Research suggests that, in individuals with carpal tunnel syndrome (CTS), low plasma pyridoxal 5'-phosphate (PLP) concentrations are related to an increased incidence and severity of symptoms associated with CTS. This study was designed to determine the relationship between plasma and red blood cell PLP concentrations and the severity and incidence of CTS symptoms. Thirty people with CTS were selected for a 9 month exercise study. Subjects were divided into either vitamin users or non-vitamin users based on supplement use data gathered at the beginning of the study. Blood was drawn at 1, 6 and 9 months. CTS symptoms questionnaires and health questionnaires were also administered at these intervals. The symptoms questionnaires were used to gather data on the frequency and nature of hand and wrist symptoms. Health questionnaires focused on vitamin supplement usage including frequency, amount and length of use. Mean plasma PLP, total plasma vitamin B6 and erythrocyte PLP concentrations were significantly higher in the sixteen vitamin users when compared to the fourteen non-vitamin users (p<0.001). While there was variation in plasma PLP and total plasma vitamin B6 over time, within each group, there were no significant changes in any of the status measures over the nine month period. Mean erythrocyte PLP concentration, in particular, was stable over time. In vitamin users, the intensity of pain, numbness and tingling was significantly higher when compared to non-vitamin users. In both groups, plasma PLP was negatively correlated with pain. This correlation reached statistical significance in vitamin users at month one and nine (p<0.01), but not at month six; a statistically significant correlation between these two variables was not found in non-vitamin users at any time point. Pain was also negatively and significantly correlated with plasma total vitamin B6 and erythrocyte PLP in vitamin users. No other symptoms were significantly correlated with the status measures. These results indicate that a higher vitamin B6 status may be related to a decrease in the severity of pain experienced by some individuals with CTS. / Graduation date: 1998

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Technikon Natal, 2002. / Carpal Tunnel Syndrome is defined as a median nerve entrapment beneath the flexor retinaculum in the carpal canal such that it produces symptoms in the hand, wrist and upper extremity. A review of related literature suggests that statistics on the incidence of Carpal Tunnel Syndrome in South Africa are unavailable. In the U. s. A, Carpal Tunnel Syndrome occurs in 1% of the population and is the most frequently diagnosed peripheral neuropathy. Several studies investigating the use of conservative care in managing Carpal Tunnel Syndrome have been performed, but none have compared the effect of wrist joint manipulation and ultrasound in the management of Carpal Tunnel Syndrome, The purpose of this study was to investigate the effectiveness of wrist joint manipulation compared to ultrasound in the management of Carpal Tunnel Syndrome. This randomized controlled clinical trial consisted of a study population offorty patients. The patients were randomly allocated to two groups of twenty each. One group received wrist joint manipulation while the other received ultrasound application to the palmar-radial aspect of the wrist. Both groups received four treatments over a two week period. Subjective measures included the Numerical Rating Scale-I 0 1 Questionnaire and the Carpal Tunnel Pain and Disability Form and objective measures consisted of the grip strength reading and goniometer readings for wrist flexion and extension. Both the subjective and objective measures were taken before the first and third visit and at the fifth follow- up consultation which took place during the following week. Inter-group analysis was done using the Mann- Whitney U test. Friedman's T test was used for intra-group analysis. ct was set at the 0.05 level of significance. The results were illustrated by means of tables and bar- charts. The results indicated that for intragroup analysis, a statistically significant difference existed for both groups, warranting the use of a multiple comparison procedure (Dunn' s procedure) to determine at which stage the treatment made a significant difference. For all the measures except the wrist extension reading in the ultrasound group, most improvement occurred between the first and fifth consultations. For inter-group analysis, no significant difference for any of the measures, except the wrist extension readings, was present between the two groups indicating that both wrist joint manipulation and ultrasound were equally effective in treating Carpal Tunnel Syndrome. The improvement in wrist extension, in the wrist joint manipulation group was significantly better than that in the ultrasound group. Although this study was limited by its single researcher design and could not clarify which treatment protocol was more effective, it supports the existing body of evidence in favour of both wrist joint manipulation and therapeutic ultrasound application in the management of Carpal Tunnel Syndrome / M

To date, most studies investigating the neural signature of pain in humans have focused on the brain, and those studies concerned with more caudal areas (such as the spinal cord (SC) or brainstem) have used only experimental models of pain. The objectives of this study were 1) to determine the neural activity in the human brainstem and SC that is caused by a noxious mechanical stimulus and 2) to compare the neural response to noxious stimuli in healthy controls and a patient population diagnosed with peripheral neuropathic pain. The SC and brainstem contain important synaptic points in several major pain pathways, and comparing the neural response between a control and patient population in these areas provides a more complete picture of healthy and pathological pain processing. Functional MRI studies of the SC and brainstem were carried out in healthy control subjects and patients diagnosed with carpal tunnel syndrome (CTS) in a 3T Siemens Magnetom Trio. Subjects reported the point at which the pressure (in mmHg, applied to the wrist at the location of the median nerve) corresponded to a pain level of 2, 4, and 6 on a numerical 11 point pain scale. Spatially normalized group results superimposed on anatomical templates in the axial orientation were visually identified using several stereotaxic atlases. We observed consistent signal intensity change in areas implicated in the transmission and modulation of pain in both control and CTS groups. Both groups showed a similar decrease in signal change with increasing pain, as results at pain level 2 are predominantly positive signal change and at pain level 6 are typically negative. This may indicate a reduction in the tonic inhibition of painful sensations. Differences between groups were readily visible in regions anatomically consistent with the dorsal horn (DH) of the cervical SC, rostral ventromedial medulla (RVM), dorsolateral pontine tegmentum (DLPT), and midbrain periaqudectal gray (PAG). The anatomical variation in signal change between groups may represent, for the first time, a visualization of the functional difference between healthy and pathological pain processing in the SC and brainstem using spinal fMRI. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2010-08-03 14:46:01.7

Thesis(M.S.)--Auburn University, 2005. / Abstract. Vita. Includes bibliographic references.

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Made available in DSpace on 2014-06-11T19:22:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-16Bitstream added on 2014-06-13T19:47:17Z : No. of bitstreams: 1 oliveira_ajjv_me_botfm.pdf: 288626 bytes, checksum: 08a257cbb3a60279d6803950ece099be (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / 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. / 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.

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Trans-scaphoid, trans-radial styloid, trans-triquetral perilunate fracture dislocations are rare. We describe a 19-year-old male who suffered this injury after crashing his bicycle. He underwent open reduction internal fixation and percutaneous pinning. Scaphoid union was achieved at 8 weeks. Near complete range of painless motion was achieved by 4 months.

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.