La UGC de Aparato Locomotor y Rehabilitación del Hospital Infanta Margarita de Cabra propone estrategias de mejora que faciliten la accesibilidad y continuidad asistencial. Se realiza una revisión bibliográfica de la situación actual del problema, analizamos las características de la población del área Córdoba Sur, sus necesidades y servicios de rehabilitación y elaboramos estrategias de mejora en accesibilidad desde AP. Hemos encontrado escasa bibliografía internacional relacionada con el objeto de nuestro estudio. Analizamos demográficamente nuestra población, definimos la cartera de servicios en AP, la distribución y la organización de los centros periféricos, nuestro compromiso en los tiempos de respuesta, la utilización de protocolos terapéuticos, finalizando con nuestras intervenciones en atención domiciliaria. La bibliografía revisada no presenta modelos extrapolables a nuestro entorno. Desde la UGC se presentan mejoras en accesibilidad como: ampliación de oferta horaria, incremento de la cartera de servicios y mejora en los tiempos de respuesta, entre otras estrategias, que permiten una atención con mayor equidad y mejor accesibilidad de la población del área Córdoba Sur (AU)

Clinical management in Andalusia grew out of strategies described in the First Quality Plan, which draws on the values of effectiveness, efficacy and efficiency in clinical practice and aims to maintain and improve healthcare. One of the quality indicators in clinical management units (CMU) is accessibility, the work done in primary care (PC) being essential. The aim of the present study, performed by the CMU for the Locomotor Apparatus and Rehabilitation of the Infanta Margarita Hospital in Cabra, was to propose strategies to improve accessibility and continuity of care. We reviewed the literature on the current situation of the problem, analyzed the characteristics and needs of the population of southern Cordoba and the rehabilitation services in this area, and designd strategies to improve accessibility from primary care. To our knowledge, there is scarce international literature on the topic of our study. We analyzed our population demographically, defined the services’ portfolio for primary care, the distribution and organization of peripheral care centers, our commitment to meeting response times, the use of therapeutic protocols, and our interventions in home-based care. The literature reviewed contained no descriptions of models that could be replicated in our environment. Since the CMU opened, improvements have been made, such as extending the opening hours, increasing the services’ portfolio, and improving response times, among other strategies. These changes have allowed greater equity and accessibility for the population of southern Cordoba (AU)