Many epidemiological studies have named pinching, deviated wrist postures, and repetitive motion as ergonomic risk factors in the development of carpal tunnel syndrome (CTS). Evidence suggests that hypervascularization of the median nerve and increased intraneural blood flow proximal to the carpal tunnel result in response to ergonomic risk factors (finger pressing and deviated wrist postures). The purposes of this study were to 1) determine the effect of a pinch posture, with and without force exerted by the finger, thumb, or both and 2) determine the effect of repetitive wrist flexion and extension on intraneural blood flow velocity in the median nerve proximal to the carpal tunnel. Eleven healthy and eleven CTS symptomatic individuals participated in this study and completed three components: 15 pinch posture force trials, 3 repetitive wrist motion trials, and 3 static wrist posture trials. Intraneural blood flow was measured using pulse wave Doppler during each trial. Main effects of pinch posture force (F4,80 = 21.397, p < 0.001) and wrist posture (F2,40 = 14.545, p < 0.001) were observed. Trials where force was applied by the finger (2.21 cm/s), thumb (2.22 cm/s) or both (2.34 cm/s) produced higher intraneural blood flow velocities than trials with no force (1.79 cm/s) or relaxed hand (1.89 cm/s). Trials performed in flexion (2.24 cm/s) were greater than neutral (2.06 cm/s) and extension (1.97 cm/s). No interactions or main effects of time were found in response to repetitive wrist motion. These results suggest that at low force levels (6 N) it’s not how the force is applied but rather that the force is being applied that has an effect on the median nerve. Additionally these results suggest that the contribution of repetitive motion to the development of CTS may not be directly to the median nerve. / Thesis / Master of Science (MSc)

No description available.

<p>A model to predict carpal tunnel syndrome (CTS) risk would improve ergonomic assessments and help reduce the incidence of occupational CTS and its associated costs. Research spanning over sixty years has shown that deviated wrist, forearm, and hand posture has on the hydrostatic pressure within the carpal tunnel (also known as carpal tunnel pressure, CTP). Elevated CTP is a mechanism of the development, or aggravation of CTS symptoms. The purpose of this thesis was to develop a model to predict CTS risk, based on CTP, and incorporate the model into an ergonomic tool for use by ergonomists. An extensive literature review identified additional studies that investigated the effects of pronation/supination, finger posture, and fingertip loading on CTP. The effect of wrist, forearm, and hand posture was then incorporated into the model via a series of regression equations developed for each plane of movement. The effect of fingertip loading (independent to the posture effects) was included using a multiplier based on the hand posture and load magnitude. To provide a user-friendly tool for ergonomists, a graphical-user-interface was developed to predict CTS risk based on the developed model. Input variables were wrist, hand, and forearm posture, and fingertip loading. CTP program estimated CTP, and compared the predicted pressure to a known threshold beyond which median nerve function has been shown to degrade. The tool was then evaluated by comparing the output of the tool (CTS risk) to the incidence of CTS in a large automotive manufacturing environment. There was no significant difference between the two groups (workers completing jobs with an incidence of CTS and workers completing jobs with no incidence of CTS). The tool marks an important first step v towards providing ergonomists with a much-needed tool to predict CTS risk based on posture, frequency, and fingertip force.</p> / Master of Science (MSc)

Title: Objectification of surgical treatment of carpal tunnel syndrome Objectives: The main aim of this work is to evaluate the effectiveness of surgical treatment of carpal tunnel syndrome. Methods: In this work was used a two-point discrimination test, that evaluated tactile sensory of the hand with carpal tunnel syndrome. It evaluated the change of discriminatory sensation after surgical treatment of carpal tunnel syndrome. The results of testing were evaluated by using the SigmaPlot statistic program SigmaStat 9.01 to 3.1 integration. Results: Research found that two-point discrimination in region of median nerve innervated is improved by surgical treatment of carpal tunnel syndrome, it improves the tactile sensory of the hand, which is impaired by carpal tunnel syndrome. Effect of physiotherapy on improvement of the discriminatory sensation after surgery was not demonstrated. However, the physiotherapy after surgical treatment of carpal tunnel syndrom is important. Keywords: carpal tunnel syndrome, sensory discrimination, a two-point discrimination test

A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior. Cerca de 5% dos pacientes com insuficiência renal crônica submetidos à hemodiálise apresentam esta condição. A história clínica e o exame físico continuam sendo as ferramentas mais adequadas para seu diagnóstico. Testes complementares têm sido usados para auxiliar o diagnóstico e o controle de tratamento; dentre eles os de avaliação da sensibilidade cutânea. O PSSD (Pressurespecified sensory device ) consiste de aparelho que incorpora transdutor de pressão acoplado a um computador capaz de determinar os limiares cutâneos de sensibilidade à pressão no território do nervo mediano(superfície volar do índex). O objetivo do estudo foi determinar através do PSSD os limiares cutâneos de pressão no território do nervo mediano antes e depois do tratamento cirúrgico da síndrome. Para tanto, os pacientes foram divididos em dois grupos: Grupo 1: pacientes portadores de insuficiência renal crônica e submetidos à hemodiálise com síndrome do túnel do carpo. Grupo 2: pacientes com síndrome do túnel do carpo sem insuficiência renal. Foram avaliados com o PSSD as seguintes medidas: limiares cutâneos de pressão no teste de um ponto estático, no teste de um ponto dinâmico, no teste estático de dois pontos e no teste dinâmico de dois pontos. Houve evolução positiva no pós operatório(menor limiar) de todos os parâmetros avaliados pelo PSSD no grupo 1, enquanto no grupo 2 houve melhora significativa em todos os parâmetros, excetuando-se os do teste dinâmico de um ponto / Carpal Tunnel Syndrome is the most common compressive neuropathy on the upper limb. About 5% of the patients with chronic renal insufficiency who are treated with hemodialysis present carpal tunnel syndrome. Clinical history and physical examination remain the most adequate tools for the diagnosis. Evaluation of sensory thresholds can be used to complement those parameters. The PSSD (Pressurespecified sensory device) is a tool that incorporates a pressure transducer linked to a computer capable of measuring the cutaneous pressure thresholds referred by the patient. The aim of this study was to determine the values of pressure thresholds with the PSSD before and after treatment of carpal tunnel syndrome. The patients were divided in two groups: Group 1: patients with carpal tunnel syndrome associated to chronic hemodialysis. Group 2: patients with carpal tunnel syndrome without renal insufficiency. The following measurements were performed: static one point, moving one point, static two points and moving two points. The results showed better results in the post operative measurements in all parameters assessed in group 1, and improvements in all parameters with exception of the moving one point test in group 2

Background - Hand intense occupational activities have been associated with an increase in the incidence of carpal tunnel syndrome (CTS). CTS is characterized by an impairment of median nerve function. To date, a dose-response relationship between wrist activity and median nerve performance has not been documented. Since repetitive hand/wrist activity in the workplace has significant implications, it is important to establish a scientific basis for the aetiology of work-related carpal tunnel syndrome. Methods -- In a laboratory environment, twenty-seven clinically confirmed asymptomatic female subjects performed continuous repetitive wrist motion in the flexion-extension plane during which an angle of 120 degrees was subtended about the neutral wrist position. Four levels of wrist activity, corresponding with 0 (static), 22 (Iow), 38 (medium) and 49 (high) repetitions per minute, were prescribed. Wrist motion was recorded using a state-of-the-art 3D electromagnetic tracking system (HumanTRAC). Mathematical descriptors of wrist kinematics, including cycle time, amplitude, angular velocity and angular acceleration, were calculated. Sensory median nerve response to imposed physical stressors was monitored antidromically and recorded using a clinical electroneurometer every ten minutes throughout the simulated work activities. Near-nerve skin temperature was recorded at three sites along the distal sensory branch of the median nerve every twenty minutes. Results - After adjusting for changes in near-nerve skin temperature, a significant within-subject effect of duration of exposure (time) was detected. Sensory median nerve conduction velocity differed statistically by 2.1 ms-1 between the static and high wrist activity conditions after 120 minutes of exposure, signifying adverse effects on nerve conduction that are uniquely attributable to repetitive hand motion. Wrist activity measures of mean angular acceleration presented a highly significant association with nerve performance, where nerve conduction decreased as wrist activity increased. Using regression analysis, a maximum safe wrist-workload exposure limit of 0.91 repetitions per minute is proposed. Limitations of this result are discussed. A biomechanical model is presented to calculate the effect of physical risk factors on tendon forces at the wrist. This model offers a method by which findings of the study can be employed for workplace exposure surveillance and development of ergonomic workstation design recommendations. Conclusions -- Across the study population of clinically asymptomatic female participants, a change in median nerve performance was observed. This significant effect was evoked due to imposed physical stressors. A dose response relationship between work intensity, exposure time and median nerve conduction velocity was demonstrated. The research explored in this thesis presents a foundation for the future development of a "Dynamic Median Nerve Stress Test". This test would involve the performance of a repetitive motion activity of the wrist during which changes in the function of the median nerve are closely monitored. The Dynamic Median Nerve Stress Test might prove to be valuable both as a provocative clinical test as well as an important research tool.

Στην μελέτη μας - που σκοπό είχε την αναζήτηση των ηλεκτροφυσιολογιών παραμέτρων εκείνων οι οποίες πρωϊμώτερα καθίστανται παθολογικές σε αρχόμενη συμπιεστική βλάβη του μέσου νεύρου στον καρπό - εξετάσαμε συνολικά 72 ασθενείς (42 χέρια δεξιά, 30 αριστερά) από τους οποίους οι 66 ήταν γυναίκες και οι 6 άνδρες. Ο μέσος όρος ηλικίας των ασθενών ήταν 49.6±9.8 έτη. Όρος επιλογής των προς μελέτη ασθενών ήταν να παρουσιάζουν συμπτώματα και σημεία τέτοια ώστε κλινικά να τίθεται βάσιμα η υπόνοια συνδρομής καρπιαίου σωλήνα, ταυτόχρονα όμως, στον ηλεκτρονευρογραφικό έλεγχο η τιμή του τελικού κινητικού χρόνου να μην υπερβαίνει τα 4.2 msec, ώστε να εξασφαλίζεται το αρχόμενο - μη προχωρημένο της συμπιεστικής συνδρομής. Στην μελέτη χρησιμοποιήθηκαν και 43 μάρτυρες (19 χέρια δεξιά, 24 χέρια αριστερά). Οι μάρτυρες επελέγησαν με κριτήρια την παντελή απουσία συμπτωμάτων και σημείων από το περιφερικό νευρικό σύστημα και με τον περιορισμό της ουδέποτε λήψης νευροτοξικών ουσιών. Από αυτούς οι 31 ήταν γυναίκες και οι 12 άνδρες, είχαν δε μέσο όρο ηλικίας 41.3±16.4 έτη. Τόσο στους ασθενείς όσο και στους μάρτυρες μελετήθηκαν οι αισθητικές αγωγιμότητες με την ορθοδρομική μέθοδο. Σε κάθε χέρι η μελέτη έγινε με ερεθισμό ένα προς ένα όλων των δακτύλων (1ου, 2ου, 3ου και 4ου) και καταγραφή με επιφανειακό ηλεκτρόδιο στον καρπό από το μέσο νεύρο επιπλέον ερεθίστηκε και ο 5ος δάκτυλος και κατεγράφη το αισθητικό δυναμικό στον καρπό από το ωλένιο νεύρο. Τα αποτελέσματα αυτών των καταγραφών αφορούσαν όλες τις παραμέτρους του αισθητικού δυναμικού (λανθάνων χρόνος, εύρος, διάρκεια) καθώς και αλλοιώσεις της μορφολογίας του, από όλους τους δακτύλους. Στη συνέχεια προχωρήσαμε σε πολλαπλές συσχετίσεις κάθε μιας παραμέτρου σε διαφορετικούς δακτύλους, διαφορετικών παραμέτρων στον ίδιο δάκτυλο, αλλά και σε διαφορετικούς δακτύλους καθώς και στην απαρίθμηση των ανώμαλων κυματομορφών όπου αυτές εμφανίζονταν. Η στατιστική επεξεργασία όλων αυτών των δεδομένων κατέληξε στην συγκρότηση μιας κλίμακος ευαισθησίας ως προς την εγκαιρότερη αλλοίωση ηλεκτροφυσιολογιών παραμέτρων σε αρχόμενη συνδρομή καρπιαίου σωλήνα. Συμπερασματικά από τη μελέτη μας προκύπτουν τα εξής: 1) Η ανάδειξη δικόρυφου δυναμικού ενεργείας σε ερεθισμό είτε του 4ου είτε του 1ου δακτύλου είναι συχνό και ισχυρό εύρημα ως προς την τεκμηρίωση αρχόμενης συνδρομής καρπιαίου σωλήνα. 2) Σε αρχόμενη συνδρομή καρπιαίου σωλήνα πρώιμα παρατείνεται ο λανθάνων χρόνος από 4ο και από 1ο δάκτυλο, αλλοιώνονται όλες οι παράμετροι από τον 4ο δάκτυλο και παρατείνεται ο λανθάνων χρόνος από 3ο δάκτυλο. Δεν υπήρξε διαφοροποίηση των παραπάνω αποτελεσμάτων που να συσχετίζονται με το φύλο ή την ηλικία. / The purpose of the present work was to investigate cases with early median nerve entrapment neuropathy (carpal tunnel syndrome) and to identify the most sensitive neurophysiological parameter by which an early diagnosis of the syndrome can be established. We examined 72 patients (42 right hands and 30 left hands) 66 women and 6 men. The mean age was 49.6±9.8 years. The inclusion criteria were symptoms and signs compatible with the diagnosis of carpal tunnel syndrome and the distal motor latency to be less than 4.2msec. We also examined 43 control subjects (19 right hands and 24 left hands) 31 women and 12 men with a mean age 41.3±16.4 years The control subjects were free of peripheral neurological problems. In all patients and control subjects we studied the sensory conduction parameters using the orthodrom method. In all hands we stimulated all five fingers and we recorded the sensory potentials from the wrist for both nerves (the median nerve for the 4 first fingers and the ulnar nerve for the 5th finger). In all patients and controls median distal motor latency, amplitude and duration of compound sensory nerve action potentials and sensory nerve conduction velocity of all five fingers were measured. The statistical analysis of the results showed the following conclusions. 1. Double peak potentials after stimulation of the 4th finger was the most sensitive test for detecting early carpal tunnel syndrome. Double peak potentials after stimulation of the 1st finger was a less frequent finding. 2. In early carpal tunnel syndrome there is a prolongation of the latency of the 4th and 1st finger Also there are changes in all parameters of the 4th finger potential and there is a prolongation of the latency of 3rd finger. Finally there were no differences between male and female measurements.

Carpal tunnel syndrome (CTS) is one of the most common injuries responsible for lost time claims to the Workplace Safety and Insurance Board (WSIB). The main purpose of this study was to determine whether measurable sensorimotor changes exist in asymptomatic individuals who are at risk for CTS such that sensory impairment and/or functional tests may be used in the early detection and intervention to reduce the impact of CTS on individuals, industry and the health care system. Participants were recruited into three strata: (1) individuals diagnosed with mild CTS, (2) asymptomatic individuals who were deemed to be at risk of developing CTS due to exposure to etiological risk factors and (3) asymptomatic individuals who were deemed to be at minimal risk of developing CTS based on non-exposure to risk factors. The main outcome measures included two-point discrimination ability, pressure acuity, vibration sense, Purdue Pegboard Test performance and tracking error and tracking variance on a manual tracking task performed at two different speeds. Seven individuals with CTS, fourteen individuals at risk of developing CTS and nine control individuals with minimal risk participated. The CTS group was significantly different from the at-risk and control groups on the main and work sections of the DASH questionnaire, and the symptom severity scale and functional status scale of the Boston Carpal Tunnel Questionnaire. The only outcome measure that showed a significant difference between the at-risk and the minimal risk group was the assembly task of the Purdue Pegboard Test (p = 0.044), however other measures including median nerve conduction latencies, and manual tracking abilities showed promise that with further recruitment, a significant difference may be seen. The sensory impairment tests did not demonstrate degradation in sensory function in individuals at risk of developing CTS, however analysis of sensory nerve conduction latencies and some aspects of fine motor skills testing did show some promise in their ability to detect individuals at risk of developing CTS. A future prospective study that follows individuals at risk of developing CTS may determine that it is possible to implement a screening tool for the early identification and treatment of CTS. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2009-09-15 12:15:45.208

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T22:12:05Z (GMT). No. of bitstreams: 1 Kaleff_PauloRoland_M.pdf: 1919373 bytes, checksum: 0201e35b3a65c9c00ada905f14f6a364 (MD5) Previous issue date: 2009 / Resumo: Propósito:Avaliação de técnica de incisão transversa limitada no tratamento da síndrome do túnel do carpo, quanto à segurança cirúrgica e efetividade na abertura do Retináculo Flexor(RF). Método: Estudo prospectivo de Trinta procedimentos realizados em vinte e oito pacientes submetidos à técnica com incisão transversa mínima. A segurança da técnica e a abertura total do RF foram avaliadas através de questionário baseado em observações clinicas e inspeção endoscópica, respectivamente. Resultados: Não foram observadas complicações maiores. Um único paciente apresentou neuropraxia de N. interdigital. Dois pacientes apresentaram hematoma local pequeno. Em dois dos cinco primeiros casos, durante a inspeção endoscópica, observou-se abertura incompleta do RF, sendo necessária abertura complementar. Todos os pacientes apresentaram melhora do quadro clínico de dor noturna e parestesias. Conclusão: A técnica foi executada com segurança no grupo analisado, sem a ocorrência de complicações graves, e com abertura do RF na quase totalidade dos casos. Uma avaliação de longo prazo e com um número maior de pacientes é necessária. / Abstract: Purpose: To evaluate the application of a limited transverse incision technique to treat the Carpal tunnel syndrome, with concern to its safety and efficacy in the opening of the Flexor Retinaculum (FR). Method: A prospective analysis of thirty FR release procedures performed on twenty-eight patients subjected to the proposed incision technique. Safety and total opening of the FR were evaluated through a questionnaire and an endoscopic inspection respectively. Results: No major complications were observed. Two cases presented small local hematoma. One patient presented with transient neuropraxia of digital branch. In two of the first five cases, incomplete FR opening was identified during endoscopic revision with need of complementary opening. All patients showed symptom relief. Conclusion: The technique was safely performed on the prospection group, no major complications were detected and the opening of FR was observed in the majority of the patients. Long term results and with a larger series of patients should be evaluated in further studies. / Mestrado / Neurologia / Mestre em Ciências Médicas

A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior. Cerca de 5% dos pacientes com insuficiência renal crônica submetidos à hemodiálise apresentam esta condição. A história clínica e o exame físico continuam sendo as ferramentas mais adequadas para seu diagnóstico. Testes complementares têm sido usados para auxiliar o diagnóstico e o controle de tratamento; dentre eles os de avaliação da sensibilidade cutânea. O PSSD (Pressurespecified sensory device ) consiste de aparelho que incorpora transdutor de pressão acoplado a um computador capaz de determinar os limiares cutâneos de sensibilidade à pressão no território do nervo mediano(superfície volar do índex). O objetivo do estudo foi determinar através do PSSD os limiares cutâneos de pressão no território do nervo mediano antes e depois do tratamento cirúrgico da síndrome. Para tanto, os pacientes foram divididos em dois grupos: Grupo 1: pacientes portadores de insuficiência renal crônica e submetidos à hemodiálise com síndrome do túnel do carpo. Grupo 2: pacientes com síndrome do túnel do carpo sem insuficiência renal. Foram avaliados com o PSSD as seguintes medidas: limiares cutâneos de pressão no teste de um ponto estático, no teste de um ponto dinâmico, no teste estático de dois pontos e no teste dinâmico de dois pontos. Houve evolução positiva no pós operatório(menor limiar) de todos os parâmetros avaliados pelo PSSD no grupo 1, enquanto no grupo 2 houve melhora significativa em todos os parâmetros, excetuando-se os do teste dinâmico de um ponto / Carpal Tunnel Syndrome is the most common compressive neuropathy on the upper limb. About 5% of the patients with chronic renal insufficiency who are treated with hemodialysis present carpal tunnel syndrome. Clinical history and physical examination remain the most adequate tools for the diagnosis. Evaluation of sensory thresholds can be used to complement those parameters. The PSSD (Pressurespecified sensory device) is a tool that incorporates a pressure transducer linked to a computer capable of measuring the cutaneous pressure thresholds referred by the patient. The aim of this study was to determine the values of pressure thresholds with the PSSD before and after treatment of carpal tunnel syndrome. The patients were divided in two groups: Group 1: patients with carpal tunnel syndrome associated to chronic hemodialysis. Group 2: patients with carpal tunnel syndrome without renal insufficiency. The following measurements were performed: static one point, moving one point, static two points and moving two points. The results showed better results in the post operative measurements in all parameters assessed in group 1, and improvements in all parameters with exception of the moving one point test in group 2