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.

The United States Navy incorporates many different occupations to ensure it achieves its overall mission. These occupations are extremely diversified and present a wide spectrum of occupational exposures. Many of these exposures have been well studied and documented. However, shipboard pneumatic tool hand-arm vibration, (HAV) and how it relates to different body postures is an area of occupational exposure that has received little attention. The chief objective of this study was to assess whether there is a difference in hand-arm vibration levels, while working on one of two surface orientations (e.g., horizontal and vertical) among distinctly different pneumatic tools while cleaning or not cleaning. The design of the study evaluated three pneumatic tools cleaning both horizontal and vertical surfaces and the fourth tool only cleaning a horizontal surface. HAV levels were measured to identify the effect horizontal and vertical surface orientations had on the tool. Five subjects were used in the evaluation of the four tools by a random sequencing order. Each subject was required to hold the tool in an idle condition, an activated without cleaning condition, and an activated cleaning condition, (surface contact) for 20 seconds each. These conditions were evaluated in two different surface orientations; horizontal and vertical (except for the 4th tool). Each subject repeated each of the cleaning/not cleaning conditions three times for a total of 7 measurements per surface. The idle condition was only conducted one time for each tool and surface. The measurements were collected from a Quest, HAVPro instrument using an accelerometer on the pneumatic tool following ISO 5349-1:2001 and ISO 5349-2:2001 methods.A three-way ANOVA (subjects by tool, by condition, (cleaning vs. not cleaning) and tool vs. condition) with replicates (not including idle conditions) was conducted on the data. The analysis included the main effects and the interaction of tool and surface orientation. The subjects were treated as a blocking variable. All the main effects and the interaction were significant at p<0.0001, except for surface, p<0.6396. Surface orientation does not affect HAV levels in pneumatic tools.

Experimental measurements are never perfect, even with sophisticated modern instruments. One of the fundamental problems in signal measurement is distinguishing the noise from the signal. Sometimes the two can be partly distinguished on the basis of frequency components: for example, the signal may contain mostly low-frequency components and the noise may be located at higher frequencies. This is the basis of filtering. This thesis discusses some changes in the experimental protocol such as determining a suitable stimulation site to elicit full compound nerve action potentials (CNAP). The effect of sampling frequency and smoothing techniques to improve the resolution of the conduction velocity distribution (CVD) estimates will also be discussed. A change in stimulation site to elicit the full CNAPs is proposed after realizing that it is relatively difficult to stimulate at the same location to recruit the nerve fibers repeatedly at the elbow. Thus, the stimulation site was changed from elbow to wrist to elicit the full CNAPs. From the simulations it is evident that there was some signal information beyond 2.5 kHz frequency resulting in an increase in the sampling rate from 5 kHz to 10 kHz. The results obtained after employing smoothing techniques improved the CVD resolution. The simulation results were corroborated with the experimental results obtained. Another aspect of this thesis is to check the error tolerance of the EMG decomposition algorithm. Once the muscle electrical activity is recorded, MU trains undergo an automatic decomposition process. Decomposition errors are present in most contractions, thus a human operator has to make changes/correct the values of the motor unit firing times. From the data acquired, false negatives, false positives and false negative-positive errors have been introduced. Different levels of errors to measure the coherence between two motor-unit firing trains from a muscle contraction were also introduced. The firing rate curves are computed for each MU to analyze the interactions between two motor units (MU). The false negatives type of errors was found to be least detrimental. Whereas the false positives and false negative-positive errors affected coherence the most, their error tolerance was only a single error per 5 seconds.

Darbo tikslas: Įvertinti pacientų, po riešo kanalo tunelinio sindromo operacijos, rankų funkciją ir savarankiškumą po ergoterapijos ir praėjus dviems metams po jos. Darbo uždaviniai: • Įvertinti pacientų, po riešo kanalo tunelinio sindromo operacijos, rankų funkciją ir savarankiškumą. • Įvertinti ergoterapijos poveikį pacientų, kuriems operuotas riešo kanalo tunelinis sindromas, rankų funkcijai ir savarankiškumui. • Nustatyti veiksnius, lemiančius pacientų rankų funkcijos ir savarankiškumo lygį po reabilitacijos ir praėjus dviems metams po jos. Metodika: Tyrimas buvo atliekamas VšĮ "Kauno kalniečių poliklinika" įstaigoje. Tyrimas buvo atliktas 2012-2014 metais. Tyrime dalyvavo 44 pacientai - 10 (23%) vyrų ir 34 (77%) moterys, kuriems buvo diagnozuotas riešo kanalo tunelinis sindromas ir atlikta operacija. Informacijai surinkti apie pacientus, kuriems buvo atlikta riešo kanalo tunelinio sindromo operacija, buvo naudojama: • Anketa; • Dinamometras; • Manometras • Goniometas; • Dviejų taškų diskriminacijos testas; • Kasdienės veiklos vertinimo klausimynas (ADL) ir SF-36 klausimynas; • Skaitmeninė skausmo įvertinimo skalė. Visi matavimai ir anketinės apklausos buvo atliekamos tris kartus: prieš ir po ergoterapijos procedūrų bei po 2 metų. Išvados: 1. Pacientai, kuriems buvo atlikta riešo kanalo tunelinio sindromo operacija, buvo sumažėjusi plaštakos raumenų jėga, riešo judesių amplitudė, sutrikę jutimai ir turėjo problemų su apsitarnavimu. 2. Po ergoterapijos... [toliau žr. visą tekstą] / Aim: To evaluate the patients after carpal tunnel syndrome surgery, hand function and independence after occupational therapy and two years after. Objectives: • To evaluate the patients after carpal tunnel syndrome surgery, hand function and independence. • To evaluate the effect of occupational therapy in patients after carpal tunnel syndrome surgery, hand function and independence. • To identify the factors influencing patients' hand function and level of independence after rehabilitation and two years after.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Nöroloji Anabilim Dalı, 2001. / Bibliyografya var.

Tez (Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, 2005. / Bibliyografya var.

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.

The object of this work is to chart an educational process of ambulant patients undergoing a planned arm surgery due to carpal tunnel syndrome or trigger finger and creating a functional educational material that leads to a change of knowledge and skills of those patients and that can be used by nurses during their work. The three questions to achieve the objectives were: 1) How does the educational process of the patient look like before arm surgery? 2) How is the patient educated on post-operative regime? 3) How are the educational activities implemented in patients undergoing arm surgery? The research project was aimed to the qualitative investigation. Generally the research survey was structured into two phases, the results are summarized in the practical part. The first phase was focused on observation of professional object and depth semi-structured interviews with patients who underwent an arm surgery were made. This survey was supplemented by direct structured observation of nurses in the process of educational activities. Six nurses were altogether involved in the survey. In the second phase, the educational material based on the obtained results, was made for the nurses to use during their work. This material includes educational cards and maps of care instructions for given diseases. Effectivnes of this material was subsequently verified by more semi-structured interviews with six patiens. The results of the survey showed that in the workplace where the respondents underwent the surgery, the educatinal process was singificantly eliminated and for its realization the nurses did not have satisfactory conditions, especially time and spatil conditions. During the educatinal process the nurses were using monologues teaching methods. Demonstration and practical methods were missing. Nurses were not using teaching aids that can make the educatinal process more effective. The results of this work can elucidate the educational reality in surgeries and focus attention on this sector, often neglected in expert literature.

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