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Search Results for : Wrist Sprain
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Effects of ulnar deviation of the wrist combined with flexion/extension on the maximum voluntary contraction of grip.
Author(s): Haque, S; Khan, AA
Journal: J Hum Ergol (Tokyo) 2010 Jan 27; Vol. 38, Issue 1; Page(s) 1-9
[Medline ID - 20034313]

Work-related musculoskeletal disorders (WMSDs) is related with the frequency of exertion for repetitive tasks requiring heavy load. Different researchers have reported that a poor posture is very much responsible for WMSD if combined with increased load and/or frequency. In the assembly tasks in different industries involve the gripping very commonly. Therefore in the present study it was tried to find the effect of a wrist posture on grip strength. For design of experiment, subjects, flexion/extension and ulnar deviation of the wrist were taken as independent variables and the dependent variable was maximum voluntary contraction (MVC) of grip. The results showed that the effect of flexion/extension angle, ulnar angle and the subject on MVC grip were highly significant (i.e., p < 0.001, 0.001 and 0.002 respectively). The two-way interaction effect of flexion/extension angle of the wrist and the subject on MVC grip was also found significant at p < 0.001. The other interaction effects were not found significant. MVC grip was found maximum at the neutral wrist posture.

Carpal tunnel syndrome: associations between risk factors and laterality.
Author(s): Zambelis, T; Tsivgoulis, G; Karandreas, N
Journal: Eur Neurol 2010 Mar 17; Vol. 63, Issue 1; Page(s) 43-7
[Medline ID - 20029215]

AIMS: The investigation of the association between known risk factors and laterality in patients with carpal tunnel syndrome (CTS). Patients and METHODS: 130 consecutive subjects with CTS only, or mainly, in the left hand were compared with 130 consecutive subjects with CTS only, or mainly, in the right hand. The following parameters were recorded: age, sex, job, handedness, hand mainly used in daily activities, BMI, diabetes mellitus, thyroid dysfunction, wrist trauma and connective tissue diseases. RESULTS: A left dominant hand was independently associated with 13-fold higher odds for left-hand CTS, while a right dominant hand had 5-fold higher odds for right-hand CTS. Right-hand CTS was more frequent in younger subjects and females. CONCLUSION: Older age, higher BMI and diabetes mellitus were more prevalent in patients with bilateral CTS. Age and BMI were independently associated with bilateral CTS.

Dynamics of intracarpal tunnel pressure in patients with carpal tunnel syndrome.
Author(s): Goss, BC; Agee, JM
Journal: J Hand Surg Am 2010 May 21; Vol. 35, Issue 2; Page(s) 197-206
[Medline ID - 20022712]

PURPOSE: To measure pressure within the carpal tunnel (intracarpal tunnel pressures) in patients with carpal tunnel syndrome and determine the effect of quantified active hand use on both the magnitude and location of peak pressures, before and after division of the transverse carpal ligament. METHODS: We measured intracarpal tunnel pressures intraoperatively in 12 patients with carpal tunnel syndrome at 5 standardized locations based on the distance between each patient's proximal pisiform and hook of hamate (HH) before endoscopic division of the ligament, using a semiconductor gauge pressure sensor inserted from proximal to distal into the tunnel under fluoroscopic control. At each location, pressure was recorded with fingers extended, fingers flexed, and 50% maximum grip using a grip dynamometer. Additional hand use activities, including maximum key and pulp pinch using a pinch dynamometer, 25% maximum grip, and maximum grip, were performed by a subset of these patients. After ligament division, we measured pressures during the same hand activities at a single location, HH. We analyzed the effect of hand activity, measurement location, and ligament division using repeated measures analysis of variance. RESULTS: Compared with fingers extended (mean pressure, 56 mm Hg), all pinch and grip activities caused significant increases in pressure at HH, with a mean peak pressure of 1151 mm Hg during maximum grip. After endoscopic release, pressures decreased significantly at HH for all hand activities. CONCLUSIONS: In patients with carpal tunnel syndrome, intracarpal tunnel pressures during active hand use are substantially greater than previously reported. Peak pressures occur at the HH, where the tunnel is most constricted and the median nerve is most compressed in carpal tunnel syndrome. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Ulnar nerve penetration by a volar ganglion in the Guyon canal.
Author(s): Chalidis, BE; Sachinis, NC; Dimitriou, CG
Journal: Plast Reconstr Surg 2010 Jan 12; Vol. 124, Issue 5; Page(s) 264e-6e
[Medline ID - 20009809]

ABSTRACT NOT AVAILABLE

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.

Pressure pain sensitivity mapping in experimentally induced lateral epicondylalgia.
Author(s): Fern; ández-Carnero, J; Binderup, AT; Ge, HY; Fern; ández-de-las-Peñas, C; Arendt-Nielsen, L; Madeleine, P
Journal: Med Sci Sports Exerc 2010 Aug 5; Vol. 42, Issue 5; Page(s) 922-7
[Medline ID - 19996999]

PURPOSE: The aim of this study was to apply topographical techniques to investigate changes in pressure pain sensitivity after induction of delayed onset muscle soreness (DOMS) in the elbow region in healthy subjects. METHODS: Pressure pain thresholds (PPT) were assessed over 12 points forming a 3 x 4 matrix (4 points in the superior part, 4 points in the middle, and 4 points in the lower part around the lateral epicondyle) over the dominant elbow in 13 healthy men, and pressure sensitivity maps were calculated. DOMS, as a model for lateral epicondylalgia (LE), was induced by repetitive high-level eccentric contractions of the wrist extensor muscles. PPT maps were assessed before, immediately after, and 24 h after eccentric exercise (DOMS). RESULTS: The two-way repeated-measure ANOVA detected significant differences in mean PPT for the measurement points (F = 5.96, P < 0.001), with lower PPT over the points located over the extensor carpi radialis brevis muscle. There was also a significant effect of time (F = 121.3, P < 0.001) but no time x point location interaction (F = 0.7, P = 0.8). PPT were lower 24 h after (P < 0.001) but not immediately after (P > 0.05) eccentric exercise. CONCLUSIONS: The study provides new key information regarding mechanical pain hyperalgesia in experimentally induced LE. Topographical pressure pain sensitivity maps from the elbow region revealed heterogeneously distributed mechanical sensitivity before and during DOMS. The most sensitive localizations for PPT assessment correspond to the muscle belly of the extensor carpi radialis brevis. Our results support the implication of the extensor carpi radialis brevis muscle in LE.

Ultrasound assessment of the displacement and deformation of the median nerve in the human carpal tunnel with active finger motion.
Author(s): Yoshii, Y; Villarraga, HR; Henderson, J; Zhao, C; An, KN; Amadio, PC
Journal: J Bone Joint Surg Am 2010 Dec 1; Vol. 91, Issue 12; Page(s) 2922-30
[Medline ID - 19952256]

BACKGROUND: Peripheral nerves are mobile structures, stretching and translating in response to changes in the position of adjuvant anatomic structures. The objective of this study was to develop a novel method to characterize the relative motion and deformation of the median nerve on cross-sectional ultrasound images of the carpal tunnel during active finger motion. METHODS: Fifteen volunteers without a history of carpal tunnel syndrome or wrist trauma were recruited. An ultrasound scanner and a linear array transducer were used to evaluate the motion of the median nerve and the flexor tendons within the carpal tunnel during motion from full extension to full flexion by the four fingers (fist motion) and by the long finger alone. The displacement of the median nerve relative to the long-finger flexor digitorum superficialis tendon as well as the perimeter, cross-sectional area, circularity, and aspect ratio of a minimum enclosing rectangle of the median nerve were measured. The data were compared between single-digit motion and fist motion and between extension and flexion positions. RESULTS: The distance between the long-finger flexor digitorum superficialis tendon and the median nerve with isolated long-finger flexion was decreased in the ulnar-radial direction and increased in the palmar-dorsal direction as compared with the distance with four-finger flexion (p < 0.01). Compared with the values with fist motion, the aspect ratio was decreased and the circularity was increased with long-finger motion (p < 0.01). CONCLUSIONS: This report presents a method with which to assess displacement and deformation of the median nerve on a cross-sectional ultrasound image during different finger motions. This method may be useful to assess pathological changes within the carpal tunnel, and we plan to perform a similar study of patients with carpal tunnel syndrome on the basis of these preliminary data.

Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature.
Author(s): Natsis, K; Iordache, G; Gigis, I; Kyriazidou, A; Lazaridis, N; Noussios, G; Paraskevas, G
Journal: Folia Morphol (Warsz) 2010 Apr 10; Vol. 68, Issue 4; Page(s) 193-200
[Medline ID - 19950066]

The median artery usually regresses after the eighth week of intrauterine life, but in some cases it persists into adulthood. The persistent median artery (PMA) passes through the carpal tunnel of the wrist, accompanying the median nerve. During anatomical dissection in our department, we found two unilateral cases of PMA originating from the ulnar artery. In both cases the PMA passed through the carpal tunnel, reached the palm, and anastomosed with the ulnar artery, forming a medio-ulnar type of superficial palmar arch. In addition, in both cases we observed a high division of the median nerve before entering the carpal tunnel. Such an artery may result in several complications such as carpal tunnel syndrome, pronator syndrome, or compression of the anterior interosseous nerve. Therefore, the presence of a PMA should be taken into consideration in clinical practice. This study presents two cases of PMA along with an embryological explanation, analysis of its clinical significance, and a review of the literature. The review of the literature includes cases observed during surgical procedures or anatomical dissections. Cases observed by means of imaging techniques were not included in the study.

Ultrasonographic and functional changes of the ulnar nerve at Guyon's canal after carpal tunnel release.
Author(s): Ginanneschi, F; Filippou, G; Reale, F; Scarselli, C; Galeazzi, M; Rossi, A
Journal: Clin Neurophysiol 2010 Mar 10; Vol. 121, Issue 2; Page(s) 208-13
[Medline ID - 19955016]

OBJECTIVE: To describe morphologic and functional modifications of the ulnar nerve at the wrist in carpal tunnel syndrome (CTS) after carpal tunnel release (CTR). METHODS: Ultrasonography was used to study the cross sectional area (CSA) of the ulnar nerve at Guyon's canal, before and 1 and 6 months after CTR, in 18 CTS patients. A parallel electrophysiological and clinical analysis was also conducted. RESULTS: CSA of the ulnar nerve significantly increased 6 months after CTR. Ten (55%) cases showed abnormal CSA values compared to a control group before surgery and five (28%) at 6 month follow-up. In addition, there were improvements in the motor and sensory ulnar axon recruitment properties and the conduction values in sensory ulnar fibres. Patients with extra-median distribution of paresthesia (4 subjects) were free from symptoms. CONCLUSIONS: CTR has a significant effect not only on the anatomical geometry of Guyon's canal, but also on the morphology and function of the ulnar nerve. SIGNIFICANCE: In CTS, high pressure in the carpal tunnel may result in anatomical changes of ulnar nerve, thus causing functional impairment to the ulnar fibres. CTR appears to reverse some of this damage.

Unusual coexistence of a variant abductor digiti minimi and reversed palmaris longus and their possible relation to median and ulnar nerves entrapment at the wrist.
Author(s): Georgiev, GP; Jelev, L
Journal: Rom J Morphol Embryol 2010 Apr 23; Vol. 50, Issue 4; Page(s) 725-7
[Medline ID - 19942973]

During routine anatomical dissection of the left upper limb of a 73-year-old female cadaver, a unique coexistence of variant muscles was found. In the forearm region, a largely developed reversed palmaris longus was discovered. Its short distal tendon was in close relation to the median nerve. In the neighboring hypothenar region, an unusual abductor digiti minimi was also observed. Its muscular body was composed of two portions - medial and lateral one, arising from the reversed palmaris longus tendon. The lateral portion passed over the ulnar nerve and artery in the canal of Guyon. In the literature, there are descriptions of entrapment neuropathies caused by either reversed palmaris longus or variant abductor digiti minimi. Here, for the first time we describe a coexistence of these variant muscles and suggest it as a possible, even rare, cause of both the median and ulnar nerves entrapment and ulnar artery thrombosis.
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