scholarly journals OBJECTIVIZATION OF THE EFFECT OF A COMPLEX OF PHYSICAL FACTORS IN PATIENTS WITH CARPAL TUNNEL SYNDROME BY ELECTROMYOGRAM TEST

World Science ◽  
2021 ◽  
Author(s):  
Evgeniya Vladeva
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Early Diagnosis ◽  
Median Nerve ◽  
Conduction Velocity ◽  
Carpal Tunnel ◽  
Diagnostic Methods ◽  
Physical Factors ◽  
Moderate Degree ◽  
Tunnel Syndrome ◽  
Reverse Development

CTS is the most common compression neuropathy with an incidence of 125-515/100 000. It is a result of compression of the median nerve by the transverse carpal ligament. It is observed in 2 to 5% of the general population, more frequently in women.Electromyography is considered the most accurate diagnostic procedure, although it cannot be fully accepted as a gold standard due to the possibility of false positives (about 15%) and false negatives (about 18%) [1]However, because of its low cost, in comparison to other diagnostic methods, its high diagnostic reliability, and the few contraindications to its application, it remains a method of choice for diagnosis and follow-up of the reinnervation of the median nerve in CTS patients.Aim of study. To investigate the effect of a complex of physical factors on the reverse development of symptoms of moderate carpal tunnel syndrome using electromyography.Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were еexamined. 38.60% of the patients were with right hand affected, 9 patients (15.80%) with left hand affected and 26 patients (45.60%) with bilateral involvement (n=26). In the last group, we examined both hands, ie 57 patients and 82 hands were investigated.Based on the analysis of our own studies, we applied the following complex physiotherapeutic program to the patients involved in the study: ultrasound, electrophoresis with Nivalin (Galantamine), and traditional kinesitherapy program.In our study, we examined the sensory and motor fibres of the n. medianus. Changes in distal latency, amplitude, and conduction velocity were observed.Results and discussion. The electroneurographic examination we performed showed a statistically significant change (p <0.001) in the normalization of distal latency, conduction velocity and M amplitude in both the sensory and motor fibres of the affected nerve. These results were reported between the first and fourth months after physiotherapy. There is also a tendency for their retention within the next 4-8 months.Correlation analysis shows that there is a very strong, statistically significant (p <0.001) relationship between the ENG parameters for n. medianus sensory and motor fibres conductivity (distant latency, SNAP and conduction velocity) and the treatment performed, which is established even at the first check-up (1-4 months) after end of the treatment, and the results achieved are maintained over time.The statistically significant changes in the values of ENG parametric fibers of n. medianus, we refer to the complex physiotherapy treatment, aimed at improving the trophic and nerve conduction, accelerating the regenerative processes of the nerve structures, improving the trophic and vascularizing the structures located in the carpal tunnel.Last but not least, the fibrolytic action of ultrasound therapy leading to the spreading of fibrous seals, which is quite common in CTS, is also important. Although different in their mechanism of action, the physiotherapeutic procedures included in our program have a synergistic effect aimed at overcoming the functional deficiency and reversing the symptoms of CTS.Conclusions. Our study on the effectiveness of a complex of physical factors in the conservative treatment of the CTS showed that early diagnosis and timely initiation of physiotherapeutic treatment are a prerequisite for achieving very good results in terms of functional recovery of the affected hand and the reverse development of clinical symptoms in patients with proven mild to moderate CTS.The segmental demyelination of the sensory and motor fibers of n. medianus in the initial stages, as a result of its compression in the area of the carpal canal, is a reversible process. An integrated approach to the treatment of CTS, including early diagnosis, prevention and treatment, is the key for success in mild and moderate forms of the syndrome, and competent and timely medical advice is often crucial.

Role of Panchakarma in the management of Carpal Tunnel Syndrome - A Review

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Suresh N. Hakkandi ◽  
Dr. Manjunath Akki ◽  
Dr. Snigdha Rani Patra
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Early Diagnosis ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Common Condition ◽  
Long Time ◽  
Tunnel Syndrome ◽  
Brachial Neuralgia ◽  
Over Time

Carpal tunnel syndrome is a common condition that causes pain, numbness and tingling in the hand and arm. The condition occurs when one of the major nerves of the hand, the median nerve is squeezed or compressed as it travels through the wrist. In most patients, carpal tunnel syndrome gets worsen over time, so early diagnosis and treatment are important.[1] If CTS (carpal tunnel syndrome) left untreated, symptoms can last a long time and get worsen. Carpal tunnel syndrome cannot be compared directly to any of the disease in Ayurveda. But to some extend we can compare CTS to Jhinjhini Vata described in Chakradatta.[2] And in later stage when CTS is left untreated the pain and numbness radiates from hand to forearm and arm, at that stage we can compared it with Vishwachi (Brachial neuralgia).[3]

Letter to the Editor: The Continuing Challenge of Evaluating Carpal Tunnel Syndrome Impairment

2000 ◽  
Vol 5 (5) ◽  
pp. 3-3, 10
Author(s):  
J. True Martin
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Conduction Velocity ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Nerve Entrapment ◽  
Accurate Information ◽  
Tunnel Syndrome ◽  
Patient’S History

Abstract The author responds to The Continuing Challenge of Evaluating Carpal Tunnel Syndrome Impairment in the March/April 2000 issue of The Guides Newsletter. Carpal Tunnel Syndrome (CTS) is a clinical diagnosis based on the patient's history and objective findings on examination. Patients present with dull, aching discomfort of the hand, forearm, or upper arm; paresthesias and tingling of the hand; subjective weakness or numbness; and, occasionally, autonomic changes. Nerve conduction velocity studies are highly accurate in documenting median nerve entrapment at the level of the wrists, but this is an anatomic finding and does not mean that the entrapment produces any symptoms. An electrophysiologic study does not predict if or when the median nerve entrapment will become symptomatic, which is based on the patient's history. Electromyography (EMG) and nerve conduction velocity (NCV) studies do not help distinguish among the many etiologies of CTS. EMG/NCV testing can provide significant, highly accurate information regarding the physiologic function of the median nerve at the level of the wrist, but physicians must know how to interpret this information in the clinical setting. [The Editor responds: Several traditional findings of CTS have little or no diagnostic value, and electrodiagnosis is the diagnostic test of choice, although reported sensitivities range from 49% to 84% with specificities of 95% to 97%.]

Electrophysiological and Clinical Improvement in Non-Invasive Treatment of Carpal Tunnel Syndrome

2020 ◽  
Vol 20 ◽  
Author(s):  
Riccardo Marvulli ◽  
Giancarlo Ianieri ◽  
Grazia Devenuto ◽  
Marta Falcicchio ◽  
Giulia A. Gallo ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Sleep Quality ◽  
Conduction Velocity ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Pantothenic Acid ◽  
Sensory Nerve ◽  
Sensory Nerve Conduction Velocity ◽  
Tunnel Syndrome

Background and Objective: Carpal tunnel syndrome (CTS) is the most common form of nerve entrapment. Clinically, various signs and symptoms compare due to overexposure to mechanical vibrations transmitted to the wrist bones and cartilage, resulting in compression of the sensory and motor nerve fibers of median nerve. Early symptoms include nocturnal paresthesia and electromyography reveals reduced sensory nerve conduction velocity. Aim of this study was to evaluate the efficacy of a dietary integrator composed of acetyl-L-carnitine, α-lipoic acid,quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins in patients with early (minimal) carpal tunnel syndrome. Methods: 36 patients (28 female and 8 male) with early CTS characterized by sensory nerve demyelination and inflammation of the transverse carpal ligament. Patients were divided into two groups, group A (18 patients received physical therapy) and group B (18 patients, received physical therapy and an oral integrator). Clinical (sleep quality questionnaire to measure severity of paresthesia) and neurophysiological assessment (Sensory Nerve Conduction Velocity) performed at baseline, and then at 30 and 60 days after treatment. Results: Sleep quality and Sensory Nerve Conduction Velocity data analysis show improvement in both groups at 30 and 60 days, with statistically difference between them in both time of analysis. Conclusions: In the early CTS, with sensory fibers damage, use of dietary integrator, such as Micronil Dol®, composed composed of acetyl-L-carnitine, α-lipoic acid,quercetin, bromelain, pantothenic acid, C and B1 and B2 and B6 and B12 vitamins can be effective in quick recovery of median nerve sensory.

scholarly journals POS0584 ULTRASONOGRAPHY OF THE MEDIAN NERVE IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER SUSPICION OF CARPAL TUNNEL SYNDROME

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 525.1-525
Author(s):  
S. Tsiami ◽  
E. Ntasiou ◽  
C. Krogias ◽  
R. Gold ◽  
J. Braun ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Conduction Velocity ◽  
Sectional Area ◽  
Cross Sectional ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Tunnel Syndrome

Background:Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome and a common extra-articular manifestation of rheumatoid arthritis (RA). Different causes of CTS are known, among them inflammatory and non-inflammatory pathologies. Electroneurography (ENG) of the median nerve, the method of choice to diagnose CTS, measures impairment of nerve conduction velocity without explaining its underlying cause. However, because the electrical stimulation is often not well tolerated, ENG results may come out inconclusive. Using greyscale ultrasonography (GS-US) provides anatomic information including a structural representation of the carpal tunnel.Objectives:To investigate the performance of nerve GS-US in the diagnosis of CTS in patients with RA.Methods:Consecutive patients with active RA under suspicion of CTS presenting to a large rheumatologic center were included. Both hands were examined by an experienced neurologist including ENG and a GS-US (ML linear probe with 6-15 Hz) of the median nerve. An established grading system for ENG (1), and an established system for GS-US based on cut-offs for the nerve cross sectional area (CSA) [mild: 0,11-0,13cm2, moderate: 0,14-0,15 cm2, severe: > 0,15 cm2 CTS (2)] were used. In addition, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) was used to assess CTS symptoms (3).Results:Both hands of 58 patients with active RA (n=116) and clinical suspicion of CTS (in 38 cases bilaterally) were included. After clinical examination, CTS was suspicious in 96 hands (82.8%), and 59 of all hands had a final diagnosis of CTS (50.9%). Of the latter, 43 hands (72.9%) had a positive ENG and 16 (27.1%) a positive GS-US finding only, while 30 hands (50.8%) were positive in both examinations.There was a good correlation of the cross-sectional area (CSA) as well as the CSA-ratio to the ENG findings: the larger the CSA, the more severe was the CTS as assessed by ENG (Spearman’s rho=0.554; p<0.001). The more severe the GS-US findings of CTS were, the more definite were the distal motor latency (Spearman’s rho=0.554; p<0.001) and sensible nerve conduction velocity of the median nerve (Spearman’s rho=-0.5411; p<0.001).In the 46 hands positive in GS-US, tenosynovial hypertrophy of the flexor tendons was detected in 19 hands (41.3%), 7 of which (36.8%) also showed an additional cystic mass. In these 19 patients, clinical complains were more severely present than in patients with non-inflammatory CTS, as assessed by the BCTSQ with a total score of 68.8±13.4 vs. 59.3±13.7, respectively (p=0.007).Conclusion:In patients with active RA and clinical complains of CTS, ultrasound examinations provide additional information about inflammation which is helpful for a diagnosis of CTS. Thus, ENG and nerve GS-US should be used complementary for a diagnostic workup of CTS in RA patients with a suspicion of CTS. Power-Doppler may further improve the diagnostic performance of GS-US.References:[1]Padua L et al. Acta Neurol Scand 1997; 96:211–217[2]El Miedany et al., Rheumatology (Oxford). 2004 Jul; 43(7):887-895[3]Levine DW et al. J Bone Joint Surg Am 1993; 75: 1585-1592Figure 1.BCTSQ scores in patients with diagnosis of CTS and absence or presence of RA-related tenosynovial hypertrophyDisclosure of Interests:None declared

Sign in / Sign up

Export Citation Format

Share Document