No description available.

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment seen within the outpatient orthopaedic clinic; therefore assessment and management of this common condition is of significant importance. Traditionally diagnosis has been made through detailed questioning; clinical examination and nerve conduction studies (NCS). There is however no true consensus as to the gold standard assessment of CTS and the use of NCS can confer additional costs and delay treatment. Previous studies have explored methods of predicting the presence of CTS including the clinician-administered Carpal Tunnel Questionnaire (CTQ) (Kamath and Stothard, 2003). The aim of the present studies is therefore to explore the versatility of the CTQ to see how a novel Patient-completed Version of the CTQ compares to the original Clinican-completed version. Psychometric properties of the questionnaire will be explored together the economic impact of integrating both versions within an orthopaedic care pathway. A further aim is to answer whether the CTQ more effective and cost-effective than NCS for patients referred to an orthopaedic clinic with suspected CTS. Method: 100 patients referred for further investigation of suspected CTS were assessed using parallel patient and clinician-completed versions of the CTQ and results were subsequently compared with those obtained from NCS. Item analysis explored each of the nine constructs of the questionnaire and the original scoring algorithm was validated using binary logistic regression and compared with alternative algorithms. Sensitivity and specificity of the questionnaire when compared to results of NCS was explored using Receiver Operating Characteristic (ROC) analyses. Inter-rater reliability was explored through Pearson’s correlation coefficient. Economic analysis and modelling was carried out to explore potential cost savings of use of the questionnaire rather than NCS for those with suspected CTS. Results demonstrated sensitivity of 92% and specificity of 54.67% (positive predictive value 95.35%) for the patient-completed questionnaire and 96% sensitivity with 70.67% specificity (98.15 positive predictive value) for the clinician-completed questionnaire when used to predict the outcome of NCS. Binary logistic regression confirmed the original scoring algorithm and a revised algorithm did not significantly improve sensitivity. Adoption of the clinician-completed CTQ would have screen out 54% of referrals for NCS, which in the case of the study site would have conferred cost savings of £73,305 per annum (base upon a referral rate of 750 per annum). The patient-completed CTQ in the current sample resulted in 43% of referrals with suspected CTS not requiring NCS to assist in diagnosis with a potential saving of £58,372.5 per annum. There are further considerations of the reduction in waiting times, which are explored further within the analysis. Conclusion: Economic evaluation is complex due to the variety of pathways adopted by different orthopaedic departments. While the results of the Patient-complete version of the CTQ may not be as convincing as the clinician completed the study does provide validation for its use and expands the versatility of this useful adjunct to the assessment of CTS. Both versions could potentially confer significant cost savings and reduce demands on investigative services, reducing waiting times and improving the patient journey in suspected CTS.

n-Hexane and its metabolites are neurotoxic to animals and man. Studies have revealed a progressive neuropathy which affects the distal regions of motor and sensory peripheral nerves. This paper describes efforts to determine whether 2-hexanone or 2,5-hexanedione is more neurotoxic to rats when given in drinking water. Our results show that 2,5-hexanedione is more neurotoxic than 2-hexanone and that it first affects the distal axon. Concentrations of 20 mM produced no effects after 3 weeks but 40 mM increased distal latency after 2 weeks.

Introduktion: Vid perifera nervundersökningar med elektroneurografi spelar temperaturen i vävnaden som undersöks stor roll. Kall vävnad leder till försämrad funktion i nervernas jonkanaler, vilket leder till att aktionspotentialer utlöses långsammare och nervledningshastigheten minskar vilket därmed kan ge falskt patologiska undersökningsresultat. För att minska den risken mäts och korrigeras alltid hudtemperaturen. Vid registrering från övre extremiteter mäts hudtemperaturen standardmässigt på handryggen. Trots att stimulering sker från handflatan och från fingrar så mäts inte temperaturen där. Syftet med studien är därför att undersöka om kalla fingrar på en i övrigt varm hand påverkar conduction velocity och peaklatenstiden, jämfört med när hand och fingrar har samma varma temperatur. Metod: 30 unga, friska personer deltog i studien. Ortodrom elektroneurografiundersökning utfördes på nervus medianus sensoriska del. Handryggstemperaturen var konstant 32° Celsius (C) och fingertoppstemperaturerna var 32° C, 27° C respektive 22° C. Vid varje fingertoppstemperatur registrerades conduction velocity och peaklatenstiden vid stimuleringar från handflatan, fingerbasen och fingertoppen på digitorum III. Resultat: En statistiskt signifikant skillnad fanns i både nervledningshastigheten och peaklatenstiden vid registrering från fingerbasen vid fingertoppstemperaturen 32° C jämfört med såväl 27° C som 22° C. Slutsats: Kalla fingrar på en varm hand ger en statistiskt signifikant påverkan på både nervledningshastigheten och peaklatenstiden. / Background: In peripheral nerve examinations with electroneurography, temperatures in the tissue that is being examined is important. Cold tissue leads to impaired function of the ion channels of the nerves, which causes action potentials to be triggered more slowly and the nerve conduction velocity to decrease, which can cause false pathological examination results. To reduce this risk, the skin temperature is always measured and corrected. When registering from the upper extremities, the skin temperature is measured by default on the back of the hand. Despite stimulating in the palm and on the fingers, the temperature is not measured there. The purpose of the study is to investigate whether cold fingers on a warm hand affects the conduction velocity and peak latency time, compared with the hand and the fingers having the same warm temperature. Methods: 30 young, healthy persons participated in the study. An orthodrome electroneurography examination was performed on the sensory part of the median nerve. The backhand temperature was constant 32° Celsius (C) and the fingertip temperatures were 32 ° C, 27 ° C and 22 ° C. Results: A statistically significant difference was found in both nerve conduction velocity and peak latency time when registering from the finger base with fingertip temperature 32 ° C compared with both 27 ° C and 22 ° C Conclusions: Cold fingers on a warm hand give a statistically significant effect on both the nerve conduction velocity and the peak latency time.

<p>The purpose of this study was to investigate the difference in amplitude between M-response from m. Abductor pollicis brevis/m. Pronator quadratus and m. Abductor pollicis brevis/m. Abductor digiti minimi on patients with carpal tunnel syndrome, compared with control subjects. We wanted to see if m. Pronator quadratus is a better alternative than m. Abductor digiti minimi as comparison with m. Abductor pollicis brevis on patients with carpal tunnel syndrome.</p><p>Nerve conduction studies were performed on 20 patients with carpal tunnel syndrome and on 31 healthy subjects.</p><p>The test-retest result shows that this method was reproducible. The amplitude difference of m. Abductor pollicis brevis-m. Abductor digiti minimi, for the patients, was 1,5mV lower and the amplitude for m. Abductor pollicis brevis-m. Pronator quadratus was 2mV lower than for healthy subjects. Two of the patients were outside the 2SD for the m. Abductor pollicis brevis-m. Pronator quadratus difference but not on the m. Abductor pollicis brevis-m. Abductor digiti minimi. This may indicate that m. Pronator quadratus was better than m. Abductor digiti minimi in the comparison with the m. Abductor pollicis brevis amplitude.</p>

O envolvimento do sistema nervoso periférico em diversas doenças auto-imunes é bem estabelecido. No entanto, não existem estudos, com desenho metodológico apropriado, que tenham investigado a relação entre síndrome antifosfolípide primária (SAFP) e neuropatia periférica. Nosso objetivo nesse trabalho foi investigar a ocorrência de neuropatia periférica em pacientes com SAFP. Vinte e seis pacientes com SAFP (critérios de Sapporo) e vinte controles, saudáveis, pareados por sexo e idade, foram recrutados em dois centros de referência. Foram excluídas as causas secundárias de neuropatia periférica e um exame neurológico completo, seguido de estudo de neurocondução, foi realizado em todos os indivíduos. Parestesias foram observadas em oito pacientes (31%). Leve fraqueza distal e anormalidades nos reflexos tendíneos profundos, foram observados em três (11,5%) pacientes. Evidência eletrofisiológica de neuropatia periférica foi observada em nove (35%) pacientes: quatro (15,5%) pacientes apresentaram neuropatia sensitiva ou sensitivo-motora axonal distais (em dois deles, com a superposição de síndrome do túnel do carpo), um (4%) paciente apresentou neuropatia sensitivo-motora, axonal e desmielinizante, acometendo os membros superiores e inferiores, enquanto que em quatro (15,5%) pacientes, observou-se a presença isolada de síndrome do túnel do carpo. As alterações clínicas e sorológicas dos pacientes com SAFP não guardaram qualquer correlação, com as alterações eletrofisiológicas. Em conclusão, neuropatia periférica, em geral assintomática, é comum na SAFP. Estudo de condução nervosa deve ser considerado na avaliação desses pacientes. / The involvement of the peripheral nervous system in diverse autoimmune diseases is well established. However, no appropriately designed studies have been performed in primary antiphospholipid syndrome (PAPS)-related peripheral neuropathy. We aimed to investigate the occurrence of peripheral neuropathy in patients diagnosed with PAPS. Twenty-six consecutive PAPS (Sapporo\'s criteria) patients and twenty age- and gender-matched healthy controls were enrolled at two referral centers. Exclusion criteria were secondary causes of peripheral neuropathy. A complete clinical neurological exam followed by nerve conduction studies (NCSs) were performed. Paresthesias were reported in 8 patients (31%). Objective mild distal weakness and abnormal symmetric deep tendon reflexes were observed in three (11.5%) patients. With regard to the electrophysiological evidence of peripheral neuropathy, nine (35.0%) patients had alterations: four (15.5%) had pure sensory or sensorimotor distal axonal neuropathy (in two of them a carpal tunnel syndrome was also present) and one (4%) had sensorimotor demyelinating and axonal neuropathy involving upper and lower extremities, while four patients (15.5%) showed isolated carpal tunnel syndrome. Clinical and serological results were similar in all PAPS patients, regardless of the presence of electrophysiological alterations. In conclusion, peripheral neuropathy is a common asymptomatic abnormality in PAPS patients. The routine performance of NCS may be considered when evaluating such patients.

O envolvimento do sistema nervoso periférico em diversas doenças auto-imunes é bem estabelecido. No entanto, não existem estudos, com desenho metodológico apropriado, que tenham investigado a relação entre síndrome antifosfolípide primária (SAFP) e neuropatia periférica. Nosso objetivo nesse trabalho foi investigar a ocorrência de neuropatia periférica em pacientes com SAFP. Vinte e seis pacientes com SAFP (critérios de Sapporo) e vinte controles, saudáveis, pareados por sexo e idade, foram recrutados em dois centros de referência. Foram excluídas as causas secundárias de neuropatia periférica e um exame neurológico completo, seguido de estudo de neurocondução, foi realizado em todos os indivíduos. Parestesias foram observadas em oito pacientes (31%). Leve fraqueza distal e anormalidades nos reflexos tendíneos profundos, foram observados em três (11,5%) pacientes. Evidência eletrofisiológica de neuropatia periférica foi observada em nove (35%) pacientes: quatro (15,5%) pacientes apresentaram neuropatia sensitiva ou sensitivo-motora axonal distais (em dois deles, com a superposição de síndrome do túnel do carpo), um (4%) paciente apresentou neuropatia sensitivo-motora, axonal e desmielinizante, acometendo os membros superiores e inferiores, enquanto que em quatro (15,5%) pacientes, observou-se a presença isolada de síndrome do túnel do carpo. As alterações clínicas e sorológicas dos pacientes com SAFP não guardaram qualquer correlação, com as alterações eletrofisiológicas. Em conclusão, neuropatia periférica, em geral assintomática, é comum na SAFP. Estudo de condução nervosa deve ser considerado na avaliação desses pacientes. / The involvement of the peripheral nervous system in diverse autoimmune diseases is well established. However, no appropriately designed studies have been performed in primary antiphospholipid syndrome (PAPS)-related peripheral neuropathy. We aimed to investigate the occurrence of peripheral neuropathy in patients diagnosed with PAPS. Twenty-six consecutive PAPS (Sapporo\'s criteria) patients and twenty age- and gender-matched healthy controls were enrolled at two referral centers. Exclusion criteria were secondary causes of peripheral neuropathy. A complete clinical neurological exam followed by nerve conduction studies (NCSs) were performed. Paresthesias were reported in 8 patients (31%). Objective mild distal weakness and abnormal symmetric deep tendon reflexes were observed in three (11.5%) patients. With regard to the electrophysiological evidence of peripheral neuropathy, nine (35.0%) patients had alterations: four (15.5%) had pure sensory or sensorimotor distal axonal neuropathy (in two of them a carpal tunnel syndrome was also present) and one (4%) had sensorimotor demyelinating and axonal neuropathy involving upper and lower extremities, while four patients (15.5%) showed isolated carpal tunnel syndrome. Clinical and serological results were similar in all PAPS patients, regardless of the presence of electrophysiological alterations. In conclusion, peripheral neuropathy is a common asymptomatic abnormality in PAPS patients. The routine performance of NCS may be considered when evaluating such patients.

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.

The purpose of this study was to investigate the difference in amplitude between M-response from m. Abductor pollicis brevis/m. Pronator quadratus and m. Abductor pollicis brevis/m. Abductor digiti minimi on patients with carpal tunnel syndrome, compared with control subjects. We wanted to see if m. Pronator quadratus is a better alternative than m. Abductor digiti minimi as comparison with m. Abductor pollicis brevis on patients with carpal tunnel syndrome. Nerve conduction studies were performed on 20 patients with carpal tunnel syndrome and on 31 healthy subjects. The test-retest result shows that this method was reproducible. The amplitude difference of m. Abductor pollicis brevis-m. Abductor digiti minimi, for the patients, was 1,5mV lower and the amplitude for m. Abductor pollicis brevis-m. Pronator quadratus was 2mV lower than for healthy subjects. Two of the patients were outside the 2SD for the m. Abductor pollicis brevis-m. Pronator quadratus difference but not on the m. Abductor pollicis brevis-m. Abductor digiti minimi. This may indicate that m. Pronator quadratus was better than m. Abductor digiti minimi in the comparison with the m. Abductor pollicis brevis amplitude.

<p>Neurodynamics refers to the mechanical and physiological components of</p> <p>the nervous system and the interconnections between them (Shacklock, 1995).</p> <p>This is a phase 1 pilot trial investigating the immediate effect of a neurodynamic</p> <p>treatment as compared to a sham treatment in eight participants with low back</p> <p>pain. Primary outcome measures included: H-reflex latency and nerve</p> <p>conduction velocity. Secondary outcome measures included: the sitting slump</p> <p>test and visual analog scale for pain following a neurodynamic treatment</p> <p>compared to a sham treatment on eight participants with low back pain. T-tests</p> <p>were used to analyze any differences between the groups at baseline and post-</p> <p>intervention. No statistically significant differences were observed between the</p> <p>groups at baseline. Statistically significant differences were noted post-</p> <p>intervention between the treatment groups for H-reflex latency (t(5)=4.323,</p> <p>p=0.008) and the unaffected leg sitting slump test (t(5)=3.402, p=0.019). The H-</p> <p>reflex latency increased for the group following the neurodynamic treatment and</p> <p>decreased following the sham treatment. This was not expected and is of</p> <p>interest due to the possible mechanisms that may be underlying these</p> <p>phenomena. Despite the small sample size used in this study, differences were</p> <p>observed and displayed trends that were unanticipated. These between-group</p> <p>differences are of interest but require further investigation using a larger sample</p> <p>population. Sample size calculations for future studies based on the primary</p> <p>outcome measures yielded a sample of 2008 participants. This accounted for</p> <p>both a 20% difference between the two groups and a 20% dropout rate. Future</p> <p>studies need to investigate the most beneficial length of time, type and dosage of</p> <p>neurodynamic treatments, as well as, the most appropriate times to assess the</p> <p>outcome measures. Comparison to controls would be beneficial in subsequent</p> <p>studies.</p> / Master of Science Rehabilitation Science (MSc)