No description available.

<p>Carpal tunnel syndrome (CTS) is one of the most prevalent work-related musculoskeletal disorders of the upper extremity yet its etiology remains elusive. Nerve hypervascularization has been proposed as a pathophysiological change in CTS and can be measured using high resolution sonography of intraneural blood flow. The purpose of this study was to determine the effects of deviated wrist postures and fingertip force on the intraneural blood flow velocity of the median nerve proximal to the wrist crease. Ten participants experiencing the classic symptoms of CTS and nine healthy volunteers were recruited and underwent qualitative assessments (Phalen’s test, Katz hand diagram, Levine’s CTS questionnaire). Intraneural blood flow velocity was measured in five wrist postures (flexion 30°, flexion 15°, neutral, extension 15°, extension 30°) with and without a middle digit fingertip press (0N, 6N). A control (N=9) group and a CTS symptomatic (N=9) group were determined, in addition to a CTS individual (N=1) that required a separate analysis. A significant main effect of force was found (F_1,16= 28.039, p < 0.0005) with the mean peak velocity being greater with force (3.56 cm/s) than without force (2.81 cm/s). Wrist posture had a main effect (F_4,64= 3.163, p < 0.020) with flow velocity as neutral (2.87 cm/s) was significantly lower than flexion 30° (3.37 cm/s), flexion 15°(3.27 cm/s) and extension 30° (3.29 cm/s). There was no significant difference in peak blood flow velocity between the two experimental groups, CTS symptomatic (3.34 cm/s) and control (3.03 cm/s) (F_1,16= 4.121, p < 0.059). The results suggest that both force and non-neutral wrist postures may acutely induce vascular changes previously associated with CTS. The quantification of reactive median nerve hypervascularity should be investigated further as it has potential to be both a reliable diagnostic technique and a non-invasive assessment of CTS risk.</p> / Master of Science in Kinesiology

Made available in DSpace on 2016-12-06T17:07:25Z (GMT). No. of bitstreams: 1 Daniela.pdf: 2419593 bytes, checksum: 894152ce479aae16445a360b52fda72a (MD5) Previous issue date: 2010-03-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study investigated the effect of Carpal Tunnel Syndrome (CTS) on hand function. It was analyzed the parameters of the grip force and their associations with the characteristics of CTS; and also, the control of the grip force in individuals with CTS during functional tasks and the effect of muscle fatigue and the object&#8223;s weight. It was evaluated 13 women with CTS (GE) and 13 without STC (GC) aged 43.54 ± 7.70 and 43.23 ± 7.89, respectively. The GE was assessed by the symptoms severity and functional status (Boston Questionnaire for CTS), the threshold of tactile sensibility and the manual dexterity (Moberg test). The maximal voluntary grip force was evaluated using a dynamometer. The parameters of the grip force analyzed were: maximal grip force (Fmax), time do reach the maximal grip force (TFmax), force rate (TDF) and area under the curve force-time (AFmax). To analyze the grip force control, the subjects performed two functional tasks while an object (instrumented with force sensor and triaxial accelerometer) was manipulated: i) drinking to bring the object close to the mouth and ii) "transition" - to lift the object 11 times sequentially and to leave it on the table after 5 s; in the trials 6-8, the object&#8223;s weight was increased; therefore, the trials without object&#8223;s additional load (average of 1-5, OBJP1) and the second lift with object&#8223;s additional load (OBP2) were compared. The parameters analyzed were: peak of the velocity (Pvel), time lag (DT), peak of the grip force (PFP), mean of the grip force in movement&#8223;s acceleration (Fac) and deceleration (Fdc) and safety margin (MS). The subjects performed the functional tasks before the fatigue protocol (FAD1) and with the muscles fatigued (FAD2). At group&#8223;s comparison, the GE showed lower values of Fmax, TDF and AFmax and higher TFmax. There were high and moderate associations between TFmax and the characteristics of the GE and a moderate association between manual dexterity and the parameters of the grip force. The temporal parameters (Pvel and DT) were not affected by the CTS, fatigue and object&#8223;s weight. Before the fatigue protocol, the GE applied higher PFP than the GC (drinking task); furthermore, both groups increased the PFP and the MS (transition task) while lifting the object with additional load. When the subjects performed the tasks with fatigued muscles, it was found a decreased of Fdc for the GE (drinking task) and also of PFP and MS for both groups (transition task); there was no difference on PFP between OBJP1 and OBJP2 for the GE. The analysis of the parameters of the grip force was useful to detect the muscle function impairments in CTS. It was identified that the TFmax might be the best parameter to indicate these changes. Moreover, it is suggested that the sensibility of the fingertips is important to avoid the excessive grip forces in functional tasks and that the manipulation of the objects with muscles of prehension fatigued may increase the likelihood of accidental slips, especially in individuals with CTS. / Este estudo investigou efeito da Síndrome do Túnel do Carpo (STC) na função manual. Foram analisados os parâmetros da força de preensão e suas associações com as características da STC, bem como o controle da força de preensão de indivíduos com STC em tarefas funcionais e o efeito causado pela fadiga e peso do objeto. Foram avaliadas 13 mulheres com STC (GE) e 13 sem STC (GC) com idade de 43,54 ± 7,70 e 43,23 ± 7,89 anos, respectivamente. O GE foi classificado quando à gravidade dos sintomas e estado funcional (Questionário de Boston para STC), o limiar de sensibilidade tátil e a destreza manual (Teste de Moberg). Foi realizado teste de força de preensão voluntária máxima em um dinamômetro. Os parâmetros da força de preensão analisados foram: força de preensão máxima (Fmax), tempo para atingir a força de preensão máxima (TFmax), taxa de desenvolvimento da força de preensão (TDF) e área sob a curva força-tempo (AFmax). Para análise do controle da força de preensão os indivíduos manipularam um objeto (instrumentado com sensor de força e acelerômetro triaxial) em duas tarefas funcionais: i) beber - levar o objeto até próximo à boca e ii) transição - realizar 11 levantamentos seqüenciais do objeto e reposicioná-lo sobre a mesa após 5 s, sendo que seu peso era aumentado nas repetições 6-8; foram comparadas as tentativas sem peso adicional do objeto (média 1-5, OBJP1) e o segundo levantamento com peso adicional (OBJP2). Os parâmetros analisados foram: pico da velocidade (Pvel), diferença temporal (DT), pico da força de preensão (PFP), média de força de preensão na aceleração (Fac) e desaceleração (Fdc) do movimento e margem de segurança (MS). Os indivíduos realizaram as tarefas funcionais antes de um protocolo de fadiga (FAD1) e com os músculos da preensão fadigados (FAD2). Os parâmetros da força de preensão foram diferentes entre grupos. GE mostrou menores valores de Fmax, TDF e AFmax e maior TFmax do que o GC. Foram encontradas associações moderadas e altas entre o TFmax e características do GE e moderada entre destreza manual e os parâmetros da força de preensão. Os parâmetros Pvel e DT não foram alterados pela STC, fadiga e peso do objeto. Antes do protocolo de fadiga, o GE aplicou maior PFP do que o GC (tarefa beber); ao levantar o objeto com peso adicional, ambos os grupos aumentaram o PFP e a MS (tarefa transição). Com os músculos fadigados, houve decréscimo da Fdc para GE (tarefa beber) e do PFP e da MS (tarefa transição) para ambos os grupos; o GE não mostrou diferença do PFP entre OBJP1 e OBJP2. A análise dos parâmetros da preensão apresentou-se útil para detectar prejuízo da função muscular na STC. Foi identificado que o TFmax pode ser o melhor parâmetro para indicar este comprometimento. Além disso, sugere-se que a sensibilidade é importante para evitar forças de preensão excessivas em tarefas funcionais e que a manipulação de objetos com músculos da preensão fadigados pode aumentar a probabilidade de deslizes acidentais, especialmente em indivíduos com STC.

Le syndrome du canal carpien (SCC) est un syndrome canalaire fréquent, qui fait partie des troubles musculo-squelettiques (TMS) d’origine professionnelle. Sa survenue en lien avec le travail sur ordinateur reste débattue.Pour faire le point sur la question, nous avons effectué une revue de la littérature et une méta-analyse sur l’éventuel lien entre le SCC et le travail sur ordinateur, confronté le résultat à celui obtenu dans deux grandes cohortes, l’une européenne et l’autre Nord-américaine et détaillé les expositions à certains facteurs biomécaniques chez les participants de la cohorte française présentant une douleur de la main.La revue de la littérature et la méta-analyse n'ont pas montré d'association entre le travail sur ordinateur et le SCC, avec un méta-OR à 1,67 (IC 95%, 0,79 à 3,55). Cependant, peu d’études longitudinales, avec des définitions standardisées du SCC, faisaient partie de cette analyse.Pour contourner ces limites, nous avons utilisé la cohorte française COSALI et la cohorte américaine Predi CTS study. Les analyses multivariées ajustées sur l'âge, le sexe, l'obésité et la présence d'antécédents médicaux n’ont pas montré que l'exposition au travail sur l’ordinateur était un facteur de risque de SCC.Ces deux études montrent que le travail sur ordinateur n’apparait pas comme un facteur de risque du SCC, contrairement à ce qui a pu être longtemps relayé.L’analyse exploratoire de la relation entre douleur de la main et travail sur ordinateur, ajustée sur les expositions biomécaniques dans la cohorte COSALI, montre dans certains groupes un possible lien entre douleur de la main et travail sur ordinateur, sous certaines conditions qui vont nécessiter des analyses ultérieures. / Carpal tunnel syndrome (CTS) is a common ductal syndrome which is part of occupational musculoskeletal disorders (MSDs). Its occurrence in connection with computer work remains debated.To review this issue, we conducted a review of the literature and a meta-analysis on the possible link between CTS and computer work, compared the result to that obtained in two large cohorts, one European and the other North American and detailed exposures to certain biomechanical factors in the French cohort in participants with pain in the hand.The literature review and meta-analysis show no association between CTS and computer work with a meta-OR at 1.67 (95% CI, 0.79 to 3.55). However, few longitudinal studies, with standardized CTS definitions were included in this analysis.To circumvent these limits, we used the French COSALI cohort and the American cohort PrediCTS study. Multivariate analyzes adjusted for age, gender, obesity and medical history did not show that computer exposure was a risk factor for CTS as it has long been relayed.The exploratory analysis of the relationship between hand pain and computer work adjusted to the biomechanical exposures in the COSALI cohort show in some groups a possible link between hand pain and computer work, under certain conditions, which will require further analysis.

No description available.

Karpaltunnelsyndrom är den vanligaste formen av infångningsneuropati hos den vuxna befolkningen. Kända riskfaktorer för karpaltunnelsyndrom inkluderar arbetsskador som upprepad och repetitiv användning av handen och handleden, men även andra orsaker som graviditet, kön, eventuella frakturer med mera. Elektroneurografi (neurografi) är en klinisk undersökningsmetod som används för att diagnostisera och gradera nervskadan av karpaltunnelsyndrom. Syftet med studien var att jämföra motorisk och sensorisk nervledningshastighet och amplitud mellan arbetsrelaterade skador och andra orsaker vid bekräftad karpaltunnelsyndrom. Patienter rekryterades från avledningen för klinisk neurofysiologi på Gävle sjukhus som var kallade för en neurografiundersökning med frågeställning karpaltunnelsyndrom. Inklusionskriterier i studien var patienter, kvinnor och män i åldern 18–65 år med bekräftad karpaltunnelsyndrom. Neurografi utfördes motorisk och sensoriskt på n. medianus och n. ulnaris bilateralt. Vidare undersöktes n. medianus bilateralt med 14–7 metoden. Ingen signifikant skillnad hittades mellan arbetsskador och andra orsaker för karpaltunnelsyndrom vid jämförelse mellan motorisk och sensorisk nervledningshastighet samt amplitud. Ingen skillnad hittades i 14–7 metoden vid registrering av n. medianus mellan grupperna. Inget samband hittades mellan kroppslängd och motorisk nervledningshastighet. / Carpal tunnel syndrome is the most common form of entrapment neuropathy in the adult population. Known risk factors for carpal tunnel syndrome include work related injuries such as repeated and repetitive use of hand and wrist, but also other causes such as pregnancy, gender, possible fractures and more. Electroneurography (neurography) is a clinical examination method used to diagnose and grade the nerve damage of carpal tunnel syndrome. The purpose of this study is to compare motor and sensory nerve conduction velocity and amplitude between work related injuries and other causes when confirmed carpal tunnel syndrome. Patients were recruited from the neurophysiology department at Gävle hospital who were called for a neurography examination with a question of carpal tunnel syndrome. Inclusion criteria in the study were patients, women, and men between the age 18-65 years with confirmed carpal tunnel syndrome. Neurography were performed bilaterally for both motor and sensory function of the median and ulnar nerve. The median nerve was also examined bilaterally with the 14-7 method. No difference was found between work related injuries and other causes in carpal tunnel syndrome when comparing motor and sensory nerve conduction velocity and amplitude. No difference was found in the 14-7 method when registering the n. medianus between the groups. No correlation was found between body height and motor nerve conduction velocity.

No description available.

No description available.

Síndrome do túnel do carpo (STC) está associada à diabetes mellitus (DM), mas a associação não está claramente demonstrada com pré-diabetes (PD). Objetivo: Determinar a prevalência de PD e fatores de risco associados em pacientes com STC. Métodos: Foi realizado estudo transversal incluindo 115 pacientes com STC idiopática e 115 controles pareados por idade, gênero e índice de massa corporal (IMC). Avaliação clínica, laboratorial e neurofisiológica foi realizada em todos os indivíduos para confirmar o diagnóstico e gravidade da STC de acordo com a classificação neurofisiológica de STC. PD foi definido usando critérios estritos. Resultados: A prevalência de PD foi similar no grupo STC e controles (27% vs. 21,7%, P=0,44). Sintomas noturnos (91,3%) e classificação moderada de STC (58,3%) foram os mais frequentemente observados. Pacientes com STC com PD apresentaram média de idade significativamente mais alta comparada à pacientes com STC sem PD (53,8 +- 10,2 vs. 49,5 +- 8,6 anos, P=0,027). Tendência de média mais alta de IMC (30,6 +- 4,1 vs. 28,7 +- 4,8 kg/m2, P=0,059) e duração dos sintomas (21,5 +- 29,6 vs. 14,8 +- 20,6 meses, P=0,062) e menor frequência de gênero feminino (80,6% vs. 92,9%, P=0,057) foram observados em pacientes com STC com PD. Frequências de pacientes com STC com PD e idade > 60 anos (29,0% vs. 8,3%, P=0,04) e IMC > 30 kg/m2 (64,5% vs. 33,3%, P=0,03) foram significativamente mais altas que em pacientes com STC sem PD. Não foram observadas diferenças significativas em ambos os grupos com relação aos sintomas (P > 0,05) e classificação neurofisiológica da STC (P > 0,05). Conclusões: Nossos achados apóiam fortemente a noção de que a STC não está associada à PD, mas está intimamente ligada a idade e sobrepeso / Carpal tunnel syndrome (CTS) is associated to Diabetes mellitus (DM) but not clearly demonstrated to Prediabetes (PD). Objective: Determine prevalence of PD and risk factors in CTS. Methods: A cross-sectional study including 115 idiopathic CTS patients and 115 age-, gender- and body mass index (BMI)- matched controls was performed. Clinical, laboratorial and neurophysiological evaluations were performed in all subjects to confirm CTS diagnosis and severity according to CTS classification. PD was defined using strict criteria. Results: Prevalence of PD was similar in CTS and control groups (27% vs. 21.7%, P=0.44). Nocturnal symptoms (91.3%) and moderate classification of CTS (58.3%) were most frequently observed in CTS patients. CTS with PD had a significant higher mean age compared to CTS without PD (53.8 +- 10.2 vs. 49.5 +- 8.6 years, P=0.027). A trend of higher mean BMI (30.6 +- 4.1 vs. 28.7 +- 4.8 kg/m2, P=0.059) and duration of symptoms (21.5 +- 29.6 vs. 14.8 +- 20.6 months, P=0.062) and lower female gender frequency (80.6% vs. 92.9%, P=0.057) were observed in CTS with PD. Frequencies of CTS with PD patients with age > 60 years (29.0% vs. 8.3%, P=0.04) and BMI > 30 kg/m2 (64.5% vs. 33.3%, P=0.03) were significantly higher than CTS without PD. No significant differences were observed in both groups regarding each symptoms (P > 0.05) and neurophysiological classifications of CTS (P > 0.05). Conclusions: Our findings strongly supports the notion that CTS is not associated with PD but is closely linked to age and overweight

Síndrome do túnel do carpo (STC) está associada à diabetes mellitus (DM), mas a associação não está claramente demonstrada com pré-diabetes (PD). Objetivo: Determinar a prevalência de PD e fatores de risco associados em pacientes com STC. Métodos: Foi realizado estudo transversal incluindo 115 pacientes com STC idiopática e 115 controles pareados por idade, gênero e índice de massa corporal (IMC). Avaliação clínica, laboratorial e neurofisiológica foi realizada em todos os indivíduos para confirmar o diagnóstico e gravidade da STC de acordo com a classificação neurofisiológica de STC. PD foi definido usando critérios estritos. Resultados: A prevalência de PD foi similar no grupo STC e controles (27% vs. 21,7%, P=0,44). Sintomas noturnos (91,3%) e classificação moderada de STC (58,3%) foram os mais frequentemente observados. Pacientes com STC com PD apresentaram média de idade significativamente mais alta comparada à pacientes com STC sem PD (53,8 +- 10,2 vs. 49,5 +- 8,6 anos, P=0,027). Tendência de média mais alta de IMC (30,6 +- 4,1 vs. 28,7 +- 4,8 kg/m2, P=0,059) e duração dos sintomas (21,5 +- 29,6 vs. 14,8 +- 20,6 meses, P=0,062) e menor frequência de gênero feminino (80,6% vs. 92,9%, P=0,057) foram observados em pacientes com STC com PD. Frequências de pacientes com STC com PD e idade > 60 anos (29,0% vs. 8,3%, P=0,04) e IMC > 30 kg/m2 (64,5% vs. 33,3%, P=0,03) foram significativamente mais altas que em pacientes com STC sem PD. Não foram observadas diferenças significativas em ambos os grupos com relação aos sintomas (P > 0,05) e classificação neurofisiológica da STC (P > 0,05). Conclusões: Nossos achados apóiam fortemente a noção de que a STC não está associada à PD, mas está intimamente ligada a idade e sobrepeso / Carpal tunnel syndrome (CTS) is associated to Diabetes mellitus (DM) but not clearly demonstrated to Prediabetes (PD). Objective: Determine prevalence of PD and risk factors in CTS. Methods: A cross-sectional study including 115 idiopathic CTS patients and 115 age-, gender- and body mass index (BMI)- matched controls was performed. Clinical, laboratorial and neurophysiological evaluations were performed in all subjects to confirm CTS diagnosis and severity according to CTS classification. PD was defined using strict criteria. Results: Prevalence of PD was similar in CTS and control groups (27% vs. 21.7%, P=0.44). Nocturnal symptoms (91.3%) and moderate classification of CTS (58.3%) were most frequently observed in CTS patients. CTS with PD had a significant higher mean age compared to CTS without PD (53.8 +- 10.2 vs. 49.5 +- 8.6 years, P=0.027). A trend of higher mean BMI (30.6 +- 4.1 vs. 28.7 +- 4.8 kg/m2, P=0.059) and duration of symptoms (21.5 +- 29.6 vs. 14.8 +- 20.6 months, P=0.062) and lower female gender frequency (80.6% vs. 92.9%, P=0.057) were observed in CTS with PD. Frequencies of CTS with PD patients with age > 60 years (29.0% vs. 8.3%, P=0.04) and BMI > 30 kg/m2 (64.5% vs. 33.3%, P=0.03) were significantly higher than CTS without PD. No significant differences were observed in both groups regarding each symptoms (P > 0.05) and neurophysiological classifications of CTS (P > 0.05). Conclusions: Our findings strongly supports the notion that CTS is not associated with PD but is closely linked to age and overweight