Submitted by GLADYS ALEXANDRA DIAS DE OLIVEIRA null (gladys.dias@hotmail.com) on 2016-04-10T00:02:01Z No. of bitstreams: 1 TESE DOUTORADO.pdf: 822240 bytes, checksum: 8999755203c72c48b11a54d5d20efe9f (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-04-11T13:47:33Z (GMT) No. of bitstreams: 1 oliveira_gad_dr_bot.pdf: 822240 bytes, checksum: 8999755203c72c48b11a54d5d20efe9f (MD5) / Made available in DSpace on 2016-04-11T13:47:33Z (GMT). No. of bitstreams: 1 oliveira_gad_dr_bot.pdf: 822240 bytes, checksum: 8999755203c72c48b11a54d5d20efe9f (MD5) Previous issue date: 2016-03-01 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Estimar a prevalência de sintomas de síndrome do túnel do carpo (STC) na gestação em parturientes e puérperas do município de Botucatu – SP e avaliar fatores associados à STC na gestação. Método: Estudo de caráter transversal e de base populacional realizado na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu. No protocolo de avaliação constavam dados obstétricos da paciente, testes específicos para avaliação clínica de STC (Tinel, Phalen e estesiometria), e o Questionário de Boston. Resultados: Foram avaliadas 461 mulheres, sendo que destas 77,7% (358) não apresentavam nenhum sintoma clínico de STC (SQ) e 22,3% (103) os apresentavam (CQ). Os dados foram analisados utilizando o Statístical Package for Social Sciences (SPSS) e realizados testes de associação entre as variáveis com nível de significância de p≤0,05. As variáveis analisadas foram idade materna, idade gestacional, número de filhos intercorrências e alterações musculoesqueléticas. Os únicos fatores que mostraram diferença significativa foram idade materna e diabete melito gestacional (DMG), com nível de significância de p≤0,001. Conclusões: A prevalência de sintomas de STC na gravidez foi de 22,3% (103) e os fatores preditores associados à ocorrência de STC foram idade materna e o DMG. / To estimate the prevalence of symptoms of carpal tunnel syndrome (CTS) during gestation by parturient women and mothers that recently given birth in Botucatu city- SP and evaluate associated factors with CTS during pregnancy. Method: transversal study and population based realized at the Maternity Hospital of Botucatu Medical School. The evaluation protocol contained obstetric data of the patient, specific tests for clinical evaluation of STC (Tinel, Phalen and esthesiometry), and Boston questionnaire.Results: 461 women were evaluated, and of these 77.7% (358) had not present any clinical symptoms of CTS (SQ) and 22.3% (103) had (CQ). The data were analyzed using the Statistical Package for Social Sciences (SPSS) and realized tests of association between variables with significance level of p<0,05. The variables analyzed were maternal age, gestational age, number of children complications and musculoskeletal disorders. The only factors that showed significant differences were maternal age and gestational diabetes mellitus (GDM), with p≤0,001 significance level. Conclusions: The prevalence of CTS symptoms during pregnancy was 22.3% (103) and predictors factors associated with CTS were maternal age and the DMG. / FAPESP: 2011/23570-1

Orientador: Luis Carlos Vulcano / Coorientador: Vânia Maria de Vasconcelos Machado / Banca: Celso Antonio Rodrigues / Banca: Rodrigo Romero Corrêa / Resumo: 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 ... / Abstract: 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 ... / Mestre

Orientador: Adriano Dias / Resumo: Estimar a prevalência de sintomas de síndrome do túnel do carpo (STC) na gestação em parturientes e puérperas do município de Botucatu – SP e avaliar fatores associados à STC na gestação. Método: Estudo de caráter transversal e de base populacional realizado na Maternidade do Hospital das Clínicas da Faculdade de Medicina de Botucatu. No protocolo de avaliação constavam dados obstétricos da paciente, testes específicos para avaliação clínica de STC (Tinel, Phalen e estesiometria), e o Questionário de Boston. Resultados: Foram avaliadas 461 mulheres, sendo que destas 77,7% (358) não apresentavam nenhum sintoma clínico de STC (SQ) e 22,3% (103) os apresentavam (CQ). Os dados foram analisados utilizando o Statístical Package for Social Sciences (SPSS) e realizados testes de associação entre as variáveis com nível de significância de p≤0,05. As variáveis analisadas foram idade materna, idade gestacional, número de filhos intercorrências e alterações musculoesqueléticas. Os únicos fatores que mostraram diferença significativa foram idade materna e diabete melito gestacional (DMG), com nível de significância de p≤0,001. Conclusões: A prevalência de sintomas de STC na gravidez foi de 22,3% (103) e os fatores preditores associados à ocorrência de STC foram idade materna e o DMG. / Abstract: To estimate the prevalence of symptoms of carpal tunnel syndrome (CTS) during gestation by parturient women and mothers that recently given birth in Botucatu city- SP and evaluate associated factors with CTS during pregnancy. Method: transversal study and population based realized at the Maternity Hospital of Botucatu Medical School. The evaluation protocol contained obstetric data of the patient, specific tests for clinical evaluation of STC (Tinel, Phalen and esthesiometry), and Boston questionnaire.Results: 461 women were evaluated, and of these 77.7% (358) had not present any clinical symptoms of CTS (SQ) and 22.3% (103) had (CQ). The data were analyzed using the Statistical Package for Social Sciences (SPSS) and realized tests of association between variables with significance level of p<0,05. The variables analyzed were maternal age, gestational age, number of children complications and musculoskeletal disorders. The only factors that showed significant differences were maternal age and gestational diabetes mellitus (GDM), with p≤0,001 significance level. Conclusions: The prevalence of CTS symptoms during pregnancy was 22.3% (103) and predictors factors associated with CTS were maternal age and the DMG. / Doutor

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.

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.

A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior. Cerca de 5% dos pacientes com insuficiência renal crônica submetidos à hemodiálise apresentam esta condição. A história clínica e o exame físico continuam sendo as ferramentas mais adequadas para seu diagnóstico. Testes complementares têm sido usados para auxiliar o diagnóstico, dentre eles os de avaliação da sensibilidade cutânea. O objetivo deste estudo é descrever a utilização do PSSD (Pressure- specified sensory device ) como auxiliar ao diagnóstico de síndrome do túnel do carpo. O PSSD consiste de aparelho que incorpora transdutor de pressão com duas extremidades rombas e com regulagem de distância entre elas, acoplado a um computador capaz de determinar os limiares cutâneos de pressão. Para tanto, os pacientes foram divididos em três grupos: Grupo 1- grupo controle, pacientes sem neuropatia no membro superior ou insuficiência renal. Grupo 2- pacientes com síndrome do túnel do carpo e insuficiência renal crônica submetidos à hemodiálise. Grupo 3- pacientes com síndrome do túnel do carpo sem insuficiência renal. Os resultados demonstraram haver um maior benefício do uso do PSSD para o diagnóstico da síndrome para os pacientes do grupo 2 em dois dos quatro parâmetros avaliados quando comparados com os pacientes do grupo 3. / Carpal Tunnel Syndrome is the most common compressive neuropathy of the superior limb. Close to 5% of the patients with chronic renal insufficiency who need hemodialysis have carpal tunnel syndrome. There are controversies about the most reliable test to complement the clinical history and physical exam that remain as the most adequate tools for the diagnosis. Evaluation of sensory thresholds is being used as one of these tests. The aim of this study is to use the PSSD (Pressure-specified sensory device) for the diagnosis of carpal tunnel syndrome. The PSSD is a tool that incorporates a pressure transducer with two prongs, linked to a computer capable of measuring the cutaneous pressure thresholds referred by the patient. The patients were divided in three groups: Group 1- patients with neither superior limb neuropathy nor renal insufficiency. Group 2- patients with carpal tunnel syndrome related to chronic renal insufficiency under hemodialysis. Group 3- patients with carpal tunnel syndrome but no renal insufficiency. The results showed, for two of the four parameters measured, that group 2 had more benefits for the diagnosis of carpal tunnel syndrome than group 3.

Orientadores: Artur Udelsmann, José Inácio de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T19:15:57Z (GMT). No. of bitstreams: 1 Nonno_RogerioOrtolan_M.pdf: 1150117 bytes, checksum: f08faacc635ddd98fd84251c2717ccab (MD5) Previous issue date: 2013 / Resumo: O presente estudo teve como objetivo identificar e descrever os pacientes com síndrome do túnel do carpo com relação aos dados demográficos, clínicos, de acometimento e de evolução. A partir disto, foi possível comparar as principais variáveis entre os tratamentos clínico e cirúrgico, e, também, avaliar se houve relação entre o tipo de tratamento com tempo de afastamento e de retorno ao trabalho. Para tornar possível a realização deste trabalho foram estudados os prontuários de 131 pacientes diagnosticados com STC no Ambulatório de Saúde do Trabalhador do HC da Unicamp. Para padronizar a coleta de dados foi utilizada uma ficha com itens que são comuns a todas as avaliações realizadas neste ambulatório. Por ter ocorrido bilateralmente em 76 indivíduos, o número total de punhos avaliados foi de 207. Para comparar as variáveis categóricas entre os grupos, foram utilizados o teste qui quadrado ou o teste exato de Fisher, e, para as variáveis numéricas entre 2 grupos, foi utilizado o teste de Mann-Whitney. De todos os 131 indivíduos pesquisados, 128 (97,71%) precisaram se afastar ao menos uma vez do trabalho e apenas 37 (28,91%) retornaram ao trabalho. O tempo médio de duração dos sintomas dos pacientes tratados cirurgicamente foi de 39 meses, enquanto o dos tratados clinicamente foi de 44,1 meses. Quanto aos resultados do tratamento, período de afastamento e de retorno ao trabalho, não houve diferença significativa entre os tratamentos clínico e cirúrgico. A partir dos resultados obtidos, foi possível concluir que a STC ocorre com maior frequência em mulheres, entre 30 e 49 anos. O acometimento foi mais frequentemente bilateral; nos casos unilaterais a mão dominante foi a mais comprometida. Tanto a evolução do tratamento clínico quanto do cirúrgico foi pouco satisfatória: em ambos os grupos apenas em cerca de 10% dos casos houve melhora total. As profissões encontradas com maior frequência foram operadores de máquinas, empregadas domésticas, trabalhadores rurais, secretárias e costureiras. Elas representam mais de 70% dos casos de STC encontradas nesta casuística / Abstract: The present study aimed to identify and describe characteristics of the patients who suffered from carpal tunnel syndrome concerning data on demographics and clinical features, type of injury and disease progression. Thus it was possible to compare the main variables between surgical and clinical treatments, and also to assess whether there was a relationship between the type of treatment and period of absence and return to work. In order to perform this study, a review of medical charts of 131 patients diagnosed with CTS in the occupational health clinic of the University Hospital of Unicamp. To standardize the data collection it was used a form with items that are common to all assessments made in this clinic. Because the carpal tunnel syndrome occurred bilaterally in 76 patients, the total wrists assessed were 207. To compare categorical variables between groups it was used chi-square test or Fisher's exact test, and to compare numerical variables between groups it was used the Mann-Whitney test. Out of 131 patients reviewed, 128 (97.71%) had to take a leave from work at least once, and only 37 (28.91%) returned to work. Mean duration of symptoms was 39 months in patients treated surgically and 44.1 months in patients treated clinically. Regarding treatment outcome, period of absence and return to work, there was no significant difference between treatments. Based on these outputs it was possible to conclude that CTS occurs more frequently in women, ranging in age 30 to 49 years. The presence of bilateral CTS was more common and in unilateral cases the dominant hand was the most affected. The progression of the surgical treatment, as well as the clinical, was not satisfactory: in both groups only around 10% of cases had complete recovery. The most frequently found professions were machine operators, domestic worker, farm workers, secretaries and sewing machine operators. They accounted for more than 70% of cases of CTS found in this sample / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Data from the McMaster Occupational Biomechanics Laboratory were consolidated to evaluate overall trends relating to tissue motion and blood flow in the carpal tunnel. Regarding tissue motion, displacements of the flexor digitorum superficialis (FDS) tendon and its subsynovial connective tissue (SSCT) were found to decrease with greater movement speed and a flexed wrist posture. Notably, changes to shear outcomes including relative tendon-SSCT displacement, the shear strain index (SSI), and maximum velocity ratio (MVR) demonstrate that greater movement speed contributes to SSCT damage according to the shear strain mechanism of injury theorised to promote carpal tunnel syndrome (CTS). Median nerve blood flow was also found to be implicated by wrist flexion, and appeared to decrease with greater CTS severity status. Finally, induced blood flow alteration of the carpal tunnel was found to elicit a median nerve blood flow response similar to the level found in CTS subjects, confirming its effectiveness as an intervention to study tissue motion in a CTS-like state. The influence of altered blood flow on tissue motion was differential, where the higher supradiastolic condition altered FDS displacement, and the lower subdiastolic condition affected SSCT displacement and SSI. These findings provide valuable evidence for changes in median nerve blood flow—and by extension, the local fluid environment within the carpal tunnel—not only being a consequence of SSCT fibrosis characteristic of CTS, but potentially also acting as a cause for said changes in carpal tunnel tissue motion. / Thesis / Master of Science in Kinesiology / This thesis aimed to evaluate and summarize key findings from the McMaster Occupational Biomechanics Laboratory relating to tissue motion and blood flow in the carpal tunnel. Performing repetitive finger movements faster and with a flexed wrist posture were found to decrease the distance travelled of the underlying finger tendon. Blood flow of the median nerve, which is implicated in carpal tunnel syndrome (CTS), is higher with forceful exertion and flexed wrist posture, and lower with greater severity of CTS. Finally, altering blood flow to the carpal tunnel was found to create a CTS-like environment, affected tissue motion in the carpal tunnel, and promoted movement disparity between these tissues that is associated with injury. This suggests that fluid/blood flow changes affecting the carpal tunnel is a plausible mechanism for increasing the likelihood of developing CTS.

The transition from text-oriented software to graphically-based software has brought about a rapid increase in the number of mouse users. Recently, increased usage of the mouse has been linked with the development of cumulative trauma disorders. This investigation concerns the effects that mouse surface height and wrist support have on wrist posture. Distance between targets and target width were varied to determine performance time and performance accuracy throughout the conditions. Results showed that the presence of a wrist support decreased wrist extension and radial deviation, and increased wrist flexion. However, wrist support had no significant effect on ulnar deviation. There was a significant interaction of support and surface height for wrist extension. Surface height had a significant effect on all dimensions of wrist posture. Higher surface height resulted in increased flexion and ulnar deviation, and decreased extension and radial deviation. Distance between targets was a significant effect for ulnar deviation. The long distance resulted in a greater amount of ulnar deviation. Accuracy was significantly affected by distance between targets and target width. There was a significant interaction of distance and width for flexion. When distance between targets and target width were converted to Indices of Difficulty (ID), it was found that as ID became larger, movement time between targets became longer (as predicted by Fitts' Law). / Master of Science

Carpal tunnel syndrome is characterized by non-inflammatory fibrosis of the subsynovial connective tissue next to the tendons in the carpal tunnel, suggesting a shear injury owing to repetitive wrist and finger motion at work. I tested the effects of several well-established biomechanical predictors of injury on tendon and subsynovial connective tissue motion and shear in the carpal tunnel. These included non-neutral finger and wrist posture, speed of work, and forceful exertion. A cadaveric paradigm was used to directly measure tendon gliding characteristics, which showed that concurrent exposure to multiple biomechanical risk factors disproportionately increased tendon frictional work (Chapter 2). Given that tendon shear cannot be directly measured in vivo, colour flow ultrasound was used to assess relative motion between tendon and subsynovial connective tissue as a metric of shear potential (Chapter 3 − 5). Healthy participants completed middle finger movements while colour flow ultrasound imaged carpal tunnel structures and optical motion capture recorded finger joint kinematics. From the data, I developed regression equations to predict both tendon and subsynovial connective tissue displacements as a function of finger joint angles, which can be used as an ergonomic method to calculate the relative displacement (Chapter 3). Furthermore, relative motion between tendon and subsynovial connective tissue increased with wrist flexion angle, suggesting a greater susceptibility to shear injury during repetitive work when the wrist is flexed (Chapter 4). Using colour flow imaging, electrogoniometry, and fine-wire EMG, relative displacement was found to increase with tendon velocity and force (Chapter 5). Relative displacements in Chapters 3 to 5 were combined into a prediction model, and further compared to a tendon friction model derived from Chapter 2. The relative displacement model showed an additive relationship with combined physical exposures, including finger and wrist position, tendon velocity, and force (Chapter 6). The relative displacement model was more responsive to lower physical exposures whereas the friction model produced greater overall changes (with higher exposures). While both models infer a greater risk of shear injury due to repetitive and forceful wrist/finger movement, future studies will aim to set protective guidelines based on tendon motion and shear during hand-intensive work. Overall, this thesis showed that tendon friction and relative motion between tendon and subsynovial connective tissue both increased in response to well-established biomechanical risk factors. We propose the current models for use in ergonomics, representing a move towards mechanistic-based injury risk assessment of the wrist and hand. / Thesis / Doctor of Philosophy (PhD)