As the incidence of diagnosed carpal tunnel syndrome continues to increase, an understanding of the mechanism(s) of insult to the median nerve which leads to its development becomes ever more imperative. Knowledge of the exact cause of CTS could lead to improved diagnostic and treatment methods, or more importantly, to better preventative measures. The goal of this study was to investigate movements and interactions of structures within the carpal tunnel during wrist flexion and hand loading in order to obtain information about a specific mechanism of insult to the median nerve. Symptomatic and normal subjects were compared to observe differences in the interactions of the median nerve and its surrounding structures. A new methodology was developed to facilitate the evaluation of these populations.

Carpal tunnel syndrome is a frequently encountered chronic peripheral nerve entrapment disorder caused by mechanical insult to the median nerve, which may occur from impingement by the surrounding digital flexor tendons and the tunnel boundaries. Anatomic finite element models of the carpal tunnel provide a method to evaluate the potential contact stresses that may develop on the median nerve between the digital flexor tendons and tunnel boundaries. Realistic finite element simulations are dependent upon the use of physiologically accurate material properties. The purpose of this work was to ascertain material properties for the digital flexor tendons, median nerve and transverse carpal ligament to inform finite element simulations. The compressive mechanical behavior of the digital flexor tendons, median nerve and transverse carpal ligament was characterized under functionally relevant axial tensile loads. These properties can now be implemented into full scale finite element models of the carpal tunnel to evaluate the mechanism of insult to the median nerve leading to the development of carpal tunnel syndrome.

The present study was designed to assess the risk factors associated with carpal tunnel syndrome (CTS). Toward this end, a wide range of putative occupational, biological , and psychosocial correlates of CTS was investigated using a case-control methodology. Cases were 87 patients from an orthopedic clinic with clinical symptoms and electrodiagnostic testing results suggestive of CTS. Controls were 74 gender-matched patients from the same orthopedic clinic, without clinical symptoms of CTS and normal electrodiagnostic testing results. Participants completed a self-report questionnaire that included eight potential occupational correlates (i.e., repetition, force, vibration, typing, lifting heavy loads, and standing on feet), 10 potential personological correlates (i.e., obesity, advocational exercise levels, diabetes, thyroid problems, arthritis, gynecological surgery, and menstrual complications), and 11 potential psychosocial correlates (i.e., depression, anxiety, somatization, health locus of control job satisfaction, and physical and mental health indices). Results of multiple logistic regression analyses revealed that occupational repetition , vigorous exercise, physical activities with wrist strain, physical health, and job satisfaction were significant predictors of CTS. In addition, obesity was a borderline significant predictor of CTS. Plausible explanations for the current findings, along with implications, are discussed .

Study Design: A blinded, prospective diagnostic test study was conducted.<p>Objectives: To assess the inter-tester reliability of clinical examination items for carpal tunnel syndrome (CTS), to assess the validity of individual clinical test items and self-report measures for the diagnosis of CTS and to assess the accuracy of an optimum test item cluster for the diagnosis of CTS.<p>Study Rational: Examination of the diagnostic validity of various clinical tests for the diagnosis of CTS has shown mixed results and the reliability of many of these tests has not been determined. The majority of the diagnostic validity research for CTS has examined tests individually which is in contrast to clinical practice where the results of multiple tests are combined as part of the clinical reasoning process in order to formulate a differential diagnosis: the test item cluster, derived through logistic regression, is proposed as a means to integrate the validity of multiple tests. Methods: 37 subjects (74 hands) were recruited from a convenience sample of consecutive patients referred to for electrodiagnostic (EDX) testing due to upper extremity symptomatic complaints. Subjects underwent EDX testing followed by completion of self-report questionnaires and a standardized clinical examination by examiners blinded to EDX results. Diagnostic validity was determined for both general and restricted CTS classification groupings. <p>Results: Out of 18 clinical test items, 12 had reliability coefficients (i.e. ICC or Kappa) of .40 or greater. There were 10 clinical exam and self-report items that were found to have likelihood point estimates above 2 or below 0.50 for the general diagnostic classification and 6 items had acceptable validity for the restricted classification. The test item cluster (TIC) derived for the general classification included hand numbness and symptom reproduction with the upper limb neurodynamic test 1. The TIC derived for the restricted classification included hand numbness and the overall score of the symptom component of the Bringham Carpal Tunnel Questionnaire. The 95% confidence intervals for most likelihood ratio point estimates were wide. <p>Conclusions: The TICs for both classification groupings did not yield improved diagnostic validity beyond that found with the single best test item (hand numbness). The value of the single best test item hand numbness was in a negative response. Further investigation is required to validate the TIC and the single best test item and to improve the point estimate precision.

Study Design: A blinded, prospective diagnostic test study was conducted.<p>Objectives: To assess the inter-tester reliability of clinical examination items for carpal tunnel syndrome (CTS), to assess the validity of individual clinical test items and self-report measures for the diagnosis of CTS and to assess the accuracy of an optimum test item cluster for the diagnosis of CTS.<p>Study Rational: Examination of the diagnostic validity of various clinical tests for the diagnosis of CTS has shown mixed results and the reliability of many of these tests has not been determined. The majority of the diagnostic validity research for CTS has examined tests individually which is in contrast to clinical practice where the results of multiple tests are combined as part of the clinical reasoning process in order to formulate a differential diagnosis: the test item cluster, derived through logistic regression, is proposed as a means to integrate the validity of multiple tests. Methods: 37 subjects (74 hands) were recruited from a convenience sample of consecutive patients referred to for electrodiagnostic (EDX) testing due to upper extremity symptomatic complaints. Subjects underwent EDX testing followed by completion of self-report questionnaires and a standardized clinical examination by examiners blinded to EDX results. Diagnostic validity was determined for both general and restricted CTS classification groupings. <p>Results: Out of 18 clinical test items, 12 had reliability coefficients (i.e. ICC or Kappa) of .40 or greater. There were 10 clinical exam and self-report items that were found to have likelihood point estimates above 2 or below 0.50 for the general diagnostic classification and 6 items had acceptable validity for the restricted classification. The test item cluster (TIC) derived for the general classification included hand numbness and symptom reproduction with the upper limb neurodynamic test 1. The TIC derived for the restricted classification included hand numbness and the overall score of the symptom component of the Bringham Carpal Tunnel Questionnaire. The 95% confidence intervals for most likelihood ratio point estimates were wide. <p>Conclusions: The TICs for both classification groupings did not yield improved diagnostic validity beyond that found with the single best test item (hand numbness). The value of the single best test item hand numbness was in a negative response. Further investigation is required to validate the TIC and the single best test item and to improve the point estimate precision.

The United States Navy incorporates many different occupations to ensure it achieves its overall mission. These occupations are extremely diversified and present a wide spectrum of occupational exposures. Many of these exposures have been well studied and documented. However, shipboard pneumatic tool hand-arm vibration, (HAV) and how it relates to different body postures is an area of occupational exposure that has received little attention. The chief objective of this study was to assess whether there is a difference in hand-arm vibration levels, while working on one of two surface orientations (e.g., horizontal and vertical) among distinctly different pneumatic tools while cleaning or not cleaning. The design of the study evaluated three pneumatic tools cleaning both horizontal and vertical surfaces and the fourth tool only cleaning a horizontal surface. HAV levels were measured to identify the effect horizontal and vertical surface orientations had on the tool. Five subjects were used in the evaluation of the four tools by a random sequencing order. Each subject was required to hold the tool in an idle condition, an activated without cleaning condition, and an activated cleaning condition, (surface contact) for 20 seconds each. These conditions were evaluated in two different surface orientations; horizontal and vertical (except for the 4th tool). Each subject repeated each of the cleaning/not cleaning conditions three times for a total of 7 measurements per surface. The idle condition was only conducted one time for each tool and surface. The measurements were collected from a Quest, HAVPro instrument using an accelerometer on the pneumatic tool following ISO 5349-1:2001 and ISO 5349-2:2001 methods.A three-way ANOVA (subjects by tool, by condition, (cleaning vs. not cleaning) and tool vs. condition) with replicates (not including idle conditions) was conducted on the data. The analysis included the main effects and the interaction of tool and surface orientation. The subjects were treated as a blocking variable. All the main effects and the interaction were significant at p<0.0001, except for surface, p<0.6396. Surface orientation does not affect HAV levels in pneumatic tools.

Experimental measurements are never perfect, even with sophisticated modern instruments. One of the fundamental problems in signal measurement is distinguishing the noise from the signal. Sometimes the two can be partly distinguished on the basis of frequency components: for example, the signal may contain mostly low-frequency components and the noise may be located at higher frequencies. This is the basis of filtering. This thesis discusses some changes in the experimental protocol such as determining a suitable stimulation site to elicit full compound nerve action potentials (CNAP). The effect of sampling frequency and smoothing techniques to improve the resolution of the conduction velocity distribution (CVD) estimates will also be discussed. A change in stimulation site to elicit the full CNAPs is proposed after realizing that it is relatively difficult to stimulate at the same location to recruit the nerve fibers repeatedly at the elbow. Thus, the stimulation site was changed from elbow to wrist to elicit the full CNAPs. From the simulations it is evident that there was some signal information beyond 2.5 kHz frequency resulting in an increase in the sampling rate from 5 kHz to 10 kHz. The results obtained after employing smoothing techniques improved the CVD resolution. The simulation results were corroborated with the experimental results obtained. Another aspect of this thesis is to check the error tolerance of the EMG decomposition algorithm. Once the muscle electrical activity is recorded, MU trains undergo an automatic decomposition process. Decomposition errors are present in most contractions, thus a human operator has to make changes/correct the values of the motor unit firing times. From the data acquired, false negatives, false positives and false negative-positive errors have been introduced. Different levels of errors to measure the coherence between two motor-unit firing trains from a muscle contraction were also introduced. The firing rate curves are computed for each MU to analyze the interactions between two motor units (MU). The false negatives type of errors was found to be least detrimental. Whereas the false positives and false negative-positive errors affected coherence the most, their error tolerance was only a single error per 5 seconds.

Darbo tikslas: Įvertinti pacientų, po riešo kanalo tunelinio sindromo operacijos, rankų funkciją ir savarankiškumą po ergoterapijos ir praėjus dviems metams po jos. Darbo uždaviniai: • Įvertinti pacientų, po riešo kanalo tunelinio sindromo operacijos, rankų funkciją ir savarankiškumą. • Įvertinti ergoterapijos poveikį pacientų, kuriems operuotas riešo kanalo tunelinis sindromas, rankų funkcijai ir savarankiškumui. • Nustatyti veiksnius, lemiančius pacientų rankų funkcijos ir savarankiškumo lygį po reabilitacijos ir praėjus dviems metams po jos. Metodika: Tyrimas buvo atliekamas VšĮ "Kauno kalniečių poliklinika" įstaigoje. Tyrimas buvo atliktas 2012-2014 metais. Tyrime dalyvavo 44 pacientai - 10 (23%) vyrų ir 34 (77%) moterys, kuriems buvo diagnozuotas riešo kanalo tunelinis sindromas ir atlikta operacija. Informacijai surinkti apie pacientus, kuriems buvo atlikta riešo kanalo tunelinio sindromo operacija, buvo naudojama: • Anketa; • Dinamometras; • Manometras • Goniometas; • Dviejų taškų diskriminacijos testas; • Kasdienės veiklos vertinimo klausimynas (ADL) ir SF-36 klausimynas; • Skaitmeninė skausmo įvertinimo skalė. Visi matavimai ir anketinės apklausos buvo atliekamos tris kartus: prieš ir po ergoterapijos procedūrų bei po 2 metų. Išvados: 1. Pacientai, kuriems buvo atlikta riešo kanalo tunelinio sindromo operacija, buvo sumažėjusi plaštakos raumenų jėga, riešo judesių amplitudė, sutrikę jutimai ir turėjo problemų su apsitarnavimu. 2. Po ergoterapijos... [toliau žr. visą tekstą] / Aim: To evaluate the patients after carpal tunnel syndrome surgery, hand function and independence after occupational therapy and two years after. Objectives: • To evaluate the patients after carpal tunnel syndrome surgery, hand function and independence. • To evaluate the effect of occupational therapy in patients after carpal tunnel syndrome surgery, hand function and independence. • To identify the factors influencing patients' hand function and level of independence after rehabilitation and two years after.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, 2001. / Bibliyografya var.

Tez (Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, 2005. / Bibliyografya var.