Orientador: Luiz Antonio de Lima Resende / Banca: Renato Mazzonetto / Banca: Paulo André Teixeira Kimaid / Resumo: Este trabalho estudou pacientes com síndrome do túnel do carpo, submetidos a estudos de condução nervosa em diferentes equipamentos: Nihon-Kohden e Nicolet Viking Select (Grupo I), Neuromax 1000 e Nicolet compass meridien (Grupo II). Para os estudos de condução nervosa sensitiva, não foram observadas diferenças estatisticamente significativas entre os equipamentos. Para os estudos de condução nervosa motora, foram observadas latências motoras mais prolongadas nos aparelhos Nicolet que nos equipamentos Nihon-Kohden e Neuromax. As diferenças entre os equipamentos foram mais pronunciadas para os casos menos graves. / Abstract: This work analysed motor and sensory conduction studies in patients with carpal tunnel syndrome. Different equipments were employed: Nihon- Kohden and Nicolet Viking Select (Group I), Neuromax 1000 and Nicolet compass meridien (Group II). For sensory conduction studies no significant statistic differences were found; for motor conduction studies enlargements of the distal motor latencies were observed for Nicolet equipments in relation to the Nihon-Kohden and Neuromax. The differences were more marked for the slight cases. / Mestre

Performance-related musculoskeletal disorders in musicians are common due to the biomechanics required in their craft. Unfortunately, injuries can cause many to abandon music, so determining the best approach to treatment and prevention is key. This case study’s importance is to evaluate the optimal approach to carpal tunnel syndrome in a drummer. The patient is a 55-year-old male full-time drummer with a history of diabetes mellitus and osteoarthritis, who presented to clinic with chronic bilateral hand numbness and tingling that had been present for years. The location of the symptoms were mainly in the palmar aspect of the 1st digit, 2nd digit, 3rd digit, and the radial side of the 4th digit. The symptoms had progressively been worsening, and his discomfort was initially rated at a 10/10 bilaterally. He had tried over-the-counter and prescription anti-inflammatory medications as well as braces without improvement. His physical exam was positive for Tinel’s sign. The diagnosis of carpal tunnel syndrome was eventually made. The patient was treated with bilateral ultrasound-guided carpal tunnel injections with lidocaine and methylprednisolone. The other component of treatment was relative rest, which allowed us to tailor treatment to his drumming. After treatment, his discomfort was rated at 0/10 bilaterally, and he was drumming without issue. It was found that relative rest and carpal tunnel injections are effective in treating carpal tunnel syndrome in drummers. His treatment was tailored to his specific instrument type, which was a key component to the success. Upon review, there is limited to no specific information on treating drummers as a specific group in the literature, but rather more information on treating musicians as a whole. Different instrumentalists have different postures and repetitive movements, so future studies would do well to examine the individual biomechanics of the different instrumentalists to better tailor treatment and prevention.

The purpose of this thesis was to understand the implications of ultrasound in the assessment of flexor tendon shear to establish its role in carpal tunnel syndrome. An in vitro and in vivo approach was used to examine ultrasound “shear” between the tendon and adjacent tenosynovium. Ultrasound shear is defined by the relative displacement between the tendon and tenosynovium, and has been considered a surrogate measure of tendon shear. However, the mechanical implications of relative displacement are not well understood. In Chapters 2 and 3, an in vitro approach was used to compare ultrasound to direct measurements of tendon displacement and tendon shear. Chapter 2 demonstrated the validity of colour Doppler ultrasonography in the evaluation of tendon displacement. Chapter 3 assessed the relationship between ultrasound shear and mechanical tendon shear using frictional work. We dispelled the notion that ultrasound shear represents tendon shear by showing it only captures the viscoelastic stretch of the tenosynovium in tendon shear; missing surface friction from neighbouring anatomical structures in the carpal tunnel. However, measuring viscoelastic resistance in tendon motion is important for the development of pathological fibrosis and thickening of the tenosynovium, a characteristic finding in carpal tunnel syndrome. In Chapter 4 we further established the clinical utility of ultrasound in vivo by showing ultrasound shear discriminated carpal tunnel syndrome symptomatic individuals from the healthy population. Ultrasound measures progressed with symptoms suggesting an etiological progression of fibrosis and thickening with carpal tunnel syndrome. This thesis concluded that ultrasound only partially represents tendon shear with the viscoelastic component, but underscored the clinical implications. Ultrasound provides a non-invasive assessment of viscoelastic resistance that will be highly valuable for our understanding of the role of wrist and hand motion in the etiology of injury with potential applications in the diagnosis of carpal tunnel syndrome. / Thesis / Master of Science in Kinesiology

O trabalho propõe uma metodologia para estimação da idade óssea baseada em um sistema totalmente automático utilizando a análise de formas de estruturas ósseas. O sistema tem como finalidade auxiliar o diagnóstico do profissional da área médica servindo de apoio a sua decisão. A metodologia é dividida em dois blocos principais. No primeiro o dedo médio é segmentado a partir da radiografia de toda a mão. No segundo, são extraídas dimensões utilizando técnicas de processamento de imagem. Finalmente a estimação da idade é realizada por meio da correlação com padrões formais de seis centos de ossificação. Os resultados mostram que a análise de forma é mais precisa em pacientes do sexo feminino, mas pode ser utilizada como estimador para ambos os sexos. / The objective of this project is to propose a methodology for estimating the bone age based on a fully automatic system using shape analysis of bone structures. The system aims to assist the diagnosis, supporting the decision of the physicians involved in the process. The methodology is divided into two main blocks. In the first, the middle finger is segmented from the radiograph of the whole hand. In the second, measurements are extracted using image processing techniques. Finally, the results are classified using correlation between the shape pattern of six different bone structures. The results show that the shape analysis is a better method for female diagnosis but it can be used as a good estimator for both genders.

Orientador: Luiz Antônio de Lima Resende / Banca: Claudi Ferreira da Rosa Sobreira / Banca: José Luiz Pedroso / Resumo: A síndrome do túnel do carpo (CTS) é a neuropatia compressiva mais comum. Após cirurgias descompressivas diferentes tipos de complicações podem ocorrer, donde a necessidade de procurarmos novas opções de tratamento. O objetivo deste estudo foi avaliar eventual eficácia da terapia com Laser de baixa intensidade na CTS. Foram realizadas avaliações clínicas e ENMG antes e após tratamento com Laser de baixa intensidade. Terapia com Laser utilizou emissor de Laser gálioíndio- fósforo-alumínio, com comprimento de onda de 660 nm, potência média de 30 nW, regime contínuo de área de 0,06 cm2. A fluência de irradiação foi de 10 J/cm2, com energia de 0,6 J, com exposição de 10 segundos por ponto, e 2 J/cm² no modo varredura, totalizando 6 pontos de irradiação sobre o canal do carpo, no sentido proximal-distal, sobre o trajeto anatômico do nervo mediano, no retináculo flexor. O Laser foi posicionado a 90o em relação à pele. Foram realizadas 2 sessões por semana, durante 12 semanas (total de 24 sessões). Os dados antes e após tratamento foram analisados pelo teste "t" de Student para amostras correlatas. Até o momento foram estudadas 20 mãos de 13 pacientes. Escala visual analógica de dor, força muscular do músculo abdutor pollicis brevis e velocidades de condução sensitiva do nervo mediano apresentaram melhora após tratamento (p < 0.0001, 0.0003 and 0.045, respectivamente). Entre estes 3 parâmetros não foram observadas correlações pelo teste de correlação de Spearman. Em nossa opinião terapia com Laser de baixa intensidade para pacientes com síndrome do túnel do carpo é inovadora, barata e não invasiva, com resultados iniciais encorajadores / Abstract: The carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. After surgery different types of complication may occur, than search for new clinical forms of treatment is necessary. The aim of this study was to test the effectiveness of low intensity laser therapy in patients with CTS. Patients with clinical and ENMG diagnosis of CTS never previously treated were included and submitted to clinical evaluation and conduction studies before and after treatment. Sensory and motor conduction studies were performed by conventional described techniques. Low intensity laser treatment was by 660 nm wave length, average power of 30 nw, continuous operation area of 0.06 cm2, fluence of irradiation of 10 J/cm2, exposure of 10 seconds per point, totaling 6 points of irradiation on the carpal tunnel, from the proximal to the distal sense. Laser was positioned at 90o to the skin, 2 sessions per week during 3 months were performed (24 sessions). To this moment 20 hands of 13 patients were studied. Visual analogic scale of pain (VAS), strength of the abductor pollicis brevis and sensory velocity of the median nerve showed improvement after the treatment (p < 0.0001, 0.0003 and 0.045, respectively). No correlation between these 3 parameters were observed from the Spearman correlation test. In our opinion low intensity laser therapy is a new, no expensive and easy to apply encouraging treatment for CTS / Mestre

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.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2005. / Restricted until May 2006. Bibliography: leaves 67-74.

Made available in DSpace on 2014-08-13T14:50:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-06-28Bitstream added on 2014-08-13T18:00:42Z : No. of bitstreams: 1 000755547_20150628.pdf: 250824 bytes, checksum: 795dea93e01fd5ccf15d5ca4b855d266 (MD5) Bitstreams deleted on 2015-06-30T11:22:15Z: 000755547_20150628.pdf,. Added 1 bitstream(s) on 2015-06-30T11:23:08Z : No. of bitstreams: 1 000755547.pdf: 2462293 bytes, checksum: 04864172a4ab96dc6e73edd28ba4e665 (MD5) / O canal do carpo foi avaliado ultrassonograficamente em 60 equinos da raça quarto de milha de corrida, hígidos, em diferentes faixas etárias. Os animais foram divididos em três grupos: potros, adultos jovens e adultos, contendo 10 machos e 10 fêmeas em cada grupo. O objetivo deste estudo foi a caracterização e padronização das estruturas do canal do carpo, pelo exame ultrassonográfico modo B e pelo exame ultrassonográfico Doppler. Dentro do canal do carpo foram avaliados os tendões flexores digitais superficial e profundo, juntamente com o tendão flexor carpo radial. Para cada tendão foi mensurado as dimensões de altura dorso palmar, largura médio lateral e a área dos tendões. Além dos tendões, foram avaliados os nervos palmar medial e palmar lateral, conforme a morfologia normal e a dimensão dorso palmar. No exame ultrassonográfico modo Doppler foram padronizados os índices dopplerfluxométricos das artérias radial e ramo palmar da artéria mediana. Para padronização de ecogenicidade e ecotextura dos tendões foram realizados o histograma. As médias da área do TFDS variaram de 99,20 a 123,20 mm2, do TFDP 114,60 a 143,80 mm2 e o TFCR 17,50 a 24,22 mm2. As médias do diâmetro do retináculo flexor variaram de 1,33 a 1,55 mm, do nervo palmar lateral de 0,93 a 1,09 mm, o do nervo palmar medial 1,10 a 1,44 mm, da artéria radial de 2,54 a 3,06 mm e da artéria palmar medial de 4,23 a 5,47. As médias do índice de resistividade e pulsatilidade da artéria radial variaram de 0,82 a 0,88 e 2,02 a 3,73, respectivamente. As médias do índice de resistividade e pulsatilidade da artéria palmar medial variaram 0,72 a 0,84 e 1,71 a 2,73. Neste estudo foi possível concluir que não ocorreu diferença entre os membros direito e esquerdo para o mesmo animal. Há tendência dos animais adultos apresentaram os tendões maiores e mais heterogêneos do que os adultos jovens e potros. Embora existam diferenças estatísticas entre as ... / The carpal tunnel was sonographically evaluated in 60 quarter horse healthy equines in different age groups, divided into three groups, being these foals, young adults and adults, with 10 males and 10 females in each group. The aim of this study was the characterization and standardization of the structures of the carpal tunnel, through the ultrasound B-mode and the Doppler ultrasonography. Within the carpal tunnel were evaluated superficial digital flexor tendon and deep with the radial carpal flexor tendon. For each tendon was measured the height dimensions dorsal palmar, the medial lateral width and the area of the tendons. Besides the tendons were evaluated the medial palmar nerves and the lateral palmar according to the normal morphology and dorsal palmar dimension. In the Doppler ultrasound were standardized the Dopplerfluxometry indices of the radial arteries and palmar branch of the median artery. For the echogenicity and echotexture standardization of the tendons were performed the histogram. The mean area of the TSDF ranged from 99.20 to 123.20 mm2, of the TDDF from 114.60 to 143.80 mm2 and of the TFCR from 17.50 to 24.22 mm2. The mean diameter of the flexor retinaculum ranged from 1.33 to 1.55 mm, of the lateral palmar nerve from 0.93 to 1.09 mm, of the medial nerve palmar from 1.10 to 1.44 mm, of the artery radial from 2.54 to 3.06 mm and of the medial palmar artery from 4.23 to 5.47. The mean of the resistivity and pulsatility indexes of the radial artery ranged from 0.82 to 0.88 and from 2.02 to 3.73, respectively. The mean resistivity and pulsatility indexes of the medial palmar artery ranged from 0.72 to 0.84 and from 1.71 to 2.73, respectively. The mean resistivity and pulsatility indexes of the medial palmar artery ranged from 0.72 to 0.84 and from 1.71 to 2.73. In this study was concluded that there was no difference between the right and left limbs for the same animal and there is ...

Base teórica A síndrome do túnel do carpo (STC) é uma lesão compressiva nervosa mais comum que afeta o nervo mediano observada na prática clínica. Existem muitas técnicas eletrofisiológicas para diagnosticar a STC, mas a maioria dispende muito tempo, é dolorosa e tem sensibilidade variada. Objetivo Avaliar a acurácia de um método eletrofisiológico de investigação da STC e correlaciona-lo com aspectos clínicos. Métodos Pacientes do ambulatório de Neurologia com critérios clínicos para STC foram submetidos a uma bateria de testes clínicos e neurofisiológicos. Primeiramente, nós aplicamos o Questionário de Síndrome do túnel do Carpo de Boston e Escala visual analógica (EVA). Após, realizamos o método eletrofisiológico convencional de avaliação sensitiva do nervo mediano e ulnar. Posteriormente, outro médico eletrofisiologista, cegado para as avaliações anteriores, realizou a técnica de estimulação simultânea dos nervos mediano e radial no polegar com registro simultâneo de ambos potenciais na região punho. Os dados foram agrupados em STC leve, moderada e grave, baseados na latência motora do nervo mediano. Resultados A latência entre picos (LEP), obtida pela técnica em estudo, foi diferente entre os grupos baseados na classificação de gravidade da STC (Bonferroni; p<0.001). A velocidade de condução nervosa sensitiva do nervo mediano, obtida através da técnica standard, apresentou também diferentes valores entre os grupos. Houve correlação entre LEP e velocidade de condução nervosa sensitiva do mediano (Sperman; r=-0.52; p<0.01), bem como entre LEP e velocidade de condução nervosa sensitiva do mediano com o desconforto causado pela STC mensurado pela Escala visual analógica (EVA). A duração e o desconforto causado pela técnica de estimulação simultânea do nervo mediano e radial estão reduzidos quando comparados com a técnica padrão (t Student; p< 0.001 para as duas comparações). Conclusão A técnica de estimulação simultânea do nervo mediano e radial é acurada, sensível, tolerável e não somente útil no diagnóstico da STC, mas também na definição da gravidade. Então, seu uso deve ser encorajado na prática clínica. / Background Carpal tunnel syndrome (CTS) is the most common nerve entrapment observed in clinical practice affecting the median nerve at the wrist level. There are many electrophysiological ways to diagnose CTS, but most of them are time consuming, painful and have variable sensitivity. Objective To evaluate the accuracy of an electophysiologic method of CTS investigation and to correlate it with clinical symptoms. Methods Patients at the clinic outpatient Neurology with CTS clinical criteria underwent a battery of clinical and neurophysiological tests. First, we applied the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and Visual analogue scale (VAS). After, we performed a standard method of analysis of the median and ulnar nerves. Posteriorly, a blinded neurophysiologist performed an orthodromic median-radial nerve simultaneous stimulation at the thumb with recording of both action potentials at the lateral aspect of the wrist. Data were grouped for mild, moderate and severe CTS, based on median motor latency. Results The interpeak latency (IPL), obtained with study technique, was different in groups based on CTS classification severity (Bonferroni. p<0.001). The median nerve conduction velocity, obtained with the standard approach, was also of different level among groups. There were correlation between IPL and median nerve conduction velocity (Sperman; r=-0.52; p<0.01), as well as, there was a significant correlation between IPL and median nerve conduction velocity with the discomfort caused by CTS and measured with VAS. However, the duration and unpleasantness caused by median-radial nerve simultaneous stimulation technique were reduced when compared to standard approach (t Student <0.001 for both comparisons). Conclusion The orthodromic median-radial nerve simultaneous stimulation technique is accurate, sensitive, tolerable and not only useful for CTS diagnosis but also for its severity assessment. Therefore, its use should be encouraged in clinical practice.

Made available in DSpace on 2015-12-10T14:24:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-27. Added 1 bitstream(s) on 2015-12-10T14:30:08Z : No. of bitstreams: 1 000851769.pdf: 1354680 bytes, checksum: 50510165e2f58c33137b57d0d3d4fe5e (MD5) / A síndrome do túnel do carpo (CTS) é a neuropatia compressiva mais comum. Após cirurgias descompressivas diferentes tipos de complicações podem ocorrer, donde a necessidade de procurarmos novas opções de tratamento. O objetivo deste estudo foi avaliar eventual eficácia da terapia com Laser de baixa intensidade na CTS. Foram realizadas avaliações clínicas e ENMG antes e após tratamento com Laser de baixa intensidade. Terapia com Laser utilizou emissor de Laser gálioíndio- fósforo-alumínio, com comprimento de onda de 660 nm, potência média de 30 nW, regime contínuo de área de 0,06 cm2. A fluência de irradiação foi de 10 J/cm2, com energia de 0,6 J, com exposição de 10 segundos por ponto, e 2 J/cm² no modo varredura, totalizando 6 pontos de irradiação sobre o canal do carpo, no sentido proximal-distal, sobre o trajeto anatômico do nervo mediano, no retináculo flexor. O Laser foi posicionado a 90o em relação à pele. Foram realizadas 2 sessões por semana, durante 12 semanas (total de 24 sessões). Os dados antes e após tratamento foram analisados pelo teste t de Student para amostras correlatas. Até o momento foram estudadas 20 mãos de 13 pacientes. Escala visual analógica de dor, força muscular do músculo abdutor pollicis brevis e velocidades de condução sensitiva do nervo mediano apresentaram melhora após tratamento (p < 0.0001, 0.0003 and 0.045, respectivamente). Entre estes 3 parâmetros não foram observadas correlações pelo teste de correlação de Spearman. Em nossa opinião terapia com Laser de baixa intensidade para pacientes com síndrome do túnel do carpo é inovadora, barata e não invasiva, com resultados iniciais encorajadores / The carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. After surgery different types of complication may occur, than search for new clinical forms of treatment is necessary. The aim of this study was to test the effectiveness of low intensity laser therapy in patients with CTS. Patients with clinical and ENMG diagnosis of CTS never previously treated were included and submitted to clinical evaluation and conduction studies before and after treatment. Sensory and motor conduction studies were performed by conventional described techniques. Low intensity laser treatment was by 660 nm wave length, average power of 30 nw, continuous operation area of 0.06 cm2, fluence of irradiation of 10 J/cm2, exposure of 10 seconds per point, totaling 6 points of irradiation on the carpal tunnel, from the proximal to the distal sense. Laser was positioned at 90o to the skin, 2 sessions per week during 3 months were performed (24 sessions). To this moment 20 hands of 13 patients were studied. Visual analogic scale of pain (VAS), strength of the abductor pollicis brevis and sensory velocity of the median nerve showed improvement after the treatment (p < 0.0001, 0.0003 and 0.045, respectively). No correlation between these 3 parameters were observed from the Spearman correlation test. In our opinion low intensity laser therapy is a new, no expensive and easy to apply encouraging treatment for CTS