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Search Results for : Cervical Sprain
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Carpal tunnel release in patients with negative neurophysiological examinations: clinical and surgical findings.
Author(s): Lama, M
Journal: Neurosurgery 2010 Mar 17; Vol. 65, Issue 4 Suppl; Page(s) A171-3
[Medline ID - 19927063]

OBJECTIVE: In 16% to 34% of patients with classic symptoms of carpal tunnel syndrome (CTS), neurophysiology is negative. Few studies have concentrated on patients with symptoms compatible with CTS with normal examinations. The purpose of our study was to examine the clinical and surgical characteristics of this subtype of CTS in order to clarify a correct approach toward these patients. METHODS: We studied a subpopulation of 25 patients (31 hands) with typical CTS symptoms despite normal neurophysiological examinations. All of the patients were initially treated with conservative therapy, and patients with work-related symptoms were advised to change their duties. In patients with persistent symptoms, wrist ultrasound and radiographic and blood examinations with rheumatic screenings were performed. Cervical magnetic resonance imaging was performed in some cases to exclude cervical radiculopathy. Other pathologies were found in 5 cases. Nine patients improved with nonsurgical therapy. Six months later, electric examinations were repeated and 3 patients with a confirmed median nerve injury underwent surgery. Eight patients with negative examinations underwent surgery (10 hands). All patients were advised of the possibility of incomplete pain remission after surgery. RESULTS: All patients improved after surgery. Median nerve injury was confirmed by operative findings according to Tuncali grading. CONCLUSION: A combination of clinical findings and instrumental procedures is required when selecting patients for successful surgery.

Cervical sprain/strain definition.
Author(s): White, K; Hudgins, TH; Alleva, JT
Journal: Dis Mon 2009 Dec 16; Vol. 55, Issue 12; Page(s) 724-8
[Medline ID - 19917322]

ABSTRACT NOT AVAILABLE

Medical and psychosocial diagnoses in women with a history of intimate partner violence.
Author(s): Bonomi, AE; Anderson, ML; Reid, RJ; Rivara, FP; Carrell, D; Thompson, RS
Journal: Arch Intern Med 2009 Nov 5; Vol. 169, Issue 18; Page(s) 1692-7
[Medline ID - 19822826]

BACKGROUND: We characterized the relative risk of a wide range of diagnoses in women with a history of intimate partner violence (IPV) compared with never-abused women. METHODS: The sample comprised 3568 English-speaking women who were randomly sampled from a large US health plan and who agreed to participate in a telephone survey to assess past-year IPV history using questions from the Behavioral Risk Factor Surveillance System (physical, sexual, and psychological abuse) and the Women's Experience with Battering Scale. Medical and psychosocial diagnoses in the past year were determined using automated data from health plan records. We estimated the relative risk of receiving diagnoses for women with a past-year IPV history compared with women with no IPV history. RESULTS: In age-adjusted models, compared with never-abused women, abused women had consistently significantly increased relative risks of these disorders: psychosocial/mental (substance use, 5.89; family and social problems, 4.96; depression, 3.26; anxiety/neuroses, 2.73; tobacco use, 2.31); musculoskeletal (degenerative joint disease, 1.71; low back pain, 1.61; trauma-related joint disorders, 1.59; cervical pain, 1.54; acute sprains and strains, 1.35); and female reproductive (menstrual disorders, 1.84; vaginitis/vulvitis/cervicitis, 1.56). Abused women had a more than 3-fold increased risk of being diagnosed with a sexually transmitted disease (3.15) and a 2-fold increased risk of lacerations (2.17) as well as increased risk of acute respiratory tract infection (1.33), gastroesophageal reflux disease (1.76), chest pain (1.53), abdominal pain (1.48), urinary tract infections (1.79), headaches (1.57), and contusions/abrasions (1.72). CONCLUSION: Past-year IPV history was strongly as sociated with a variety of medical and psychosocial conditions observed in clinical settings.

Increased forward head posture and restricted cervical range of motion in patients with carpal tunnel syndrome.
Author(s): De-la-Llave-Rinc; ón, AI; Fern; ández-de-las-Peñas, C; Palacios-Ce; ña, D; Cleland, JA
Journal: J Orthop Sports Phys Ther 2009 Dec 16; Vol. 39, Issue 9; Page(s) 658-64
[Medline ID - 19721213]

STUDY DESIGN: Case control study. OBJECTIVES: To compare the amount of forward head posture (FHP) and cervical range of motion between patients with moderate carpal tunnel syndrome (CTS) and healthy controls. We also sought to assess the relationships among FHP, cervical range of motion, and clinical variables related to the intensity and temporal profile of pain due to CTS. BACKGROUND: It is plausible that the cervical spine may be involved in patients with CTS. No studies have investigated the possible associations among FHP, cervical range of motion, and symptoms related to CTS. METHODS: FHP and cervical range of motion were assessed in 25 women with CTS and 25 matched healthy women. Side-view pictures were taken in both relaxed-sitting and standing positions to measure the craniovertebral angle. A CROM device was used to assess cervical range of motion. Posture and mobility measurements were performed by an experienced therapist blinded to the subjects' condition. Differences in cervical range of motion were examined using the nonparametric Mann-Whitney U test. A 2-way mixed-model analysis of variance (ANOVA) was used to evaluate differences in FHP between groups and positions. RESULTS: The ANOVA revealed significant differences between groups (F = 30.4; P < .001) and between positions (F = 6.5; P < .01) for FHP assessment. Patients with CTS had a smaller craniovertebral angle (greater FHP) than controls (P < .001) in both standing and sitting. Additionally, patients with CTS showed decreased cervical range of motion in all directions when compared to controls (P < .001). Only cervical flexion (rs = -0.43; P = .02) and lateral flexion contralateral to the side of the CTS (rs = -0.51; P = .01) were associated with the reported lowest pain experienced in the preceding week. A positive association between FHP and cervical range of motion was identified in both groups: the smaller the craniovertebral angle (reflective of a greater FHP), the smaller the range of motion (r values between 0.27 and 0.45; P < .05). Finally, cervical range of motion and FHP were negatively associated with age in the control group but not in the group with CTS. CONCLUSIONS: Patients with mild/moderate CTS exhibited a greater FHP and less cervical range of motion, as compared to healthy controls. Additionally, a greater FHP was associated with a reduction in cervical range of motion. However, a cause-and-effect relationship cannot be inferred from this study. Future research should investigate if FHP and restricted cervical range of motion is a consequence or a causative factor of CTS and related symptoms (eg, pain).

Cubital tunnel surgery in patients with cervical radiculopathy: double crush syndrome?
Author(s): Galarza, M; Gazzeri, R; Gazzeri, G; Zuccarello, M; Taha, J
Journal: Neurosurg Rev 2009 Dec 16; Vol. 32, Issue 4; Page(s) 471-8
[Medline ID - 19685252]

To determine differences in clinical outcomes in patients harboring both cubital tunnel syndrome (CuTS) and cervical radiculopathy and the influence of the so-called double crush syndrome. Both procedures were performed in 24 patients, mean age 55 years; first group of 14 patients underwent CuTS surgery as a first procedure. Second group of 10 patients underwent anterior cervical discectomy and fusion (ACDF) then ulnar nerve release (UNR). Two patients underwent bilateral nerve surgery and six multiple cervical discectomies. Surgeries consisted in 26 nerve releases with associated external neurolysis in five, and 34 ACDF procedures, with plating in six. Clinical complaints (mean time 12 months) were sensory in 20 arms, with associated motor weakness and hypothenar atrophy involvement in another six. Electromyography changes were mild (two arms), moderate (16 arms), and severe (eight arms). Mean time of follow-up was 3 years (range 18 months-14 years). Clinical improvement was evidenced in 14 patients. Sensory nerve symptoms improved in 13 limbs in both groups and motor improvement was evident in three patients with UNR as first surgery. A comparative cohort of 20 patients with UNR but without cervical radiculopathy was studied to disclose outcome differences. Of these, 13 patients had clinical improvement. No differences were found among groups. In patients with double crush syndrome, factors that seemed to influence a poor CuTS outcome were evolution of symptoms longer than a year, history of multiple neuropathies or radiculopathies, and ACDF performed before UNR.

Scaphoid nonunion in break-dancers: a report of 3 cases.
Author(s): Cho, CH; Song, KS; Min, BW; Bae, KC; Lee, KJ; Kim, SH
Journal: Orthopedics 2009 Oct 16; Vol. 32, Issue 7; Page(s) 526
[Medline ID - 19634840]

Most injuries resulting from break-dancing are minor, such as sprains and strains, but there is great potential for dance participants to sustain severe and life-threatening conditions, such as cervical cord injuries. Break-dancing carries many of the risks of conventional dance and gymnastics, but unlike those forms of activity, it is usually performed without trained supervision, as is supplied by coaches in other sports. It is necessary for clinicians to inquire more thoroughly into the nature of the activities that result in both unusual and common injuries in break-dancers and to educate break-dancers about the hazards of these activities. The pleasure of break-dancing carries with it the responsibility of proper and thorough preparation. It is essential that break-dancers wear protective devices and perform proper warm-up and cool-down exercises. Break-dancing has become a popular youth subculture. Its complex acrobatic moves, such as splits, handstands, spins, and tumbling, have important medical implications. We report 3 cases of scaphoid nonunion in a break-dancer, the first such report in the English literature to our knowledge. Accordingly, we believe that the clinician must inquire more thoroughly into the nature of patients' activities that result in both unusual and common injuries and educate those who are break-dancers about the hazards of this activity. Careful screening, instruction, and coaching of break-dancers will help prevent injuries.

Clinical outcomes of surgical release among diabetic patients with carpal tunnel syndrome: prospective follow-up with matched controls.
Author(s): Thomsen, NO; Cederlund, R; Ros; én, I; Bj; örk, J; Dahlin, LB
Journal: J Hand Surg Am 2010 Jan 16; Vol. 34, Issue 7; Page(s) 1177-87
[Medline ID - 19556077]

PURPOSE: To compare the clinical outcome after carpal tunnel release in diabetic and nondiabetic patients. METHODS: We evaluated a prospective, consecutive series of 35 diabetic patients (median age, 54 years; 15 with type 1 and 20 with type 2 diabetes) with carpal tunnel syndrome, who were age- and gender-matched with 31 nondiabetic patients (median age, 51 years) having idiopathic carpal tunnel syndrome. Exclusion criteria were other focal nerve entrapments, cervical radiculopathy, inflammatory joint disease, renal failure, thyroid disorders, previous wrist fracture, and long-term exposure to vibrating tools. Participants were examined independently at baseline (preoperatively) and 6, 12, and 52 weeks after surgery, including evaluating sensory function (Semmes-Weinstein), motor function (abductor pollicis brevis muscle strength and grip strength), pillar pain, cold intolerance, and patient satisfaction. RESULTS: The number of patients with normal sensory function (pulp of index finger) increased notably in both patient groups from baseline (diabetic patients, 7 of 35; nondiabetic patients, 10 of 31) compared with the 52-week follow-up (diabetic patients, 25 of 35; nondiabetic patients, 24 of 31). Grip strength decreased temporarily at 6 weeks but recovered completely after 12 weeks. At the 52-week follow-up, mean grip strength (95% confidence interval) had improved significantly in both patient groups (diabetic patients: 3.0 kg [-0.3 to 6.2], nondiabetic patients: 3.4 kg [0.2 to 6.6]). Pillar pain correlated significantly with grip strength at the 6-week follow-up (r(s) = -0.41 to -0.54 [p < .05]). The number of patients reporting cold intolerance decreased over time (diabetic patients, 22 of 35 to 19 of 35; nondiabetic patients, 18 of 31 to 8 of 31), but decreased markedly less for the diabetic patients. Level of patient satisfaction was equal between groups. Comparing type 1 and type 2 diabetic patients, no important difference was noted on any test variables. CONCLUSIONS: Patients with diabetes have the same beneficial outcome after carpal tunnel release as nondiabetic patients. Only cold intolerance demonstrated a lesser extent of relief for diabetic patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic I.

Musculoskeletal injuries in break-dancers.
Author(s): Cho, CH; Song, KS; Min, BW; Lee, SM; Chang, HW; Eum, DS
Journal: Injury 2010 Aug 27; Vol. 40, Issue 11; Page(s) 1207-11
[Medline ID - 19540489]

BACKGROUND: Since no epidemiologic studies have been reported about musculoskeletal injuries in break-dancers, there are no data on the rates and patterns of musculoskeletal injuries in this population that clinicians can use to find ways to decrease injury rate. HYPOTHESIS: We believe that the incidence of injuries in break-dancers is higher than assumed and that injury rates and patterns differ between professional and amateur dancers. STUDY DESIGN: Descriptive epidemiologic study. MATERIALS AND METHODS: Of a total of 42 study subjects, 23 were professional dancers and 19 were amateur dancers. Injury frequency, site and type, along with the presence of supervised training, the use of protective devices and warm-up exercises done were recorded. RESULTS: Of the 42 study subjects, excluding two amateur dancers, 40 (95.2%) had had musculoskeletal injuries at more than one site. The mean number of sites per dancer was 4.60. The frequency of injury depended on the site and was as follows: wrist (69.0%), finger (61.9%), knee (61.9%), shoulder (52.4%), lumbar spine (50.0%), elbow (42.9%), cervical spine (38.1%), ankle (38.1%), foot (28.6%) and hip (16.7%). Sprain, strain and tendinitis were the most common injuries, accounting for the most cases. Of the 42 dancers, 13 (31%) had had fractures or dislocations. Eight (19.1%) learned break-dancing under supervised instruction, 17 (40.5%) used protective devices and 28 (66.7%) performed warm-up exercises before dancing. There were significant differences in age, dance career length, amount of dance training, mean number of injury sites and the presence of supervised training between professionals and amateurs (P < 0.05). CONCLUSION: Clinicians must inquire thoroughly into the nature of the activities that result in both unusual and common injuries in break-dancers and educate them about safety. Careful screening, instruction and supervised training of break-dancers will help to prevent injuries.

[Multilevel contiguous injuries of the lower cervical spine during flexion trauma with delayed diagnosis: a case report]
Author(s): Uzel, AP; Do, L
Journal: Neurochirurgie 2010 Mar 10; Vol. 55, Issue 6; Page(s) 585-8
[Medline ID - 19481230]

The authors report a case of bilateral C4-C5 facet fracture dislocation associated with a severe sprain underlying C5-C6, which had occurred during an traffic accident. The diagnosis of severe sprain was raised on the 55 th day. The injury mechanism is studied. Contiguous multilevel injuries of the lower cervical spine should be suspected in case of high-energy trauma. MRI can provide an exhaust if diagnosis of possible multilevel injuries. After fixation of the obvious lesion, intraoperative dynamic fluoroscopy must be performed to demonstrate any instability in another area.

Treatment of carpal tunnel syndrome.
Author(s): Keith, MW; Masear, V; Amadio, PC; Andary, M; Barth, RW; Graham, B; Chung, K; Maupin, K; Watters, WC; Haralson, RH; Turkelson, CM; Wies, JL; McGowan, R
Journal: J Am Acad Orthop Surg 2009 Sep 11; Vol. 17, Issue 6; Page(s) 397-405
[Medline ID - 19474449]

In September 2008, the Board of Directors of the American Academy of Orthopaedic Surgeons approved a clinical practice guideline on the treatment of carpal tunnel syndrome. This guideline was subsequently endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The guideline makes nine specific recommendations: A course of nonsurgical treatment is an option in patients diagnosed with carpal tunnel syndrome. Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects. Another nonsurgical treatment or surgery is suggested when the current treatment fails to resolve symptoms within 2 to 7 weeks. Sufficient evidence is not available to provide specific treatment recommendations for carpal tunnel syndrome associated with such conditions as diabetes mellitus and coexistent cervical radiculopathy. Local steroid injection or splinting is suggested before considering surgery. Oral steroids or ultrasound are options. Carpal tunnel release is recommended as treatment. Heat therapy is not among the options to be used. Surgical treatment of carpal tunnel syndrome by complete division of the flexor retinaculum is recommended. Routine use of skin nerve preservation and epineurotomy is not suggested when carpal tunnel release is performed. Prescribing preoperative antibiotics for carpal tunnel surgery is an option. It is suggested that the wrist not be immobilized postoperatively after routine carpal tunnel surgery. It is suggested that instruments such as the Boston Carpal Tunnel Questionnaire and the Disabilities of the Arm, Shoulder, and Hand questionnaire be used to assess patient responses to carpal tunnel syndrome treatment for research.
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