Carpal tunnel syndrome (CTS) is a neuropathic condition commonly caused by the entrapment of the median nerve. The most common complaint presented by the CTS patients is pricking sensation, numbness, pins and needles, burning sensation as well as in the hand and sometimes the arm/s distribution of the affected side. The patients with CTS usually complain of nocturnal periodic sleep disruption caused by the pain discomfort. In my dissertation, I explore the extent to which the CTS pain influences sleep architecture using neurophysiological measurements like an overnight electroencephalogram (EEG), conduction tests as well as subjective questionnaires. I initially conducted a pilot research study on 33 patients with CTS using subjective questionnaires. The CTS patients reported sleep disturbance. I also demonstrated that they (patients) had a minimal mood and psychological disturbance. I was prompted therefore to investigate the influence of the CTS pain on the sleep architecture using more objective empirical instruments like the polysomnogram as well as subjective measurements such as Beck Depression Inventory, Profile of mood states, Visual analogue scales as well as the McGill pain questionnaire to further investigate changes. The patients were required to spend four nights in the sleep laboratory divided into two nights before surgery and two nights at least two to six weeks following the CTS surgery. The CTS surgery is commonly used to release the compression of the median nerve at the wrist. The changes in subjective and objective variables were compared before and after CTS surgery. The age and gender-matched control group was introduced into the research study. The control group was required to spend the same number of nights in the sleep laboratory as the CTS group. The control group was also going to have a non-painful procedure of the same magnitude as the experimental subjects. The conclusion I reached on this study was that the CTS patients reported poor sleep quality. I also demonstrated that there were not many changes in the polysomnogram and that there were minimum changes shown on the nerve conduction studies variables as might have been expected based on the severity of the carpal tunnel syndrome. Another important finding was that there was a relationship between pain and depressive mood in CTS patients. The removal of pain in CTS patients showed that there was a subsequent subjective improvement in mood and psychological status and no significant improvement in subjective measurements. There were no significant changes noted on the control subjects who were pain-free.

The morphology and function of the wrist is poorly understood. Improved understanding of carpal anatomy may facilitate improved understanding of carpal mechanics and may enhance the clinical management of wrist dysfunction. Many detailed investigations of wrist structure have been reported, many of which have focussed on the scaphoid and its ligamentous supports. The results of these studies are not readily collated to provide an accurate description of the scaphoid and its supports. This study attempted to provide a detailed description of the anatomy of the scaphoid and its supporting structures. A detailed nomenclature was proposed to facilitate accurate description of the scaphoid and related structures. Gross observation enabled separation of the sample population of scaphoids into two groups. Morphometric analyses were used to determine any significant differences between the groups (type one and type two). The histological sections were then used to facilitate accurate gross identification of ligaments and computed tomographs were used to investigate the in situ variation of scaphoid orientation. The investigations suggest that two distinct populations of scaphoid existed within the sample population. The scaphoids varied in bone morphology, arrangement and degree of ligamentous support and position relative to the capitate. Articular facet shape and size differed between scaphoid types. The orientation and number of ligaments supporting the scaphoid were suggestive of variable scaphoid motion. The variation in ligamentous patterns was supported by histological investigation. Computed tomographs through the longitudinal axis of the scaphoid suggested a variable position of the scaphoid relative to the capitate. The variation of these structures was discussed in relation to the kinematic findings of others. A theoretical model of variable scaphoid function was proposed based on the anatomical findings. The data presented and the reviewed kinematic data may be extrapolated to suggest two models of scaphoid motion. The scaphoids may be divided into rotating/translating scaphoids and flexing/extending scaphoids. This must be confirmed by a combined anatomical and mechanical study. The clinical implications of different scaphoid structure and function may be profound. The ability to identify such differences in situ may facilitate varied clinical management for the various types of wrist suggested. / Thesis (Ph.D.)--Department of Anatomical Sciences, 2004.

Thesis (M.Sc.)--York University, 2004. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 68-74). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL:http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss&rft%5Fval%5Ffmt=info:ofi/fmt:kev:mtx:dissertation&rft%5Fdat=xri:pqdiss:MQ99282

Thesis (M.F.A.)--Ohio State University, 2006. / Includes bibliographical references (leaves 112-114). Available online via OhioLINK's ETD Center

The purpose of this study was to determine the utility of decomposition-based quantitative electromyography (DQEMG) in detecting signs of motor unit loss and collateral sprouting in compression neuropathy. In order to accomplish this, needle- and surface-detected motor unit potential (MUP) morphological features, determined by DQEMG, were used to determine evidence of collateral sprouting. Evidence of motor unit loss was measured using motor unit number estimates (MUNEs). Six subjects with severe carpal tunnel syndrome (CTS), eight subjects with mild CTS and nine healthy individuals with no known neuropathy participated in this cross sectional study. All subjects completed two phases of data collection: 1) an examination consisting of physical and electrophysiological tests to assess the presence and/or severity of CTS and 2) quantitative electromyography techniques to record MUNEs and MUP morphological characteristics. The needle-detected MUP parameters included peak-to-peak amplitude, duration and number of phases. The presence of satellite potentials was also investigated in the needle-detected MUPs. The surface-detected MUP parameters examined included peak-to-peak amplitude, duration and negative peak area. Kruskall-Wallace tests were used to determine group differences for all outcome measures. The MUNEs were lower (p<0.017) in the severe CTS group as compared to those with mild or no CTS. This result suggests that individuals with severe CTS experience a decrease in the number of functioning motor units. Despite statistically similar surface-detected MUP morphology, there were significantly larger needle-detected MUP amplitudes (p<0.017) and satellite potentials (p<0.05) were present in the severe CTS group as compared to the mild CTS group and healthy control group. These findings suggest there is collateral reinnervation in individuals with severe CTS. The results of this study support the use of DQEMG in future studies of compression neuropathies as an effective means to document the progression of motor deficits. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2008-09-16 12:08:13.587

Thesis (PhDPhysiotherapy)--University of South Australia, 2001

Thesis (MAppSc in Physiotherapy)--University of South Australia, 1996

Thesis (PhDPhysiotherapy)--University of South Australia, 2001

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2007. / Title from title screen (site viewed Apr. 29, 2008). PDF text: ix, 121 p. : ill. ; 1 Mb. UMI publication number: AAT 3278295. Includes bibliographical references. Also available in microfilm and microfiche formats.

Resumo não disponível.