Sensitivity and specificity of carpal tunnel syndrome signs.

The sensitivity and specificity of six carpal tunnel syndrome (CTS) signs were determined by evaluating 143 subjects (228 hands) with symptoms of CTS. Immediately after performing the six physical examination tests, standard nerve conduction studies were performed on all 228 hands to determine the presence or absence of CTS. CTS was present in 142 hands and absent in 86 hands. The signs were not very sensitive (23-69%), but were fairly specific (66-87%) for CTS. A square-shaped wrist and abductor pollicis brevis weakness were the most sensitive signs (69 and 66%, respectively), and are recommended as part of the examination of CTS. Median nerve hypesthesia and the Phalen sign both have fair sensitivity (51%) but good specificity (85 and 76%, respectively). The median nerve compression sign and the Hoffmann-Tinel sign both have poor sensitivity (28 and 23%, respectively), and thus are less helpful in evaluating subjects with suspected CTS.

Bilateral musculocutaneous nerve palsy. A case report.

A case of bilateral, isolated, proximal musculocutaneous nerve palsy is reported. Initial physical and electromyographic examinations demonstrated complete denervation of the biceps brachii, brachialis, and coracobrachialis muscles bilaterally. Nerve conduction studies of the musculocutaneous nerves initially revealed no evoked potentials. The patient underwent resection with end-to-end anastomosis on the left and neurolysis without resection on the right. Significant functional recovery was noted bilaterally but was more rapid and complete on the side that underwent neurolysis without resection.

Congenital diaphragmatic hernia: prognosis and prenatal detection.

Fifty consecutive cases of isolated congenital diaphragmatic hernia were reviewed for prenatal ultrasound and neonatal physical findings. These were compared to survival and the need for extracorporeal membrane oxygenation (ECMO). No prenatal findings predicted survival or the need for ECMO. In left-sided hernias, the presence of the liver in the chest predicted (p = 0.02) the requirement for ECMO. In a cohort of 13 prenatally diagnosed inborn cases, the ultrasound triad of polyhydramnios, mediastinal shift and intrathoracic stomach predicted the presence of liver in the chest (p < 0.03).

Cervical range of motion in the elderly.

This study was conducted to establish normative cervical range of motion values for the elderly and to compare those values to standard young adult cervical range of motion values. Differences in range of motion between men and women were also assessed. A gravity goniometer was used to measure six cervical motions in 42 subjects aged 70 to 90 years and 31 subjects aged 20 to 30 years. The elderly group had significantly less motion than the younger group for all six motions measured (p < .001). A comparison of the mean range of motion values between the two groups found that the elderly group had approximately 12% less flexion, 32% less extension, 22% less lateral flexion, and 25% less rotation. The elderly group also had a wider variation of cervical range of motion values as compared to the younger group. Women had greater cervical range of motion values than men in both age groups.

Doppler evaluation of umbilical and uterine-arcuate arteries in the postdates pregnancy.

To assess the correlation between Doppler velocimetry and perinatal outcome in the postdates pregnancy, 75 women who were at least 41 weeks' gestation were evaluated twice weekly until delivery. Evaluation included Doppler velocimetry of the umbilical and uterine-arcuate arteries, as well as nonstress testing and amniotic fluid volume estimation. The mean umbilical artery systolic-diastolic ratio (S/D) was significantly higher in the pregnancies with subsequent abnormal perinatal outcomes than in those with normal outcomes (2.42 versus 2.19; P = .03). Using a receiver operating characteristic curve, an abnormal umbilical artery S/D was defined as 2.40 or greater. Using this value, sensitivity was 57.1% and specificity was 77.8%. Our study suggests that an umbilical artery S/D of 2.40, rather than the more traditionally accepted cutoff of 3.0, may be a useful threshold to identify those postdates pregnancies at high risk for abnormal perinatal outcome.

Acoustic stimulation testing.

The nonstress test is the most widely employed method of fetal health assessment. The current approach is to use the OCT or biophysical profile as a means of identifying the fetus at very high risk should the nonstress test be either nonreassuring or equivocal. The acoustic stimulation test may have a predictive ability similar to that of the biophysical profile and thus may be used to complement nonstress testing as early as 28 weeks' gestation. It reliably invokes a reactive NST in those fetuses destined to demonstrate reactivity with persistence in monitoring and facilitates more rapid and efficient testing. The acoustic test may have the additional benefit of providing a screening mechanism for anomalies in which neurologic performance is suboptimal. However, because the test has not been studied on large numbers of patients and because different applications of such stimuli may elicit differing responses, its adaptation for clinical use should be cautious at the present time.

Ultrasonic imaging of normal fetal response to external vibratory acoustic stimulation.

Fetal facial reactions and response decrement patterns to external noise stimulation were studied to characterize normal fetal neurobehavior in the third trimester. Response decrement, or habituation, is thought to reflect higher central nervous system function. Two hundred women with uncomplicated pregnancies, who were subsequently delivered of healthy infants at term, were studied between 26 and 41 weeks' gestation. After ultrasound views of the fetal face were obtained, a vibratory acoustic stimulus was applied repetitively to the maternal abdomen near the fetal head. Response decrement was defined as cessation of all components of the facial reaction, except eye blinking, over two sequential stimuli. Three response patterns were scored: (1) no startle, (2) startle without response decrement, and (3) response decrement by 12 stimuli. Whereas only 53% of fetuses between 26 and 27 weeks displayed startle reaction, all fetuses displayed startle responses by 28 weeks. As gestational age advances, an increasing number of fetuses exhibit response decrement, from no decrement at 26 to 27 weeks to 100% decrement at 40 to 41 weeks. A maturation of neurobehavioral response patterns takes place in normal third-trimester pregnancies. Response decrement testing may be a useful tool for in utero neurologic evaluation.