Efficacy of focused shockwave therapy in patients with moderate-to-severe carpal tunnel syndrome: a preliminary study.

OBJECTIVE: To evaluate the efficacy of focused extracorporeal shockwave therapy for symptoms and function in patients with moderate-to-severe carpal tunnel syndrome. DESIGN: A single-blind randomized controlled trial. SUBJECTS: Twenty-four outpatients with moderate-to-severe carpal tunnel syndrome. METHODS: Patients were randomly allocated into 2 groups: a focused extracorporeal shockwave therapy group and a control group. The focused extracorporeal shockwave therapy group received conservative treatment in addition to focused extracorporeal shockwave therapy with an energy flux density ranging from 0.01 to 0.15 mJ/mm2, a frequency of 4-5 Hz, and 1500 pulses per session once a week for a total of 3 sessions. The control group received only conservative treatment, which comprised gliding exercises for carpal tunnel syndrome, a night wrist splint, and lifestyle modification. The Thai version of the Boston Carpal Tunnel Questionnaire (T-BCTQ), a nerve conduction study, and ultrasonography of the median nerve cross-sectional area were performed before treatment and at 3 and 6 weeks after baseline. RESULTS: The T-BCTQ symptom and function scores had significantly decreased in both groups, favouring focused extracorporeal shockwave therapy at all time-points. In addition, distal sensory and motor latency were significantly different between the groups at 3 weeks from baseline. CONCLUSION: Focused extracorporeal shockwave therapy plus conservative treatment effectively provided short-term improvement in symptoms, hand function, and nerve conduction in patients with moderate-to-severe carpal tunnel syndrome compared with conservative treatment alone.

Short-Term Efficacy of High-Intensity Laser Therapy in Alleviating Pain in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial.

Objectives: The aim of the study is to evaluate the efficacy of high-intensity laser therapy (HILT) on pain reduction in patients with knee osteoarthritis (OA). Methods: Forty-two patients diagnosed with primary knee OA, with a Kellgren-Lawrence classification of 2-4, were recruited into the study. The patients were randomly allocated to two groups: HILT and control. The intervention group received HILT (energy density of 22.39 J/cm2, 562.5 joule/session), while the control group received a sham laser, which was done 2-3 sessions per week for a total of 10 sessions. Both the groups also received the same conservative treatment. The main outcome measures were the visual analogue scale (VAS) and the modified Thai version of the Western Ontario and McMaster Universities Osteoarthritis Index (T-WOMAC) which were evaluated at baseline and immediately after treatment completion. Results: At the end of the study, the overall analysis showed a significant decrease in VAS and T-WOMAC scores in both the groups; a greater decrease in scores was found in the HILT group than in the control group (p < 0.001). The between-group comparison also showed a significant difference in VAS, but not in the T-WOMAC score, favouring HILT (p < 0.05). Conclusion: The HILT plus conservative treatment can help alleviate pain in patients with knee OA. The findings of the present study could be used in clinical practice to add HILT as another noninvasive treatment option for knee OA. This could be advantageous, particularly for individuals who are at high risk of surgery due to multiple comorbidities or older people. Trial Registration. This clinical trial registration was performed at Clinical.gov (NCT04889885).

Claw Hand Deformity: A Rare Complication of Herpes Zoster.

Distal upper extremity weakness is a rare complication after herpes zoster, which can be easily misdiagnosed by other nerve entrapment syndromes. We present a 31-year-old immunocompromised woman who developed a claw-like deformity of her right hand after full medical treatment and resolution of herpes zoster. The electrodiagnostic finding was compatible with right multiple mononeuropathies of the median and ulnar nerves, ongoing axonal loss, unlike the nerve entrapment patterns. The early recognition and early electrodiagnosis of herpes zoster-induced distal motor weakness, especially in the upper extremity, is necessary to exclude the nerve entrapment syndrome and to be the baseline for functional motor recovery prediction. The prognosis of functional motor recovery is considered good but may take months to years to accomplish. Rehabilitation management plays an important role after full medical treatment.

Correlation between the action research arm test and the box and block test of upper extremity function in stroke patients.

OBJECTIVE: The objective of the present study was to determine the correlation between the scores of the Action Research Arm Test (ARAT) and the Box and Block Test (BBT), commonly used tests of upper extremity (UE)function. MATERIAL AND METHOD: Forty first-time subacute stroke patients without severe cognitive, language, or motion impairment were administered the ARAT and BBT before and after participating in a 4-week rehabilitation program. Their scores were analyzed by Wilcoxon sign-rank testing and by Spearman's rank correlation, standardized response mean, and scatter-plot analysis. RESULTS: The ARAT and the BBT scores have a high level of responsiveness to change and are highly correlated. The BBThas afloor effect compared with the ARAT while the ARAT has a small ceiling effect compared with the BBT CONCLUSION: The ARAT and the BBT scores have excellent concurrent validity and are highly responsive to change, indicating that the BBT can effectively assess UE function.

Cross-cultural adaptation to the Thai language of the neuropathic pain diagnostic questionnaire (DN4).

OBJECTIVE: To cross-culturally adapt the neuropathic pain diagnostic questionnaire (DN4) to Thai language MATERIAL AND METHOD: Phase 1: Forward and backward translation followed by assessment of semantic equivalence. Phase 2: Testing of the questionnaire in 30 neuropathic pain patients who were seen and diagnosed by experts, followed by modifications to produce a final version. RESULTS: All the Thai translated pain descriptors except 'tingling' got high percentages of understanding among neuropathic pain patients in the first round of testing. After some adaptation of the Thai word for 'tingling' had been made, the new translated word was retested, and all subjects doing the retest understood the word very well. CONCLUSION: The Thai DN4 questionnaire was systematically translated and validated. This offers a simple Thai neuropathic pain diagnostic tool for clinical use.

Measuring functional status in Thai children with disabilities.

OBJECTIVE: The purpose of this study was to compare normal children with age-appropriate functional abilities and children with identified disabilities in Thailand. SUBJECTS AND METHOD: Data were collected for 157 nondisabled children and 80 children with cerebral palsy. Their ages ranged from 6 to 100 months. The Functional Independence Measure for children (WeeFIM) is an instrument used to assess independence in self-care, sphincter control, transfers, locomotion, communication, and social cognition. RESULTS: The WeeFIM of the disabilities scored consistently lower in all areas than those of the nondisabled children (p<0.05). Total score, motor score, and cognitive subscores increased with age. When data from Thai children was compared with that from American and Japanese children, total WeeFIM mean scores for each age group and Pearson's correlation coefficients between each age group and total WeeFIM scores showed similar trends. CONCLUSION: WeeFIM can be used as a disability-measuring instrument for Thai children.