Can Carpal Tunnel Syndrome be Appropriately Diagnosed in a Cold Hand?

INTRODUCTION: The diagnosis of carpal tunnel syndrome (CTS) with nerve conduction studies traditionally involves warming the hand to avoid misleading prolongation of distal latency (DL). Comparing the median nerve DL to the ulnar and radial nerves using the combined sensory index (CSI) has been reported to improve the accuracy of CTS diagnosis. During this study, the authors examined the effect of hand temperature on the CSI and diagnosis of CTS. METHODS: The authors conducted a prospective, controlled, cohort study with 20 asymptomatic control patients and 21 symptomatic patients with confirmed CTS. Symptomatic patients underwent nerve conduction studies with the CSI calculated under both cold and warm conditions. RESULTS: Control subjects with warm hands had an average CSI of 0.0 milliseconds (ms), and -0.3ms with cold hands. CTS subjects with warm hands had an average CSI of 3.2ms, and 3.7ms with cold hands. Although hand temperature was shown to slow sample latencies, differences calculated with the CSI did not misclassify any of the 41 sample subjects. CONCLUSIONS: During this study, cold temperature did not result in misclassification of either control patients or CTS patients when CSI was diagnostically used. Based on these results, peak latency comparisons in cold hands can be considered as diagnostically reliable as under standard hand temperature ranges for the diagnosis of CTS, with caution warranted in borderline cases. This diagnostic technique can save time for the patient, physician, and care team without compromising quality of care. Future larger sample blinded studies at multiple electrodiagnostic sites are indicated.

Incidence of injury and illness during the 2013 world dwarf games.

BACKGROUND: Dwarfism, or skeletal dysplasia, is a term used to describe short stature. Injuries to athletes with disabilities and medical co-morbidities, such as those present in the dwarf population, can have significant consequences on functionality. The main objectives of this retrospective descriptive study were to 1) evaluate the safety of athletic participation among athletes with skeletal dysplasia, 2) investigate the incidence and characteristics of injuries and illnesses among athletes with skeletal dysplasia during the 2013 World Dwarf Games held on the campus of Michigan State University, 3) describe details and overview of the World Dwarf Games, and 4) identify possible safety and rule issues to improve safety at future World Dwarf Games. METHODS: This was a retrospective review of case series interactions between dwarf athletes and the medical staff present at the 2013 World Dwarf games from August 3-10, 2013. Injury incidence rates were calculated by dividing the number of incident injuries by total athlete-competitions. Epidemiologic incidence proportion calculations were used to measure average injury risks. RESULTS: A total of 24 competition related injuries were recorded among the 409 athletes. Only 1 illness (otitis media) was reported during the week of games. The overall injury incidence rate was found to be 0.78 injuries per 100 athlete-competitions. The overall epidemiologic incidence proportion was 5.9% (7.2% for males, 3.0% for females). The most common type of injury was a muscle/tendon strain (41.7% of all injuries). The sport with the most reported injuries was soccer with 4.63 injuries per 100 athlete-competitions. CONCLUSIONS: Based on the data collected, it does appear that athletes with skeletal dysplasia can safely participate in the events offered during the World Dwarf Games. None of the reported injuries or illnesses precluded the athletes from returning to play. Data collected at future competitions will help identify trends, which may lead to rule changes to improve safety and a decrease in injuries. Adding a designated spectator area for athletes as well as modifying rules to prevent excessive physical contact in soccer and basketball competitions may reduce the incidence of injury.