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Sample records for carpal tunnel decompression

  1. Is carpal tunnel decompression warranted for HNPP?

    PubMed

    Earle, Nicholas; Zochodne, Douglas W

    2013-12-01

    The role of carpal tunnel decompression surgery for patients that have hereditary neuropathy with liability to pressure palsy (HNPP) is currently unknown. Since recovery from carpal tunnel compression is often associated with remyelination or nodal reconstruction rather than axonal regeneration, it is uncertain whether the PMP22 deletion associated with HNPP interrupts myelin or nodal reconstitution. We describe two patients with genetically confirmed HNPP and symptomatic carpal tunnel syndrome that had clinical and electrophysiological improvement after surgical decompression. The findings indicate a capacity for conduction repair in HNPP. They also suggest a need for further investigation and discussion around whether to offer carpal tunnel decompression to symptomatic HNPP patients. PMID:24171697

  2. Pictorial essay: Role of ultrasound in failed carpal tunnel decompression

    PubMed Central

    Botchu, Rajesh; Khan, Aman; Jeyapalan, Kanagaratnam

    2012-01-01

    USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression. PMID:22623813

  3. Carpal tunnel release

    MedlinePlus

    Median nerve decompression; Carpal tunnel decompression; Surgery - carpal tunnel ... The median nerve and the tendons that flex (or curl) your fingers go through a passage called the carpal tunnel in ...

  4. Carpal tunnel biopsy

    MedlinePlus

    Calandruccio JH. Carpal tunnel syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; 2012: ...

  5. Aberrant Radial Artery Causing Carpal Tunnel Syndrome

    PubMed Central

    Kokkalis, Zinon T.; Tolis, Konstantinos E.; Megaloikonomos, Panayiotis D.; Panagopoulos, Georgios N.; Igoumenou, Vasilios G.; Mavrogenis, Andreas F.

    2016-01-01

    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic. PMID:27517078

  6. Aberrant Radial Artery Causing Carpal Tunnel Syndrome.

    PubMed

    Kokkalis, Zinon T; Tolis, Konstantinos E; Megaloikonomos, Panayiotis D; Panagopoulos, Georgios N; Igoumenou, Vasilios G; Mavrogenis, Andreas F

    2016-06-01

    Anatomical vascular variations are rare causes of carpal tunnel syndrome. An aberrant medial artery is the most common vascular variation, while an aberrant radial artery causing carpal tunnel syndrome is even more rare, with an incidence ranging less than 3%. This article reports a patient with compression of the median nerve at the carpal tunnel by an aberrant superficial branch of the radial artery. An 80- year- old man presented with a 5-year history of right hand carpal tunnel syndrome; Tinel sign, Phalen test and neurophysiological studies were positive. Open carpal tunnel release showed an aberrant superficial branch of the radial artery with its accompanying veins running from radially to medially, almost parallel to the median nerve, ending at the superficial palmar arterial arch. The median nerve was decompressed without ligating the aberrant artery. At the last follow-up, 2 years after diagnosis and treatment the patient is asymptomatic. PMID:27517078

  7. Carpal Tunnel Syndrome

    MedlinePlus

    ... through NIH's National Center for Complementary and Alternative Medicine are investigating the effects of acupuncture on pain, loss of median nerve function, and changes in the brain associated with carpal tunnel syndrome. In addition, a ...

  8. Carpal Tunnel Surgery

    MedlinePlus Videos and Cool Tools

    ... is the incriminating structure in carpal tunnel syndrome. As it increases in size, the pressures within the ... you can visualize the movement of the tendons as I move the fingers, the tendons are gliding ...

  9. Carpal tunnel syndrome

    MedlinePlus

    ... also need to make changes in your work duties or home and sports activities. Some of the ... Call for an appointment with your provider if: You have symptoms of carpal tunnel syndrome Your symptoms ...

  10. Carpal Tunnel Syndrome

    PubMed Central

    Zimmerman, Gregory R.

    1994-01-01

    Carpal tunnel syndrome is a neuropathy resulting from compression of the median nerve as it passes through a narrow tunnel in the wrist on its way to the hand. The lack of precise objective and clinical tests, along with symptoms that are synonymous with other syndromes in the upper extremity, cause carpal tunnel syndrome to appear to be a rare entity in athletics. However, it should not be ruled out as a possible etiology of upper extremity paralysis in the athlete. More typically, carpal tunnel syndrome is the most common peripheral entrapment neuropathy encountered in industry. Treatment may include rest and/or splinting of the involved wrist, ice application, galvanic stimulation, or iontophoresis to reduce inflammation, and then transition to heat modalities and therapeutic exercises for developing flexibility, strength, and endurance. In addition, an ergonomic assessment should be conducted, resulting in modifications to accommodate the carpal tunnel syndrome patient. ImagesFig 3.Fig 4.Fig 5.Fig 6.Fig 7. PMID:16558255

  11. Carpal tunnel syndrome

    PubMed Central

    2014-01-01

    Introduction Carpal tunnel syndrome is a collection of clinical symptoms and signs caused by compression of the median nerve within the carpal tunnel. However, the severity of symptoms and signs does not often correlate well with the extent of nerve compression. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgical treatments for carpal tunnel syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: carpal tunnel release surgery (open and endoscopic), diuretics, local corticosteroids injection, non-steroidal anti-inflammatory drugs (NSAIDs), therapeutic ultrasound, and wrist splints.

  12. Electroacupuncture Helped Ease Carpal Tunnel in Study

    MedlinePlus

    ... 159240.html Electroacupuncture Helped Ease Carpal Tunnel in Study But experts say finding is preliminary, didn't ... condition known as carpal tunnel syndrome. In the study, electroacupuncture helped carpal tunnel patients with long-lasting ...

  13. Carpal tunnel syndrome

    PubMed Central

    Aroori, Somaiah; Spence, Roy AJ

    2008-01-01

    Carpal tunnel syndrome is one of the most common peripheral neuropathies. It affects mainly middle aged women. In the majority of patients the exact cause and pathogenesis of CTS is unclear. Although several occupations have been linked to increased incidence and prevalence of CTS the evidence is not clear. Occupational CTS is uncommon and it is essential to exclude all other causes particularly the intrinsic factors such as obesity before attributing it to occupation. The risk of CTS is high in occupations involving exposure to high pressure, high force, repetitive work, and vibrating tools. The classic symptoms of CTS include nocturnal pain associated with tingling and numbness in the distribution of median nerve in the hand. There are several physical examination tests that will help in the diagnosis of CTS but none of these tests are diagnostic on their own. The gold standard test is nerve conduction studies. However, they are also associated with false positive and false negative results. The diagnosis of CTS should be based on history, physical examination and results of electrophysiological studies. The patient with mild symptoms of CTS can be managed with conservative treatment, particularly local injection of steroids. However, in moderate to severe cases, surgery is the only treatment that provides cure. The basic principle of surgery is to increase the volume of the carpal tunnel by dividing transverse carpal ligament to release the pressure on the median nerve. Apart from early recovery and return to work there is no significant difference in terms of early and late complications and long-term pain relief between endoscopic and open carpal tunnel surgery. PMID:18269111

  14. Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients

    PubMed Central

    Marquardt, Tamara L.; Evans, Peter J.; Seitz, William H.; Li, Zong-Ming

    2015-01-01

    The purpose of this study was to investigate the morphological changes of the carpal arch and median nerve during the application of radiounlarly directed compressive force across the wrist in patients with carpal tunnel syndrome. Radioulnar compressive forces of 10 N and 20 N were applied at the distal level of the carpal tunnel in 10 female patients diagnosed with carpal tunnel syndrome. Immediately prior to force application and after 3 minutes of application, ultrasound images of the distal carpal tunnel were obtained. It was found that applying force across the wrist decreased the carpal arch width (p < 0.001) and resulted in increased carpal arch height (p < 0.01), increased carpal arch curvature (p < 0.001), and increased radial distribution of the carpal arch area (p < 0.05). It was also shown that wrist compression reduced the flattening of the median nerve, as indicated by changes in the nerve’s circularity and flattening ratio (p < 0.001). Statement of clinical significance This study demonstrated that the carpal arch can be non-invasively augmented by applying compressive force across the wrist, and that this strategy may decompress the median nerve providing symptom relief to patients with carpal tunnel syndrome. PMID:26662276

  15. Carpal arch and median nerve changes during radioulnar wrist compression in carpal tunnel syndrome patients.

    PubMed

    Marquardt, Tamara L; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2016-07-01

    The purpose of this study was to investigate the morphological changes of the carpal arch and median nerve during the application of radiounlarly directed compressive force across the wrist in patients with carpal tunnel syndrome. Radioulnar compressive forces of 10 N and 20 N were applied at the distal level of the carpal tunnel in 10 female patients diagnosed with carpal tunnel syndrome. Immediately prior to force application and after 3 min of application, ultrasound images of the distal carpal tunnel were obtained. It was found that applying force across the wrist decreased the carpal arch width (p < 0.001) and resulted in increased carpal arch height (p < 0.01), increased carpal arch curvature (p < 0.001), and increased radial distribution of the carpal arch area (p < 0.05). It was also shown that wrist compression reduced the flattening of the median nerve, as indicated by changes in the nerve's circularity and flattening ratio (p < 0.001). This study demonstrated that the carpal arch can be non-invasively augmented by applying compressive force across the wrist, and that this strategy may decompress the median nerve providing symptom relief to patients with carpal tunnel syndrome. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1234-1240, 2016. PMID:26662276

  16. Ganglion cysts and carpal tunnel syndrome.

    PubMed

    Kerrigan, J J; Bertoni, J M; Jaeger, S H

    1988-09-01

    We review 12 cases of ganglion cyst with carpal tunnel syndrome in 11 patients seen at the Hand Rehabilitation Center. Mean age was 42 years (range, 28 to 60 years). One half of the cysts were associated with direct trauma, usually with wrist hyperextension. Symptoms usually developed after the appearance or sudden growth of the cyst. Motor conduction or distal sensory latency was abnormal in seven of eight studied cases. Tinel's sign on tapping the cyst may be pathognomonic for this syndrome. Cyst removal and incision of the flexor retinaculum relieved the symptoms in 11 cases. The other case had total resolution after spontaneous cyst rupture. This syndrome is successfully treated with cyst decompression with release of the carpal canal and has an excellent prognosis. To our knowledge this represents the largest operative series of carpal tunnel syndrome and ganglion cyst. PMID:3241055

  17. Pathophysiology of carpal tunnel syndrome

    PubMed Central

    Aboonq, Moutasem S.

    2015-01-01

    Carpal tunnel syndrome (CTS) is the most common median nerve neuropathy, accounting for 90% of all neuropathies. Carpal tunnel syndrome presents in 3.8% of the general population, with a higher prevalence among women. There are several risk factors associated with CTS, including both medical and non medical factors. The pathophysiologic mechanisms involved in the median nerve compression and traction are thought to be complex, and as yet are not fully understood. The present review aimed to provide an overview of the pathophysiology of median nerve neuropathy in the carpal tunnel, and subsequent development of CTS. PMID:25630774

  18. Carpal tunnel syndrome and work.

    PubMed

    Newington, Lisa; Harris, E Clare; Walker-Bone, Karen

    2015-06-01

    Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance' symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed. PMID:26612240

  19. Carpal tunnel release

    MedlinePlus

    ... cuts through the carpal ligament to make more space for the nerve and tendons. The surgery is done in the following way: First, you receive numbing medicine so that you do not feel pain during ...

  20. [Ultrasonography for carpal tunnel syndrome].

    PubMed

    Nakamichi, Kenichi

    2014-03-01

    Ultrasonography in cases of carpal tunnel syndrome is described with respect to the following aspects: (1) imaging technique; (2) image characteristics; (3) detection of pathophysiology; (4) diagnosis of idiopathic cases; (5) screening of local pathologies (space-occupying lesions, tenosynovitis, and bone and joint abnormalities), incomplete release, and anatomic variations; and (6) role in facilitating minimally-invasive surgery. PMID:24607945

  1. Pressure-morphology relationship of a released carpal tunnel.

    PubMed

    Kim, Dong Hee; Marquardt, Tamara L; Gabra, Joseph N; Shen, Zhilei Liu; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2013-04-01

    We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure-morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p < 0.001), with an increase of >62 mm(2) at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p < 0.05). As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery. PMID:23184493

  2. [Carpal tunnel syndrome revealed by digital ulcerations caused by arterial vasospasm].

    PubMed

    Léger, O; Lavallé, F

    2005-02-01

    Carpal tunnel syndrome presenting as a trophic disorder in the hand is unusual. We report the case of a 66 year old man in whom nerve conduction tests confirmed compression of the median nerve in the carpal tunnel, and vasospasm in the corresponding area was demonstrated by arteriography for, we believe, the first time. Simple decompression of the carpal tunnel brought about total recovery. The mechanism of the autonomic disorders found in carpal tunnel syndrome remains controversial. The clinical case that we report objectively demonstrates the vasospasm caused by the compression of the autonomic fibres of the median nerve. PMID:15754710

  3. Carpal tunnel syndrome: role of carpal canal size.

    PubMed

    Bleecker, M L; Bohlman, M; Moreland, R; Tipton, A

    1985-11-01

    Carpal canal size was examined as a risk factor associated with carpal tunnel syndrome in the workplace. Seven of 14 electricians had symptomatic carpal tunnel syndrome. On measuring cross-sectional areas by CT, affected workers had a cross-sectional area of 1.75 +/- 0.21 cm2; control values were 2.53 +/- 0.15 cm2 (p less than 0.05). Individuals with a subclinical syndrome had an area of 1.83 +/- 0.22 cm2, similar to the symptomatic group. Wrist circumference was not a predictor of smallest carpal canal area. Unusual bony and soft tissue structures within the carpal canal were easily identified with CT. PMID:4058749

  4. Carpal Tunnel Syndrome

    MedlinePlus

    ... at the base of your hand. It contains nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed. Symptoms usually start gradually. As ...

  5. Carpal tunnel biopsy

    MedlinePlus

    ... syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell's Operative ... Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, ...

  6. Pressure-Morphology Relationship of a Released Carpal Tunnel

    PubMed Central

    Kim, Dong Hee; Marquardt, Tamara L.; Gabra, Joseph N.; Shen, Zhilei Liu; Evans, Peter J.; Seitz, William H.; Li, Zong-Ming

    2013-01-01

    The purpose of this study was to investigate morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament. However, the pressure-morphology relationship of the carpal tunnel after release of the transverse carpal ligament has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system and pressure measurements were recorded by a pressure transducer. It was found that carpal tunnel pressure significantly affected carpal arch area (p<0.001), with an increase >62 mm2 at 120 mmHg. Carpal arch height, length, and width were also found to significantly change with carpal tunnel pressure (p<0.05). As carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact transverse carpal ligament. This change of structural properties as a result of transecting the transverse carpal ligament helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery. PMID:23184493

  7. Carpal tunnel area as a risk factor for carpal tunnel syndrome.

    PubMed

    Winn, F J; Habes, D J

    1990-03-01

    Carpal tunnel area was investigated as a risk factor for carpal tunnel syndrome (CTS). It was hypothesized that if canal area is a risk factor for the syndrome, individuals who develop the syndrome should have smaller carpal canal areas than those who remain free of the syndrome. Sixty-one subjects, approximately equally divided by sex, age group, and diagnosis, were examined. A measurement of cross-sectional areas of the carpal canal by computerized axial tomography indicated that individuals diagnosed as carpal tunnel patients had significantly larger carpal canal areas than controls. The results indicate that a small carpal canal area does not appear to be a risk factor for carpal tunnel syndrome. PMID:2181299

  8. Work-Related Carpal Tunnel Syndrome: Diagnosis and Treatment Guideline.

    PubMed

    Franklin, Gary M; Friedman, Andrew S

    2015-08-01

    Carpal tunnel syndrome is the most common entrapment neuropathy, and its risk of occurrence in the presence of repetitive, forceful angular hand movements, or vibration, is common. It is critical to make the diagnosis based on appropriate clinical history and findings and with corroborating electrodiagnostic studies. Conservative management should be undertaken with the goal of maintaining employment; surgical decompression can be highly effective, particularly if undertaken early on. PMID:26231963

  9. Anthropometry and endoscopic carpal tunnel release.

    PubMed

    Schonauer, F; Belcher, H J

    1999-02-01

    A prospective study was performed in 100 consecutive endoscopic carpal tunnel releases (ECTR) to assess the effect of a number of anthropometric measures on the ease of introduction of the ECTR system into the carpal tunnel. Ease of access to the carpal tunnel correlated with the wrist circumference, height and age of patients. Surgeons should be aware that ECTR is likely to be more difficult in small patients with small wrists and should have a higher threshold for conversion to the open technique to avoid neurological complications. PMID:10190595

  10. Carpal tunnel syndrome caused by vascular nerve impairment treated with open release of the carpal tunnel

    PubMed Central

    Juul, Rasmus; Tarnowski, Jan R.; Houe, Thomas

    2015-01-01

    Abstract We present a patient suffering from classical unilateral symptoms of carpal tunnel syndrome, where the results of electrophysiological examinations were negative. Ultrasound showed at pulsatile median artery that led to direct mechanical impact on the median nerve. The patient was successfully treated with open release of the carpal tunnel.

  11. Carpal tunnel syndrome in children.

    PubMed

    Van Meir, Nathalie; De Smet, Luc

    2003-10-01

    Carpal tunnel syndrome (CTS) is rarely seen in children. A literature search in 1989 revealed 52 published cases. The authors review 163 additional cases that were published since that date. The majority of these cases were related with a genetic condition. The most common aetiology was lysosomal storage disease: mucopolysaccharidoses (MPS) in 95 and mucolipidoses (ML) in 22. In CTS secondary to MPS, clinical signs typical of adult CTS are rarely seen, and difficulty with fine motor tasks is the most frequent finding. CTS in MPS does not seem to be prevented by bone marrow transplantation, the usual treatment for the condition. CTS is probably due to a combination of excessive lysosomal storage in the connective tissue of the flexor retinaculum and a distorted anatomy because of underlying bone dysplasia. Mucolipidoses come next in the aetiology, with essentially similar symptoms. The authors found in the literature 11 cases of primary familial CTS, a condition which presents as an inheritable disorder of connective tissue mediated by an autosomal dominant gene; the symptoms may be more typical in some cases, but are more similar to MPS in others. A case with self-mutilation has been reported. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare autosomal dominant condition characterised by episodes of decreased sensation or palsies after slight traction or pressure on peripheral nerves; it may also give symptoms of CTS. Schwartz-Jampel syndrome (SJS), another genetic disorder with autosomal recessive skeletal dysplasia, is characterised by varying degrees of myotonia and chondrodysplasia; it has also been noted associated with CTS in a child. Melorrheostosis and Leri's syndrome have also been noted in children with CTS, as well as Déjerine-Sottas syndrome and Weill-Marchesani syndrome. Among non-genetic causes of CTS in children, idiopathic cases with children onset have been reported, usually but not always related with thickening of the

  12. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography.

    PubMed

    Lee, D; van Holsbeeck, M T; Janevski, P K; Ganos, D L; Ditmars, D M; Darian, V B

    1999-07-01

    This article presents a new technique for diagnosing carpal tunnel syndrome using ultrasound. The ultrasound characteristics of the normal and abnormal median nerve are discussed in relation to carpal tunnel syndrome. The development of ultrasound as a new diagnostic modality for carpal tunnel syndrome is presented in a three-part study correlating the ultrasound measurements of the median nerve and electromyogram of the median nerve. A new algorithm for evaluating patients with carpal tunnel syndrome is presented. PMID:10442084

  13. Treatment of repetitive use carpal tunnel syndrome

    NASA Astrophysics Data System (ADS)

    Smith, Chadwick F.; Vangsness, C. Thomas; Anderson, Thomas; Good, Wayne

    1995-05-01

    In 1990, a randomized, double-blind study was initiated to evaluate the use of an eight-point conservative treatment program in carpal tunnel syndrome. A total of 160 patients were delineated with symptoms of carpal tunnel syndrome. These patients were then divided into two groups. Both groups were subjected to an ergonomically correct eight-point work modification program. A counterfeit low level laser therapy unit was utilized in Group A, while an actual low level laser therapy unit was utilized in Group B. The difference between Groups A and B was statistically significant in terms of return to work, conduction study improvement, and certain range of motion and strength studies.

  14. Carpal tunnel release: do we understand the biomechanical consequences?

    PubMed

    Morrell, Nathan T; Harris, Andrew; Skjong, Christian; Akelman, Edward

    2014-11-01

    Carpal tunnel release is a very common procedure performed in the United States. While the procedure is often curative, some patients experience postoperative scar sensitivity, pillar pain, grip weakness, or recurrent median nerve symptoms. Release of the carpal tunnel has an effect on carpal anatomy and biomechanics, including increases in carpal arch width and carpal tunnel volume and changes in muscle and tendon mechanics. Our understanding of how these biomechanical changes contribute to postoperative symptoms is still evolving. We review the relevant morphometric and biomechanical changes that occur following release of the transverse carpal ligament. PMID:25364635

  15. High-resolution ultrasonography of the carpal tunnel.

    PubMed

    Buchberger, W; Schön, G; Strasser, K; Jungwirth, W

    1991-10-01

    Twenty-eight wrists of 25 patients with carpal tunnel syndrome (CTS) and 28 wrists of 14 normal control subjects were studied with high-frequency real-time ultrasonography. Three general findings could be observed in CTS, regardless of its cause: swelling of the median nerve at the entrance of the carpal tunnel; flattening of the median nerve in the distal carpal tunnel; and increased palmar flexion of the transverse carpal ligament. Quantitative analysis proved these findings to be significant. We conclude that high-resolution sonography is able to diagnose median nerve compression in the carpal tunnel syndrome and to detect some of its potential causes. PMID:1942218

  16. Employees' Knowledge of Carpal Tunnel Syndrome.

    ERIC Educational Resources Information Center

    Gandy-Goldston, Terrie M.

    A study examined employees' knowledge of the causes of carpal tunnel syndrome (CTS), its prevention, and their legal rights after being diagnosed with CTS. A 24-item questionnaire was administered to a random sample of 30 Chicago-area employees who had been afflicted with CTS. Of those surveyed, 99% considered their CTS injury related to their…

  17. Carpal Tunnel Syndrome in ARL Libraries.

    ERIC Educational Resources Information Center

    Thornton, Joyce K.

    1997-01-01

    A survey of 72 member libraries in the Association of Research Libraries revealed the incidence of carpal tunnel syndrome (CTS) and the measures taken to cope with it. Recommends implementing proactive ergonomics programs; soliciting staff input for solutions; providing report guidelines; using external help; stressing preventive measures and…

  18. Biomechanical Role of the Transverse Carpal Ligament in Carpal Tunnel Compliance

    PubMed Central

    Li, Zong-Ming; Marquardt, Tamara L.; Evans, Peter J.; Seitz, William H.

    2014-01-01

    The transverse carpal ligament (TCL) is a significant constituent of the wrist structure and forms the volar boundary of the carpal tunnel. It serves biomechanical and physiological functions, acting as a pulley for the flexor tendons, anchoring the thenar and hypothenar muscles, stabilizing the bony structure, and providing wrist proprioception. This article mainly describes and reviews our recent studies regarding the biomechanical role of the TCL in the compliant characteristics of the carpal tunnel. First, force applied to the TCL from within the carpal tunnel increased arch height and area due to arch width narrowing from the migration of the bony insertion sites of the TCL. The experimental findings were accounted for by a geometric model that elucidated the relationships among arch width, height, and area. Second, carpal arch deformation showed that the carpal tunnel was more flexible at the proximal level than at the distal level and was more compliant in the inward direction than in the outward direction. The hamate-capitate joint had larger angular rotations than the capitate-trapezoid and trapezoid-trapezium joints for their contributions to changes of the carpal arch width. Lastly, pressure application inside the intact and released carpal tunnels led to increased carpal tunnel cross-sectional areas, which were mainly attributable to the expansion of the carpal arch formed by the TCL. Transection of the TCL led to an increase of carpal arch compliance that was nine times greater than that of the intact carpal tunnel. The carpal tunnel, while regarded as a stabile structure, demonstrates compliant properties that help to accommodate biomechanical and physiological variants such as changes in carpal tunnel pressure. PMID:25364633

  19. A randomized controlled trial of knifelight and open carpal tunnel release.

    PubMed

    Bhattacharya, R; Birdsall, P D; Finn, P; Stothard, J

    2004-04-01

    A randomized controlled trial was done to compare the results of carpal tunnel decompression using the standard open approach and the Knifelight technique. Twenty-six patients with bilateral carpal tunnel syndrome requiring operation were selected for the study and the operative technique was randomized for the first hand. Six weeks later, the second hand was operated upon using the alternate technique. There was little difference between the two techniques with regard to time taken to return to work, return of grip strength, symptom relief, complications, incidence of pillar pain and patient preference. However, the incidence of scar tenderness was significantly lower with the Knifelight technique. PMID:15010154

  20. Carpal Tunnel Cross-Sectional Area Affected by Soft Tissues Abutting the Carpal Bones.

    PubMed

    Gabra, Joseph N; Li, Zong-Ming

    2013-02-01

    The carpal tunnel accommodates free movement of its contents, and the tunnel's cross-sectional area is a useful morphological parameter for the evaluation of the space available for the carpal tunnel contents and of potential nerve compression in the tunnel. The osseous boundary of the carpal bones as the dorsal border of the carpal tunnel is commonly used to determine the tunnel area, but this boundary contains soft tissues such as numerous intercarpal ligaments and the flexor carpi radialis tendon. The aims of this study were to quantify the thickness of the soft tissues abutting the carpal bones and to investigate how this soft tissue influences the calculation of the carpal tunnel area. Magnetic resonance images were analyzed for eight cadaveric specimens. A medical balloon with a physiological pressure was inserted into an evacuated tunnel to identify the carpal tunnel boundary. The balloon-based (i.e. true carpal tunnel) and osseous-based carpal tunnel boundaries were extracted and divided into regions corresponding to the hamate, capitate, trapezoid, trapezium, and transverse carpal ligament (TCL). From the two boundaries, the overall and regional soft tissue thicknesses and areas were calculated. The soft tissue thickness was significantly greater for the trapezoid (3.1±1.2mm) and trapezium (3.4±1.0mm) regions than for the hamate (0.7±0.3mm) and capitate (1.2±0.5mm) regions. The carpal tunnel area using the osseous boundary (243.0±40.4mm(2)) was significantly larger than the balloon-based area (183.9±29.7mm(2)) with a ratio of 1.32. In other words, the carpal tunnel area can be estimated as 76% (= 1/1.32) of the osseous-based area. The abundance of soft tissue in the trapezoid and trapezium regions can be attributed mainly to the capitate-trapezium ligament and the flexor carpi radialis tendon. Inclusion of such soft tissue leads to overestimations of the carpal tunnel area. Correct quantification of the carpal tunnel area aids in examining carpal

  1. Carpal Tunnel Cross-Sectional Area Affected by Soft Tissues Abutting the Carpal Bones

    PubMed Central

    Gabra, Joseph N.; Li, Zong-Ming

    2013-01-01

    The carpal tunnel accommodates free movement of its contents, and the tunnel's cross-sectional area is a useful morphological parameter for the evaluation of the space available for the carpal tunnel contents and of potential nerve compression in the tunnel. The osseous boundary of the carpal bones at the dorsal border of the carpal tunnel is commonly used to determine the tunnel area, but this boundary contains soft tissues such as numerous intercarpal ligaments and the flexor carpi radialis tendon. The aims of this study were to quantify the thickness of the soft tissues abutting the carpal bones and to investigate how this soft tissue influences the calculation of the carpal tunnel area. Magnetic resonance images were analyzed for eight cadaveric specimens. A medical balloon with a physiological pressure was inserted into an evacuated tunnel to identify the carpal tunnel boundary. The balloon-based (i.e., true carpal tunnel) and osseous-based carpal tunnel boundaries were extracted and divided into regions corresponding to the hamate, capitate, trapezoid, trapezium, and transverse carpal ligament (TCL). From the two boundaries, the overall and regional soft tissue thicknesses and areas were calculated. The soft tissue thickness was significantly greater for the trapezoid (3.1 ± 1.2 mm) and trapezium (3.4 ± 1.0 mm) regions than for the hamate (0.7 ± 0.3 mm) and capitate (1.2 ± 0.5 mm) regions. The carpal tunnel area using the osseous boundary (243.0 ± 40.4 mm2) was significantly larger than the balloon-based area (183.9 ± 29.7 mm2) with a ratio of 1.32. In other words, the carpal tunnel area can be estimated as 76% (= 1/1.32) of the osseous-based area. The abundance of soft tissue in the trapezoid and trapezium regions can be attributed mainly to the capitotrapezial ligament and the flexor carpi radialis tendon. Inclusion of such soft tissue leads to overestimations of the carpal tunnel area. Correct quantification of the carpal

  2. Personal and occupational factors associated with carpal tunnel syndrome.

    PubMed

    Cannon, L J; Bernacki, E J; Walter, S D

    1981-04-01

    This paper describes a case control study of the personal and environmental factors associated with the onset of carpal tunnel syndrome in workers at an aircraft engine manufacturing company. A comparison of 30 patients with carpal tunnel syndrome and 90 matched controls indicated that the use of vibratory hand tools and a history of gynecological surgery, specifically hysterectomy and oophorectomy, were strongly associated with the onset of carpal tunnel syndrome. PMID:7218063

  3. In the Clinic. Carpal Tunnel Syndrome.

    PubMed

    Kleopa, Kleopas A

    2015-09-01

    This issue provides a clinical overview of carpal tunnel syndrome, focusing on screening and prevention, diagnosis, and treatment. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers. PMID:26322711

  4. Screening for Carpal Tunnel Syndrome Using Sonography

    PubMed Central

    Roll, Shawn C.; Evans, Kevin D.; Li, Xiaobai; Freimer, Miriam; Sommerich, Carolyn M.

    2013-01-01

    Objectives The use of sonography in musculoskeletal research and clinical applications is increasing; however, measurement techniques for diagnosing carpal tunnel syndrome with sonography continue to be inconsistent. Novel methods of measurement using internal comparisons to identify swelling of the median nerve require investigation and comparison to currently used techniques. Methods The flattening ratio of the median nerve, bowing of the flexor retinaculum, and cross-sectional area of the median nerve were collected in the forearm, at the radio-carpal joint, and at the level of the pisiform in both symptomatic patients and asymptomatic control participants. Electrodiagnostic testing was completed in symptomatic patients as a diagnostic standard. Results Median nerve measurements were collected from 166 wrists of symptomatic and asymptomatic participants. The flattening ratio did not show any correlation to electrodiagnostic testing and was identical between both symptomatic and asymptomatic participants. Moderate to strong correlations were noted between electrodiagnostic testing results and sonographic measurements of the cross-sectional area at the pisiform, retinacular bowing, and both the ratio and change of the cross-sectional area between the forearm and pisiform. The area under the curve was large for all receiver operating characteristic curves for each measurement (0.759–0.899), and sensitivity was high (80.4%–82.4%). Conclusions Measurement of swelling through a ratio or absolute change had similar diagnostic accuracy as individual measurement of the cross-sectional area within the carpal tunnel. These measures may be useful for improving accuracy in more diverse clinical populations. Further refinement of protocols to identify the largest cross-sectional area within the carpal tunnel region and statistical methods to analyze clustered, multilevel outcome data are recommended to improve diagnostics. PMID:22124001

  5. Effects of static fingertip loading on carpal tunnel pressure

    NASA Technical Reports Server (NTRS)

    Rempel, D.; Keir, P. J.; Smutz, W. P.; Hargens, A.

    1997-01-01

    The purpose of this study was to explore the relationship between carpal tunnel pressure and fingertip force during a simple pressing task. Carpal tunnel pressure was measured in 15 healthy volunteers by means of a saline-filled catheter inserted percutaneously into the carpal tunnel of the nondominant hand. The subjects pressed on a load cell with the tip of the index finger and with 0, 6, 9, and 12 N of force. The task was repeated in 10 wrist postures: neutral; 10 and 20 degrees of ulnar deviation; 10 degrees of radial deviation; and 15, 30, and 45 degrees of both flexion and extension. Fingertip loading significantly increased carpal tunnel pressure for all wrist angles (p = 0.0001). Post hoc analyses identified significant increase (p < 0.05) in carpal tunnel pressure between unloaded (0 N) and all loaded conditions, as well as between the 6 and 12 N load conditions. This study demonstrates that the process whereby fingertip loading elevates carpal tunnel pressure is independent of wrist posture and that relatively small fingertip loads have a large effect on carpal tunnel pressure. It also reveals the response characteristics of carpal tunnel pressure to fingertip loading, which is one step in understanding the relationship between sustained grip and pinch activities and the aggravation or development of median neuropathy at the wrist.

  6. Effect of Wrist Posture on Carpal Tunnel Pressure while Typing

    PubMed Central

    Rempel, David M.; Keir, Peter J.; Bach, Joel M.

    2009-01-01

    Long weekly hours of keyboard use may lead to or aggravate carpal tunnel syndrome. The effects of typing on fluid pressure in the carpal tunnel, a possible mediator of carpal tunnel syndrome, are unknown. Twenty healthy subjects participated in a laboratory study to investigate the effects of typing at different wrist postures on carpal tunnel pressure of the right hand. Changes in wrist flexion/extension angle (p = 0.01) and radial/ulnar deviation angle (p = 0.03) independently altered carpal tunnel pressure; wrist deviations in extension or radial deviation were associated with an increase in pressure. The activity of typing independently elevated carpal tunnel pressure (p= 0.001) relative to the static hand held in the same posture. This information can guide the design and use of keyboards and workstations in order to minimize carpal tunnel pressure while typing. The findings may also be useful to clinicians and ergonomists in the management of patients with carpal tunnel syndrome who use a keyboard. PMID:18383144

  7. Subclinical carpal tunnel syndrome in patients with acute stroke

    PubMed Central

    Dahmardeh, Maryam; Dabiri, Soroosh

    2012-01-01

    Background Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients. Methods The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied. Results After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides. Conclusion The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients. PMID:24250872

  8. Narrowing carpal arch width to increase cross-sectional area of carpal tunnel – a cadaveric study

    PubMed Central

    Li, Zong-Ming; Gabra, Joseph N.; Marquardt, Tamara L.; Kim, Dong Hee

    2013-01-01

    Background Carpal tunnel morphology plays an essential role in the etiology and treatment of carpal tunnel syndrome. The purpose of this study was to observe the morphological changes of the carpal tunnel as a result of carpal arch width narrowing. It was hypothesized carpal arch width narrowing would result in increased height and area of the carpal arch. Methods The carpal arch width of eight cadaveric hands was narrowed by a custom apparatus and cross-sectional ultrasound images were acquired. The carpal arch height and area were quantified as the carpal arch width was narrowed. Correlation and regression analyses were performed for the carpal arch height and area with respect to the carpal arch width. Findings The carpal tunnel became more convex as the carpal arch width was narrowed. The initial carpal arch width, height, and area were 25.7 (SD 1.9) mm, 4.1 (SD 0.6) mm, and 68.5 (SD 14.0) mm2, respectively. The carpal arch height and area negatively correlated with the carpal arch width, with correlation coefficients of −0.974 (SD 0.018) and −0.925 (SD 0.034), respectively. Linear regression analyses showed a 1 mm narrowing of the carpal arch width resulted in proportional increases of 0.40 (SD 0.14) mm in the carpal arch height and 4.0 (SD 2.2) mm2 in the carpal arch area. Interpretation This study demonstrates that carpal arch width narrowing leads to increased carpal arch height and area, a potential mechanism to reduce the mechanical insult to the median nerve and relieve symptoms associated with carpal tunnel syndrome. PMID:23583095

  9. Carpal ligament decompression under local anaesthesia: the effect of lidocaine warming and alkalinisation on infiltration pain.

    PubMed

    Yiannakopoulos, C K

    2004-02-01

    This study investigated the effects of alkalinization and warming of lidocaine 1% on injection pain in patients undergoing carpal tunnel decompression. Sixty-four adult patients were randomly allocated into one of three groups: Group A (n=20) received plain lidocaine 1%, Group B (n=22) alkalinized lidocaine and Group C (n=22) warmed and alkalinized lidocaine. Pain on needle insertion and on infiltration was assessed using a 100mm Visual Analogue Scale (VAS). There was no significant difference regarding pain on needle insertion whereas significant differences were noted in reference to infiltration pain. In Groups B and C (alkalinized lidocaine) the VAS scores on skin infiltration were significantly lower than in Group A, while the pain score in Group C (alkalinized and warmed lidocaine) was significantly lower than in Group B. PMID:14734067

  10. [Carpal tunnel syndrome among supermarket cashiers].

    PubMed

    Bonfiglioli, R; Venturi, S; Graziosi, F; Fiorentini, C; Mattioli, S

    2005-01-01

    We studied Carpal Tunnel Syndrome prevalence in part time and full time female supermarket cashiers and in a control group (female primary school teachers). Subjects underwent a clinical examination in which information about personal, physiological, pathological and occupational factors were collected by a physician with a questionnaire and a self-administered Katz's hand diagram. The study protocol included median nerve conduction studies (NCS) for each worker, performed bilaterally according to the palmar technique described by J. Kimura. Case definition of Carpal Tunnel Syndrome was based on the combination of typical symptoms (classic/probable or possible) and electrodiagnostic findings according to the Consensus Criteria for the Classification of Carpal Tunnel Syndrome published by Rempel et al. in 1998. Biomechanical risk for upper limb was assessed by a group of trained observer using videotape and scales of hand activity level (HAL) and normalized peak of force (PF) proposed by the American Conference of Governmental Industrial Hygienists (ACGIH): supermarket cashier job tasks resulted on the threshold limit value line, confirming high biomechanical risk factors for CTS. Both symptoms and case prevalence resulted higher in supermarket cashiers than in control group and in full time cashiers if compared with part time ones. This difference between groups of part-/full-time cashiers could be due to total hours of exposure during the week and/or to the amount of recovery time between work sessions. Further longitudinal study could give more information about the role of different biomechanical risk factors in the onset of cumulative trauma disorders of the upper limb. PMID:15915683

  11. The relationship among five common carpal tunnel syndrome tests and the severity of carpal tunnel syndrome.

    PubMed

    Priganc, Victoria W; Henry, Sharon M

    2003-01-01

    The purpose of this research was to examine the relationship among clinical carpal tunnel syndrome (CTS) tests and the severity of CTS. A total of 66 subjects with electrodiagnostically confirmed CTS were tested on five CTS tests, then classified according to the severity of CTS. An association was found between testing positive on Phalen's test and the severity of CTS (p < 0.05). In contrast, no association was found between the severity of CTS and results on Tinel's sign, manual version of the carpal compression test (mCCT), Katz-Stirrat hand diagram, or carpal tunnel outcomes assessment tool. The more severe the CTS, the more likely one is to test positive on Phalen's test. Tinel's sign and the mCCT are not influenced by the severity of CTS. This study suggests that Tinel's sign and mCCT may not be useful in assessing the effectiveness of treatment. The Katz-Stirrat hand diagram and the carpal tunnel outcomes assessment tool are not influenced by the severity of CTS, indicating that numerous factors can influence a patient's response on subjective questionnaires. PMID:12943125

  12. Carpal tunnel syndrome caused by lipoma: a case report

    PubMed Central

    Sbai, Mohamed Ali; Benzarti, Sofien; Msek, Hichem; Boussen, Monia; Khorbi, Adel

    2015-01-01

    Lipoma is a relatively frequent, benign soft-tissue tumor rarely located in the hand. A lipoma of the hand causing a carpal tunnel syndrome by compression of the median nerve is exceptional. We report the case of a 70-year-old female presenting with a carpal tunnel syndrome. A compression of the median nerve by a lipoma was discovered during surgery. Transverse carpal ligament release with lipoma excision and neurolysis of the median nerve were performed. Histopathological study of the resected mass was consistent with a lipoma. Two-month postoperatively, the patient recovered full hand function with entire disappearance of acroparesthesia. Carpal tunnel syndrome caused by space occupying lesions is rare. Diagnosis is difficult, usually based on the clinical study, electrophysiology and magnetic resonance imaging (MRI). Transverse carpal ligament release and excision of lipoma provides excellent functional recovery. PMID:26664552

  13. Elliptical Morphology of the Carpal Tunnel Cross Section

    PubMed Central

    Gabra, Joseph N.; Kim, Dong Hee; Li, Zong-Ming

    2015-01-01

    Summary Although the carpal tunnel is known for its anatomical constituents, its morphology is not well recognized. The aim of this study was to investigate the morphometric properties of the carpal tunnel and its surrounding structures. Magnetic resonance, cross-sectional images of the distal carpal tunnel were collected from eight cadaveric hands. Morphological analyses were performed for the cross sections of the carpal tunnel, interior carpus boundary, and exterior carpus boundary. The specimens had a carpal arch width and height of 23.9 ± 2.9 mm and 2.2 ± 0.9 mm, respectively. The carpal tunnel, interior carpus boundary, and exterior carpus boundary had perimeters of 54.8 ± 4.5 mm, 68.5 ± 7.0 mm, and 130.6 ± 11.8 mm, respectively, and areas of 183.5 ± 30.1 mm2, 240.7 ± 40.2 mm2, and 1002.3 ± 183.7 mm2, respectively. The cross sections were characterized by elliptical fitting with aspect ratios of 1.96 ± 0.15, 1.96 ± 0.19, and 1.76 ± 0.19 for the carpal tunnel, interior carpus boundary, and exterior carpus boundary, respectively. The major axis of the boundaries increased in pronation angle, relative to the hamate-trapezium axis, for the exterior carpus (6.0 ± 3.0°), interior carpus (8.2 ± 3.2°), and carpal tunnel (15.9 ± 2.2°). This study advances our understanding of the structural anatomy of the carpal tunnel, and the morphological information is valuable in the identification of structural abnormality, assistance of surgical planning, and evaluation of treatment of effects. PMID:25949095

  14. The effect of transverse carpal ligament lengthening on carpal tunnel volumetry: a comparison between four techniques.

    PubMed

    Pavlidis, Leonidas; Chalidis, Byron E; Demiri, Efterpi; Dimitriou, Christos G

    2010-11-01

    Transverse carpal ligament (TCL) reconstruction after open carpal tunnel release has been advocated to restore wrist kinematics and grip strength. This study investigates the effect of TCL reconstruction in carpal tunnel volume (CTV). Thirty-eight cadaveric wrists were volarly approached and TCL was exposed to its proximal and distal edges. Carpal tunnel contents were removed and the CTV was measured considering that carpal tunnel resembled the shape of a truncated cone. TCL was then dissected and subsequently reconstructed by using 4 different surgical lengthening techniques. Three of these techniques were retrieved from the literature. The fourth was proposed and performed by the authors. Postreconstruction calculation of CTV was done with the same method. In 6 cadavers, a magnetic resonance imaging-based measurement of CTV was performed to assess the validity and reliability of simulation method. The average increase of CTV ranged from 31% to 44% (P < 0.001 for all techniques). However, no statistical significant difference was found between the 4 techniques (P = 0.097). Magnetic resonance imaging volumetric values were equal to simulation measured values before and after reconstruction of TCL (P = 0.224 and P = 0.674, respectively). Lengthening of TCL substantially increases the carpal tunnel capacity regardless the applied surgical technique. The simulation model method seems to be an accurate, precise, and cost-effective approach for the evaluation of CTV. PMID:20661126

  15. Carpal Tunnel Syndrome: The Risk to Educational Interpreters.

    ERIC Educational Resources Information Center

    Stedt, Joe D.

    1989-01-01

    This paper describes Carpal Tunnel Syndrome and its ramifications for sign language users, in particular, educational interpreters. Discussed are the syndrome's incidence, causes, diagnostic procedures, medical and surgical interventions, and prevention guidelines. (JDD)

  16. Neglected lunate dislocation presenting as carpal tunnel syndrome

    PubMed Central

    Cansü, Eren; Heydar, Ahmed Majid; Elekberov, Anar; Ünal, Mehmet Bekir

    2015-01-01

    Abstract Most of carpal tunnel syndrome cases are idiopathic, and secondary causes are so rare that can be easily missed. We present a patient with neglected undiagnosed lunate dislocation compressing on median nerve causing its signs and symptoms. PMID:27252962

  17. PROSPECTIVE COMPARATIVE STUDY BETWEEN PROXIMAL TRANSVERSE INCISION AND THE CONVENTIONAL LONGITUDINAL INCISIONS FOR CARPAL TUNNEL RELEASE

    PubMed Central

    Teixeira Alves, Marcelo de Pinho

    2015-01-01

    Carpal tunnel syndrome (CTS) is a pathological condition frequently seen in orthopedic consultation offices. It is most common compressive neuropathy and also the one most often treated surgically. CTS is usually diagnosed clinically, through the clinical history, physical examination (Tinel, Phalen and Durkan tests) and complementary examinations, and more specifically, nerve conduction studies. Ultrasound scans and magnetic resonance imaging may also be used. Conservative treatment is reserved for patients presenting with mild symptoms, with little incapacitation, who show good response to non-steroidal or steroidal anti-inflammatory drugs, physiotherapy and lifestyle changes. Surgical treatment is more frequent, and a variety of techniques are used. The goal of the surgery is to decompress the carpal tunnel and, by sectioning the transverse carpal ligament, release the median nerve. The aim of this paper was to compare surgical treatment of CTS by means of a transverse mini-incision made proximally to the carpal canal, with the classic longitudinal incision over the carpal canal. The mini-incision technique was shown to be less invasive and equally effective for treating CTS, with less morbidity than with the classic longitudinal incision. PMID:27022592

  18. Area and shape changes of the carpal tunnel in response to tunnel pressure.

    PubMed

    Li, Zong-Ming; Masters, Tamara L; Mondello, Tracy A

    2011-12-01

    Carpal tunnel mechanics is relevant to our understanding of median nerve compression in the tunnel. The compliant characteristics of the tunnel strongly influence its mechanical environment. We investigated the distensibility of the carpal tunnel in response to tunnel pressure. A custom balloon device was designed to apply controlled pressure. Tunnel cross sections were obtained using magnetic resonance imaging to derive the relationship between carpal tunnel pressure and morphological parameters at the hook of hamate. The results showed that the cross-sectional area (CSA) at the level of the hook of hamate increased, on average, by 9.2% and 14.8% at 100 and 200 mmHg, respectively. The increased CSA was attained by a shape change of the cross section, displaying increased circularity. The increase in CSA was mainly attributable to the increase of area in the carpal arch region formed by the transverse carpal ligament. The narrowing of the carpal arch width was associated with an increase in the carpal arch. We concluded that the carpal tunnel is compliant to accommodate physiological variations of the carpal tunnel pressure, and that the increase in tunnel CSA is achieved by increasing the circularity of the cross section. PMID:21608024

  19. Medical surveillance for carpal tunnel syndrome in workers.

    PubMed

    Bleecker, M L

    1987-09-01

    Carpal canal size was examined as a risk factor associated with carpal tunnel syndrome in the workplace. Seven of 14 electricians had symptoms of carpal tunnel syndrome. When cross-sectional areas were measured by computed tomography (CT), affected workers had a cross-sectional area of 1.75 +/- 0.21 cm2; control values were 2.53 +/- 0.15 cm2 (p less than 0.05). Subjects with a subclinical syndrome had an area of 1.83 +/- 0.22 cm2, which was similar to the group with symptoms. Wrist circumference was not a predictor of the smallest carpal canal area. Unusual bony and soft tissue structures within the carpal canal were easily identified with CT. PMID:3655258

  20. The role of proteoglycans in idiopathic carpal tunnel syndrome.

    PubMed

    Tucci, Michelle; Freeland, Alan; Mohamed, Adel; Benghuzzi, Ham

    2005-01-01

    Decompression of the carpal canal is the most common hand surgery performed in the United States. Hand surgeons perform 460,000 carpal tunnel releases (CTR) each year, which cost the medical industry in excess of two billion dollars per year. The focus of this investigation was to identify the changes, which occur in the flexor tenosynovium of patients undergoing CTR at the connective tissue level. The connective tissues determine the amount and arrangement of macromolecules (fibers, proteoglycans, and glycoproteins) in the extracellular matrix. The proteoglycans are soluble macromolecules that have both structural and metabolic roles. Glycoproteins help to form the interstitial space, basement membrane and function as cell surface receptors. The mechanical function of the proteoglycans includes stabilization of the collagen fibers as well as function in the hydration of the tissues. It has been previous shown that changes in the oxygen concentration at the tissue level can alter the proteoglycans profile of the tissue. During periods of hypoxia, such as those obtained during repetitive motion CTS; the glycolytic pathway acts as the energy source for the tissue. Productions of chondroitin sulfates are a process consumes NAD and would be potentially toxic to the cells under anaerobic conditions. Production of keratan sulfate is NAD sparing product, and may act as a survival pathway for cells under adverse conditions. The disruption in the proteoglycan balance will allow for alterations in the ECM and changes in hydration status of the tissues may have serious implication in CTS because the carpal canal is anatomically very narrow and increases in volume within the canal can result in further compression of the nerve. Flexor tenosyioum was obtained from patients undergoing CTR and compared with control tissue for dermatan, keratan and chondroitin sulfate. The results show a greater density of keratan reactivity in CTS tissues identified by immunostaining. In addition

  1. Vascular factors in carpal tunnel syndrome.

    PubMed

    Boland, Robert A; Adams, Roger D

    2002-01-01

    An increase in hand and forearm volume was induced without hand movement in ten subjects who had carpal tunnel syndrome (CTS). A tester, unaware of sides affected by CTS, performed the Volume Provocation Test (VPT) by inflating a sphygmomanometer cuff around the upper arm to 15 mm Hg less than diastolic pressure for four minutes. Pre- and post-test volumes, intensity of discomfort, and quality and distribution of produced symptoms were recorded. The VPT induced significant increases of segment volumes bilaterally (P1 tailed <0.05), but not more on the side of strongest symptoms compared to the less affected, or asymptomatic side (P1 tailed = 0.07). Mean discomfort on the side of strongest symptoms (5.4/10) was significantly higher (P1 tailed <0.01) than on the contralateral side (2.4/10). In 44% of the affected arms, some or all of the subjects' nocturnal symptoms were reproduced after volume increase, suggesting that CTS is a vascular phenomenon in these patients. PMID:11866348

  2. Carpal Tunnel Syndrome Caused by Space Occupying Lesions

    PubMed Central

    Kang, Ho Jung; Yoon, Hong Ki; Hahn, Soo Bong; Kim, Sung Jae

    2009-01-01

    Purpose To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). Materials and Methods Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. Results The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. Conclusion In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary. PMID:19430560

  3. Carpal tunnel syndrome, syndrome of partial thenar atrophy, and W. Russell Brain: a historical perspective.

    PubMed

    Boskovski, Marko T; Thomson, J Grant

    2014-09-01

    This article presents the history of the discovery of compression of the median nerve in the carpal tunnel without an identifiable cause as a distinct clinical entity. By analyzing primary sources, we show that, at the beginning of the twentieth century, physicians described patients with paresthesias and numbness in the hands, most prominent at night, accompanied by bilateral symmetrical atrophy along the radial side of thenar eminence. At the time, the 2 most influential hypotheses regarding etiology were, first, compression of the lower trunk of the brachial plexus by a cervical or first rib, and second, compression of the thenar branch of the median nerve as it passes beneath the anterior annular ligament of the wrist. The condition was named syndrome of partial thenar atrophy and was considered a distinct clinical entity. In 1946, after extensive analysis, neurologist Walter Russell Brain concluded that both sensory and motor symptoms of the syndrome were caused by "compression neuritis" of the median nerve in the carpal tunnel. At his suggestion, surgeon Arthur Dickson Wright performed decompression of the nerve by "an incision of the carpal ligament," with excellent results. Brain presented this work at the Royal Society of Medicine in London in 1946 and published his landmark paper in Lancet the following year. In so doing, he established the basis for the disease we know today as idiopathic carpal tunnel syndrome. Unfortunately, in 1947, Brain did not realize that another "condition" with the same clinical picture but without atrophy of the thenar muscles, known as acroparesthesia at the time, was actually the same disease as syndrome of partial thenar atrophy, but of lesser severity. As a result of Brain's influence, 7 other papers were published by 1950. Between 1946 and 1950, there were at least 10 papers that presented, in total, 31 patients (26 women) who exhibited symptoms of compression of the median nerve without an identifiable cause and underwent

  4. Atypical Carpal Tunnel Syndrome in a Holt Oram Patient: A Case Report and Literature Review

    PubMed Central

    Mace, James; Reddy, Srikanth; Mohil, Randeep

    2014-01-01

    We present a case report of a patient diagnosed with Holt-Oram syndrome (HOS) presenting with clinical and electrophysiologically confirmed carpal tunnel syndrome. Pre-operative Magnetic resonance imaging revealed an abnormal course of the median nerve; as such an atypical incision and approach were carried out to decompress the nerve to excellent post operative clinical effect. To our knowledge this is the first description of abnormal nervous course in a patient with HOS leading to peripheral entrapment. A literature surrounding the important aspects of HOS to the orthopaedic surgeon is presented concomitantly. PMID:25621081

  5. Acute Carpal Tunnel Syndrome: A Review of Current Literature.

    PubMed

    Gillig, Jonathan D; White, Stephen D; Rachel, James Nicholas

    2016-07-01

    Acute carpal tunnel syndrome is a progressive median nerve compression leading to loss of two-point discrimination. Most cases encountered are in the emergency department following wrist trauma and distal radius fractures. Although rare, atraumatic etiologies have been reported and diligent evaluation of these patients should be performed. If missed or neglected, irreversible damage to the median nerve may result. Once diagnosed, emergent carpal tunnel release should be performed. If performed in a timely manner outcomes are excellent, often with complete recovery. PMID:27241382

  6. A vertical mouse and ergonomic mouse pads alter wrist position but do not reduce carpal tunnel pressure in patients with carpal tunnel syndrome.

    PubMed

    Schmid, Annina B; Kubler, Paul A; Johnston, Venerina; Coppieters, Michel W

    2015-03-01

    Non-neutral wrist positions and external pressure leading to increased carpal tunnel pressure during computer use have been associated with a heightened risk of carpal tunnel syndrome (CTS). This study investigated whether commonly used ergonomic devices reduce carpal tunnel pressure in patients with CTS. Carpal tunnel pressure was measured in twenty-one patients with CTS before, during and after a computer mouse task using a standard mouse, a vertical mouse, a gel mouse pad and a gliding palm support. Carpal tunnel pressure increased while operating a computer mouse. Although the vertical mouse significantly reduced ulnar deviation and the gel mouse pad and gliding palm support decreased wrist extension, none of the ergonomic devices reduced carpal tunnel pressure. The findings of this study do therefore not endorse a strong recommendation for or against any of the ergonomic devices commonly recommended for patients with CTS. Selection of ergonomic devices remains dependent on personal preference. PMID:25479984

  7. Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review

    PubMed Central

    Senger, Jenna-Lynn; Classen, Dale; Bruce, Garth; Kanthan, Rani

    2014-01-01

    A three-year-old boy was investigated for inexplicable incessant crying. On examination, his left wrist was mildly swollen (three to four months) and sensitive. Exploration and carpal tunnel decompression of the left wrist with incisional biopsy was performed for the presence of a fusiform swelling intimately associated with the median nerve. Histopathology revealed the presence of enlarged nerve bundles admixed with mature fat cells and diffuse fibroblastic proliferation. Three months later, he underwent urgent contralateral carpal tunnel decompression for a similar presentation. The final diagnosis was bilateral fibrolipomatous hamartoma (FLH) of the median nerves causing acute bilateral compression neuropathy. FLH of the median nerve is an extremely unusual cause of acute bilateral carpal tunnel syndrome in a young child presenting with ‘incessant crying’. A comprehensive review of FLH including epidemiology, etiology, clinical presentation, differential diagnosis, imaging, pathology, treatment and prognosis is discussed. PMID:25332651

  8. Prevalence of Carpal Tunnel Syndrome among Individuals with Down Syndrome.

    ERIC Educational Resources Information Center

    Christensen, Jens Erik Just; Peter, Peter Johannsen; Nielsen, Viggo Kamp; Mai, Jesper

    1998-01-01

    Forty-eight patients with Down syndrome were examined clinically and electrophysiologically for occurrence of carpal tunnel syndrome. Twenty-seven patients had normal findings, 13 had prolonged distal motor latency and reduced distal nerve conduction velocity, and 8 patients had one of these signs. Results show that prevalence of…

  9. Carpal tunnel and transverse carpal ligament stiffness with changes in wrist posture and indenter size.

    PubMed

    Holmes, Michael W R; Howarth, Samuel J; Callaghan, Jack P; Keir, Peter J

    2011-11-01

    This study investigated the effects of loading and posture on mechanical properties of the transverse carpal ligament (TCL). Ten fresh-frozen cadaver arms were dissected to expose the TCL and positioned in the load frame of a servo-hydraulic testing machine, equipped with a load cell and custom made indenters. Four cylindrical indenters (5, 10, 20, and 35 mm) loaded the TCL in three wrist postures (30° extension, neutral and 30° flexion). Three loading cycles with a peak force of 50 N were applied at 5 N/s for each condition. The flexed wrist posture had significantly greater TCL stiffness (40.0 ± 3.3 N/mm) than the neutral (35.9 ± 3.5 N/mm, p = 0.045) and extended postures (34.9 ± 2.8 N/mm, p = 0.025). TCL stiffness using the 10 and 20 mm indenters was larger than the 5 mm indenter. Stiffness was greatest with the 20 mm indenter, which had the greatest indenter contact area on the TCL. The 35 mm indenter covered the carpal bones, compressed the carpal tunnel and produced the lowest stiffness. The complexity of the TCL makes it an important part of the carpal tunnel and the mechanical properties found are essential to understanding mechanisms of carpal tunnel syndrome.  PMID:21520261

  10. Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers*

    PubMed Central

    Castro, Adham do Amaral e; Skare, Thelma Larocca; Nassif, Paulo Afonso Nunes; Sakuma, Alexandre Kaue; Barros, Wagner Haese

    2015-01-01

    Objective To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations. Materials and Methods Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome. Results Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel’s test (p < 0.0001), Phalen’s test (p < 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24). Conclusion The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome. PMID:26543279

  11. Mechanical behavior of carpal tunnel subsynovial connective tissue under compression.

    PubMed

    Goetz, Jessica E; Baer, Thomas E

    2011-01-01

    Subsynovial connective tissue (SSCT) is a fluid-permeated loose connective tissue that occupies the majority of the space in the carpal tunnel not occupied by the digital flexor tendons or the median nerve. It is arranged in layers around these more discrete structures, presumably to assist with tendon gliding. As a result of this arrangement, the compressive behavior and the fluid permeability of this tissue may substantially affect the stresses in the median nerve resulting from contact with its neighboring tendons or with the walls of the tunnel itself. These stresses may contribute to damage of the median nerve and the development of carpal tunnel syndrome. In this study, the fluid permeability and the compressive behavior of the SSCT were investigated to better understand the mechanics of this tissue and how it may mediate mechanical insult to the median nerve. A custom experimental apparatus was built to allow simultaneous measurement of tissue compression and fluid flow. Using Darcy's law, the average SSCT fluid permeability was 8.78×10(15) m(4)/Ns. The compressive behavior of the SSCT demonstrated time dependence, with an initial modulus of 395kPa gradually decreasing to a value of 285kPa. These baseline tissue data may serve as a mechanical norm (toward which pathological tissue might be returned, therapeutically) and may serve as essential properties to include in future mechanical models of the carpal tunnel. PMID:22096431

  12. MECHANICAL BEHAVIOR OF CARPAL TUNNEL SUBSYNOVIAL CONNECTIVE TISSUE UNDER COMPRESSION

    PubMed Central

    Goetz, Jessica E; Baer, Thomas E

    2011-01-01

    Subsynovial connective tissue (SSCT) is a fluid-permeated loose connective tissue that occupies the majority of the space in the carpal tunnel not occupied by the digital flexor tendons or the median nerve. It is arranged in layers around these more discrete structures, presumably to assist with tendon gliding. As a result of this arrangement, the compressive behavior and the fluid permeability of this tissue may substantially affect the stresses in the median nerve resulting from contact with its neighboring tendons or with the walls of the tunnel itself. These stresses may contribute to damage of the median nerve and the development of carpal tunnel syndrome. In this study, the fluid permeability and the compressive behavior of the SSCT were investigated to better understand the mechanics of this tissue and how it may mediate mechanical insult to the median nerve. A custom experimental apparatus was built to allow simultaneous measurement of tissue compression and fluid flow. Using Darcy’s law, the average SSCT fluid permeability was 8.78×1015 m4/Ns. The compressive behavior of the SSCT demonstrated time dependence, with an initial modulus of 395kPa gradually decreasing to a value of 285kPa. These baseline tissue data may serve as a mechanical norm (toward which pathological tissue might be returned, therapeutically) and may serve as essential properties to include in future mechanical models of the carpal tunnel. PMID:22096431

  13. Sonographic Appearance of the Median Nerve Following Revision Carpal Tunnel Surgery

    PubMed Central

    Shapiro, Shane A; Alkhamisi, Ashkan; Pujalte, George G A

    2016-01-01

    The main objective of this pictorial essay is to illustrate the sonographic appearance of the postoperative carpal tunnel and median nerve. Carpal tunnel surgical treatment failures have been shown to occur in up to 19% of a large series requiring re-exploration. Surgical management options for recurrent carpal tunnel syndrome (CTS) include revision release, neurolysis, vein wrapping, and fat grafting procedures. While several descriptions of median nerve entrapment in CTS exist in the ultrasound literature, little is written regarding its postoperative appearance. We report the sonographic changes in the appearance of the median nerve and postoperative carpal tunnel. PMID:27195177

  14. [Carpal tunnel syndrome in children with mucopolysaccharidosis type 1H: diagnosis and therapy in an interdisciplinary centre].

    PubMed

    Meyer-Marcotty, M V; Kollewe, K; Dengler, R; Grigull, L; Altintas, M A; Vogt, P M

    2012-01-01

    Carpal tunnel syndrome is common in children with mucopolysaccharidosis type 1H (MPS type 1H). Clinical signs of carpal tunnel syndrome are frequently absent in these children and it is often very difficult to perform and interpret neurophysiological investigations. In this article we wish to present our experience and results regarding the diagnosis and postoperative results after decompression of the median nerve.In an interdisciplinary set-up we are currently treating 11 MPS type 1H children following blood stem cell transplantation. 7 patients were operated 12 times (5 bilateral operations) because of a carpal tunnel syndrome (age at the time of operation 83,3 months, (43-143 months), 2 male, 5 female). 6 patients had a follow up after 23,7 months (9-59 months). 6 patients had a histological analysis of the flexor retinaculum. Three patients had a postoperative neurophysiological investigation.Each of the operated patients had at least 1 preoperative clinical sign of a carpal tunnel syndrome. We found at least 1 pathological finding in motor and sensory nerve conduction studies in each patient. 6 of the 7 children operated on were symptom-free at postoperative follow-up. 1 of the 3 patients with a postoperative neurophysiological follow up showed a deterioration of the nerve conduction studies. This patient was free of symptoms postoperatively. Biopsy of the flexor retinaculum confirmed abundant proteoglycan deposition. We had neither postoperative complications nor were revisional operations necessary.The Diagnosis of a carpal tunnel syndrome in children with MPS Typ 1H needs a thorough medical history, the correct interpretation of the clinical symptoms and sophisticated nerve conduction studies. Wether the improvement of the postoperative clinical situation lasts has to be evaluated in a long term investigation especially because in one patient in our group we saw a deterioration of the nerve conduction studies postoperatively. PMID:22382905

  15. Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy.

    PubMed

    Hunter, J M

    1991-08-01

    This article has reviewed recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy of the median nerve. The problems surrounding the diagnosis and treatment of recurrent CTS have been discussed at length. The percent of failures from traditional open ligament surgery is observed to be high, and will become more prevalent as more casual treatments are carried out. This article makes a positive statement with reference to mobilization of the median nerve and anatomic restoration of the transverse carpal ligament. Fibrous fixation of the median nerve is a product of life and function. All cases are different, reflecting the strength, abilities, and personalities of the patients. A bottom line is drawn on these patients, where the summation of the problems of life become symptomatic and disabling. Epineural fibrous fixations induce median nerve traction, governed by hand, wrist, and forearm movements. Traction and tension suggest the intermittent disturbance of nerve nutrition and nerve conduction as the elastic limits of the nerve are approached. These factors accumulate and, in time, cause traction neuropathies with pain. This is followed by a reduced work capability. This impairment can be reversed by surgical nerve mobilization followed by functional nerve gliding therapy. A background history injury to the hand and wrist may be significant, as well as factors such as overuse and misuse of the hand and extremity. Prior to surgery, the careful application of diagnostic stress tests are essential, for the differential diagnosis of fixation traction and positional peripheral neuropathies. Nerve mobilization supported by magnification and the techniques of hand surgery has been successful by the methods discussed and has permitted, importantly, the restoration of the anatomic retinaculum for the flexor tendon system. This can be restored in carpal tunnel surgery and reconstructed with basic ligament material in recurrent carpal tunnel

  16. Efficacy of high frequency ultrasound in postoperative evaluation of carpal tunnel syndrome treatment

    PubMed Central

    Urbanik, Andrzej

    2016-01-01

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leave because of work-related hand overload. The main treatment is operation. Aim The aim of the study is to assess the usefulness of high frequency ultrasound in the postoperative evaluation of CTS treatment efficacy. Material and methods Sixty-two patients (50 women and 12 men aged 28–70, mean age 55.2) underwent surgical treatment of CTS. Ultrasound examinations of the wrist in all carpal tunnel sufferers were performed 3 months after the procedure with the use of a high frequency broadband linear array transducer (6–18 MHz, using 18 MHz band) of MyLab 70/Esaote. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging for postoperative evaluation of CTS treatment efficacy. Results Among all 62 patients, 3 months after surgical median nerve decompression: in 40 patients, CTS symptoms subsided completely, and sonographic evaluation did not show median nerve entrapment signs; in 9 patients, CTS symptoms persisted or exacerbated, and ultrasound proved nerve compression revealing preserved flexor retinaculum fibers; in 13 patients, scar tissue symptoms occurred, and in 5 of them CTS did not subside completely (although ultrasound showed no signs of compression). Conclusions Ultrasound imaging with the use of a high frequency transducer is a valuable diagnostic tool for postoperative assessment of CTS treatment efficacy. PMID:27103999

  17. [Capitate Non-Union: One of the Causes of Carpal Tunnel Syndrome].

    PubMed

    Stocker, R L; Macheiner, A

    2016-06-01

    We report on a carpal tunnel syndrome in a 50-year-old woman, presumably caused in part by a 35-year-old asymptomatic capitate non-union. The carpal tunnel was released and a large exostosis removed. 3 weeks after the operation the patient was free of symptoms. PMID:26053562

  18. Melorheostosis of the hand affecting the c6 sclerotome and presenting with carpal tunnel syndrome.

    PubMed

    Abdullah, Shalimar; Mat Nor, Noreen Fazlina; Mohamed Haflah, Nor Hazla

    2014-04-01

    Melorheostosis is a rare, progressive bone disease accompanied by hyperostosis and soft tissue fibrosis. While affected adults present with contracture and pain, children present with limb length discrepancy and deformity. We report the case of a 20-year-old woman with melorheostosis since childhood who presented with right hand deformity and numbness. Radiographs showed not only a combination of dense sclerosis and opacities, but also the classic 'flowing candle wax' appearance. Radiography can be used to identify melorheostosis, thus preventing unnecessary bone biopsies. Carpal tunnel release revealed the presence of a thickened flexor retinaculum and a degenerated median nerve distal to the retinaculum, but did not show hyperostosis. This case highlights the role of nerve decompression in melorheostosis and the importance of early identification of the disease to prevent unnecessary bone biopsies. PMID:24763843

  19. Does aging matter? The efficacy of carpal tunnel release in the elderly.

    PubMed

    Fung, Bettina Wai Yan; Tang, Chris Yuk Kwan; Fung, Boris Kwok Keung

    2015-05-01

    Open release remains the gold standard in the treatment of carpal tunnel syndrome in cases where conservative treatment fails. However, the efficacy of carpal tunnel release in the elderly has been debated in the literature throughout the years. This review aims to review the current evidence pertaining to the efficacy of carpal tunnel release in the elderly. Based on the current evidence, the outcome of carpal tunnel release is unpredictable in the elderly. Elderly patients are also less satisfied with the operation compared to younger patients. The authors recommend that these messages be conveyed to elderly patients before surgery. Moreover, open carpal tunnel release should be offered in the early stages of treatment whenever operative management is indicated. PMID:26015881

  20. Validation of a diagnostic sign in carpal tunnel syndrome.

    PubMed Central

    Pryse-Phillips, W E

    1984-01-01

    Of three signs in carpal tunnel syndrome, Phalen's, Tinel's and the Flick sign, the last of these was the most valid and reliable. The presence of a positive Flick sign predicted electrodiagnostic abnormality in 93% of cases and had a false positive rate of under 5% among other neural lesions in the arm. The key question consists of an enquiry as to what the patient does with the affected hand at times when symptoms are at their worst; a flicking movement of the wrist and fingers demonstrated by the patient constitutes a positive response. Images PMID:6470728

  1. Carpal tunnel syndrome severity staging using sonographic and clinical measures

    PubMed Central

    Roll, Shawn C.; Volz, Kevin R.; Fahy, Christine M.; Evans, Kevin D.

    2014-01-01

    Introduction Ultrasonography may be valuable in staging carpal tunnel syndrome severity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinical measures. Methods Measures were obtained in 104 participants. Multiple categorization structures for each variable were correlated to diagnostic severity based on nerve conduction. Goodness-of-fit was evaluated for models using iterative combinations of highly correlated variables. Using the best-fit model, a preliminary scoring system was developed, and frequency of misclassification was calculated. Results The severity staging model with best fit (Rho 0.90) included patient-reported symptoms, functional deficits, provocative testing, nerve cross-sectional area, and nerve longitudinal appearance. An 8-point scoring scale classified severity accurately for 79.8% of participants. Discussion This severity staging model is a novel approach to carpal tunnel syndrome evaluation. Including more sensitive measures of nerve vascularity, nerve excursion, or other emerging techniques may refine this preliminary model. PMID:25287477

  2. Occupational carpal tunnel syndrome in Washington State, 1984-1988.

    PubMed Central

    Franklin, G M; Haug, J; Heyer, N; Checkoway, H; Peck, N

    1991-01-01

    BACKGROUND: There are no published population-based studies of occupational carpal tunnel syndrome (OCTS) using a strict case definition. Most studies are either industry specific or present patient self-report of symptoms. METHODS: We conducted a population-based incidence study of OCTS using the Washington State Workers' Compensation database. Incident OCTS claims were identified with paid bills for physician reported ICD codes 354.0 and 354.1. RESULTS: There were 7,926 incident OCTS claims identified for the years 1984-1988, which yields an industry-wide incidence rate of 1.74 claims/1,000 FTEs. The mean age (37.4 years) and female/male ratio (1.2:1) in this population differ from those reported in nonoccupational carpal tunnel studies (mean age, 51 years; female/male ratio, 3:1). The female-specific OCTS incidence rate increased significantly during the study period. The highest industry specific OCTS rates were found in the food processing, carpentry, egg production, wood products, and logging industries. CONCLUSION: Demographic differences and industry-specific rates consistent with workplace exposures suggest that OCTS is distinct from CTS occurring in nonoccupational settings. Workers' compensation data proved useful in identifying high risk industries. PMID:1827570

  3. Familial carpal tunnel syndrome: a report of a Finnish family.

    PubMed

    Mahjneh, I; Saarinen, A; Siivola, J

    2001-12-01

    The existence of familial carpal tunnel syndrome (FCTS) as a separate autonomic entity has been discussed during the last few years. In order to contribute with more data to the literature, we report here the results of clinical. electrophysiological, pathological and radiological studies performed in 5 patients belonging to the same Finnish pedigree. The disease appeared usually before the second decade with numbness and pain on the I--III digits. In most patients symptoms were unilateral but within 2 years they became bilateral. In all patients typical electrophysiological features of median nerve entrapment have been recorded. X-rays of the wrist showed narrow carpal tunnel in all patients. In all patients the possibility of having HNPP as well as familial amyloidosis has been excluded by molecular genetic and pathological studies. All patients underwent surgery and at postoperative stage symptoms were relieved or completely disappeared. Our study supports the theory that FCTS exists as a separate autonomic entity, therefore it is important in front of a sporadic case to investigate the family occurrence of CTS. PMID:11903093

  4. Changes in Clinical Symptoms, Functions, and the Median Nerve Cross-Sectional Area at the Carpal Tunnel Inlet after Open Carpal Tunnel Release

    PubMed Central

    Koh, Young-Do; Kim, Jong Oh; Choi, Shin Woo

    2016-01-01

    Background The aim of this study was to investigate the relationship between clinical symptoms and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet before and after open carpal tunnel release (CTR). Methods Thirty-two patients (53 hands) that underwent open CTR for idiopathic carpal tunnel syndrome were prospectively enrolled. Median nerve CSA at the carpal tunnel inlet was measured preoperatively and at 2 and 12 weeks after CTR by high resolution ultrasonography. The Boston carpal tunnel questionnaire (BCTQ) was also completed at these times. Results BCTQ symptom (BCTQ-S) score was significantly improved at 2 weeks postoperatively, but BCTQ function (BCTQ-F) score and CSA were significantly improved at 12 weeks postoperatively. Preoperative CSA was significantly correlated with preoperative BCTQ-S and BCTQ-F scores but was not significantly correlated with postoperative BCTQ scores or postoperative changes in BCTQ scores. Postoperative median nerve CSA was not significantly correlated with postoperative BCTQ-S or BCTQ-F scores, and postoperative changes in median nerve CSA were not significantly correlated with postoperative changes in BCTQ-S or BCTQ-F scores. Conclusions The study shows clinical symptoms resolve rapidly after open CTR, but median nerve swelling and clinical function take several months to recover. In addition, preoperative median nerve swelling might predict preoperative severities of clinical symptoms and functional disabilities. However, postoperative reductions in median nerve swelling were not found to reflect postoperative reductions in clinical symptoms or functional disabilities. PMID:27583113

  5. Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity

    PubMed Central

    Smith, Bryan; Wright, Sean; Weiner, Mark; Wright, Kevin; Rubin, David

    2014-01-01

    Purpose To examine the prevalence, onset, and risk factors of carpal tunnel syndrome during pregnancy. Methods Maternal electronic medical records were linked to birth certificate records using social security number. The outcome of carpal tunnel syndrome during pregnancy was defined as ICD9 code 354.0 given at a prenatal visit. Chi-square, t-test, and adjusted logistic regression were performed. Results We analyzed 17,623 prenatal visits from the Hospital of the University of Pennsylvania from 1/2003–12/2007. Mean maternal age was 26.4 (6.5) years, with 21% white, 69% black, and 46% overweight or obese. Ninety-one (2.8%) mothers participated in 765 prenatal visits given a carpal tunnel syndrome diagnosis code. Compared to mothers without carpal tunnel syndrome, mothers with carpal tunnel syndrome were older (29.72 (5.42) versus 26.04 (6.37) years, p = 0.005), gained more weight during pregnancy (40.65 (10.13) pounds versus 34.2 (9.41) pounds, p = 0.04), and more likely to have college education (69.9% versus 44.5%, p = 0.03). Average onset (SD) of carpal tunnel syndrome was 18.1 (8.4) weeks’ gestation. Conclusion Mothers with carpal tunnel syndrome had high rates of overweight, obesity, and excessive gestational weight gain. Diagnosis of carpal tunnel syndrome was rare but often occurred in the first and second trimesters, earlier than the frequently reported third trimester onset seen in literature. When looking at predictors of carpal tunnel syndrome, obese prepregnancy body mass index (BMI ≥ 30 kg/m2) and excessive gestational weight gain, greater than two previous live births, higher level of maternal education and more prenatal care (>10 visits) were associated with increased risk of carpal tunnel syndrome. Higher maternal age was not associated with carpal tunnel syndrome diagnosis after adjusting for weight and parity, suggesting mediation by these covariates.

  6. Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

    PubMed Central

    Malahias, Michael Alexander; Johnson, Elizabeth O.; Babis, George C.; Nikolaou, Vasileios S.

    2015-01-01

    Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1–2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome. PMID:26807124

  7. The sectional anatomy of the carpal tunnel and its related neurovascular structures studied by using plastination.

    PubMed

    Sora, M-C; Genser-Strobl, B

    2005-05-01

    The aim of this study was to evaluate the morphology of the carpal tunnel and its related neurovascular structures. A slice anatomy study was performed on 12 right wrists of unfixed human cadavers by using the plastination technique. The measurements were performed at the level of the pisiform, hook of the hamate and in the middle between these structures. The diameters of the carpal tunnel and the median nerve were measured at the level of the hook of the hamate. The median nerve can be predicted to be 18 +/- 1.6 mm radial to the pisiform and the ulnar neurovascular bundle 6.8 +/- 1.4 mm radial to the pisiform. Between those structures there will be at least a 9-mm area, localized 8 mm radial to the pisiform, where the incision of the transverse carpal ligament could be performed risk-free. At the hamate hook the median nerve can be predicted at 9.24 +/- 1.18 mm and the ulnar artery lies usually 1.26 +/- 2.5 mm radial to the hook. An understanding of the contents and their positions, and relationships to each other allows an accurate identification of neurovascular structures in the carpal tunnel. Our findings can be used as anatomic landmarks of the carpal tunnel and could be helpful to physicians performing carpal tunnel investigations. PMID:15804269

  8. Reliability Assessment of Various Sonographic Techniques for Evaluating Carpal Tunnel Syndrome.

    PubMed

    Junck, Anthony D; Escobedo, Eva M; Lipa, Bethany M; Cronan, Michael; Anthonisen, Colleen; Poltavskiy, Eduard; Bang, Heejung; Han, Jay J

    2015-11-01

    Objectives-The aim of this study was to determine the intra- and inter-rater reliability of sonographic measurements of the median nerve cross-sectional area in individuals with carpal tunnel syndrome and healthy control participants.Methods-The median nerve cross-sectional area was evaluated by sonography in 18 participants with carpal tunnel syndrome (18 upper extremities) and 9 control participants (18 upper extremities) at 2 visits 1 week apart. Two examiners, both blinded to the presence or absence of carpal tunnel syndrome, captured independent sonograms of the median nerve at the levels of the carpal tunnel inlet, pronator quadratus, and mid-forearm. The cross-sectional area was later measured by each examiner independently. Each also traced images that were captured by the other examiner.Results-Both the intra- and inter-rater reliability rates were highest for images taken at the carpal tunnel inlet (radiologist, r = 0.86; sonographer, r = 0.87; inter-rater, r = 0.95; all P < .0001), whereas they was lowest for the pronator quadratus (r = 0.49, 0.29, and 0.72, respectively; all P < .0001). At the mid-forearm, the intra-rater reliability was lower for both the radiologist and sonographer, whereas the inter-rater reliability was relatively high (r = 0.54, 0.55, and 0.81; all P < .0001). Tracing of captured images by different examiners showed high concordance for the median cross-sectional area at the carpal tunnel inlet (r = 0.96-0.98; P < .0001).Conclusions-The highest intra- and inter-rater reliability was found at the carpal tunnel inlet. The results also demonstrate that tracing of the median nerve cross-sectional area from captured images by different examiners does not contribute significantly to measurement variability. PMID:26453123

  9. Comparison of postoperative pain after open and endoscopic carpal tunnel release: A randomized controlled study

    PubMed Central

    Orak, Mehmet Müfit; Gümüştaş, Seyit Ali; Onay, Tolga; Uludağ, Serkan; Bulut, Güven; Börü, Ülkü Türk

    2016-01-01

    Background: Results of open and endoscopic carpal tunnel surgery were compared with many studies done previously. To the best of our knowledge, difference in pain after endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) has not been objectively documented in literature. The aim of the study was to compare the pain intensity in the early postoperative period in patients undergoing OCTR versus those undergoing ECTR. Materials and Methods: Fifty patients diagnosed with carpal tunnel syndrome were randomized into two groups using “random number generator” software (Research Randomizer, version 3.0); endoscopic surgery group [(21 female, 1 male; mean age 49 years (range 31–64 years)] and open surgery group [(25 female, 3 male; mean age 45.1 years (range 29–68 years)] and received carpal tunnel release. Surgery was performed under regional intravenous anesthesia. The patients’ pain level was assessed at the 1st, 2nd, 4th, and 24th postoperative hours using a visual analog scale (VAS) score. Results: Mean age, gender and duration of symptoms were found similar for both groups. Boston functional scores were improved for both groups (P < 0.001, P < 0.001). Pain assessment at the postoperative 1st, 2nd, 4th and 24th hours revealed significantly low VAS scores in the endoscopic surgery group (P = 0.003, P < 0.001, P < 0.001, P < 0.001). Need for analgesic medication was significantly lower in the endoscopic surgery group (P < 0.001). Conclusion: Endoscopic carpal tunnel surgery is an effective treatment method in carpal tunnel release vis-a-vis postoperative pain relief. PMID:26955179

  10. Effectiveness of low-level laser on carpal tunnel syndrome

    PubMed Central

    Li, Zhi-Jun; Wang, Yao; Zhang, Hua-Feng; Ma, Xin-Long; Tian, Peng; Huang, Yuting

    2016-01-01

    Abstract Background: Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review. Methods: We conducted electronic searches of PubMed (1966–2015.10), Medline (1966–2015.10), Embase (1980–2015.10), and ScienceDirect (1985–2015.10), using the terms “carpal tunnel syndrome” and “laser” according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes. Results: Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MD = 2.04; 95% CI: 0.08–3.99; P = 0.04; I2 = 62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MD = 0.97; 95% CI: 0.84–1.11; P < 0.01; I2 = 0%). The sensory nerve action potential (SNAP) (at 12 weeks) was better in the LLLT group (MD = 1.08; 95% CI: 0.44–1.73; P = 0.001; I2 = 0%). However, 1 included study was weighted at >95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups. Conclusion

  11. Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome

    PubMed Central

    Uchiyama, S; Itsubo, T; Yasutomi, T; Nakagawa, H; Kamimura, M; Kato, H

    2005-01-01

    Objective: To correlate morphological findings of idiopathic carpal tunnel syndrome (CTS) with the function of the median nerve. Methods: In this study, 105 wrists of 105 women patients with idiopathic CTS, and 36 wrists of 36 female volunteers were subjected to nerve conduction studies and MRI. Cross sectional area, signal intensity ratio, and the flattening ratio of the median nerve, carpal tunnel area, flexor tendon area, synovial area, and intersynovial space, and the palmar bowing of the transverse carpal ligament (TCL) were quantified by MRI and correlated with the severity of the disease determined by nerve conduction studies. Results: Cross sectional areas of the median nerve, flexor tendons, and carpal tunnel, and the palmar bowing of the TCL of the CTS groups were greater than in the control group, but differences were not detected among the CTS groups for the area of the flexor tendons and the carpal tunnel. Enlargement, flattening, and high signal intensity of the median nerve at the distal radioulnar joint level were more significant in the advanced than in the earlier stages of the disease. Increase in palmar bowing of the TCL was less prominent in the most advanced group. Linear correlation between the area of the carpal tunnel and palmar bowing of the TCL was noted. Conclusion: Severity of the disease could be judged by evaluating not only longitudinal changes of signal intensity and configuration of the median nerve, but also palmar bowing of the TCL. Increased palmar bowing of the TCL was found to be associated with an increase in the area of the carpal tunnel. PMID:16024888

  12. Decompression sickness during construction of the Great Belt Tunnel, Denmark.

    PubMed

    Andersen, H L

    2002-01-01

    Thirteen cases of decompression sickness (DCS) occurred during the construction of the 8-km long railway tunnel under the Great Belt in Denmark between January 1992 and February 1996. 320 compressed air workers were subjected to 9018 pressure exposures in four tunnel boring machines. Overall DCS incidence was 0.14%. Working pressures ranged between 0.25 bar (1.25 atm abs or 126.3 kPa) and 2.95 bar (3.91 atm abs or 396.3 kPa) and working times ranged between 2 minutes and 339 minutes. During the first 1798 pressure exposures 7 DCS cases occurred using French air decompression tables from 1974. The following 7220 exposures were then decompressed in accordance with the newly issued French air decompression tables of 1992. After changing schedules 6 DCS cases occurred and DCS incidence was reduced to 0.08%. Two of the first seven DCS cases had permanent residual symptoms after recompression treatment. All DCS cases, except one, occurred among the 30% of exposures that imposed the greatest decompression stress. DCS incidence among these exposures was 0.42%. PMID:12670120

  13. What is the role of Semmes-Weinstein monofilament testing in the diagnosis of electrophysiologically graded carpal tunnel syndrome?

    PubMed Central

    Yildirim, Pelin; Gunduz, Osman Hakan

    2015-01-01

    [Purpose] The aim of the study was to investigate the ability of Semmes-Weinstein Monofilament testing to detect carpal tunnel syndrome, as well as moderate-to-severe carpal tunnel syndrome using varying thresholds and methods. [Subjects] Clinical and electrophysiological data of 62 patients (124 hands) with a mean age of 49.09±10.5 years were evaluated in this study. [Methods] Sensitivity and specificity were calculated according to two threshold values (2.83 and 3.22) and two methods, a conventional method and an internal comparison method. A threshold value of 3.22 was also used to determine sensitivity and specificity in the diagnosis of electrophysiologically moderate-to-severe carpal tunnel syndrome. Data of the first three digits were averaged to reveal the mean strength value of the monofilaments for each hand. [Results] The criteria of 2.83-conventional method yielded a sensitivity of 98% and a specificity of 17% in the diagnosis of carpal tunnel syndrome. The threshold value of 3.22 using a conventional method was found to detect moderate-to-severe carpal tunnel syndrome with high sensitivity (80%) and excellent specificity (93%). A statistically significant difference was observed in the mean strength values of the monofilaments in moderate-to-severe carpal tunnel syndrome hands and hands without carpal tunnel syndrome. [Conclusion] The current study demonstrated that Semmes-Weinstein monofilament testing might be a valuable quantitative method for detecting moderate-to-severe carpal tunnel syndrome. PMID:26834344

  14. Changes in the carpal tunnel while wearing the Manu® soft hand brace: a sonographic study.

    PubMed

    Manente, G; Melchionda, D; Staniscia, T; D'Archivio, C; Mazzone, V; Macarini, L

    2013-01-01

    We studied the effect of the Manu(®) soft hand brace, which has been designed to relieve median nerve entrapment in carpal tunnel syndrome. An observational, controlled study was conducted in 10 participants, five with bilateral carpal tunnel syndrome and five controls, using sonography to study changes in the dimensions of the carpal tunnel before and while wearing the brace. An increase in transverse diameter, thinning of the flexor retinaculum, and displacement of the proximal insertion of the lumbrical muscle to the middle finger from the edge of the carpal tunnel were observed in patients while wearing the brace. The changes in the morphology of the carpal tunnel while wearing the Manu(®) support its use as an alternative to a night wrist splint. PMID:22640934

  15. Increased Prevalence of Carpal Tunnel Syndrome in Albright Hereditary Osteodystrophy

    PubMed Central

    Joseph, Andrew W.; Shoemaker, Ashley H.

    2011-01-01

    Context: Albright hereditary osteodystrophy (AHO) is a rare genetic disorder characterized by phenotypic abnormalities including brachydactyly/brachymetacarpia, short stature, and sc ossifications. Carpal tunnel syndrome (CTS) is a chief complaint in many patients with AHO. Objective: The objective of the study was to investigate the prevalence of CTS in patients with AHO. Design: This was a cross-sectional study. Setting: The study was conducted at the Clinical Research Center (Institute of Clinical and Translational Medicine), Johns Hopkins University School of Medicine and Albright Clinic, Kennedy Krieger Institute. Participants: Thirty-three subjects with a diagnosis of AHO participated in the study. Main Outcome Measures: We assessed for the presence and location of hand tingling, numbness, pain, weakness, flick sign, difficulty with fine motor skills, severe hand or nail biting, and nocturnal symptoms in the setting of normocalcemia and a euthyroid state. Patients were considered to have CTS if they were positive for three of these symptoms. All subjects were analyzed for mutations in the GNAS gene. Results: Twenty-two subjects (67%) had a clinical diagnosis of CTS (95% confidence interval 0.48, 0.82). Twenty-eight of 33 subjects were confirmed to have mutations in GNAS, of whom 68% had CTS (95% confidence interval 0.48, 0.84). There were 14 children in this study; 36% had a clinical diagnosis of CTS. Body mass index, brachydactyly/brachymetacarpia, prior GH treatment, and specific GNAS mutations were not associated with CTS. Conclusions: We report a high prevalence of CTS in both adults and children with AHO. The diagnosis of CTS should be considered when evaluating a patient with AHO because the intervention for CTS could improve overall function and quality of life in these patients. PMID:21525160

  16. Treatment of carpal tunnel syndrome with alpha-lipoic acid.

    PubMed

    Di Geronimo, G; Caccese, A Fonzone; Caruso, L; Soldati, A; Passaretti, U

    2009-01-01

    Carpal Tunnel Syndrome (CTS) is the most common peripheral mononeuropathy; its symptoms and functional limitations significantly penalize the daily activities and quality of life of many people. While surgery is reserved to most severe cases, the earlier stages of disease may be controlled by a pharmacological treatment aimed to "neuroprotection", i.e. to limiting and correcting the nerve damage. Our study was aimed to compare the efficacy of a fixed association of alpha-lipoic acid (ALA) 600 mg/die and gamma-linolenic acid (GLA) 360 mg/die, and a multivitamin B preparation (Vit B6 150 mg, Vit B1 100 mg, Vit B12 500 microg daily) for 90 days in 112 subjects with moderately severe CTS. Demographic, case-history and treatment efficacy data were collected; the Boston questionnaire was administered and the patients were evaluated by Hi-Ob scale and electro-myography. A significant reduction in both symptoms scores and functional impairment (Boston questionnaire) was observed in ALA/GLA group, while the multivitamin group experienced a slight improvement of symptoms and a deterioration of functional scores. Electromyography showed a statistically significant improvement with ALA/GLA, but not with the multivitamin product. The Hi-Ob scale showed significant efficacy of ALA/GLA in improving symptoms and functional impairment, while in the multivitamin group the improvement was significant, but less marked than in the ALA/GLA group. In conclusion, the fixed association of ALA and GLA proved to be a useful tool and may be proposed for controlling symptoms and improving the evolution of CTS, especially in the earlier stages of disease. PMID:19499849

  17. [Acute Carpal Tunnel Syndrome due to Spontaneous Bleeding after Taking Rivaroxaban (Xarelto®)].

    PubMed

    Hohendorff, B; Biber, F; Sauer, H; Franke, J

    2016-06-01

    A 64-year-old man suffered from acute carpal tunnel syndrome of his right hand without explainable reason. An emergency operation drained a pronounced haematoma. There is a strong suspicion this was a bleeding complication related to taking rivaroxaban (Xarelto(®)). PMID:25970598

  18. Median nerve deformation and displacement in the carpal tunnel during index finger and thumb motion.

    PubMed

    van Doesburg, Margriet H M; Yoshii, Yuichi; Villarraga, Hector R; Henderson, Jacqueline; Cha, Stephen S; An, Kai-Nan; Amadio, Peter C

    2010-10-01

    The purpose of this study was to investigate the deformation and displacement of the normal median nerve in the carpal tunnel during index finger and thumb motion, using ultrasound. Thirty wrists from 15 asymptomatic volunteers were evaluated. Cross-sectional images during motion from full extension to flexion of the index finger and thumb were recorded. On the initial and final frames, the median nerve, flexor pollicis longus (FPL), and index finger flexor digitorum superficialis (FDS) tendons were outlined. Coordinate data were recorded and median nerve cross-sectional area, perimeter, aspect ratio of the minimal-enclosing rectangle, and circularity in extension and flexion positions were calculated. During index finger flexion, the tendon moves volarly while the nerve moves radially. With thumb flexion, the tendon moves volarly, but the median nerve moves toward the ulnar side. In both motions, the area and perimeter of the median nerve in flexion were smaller than in extension. Thus, during index finger or thumb flexion, the median nerve in a healthy human subject shifts away from the index finger FDS and FPL tendons while being compressed between the tendons and the flexor retinaculum in the carpal tunnel. We are planning to compare these data with measurements in patients with carpal tunnel syndrome (CTS) and believe that these parameters may be useful tools for the assessment of CTS and carpal tunnel mechanics with ultrasound in the future. PMID:20225286

  19. Grey-scale sonography and sonoelastography for diagnosing carpal tunnel syndrome

    PubMed Central

    Miyamoto, Hideaki; Morizaki, Yutaka; Kashiyama, Takahiro; Tanaka, Sakae

    2016-01-01

    Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Grey-scale sonography and sonoelastography (SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area (CSA). Several authors have assessed additional parameters. “Delta CSA” is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The “CSA ratio” is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS. PMID:27027498

  20. Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch.

    PubMed

    Bijannejad, Dariush; Azandeh, Saeed; Javadnia, Fatemeh; Gholami, Mohammad Reza; Gharravi, Anneh Mohammad; Zhaleh, Mohsen

    2016-01-01

    Persistent median artery (PMA) in present cadaver originated from the brachial artery and anastomosed with the superficial palmar arch (SPA). As the PMA may be the cause of carpal tunnel syndrome and SPA is the main source of arterial supply, knowledge of which are important for the hand surgical interventions. PMID:27583265

  1. Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch

    PubMed Central

    Bijannejad, Dariush; Azandeh, Saeed; Javadnia, Fatemeh; Gholami, Mohammad Reza; Gharravi, Anneh Mohammad; zhaleh, Mohsen

    2016-01-01

    Abstract Persistent median artery (PMA) in present cadaver originated from the brachial artery and anastomosed with the superficial palmar arch (SPA). As the PMA may be the cause of carpal tunnel syndrome and SPA is the main source of arterial supply, knowledge of which are important for the hand surgical interventions. PMID:27583265

  2. Yoga Asanas for the Relief and Prevention of Carpal Tunnel Syndrome.

    ERIC Educational Resources Information Center

    Beleu, Steve

    This collection of yoga asanas (exercises) can help relieve the pain of carpal tunnel syndrome (CTS) and help prevent CTS among people who work on computer terminals. For maximum benefit, the exercises should be practiced daily or on as regular a schedule as possible. They are not intended to replace surgery or a physician's prescribed care. They…

  3. Interpreter's Wrist: Repetitive Stress Injury and Carpal Tunnel Syndrome in Sign Language Interpreters.

    ERIC Educational Resources Information Center

    Stedt, Joe D.

    1992-01-01

    In a survey concerning repetitive stress injury (RSI) and carpal tunnel syndrome, 87 percent of the 40 sign language interpreters reported that they had at some time experienced at least 2 symptoms associated with RSI, and most interpreters knew others with RSI problems. Data indicate that RSI is a severe problem among sign language interpreters.…

  4. Transverse Movement of the Median Nerve in the Carpal Tunnel during Wrist and Finger Motion in Patients with Carpal Tunnel Syndrome.

    PubMed

    Nanno, Mitsuhiko; Sawaizumi, Takuya; Kodera, Norie; Tomori, Yuji; Takai, Shinro

    2015-01-01

    Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy of the upper extremity. Repetitive wrist and finger motion has been suggested as a major factor of pathogenesis of CTS. However, little is known about the pathomechanics of CTS. We aimed to evaluate the movement of the median nerve in the carpal tunnel during wrist and finger motions using transverse ultrasound in 21 patients with CTS (5 men and 16 women with mean age 69.0 years). We examined quantitatively the median nerve location as a coordinate within the carpal tunnel at varied wrist positions with all fingers full extension and flexion respectively in the affected and unaffected sides. We thus found that at all wrist positions during finger motion, the median nerve moved significantly more ulnopalmarly in the affected side compared to the unaffected side (p < 0.05). Especially, at the wrist palmar-flexion position as a provocative test, the nerve moved significantly (p < 0.05) the most ulnopalmarly among all wrist positions in the affected side. The nerve was the most strongly compressed against the transverse carpal ligament by the flexor tendons. Additionally, the displacement amount of the nerve in the dorsal-palmar direction was significantly smaller in the affected side than in the unaffected side. These findings indicate that such a pattern of nerve movement has the potential to distinguish affected from unaffected individuals. This ultrasound information could be useful in better understanding of the pathomechanics of CTS, and in further improvement of diagnosis and treatment for CTS. PMID:26133190

  5. An Association between Carpal Tunnel Syndrome and Migraine Headaches—National Health Interview Survey, 2010

    PubMed Central

    Law, Huay-Zong; Amirlak, Bardia; Cheng, Jonathan

    2015-01-01

    Background: Migraine headaches have not historically been considered a compression neuropathy. Recent studies suggest that some migraines are successfully treated by targeted peripheral nerve decompression. Other compression neuropathies have previously been associated with one another. The goal of this study is to evaluate whether an association exists between migraines and carpal tunnel syndrome (CTS), the most common compression neuropathy. Methods: Data from 25,880 respondents of the cross-sectional 2010 National Health Interview Survey were used to calculate nationally representative prevalence estimates and 95% confidence intervals (95% CIs) of CTS and migraine headaches. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% CI for the degree of association between migraines and CTS after controlling for known demographic and health-related factors. Results: CTS was associated with older age, female gender, obesity, diabetes, and smoking. CTS was less common in Hispanics and Asians. Migraine was associated with younger age, female gender, obesity, diabetes, and current smoking. Migraine was less common in Asians. Migraine prevalence was 34% in those with CTS compared with 16% in those without CTS (aOR, 2.60; 95% CI, 2.16–3.13). CTS prevalence in patients with migraine headache was 8% compared with 3% in those without migraine headache (aOR, 2.67; 95% CI, 2.22–3.22). Conclusions: This study is the first to demonstrate an association between CTS and migraine headache. Longitudinal and genetic studies with physician verification of migraine headaches and CTS are needed to further define this association. PMID:25878944

  6. Thrombosis of the persistent median artery as a cause of carpal tunnel syndrome - case study.

    PubMed

    Rzepecka-Wejs, Ludomira; Multan, Aleksandra; Konarzewska, Aleksandra

    2012-12-01

    Carpal tunnel syndrome is the most frequent neuropathy of the upper extremity, that mainly occurs in manual workers and individuals, whose wrist is overloaded by performing repetitive precise tasks. In the past it was common among of typists, seamstresses and mechanics, but nowadays it is often caused by long hours of computer keyboard use. The patient usually complains of pain, hypersensitivity and paresthesia of his hand and fingers in the median nerve distribution. The symptoms often increase at night. In further course of the disease atrophy of thenar muscles is observed. In the past the diagnosis was usually confirmed in nerve conduction studies. Nowadays a magnetic resonance scan or an ultrasound scan can be used to differentiate the cause of the symptoms. The carpal tunnel syndrome is usually caused by compression of the median nerve passing under the flexor retinaculum due to the presence of structures reducing carpal tunnel area, such as an effusion in the flexor tendons sheaths (due to overload or in the course of rheumatoid diseases), bony anomalies, muscle and tendon variants, ganglion cysts or tumors. In some cases diseases of upper extremity vessels including abnormalities of the persistent median artery may also result in carpal tunnel syndrome. We present a case of symptomatic carpal tunnel syndrome caused by thrombosis of the persistent median artery which was diagnosed in ultrasound examination. The ultrasound scan enabled for differential diagnosis and resulted in an immediate referral to clinician, who recommended instant commencement on anticoagulant treatment. The follow-up observation revealed nearly complete remission of clinical symptoms and partial recanalization of the persistent median artery. PMID:26676173

  7. Quality of information on the Internet about carpal tunnel syndrome: an update.

    PubMed

    Lutsky, Kevin; Bernstein, Joseph; Beredjiklian, Pedro

    2013-08-01

    The use of the Internet for health-related information has increased significantly. In 2000, the current authors examined the source and content of orthopedic information on the Internet. At that time, Internet information regarding carpal tunnel syndrome was found to be of limited quality and poor informational value. The purposes of the current study were to reevaluate the type and quality of information on the Internet regarding carpal tunnel syndrome and to determine whether the quality of information available has improved compared with 1 decade ago. The phrase carpal tunnel syndrome was entered into the 5 most commonly used Internet search engines. The top 50 nonsponsored and the top 5 sponsored universal resource locators identified by each search engine were collected. Each unique Web site was evaluated for authorship and content, and an informational score ranging from 0 to 100 points was assigned. Approximately one-third of nonsponsored Web sites were commercial sites or selling commercial products. Seventy-six percent of sponsored sites were selling a product for the treatment of carpal tunnel syndrome. Thirty-eight percent of nonsponsored sites provided unconventional information, and 48% of sponsored sites provided misleading information. Just more than half of nonsponsored sites were authored by a physician or academic institution. The informational mean score was 53.8 points for nonsponsored sites and 14.5 points for sponsored sites. The informational quality on the Internet on carpal tunnel syndrome has improved over the past decade. Despite this progress, significant room exists for improvement in the quality and completeness of the information available. PMID:23937750

  8. Carpal Tunnel Syndrome Associated with Oral Bisphosphonates. A Population-Based Cohort Study

    PubMed Central

    Carvajal, Alfonso; Martín Arias, Luis H.; Sáinz, María; Escudero, Antonio; Fierro, Inmaculada; Sauzet, Odile; Cornelius, Victoria R.; Molokhia, Mariam

    2016-01-01

    Background Bisphosphonates are widely used to prevent osteoporotic fractures. Some severe musculoskeletal reactions have been described with this medication; among them, some cases of carpal tunnel syndrome. Thus, the aim of this study was to explore whether bisphosphonates may be associated with this syndrome. Methods A cohort study was conducted to compare exposed to unexposed women; the exposed group was that composed of women having received at least one prescription of an oral bisphosphonate. For the purpose, we used information from The Health Improvement Network (THIN) database. The outcome of interest was defined as those women diagnosed with carpal tunnel syndrome. A survival analysis was performed; the Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals, and to adjust for identified confounding variables. Results Out of a sample of 59,475 women older than 51 years, 19,825 were treated with bisphosphonates during the period studied. No differences in age distribution or mean follow-up time were observed between the two groups in comparison. Overall, there were 572 women diagnosed with carpal tunnel syndrome, 242 (1.2%) in the group exposed to bisphosphonates, and 330 (0.8%) in the unexposed. An adjusted hazard ratio of developing carpal tunnel syndrome of 1.38 (95%CI, 1.15–1.64) was found for women exposed to bisphosphonates; no significant changes in the hazard ratios were found when considering different levels of bisphosphonate exposure. Conclusions An increased risk of carpal tunnel syndrome is associated with the use of bisphosphonates in postmenopausal women. PMID:26765346

  9. Technical Tip for Proximal Release During Open Carpal Tunnel Release Using a Subcutaneous Pocket.

    PubMed

    Nikkhah, Dariush; Sadr, Amir H; Akhavani, Mohammed Ali

    2016-06-01

    Technical steps to avoid incomplete proximal release of the carpal tunnel are described. Local anaesthesia is infiltrated as a subcutaneous bleb over the distal wrist crease and extending 2-3 cm over the forearm fascia. Tumescence of local anaesthesia into the subcutaneous plane helps create a pocket between the forearm fascia and subcutaneous tissues. Intraoperatively a subcutaneous pocket is made above the transverse carpal ligament and antebrachial fascia with blunt dissection. A retractor is placed under the pocket, which facilitates optimal visualization to allow reliable complete proximal release of compression.The authors have found that this technique is reproducible and reliable across their collective experience. PMID:27454649

  10. Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial

    PubMed Central

    Yeo, G.; Gupta, A.; Ding, G.; Skerman, H.; Khatun, M.; Melsom, D.

    2015-01-01

    Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase group receiving both hyaluronidase and local anaesthetic. Pain scores were rated using the visual analogue scale (VAS) by patients immediately after local anaesthetic injection and again immediately after the carpal tunnel release. Results. Preoperative VAS scores, taken after local anaesthetic injection, were greater than postoperative VAS scores. Postoperative VAS scores were significantly lower in the hyaluronidase group and tourniquet times were significantly shorter in the hyaluronidase group. Conclusion. Hyaluronidase addition to local anaesthetic in carpal tunnel release resulted in significant reductions in operative time and pain immediately after operation. PMID:26587288

  11. Comparative study on the stiffness of transverse carpal ligament between normal subjects and carpal tunnel syndrome patients.

    PubMed

    Miyamoto, Hideaki; Miura, Toshiki; Morizaki, Yutaka; Uehara, Kosuke; Ohe, Takashi; Tanaka, Sakae

    2013-01-01

    The purpose of this study was to compare the stiffness of the transverse carpal ligament (TCL) between healthy volunteers and carpal tunnel syndrome (CTS) patients using sonoelastography. We studied 17 healthy volunteers (four men, 13 women; range 37-84 years) and 18 hands of 13 patients with CTS (three men, ten women; range 41-79 years). Thickness and elasticity of the TCL were evaluated by sonoelastography. Elasticity was estimated by strain ratio of an acoustic coupler, which has a standardized elasticity as a reference medium, to the TCL (AC/T strain ratio). The AC/T strain ratios of the healthy volunteers and the CTS patients were 6.0 and 8.1, respectively (p = 0.030). The AC/T strain ratio showed a positive correlation with the duration of symptoms in the CTS patients (p = 0.035, r = 0.50). We concluded that increased stiffness of the TCL could be one of the causes for CTS. PMID:24164125

  12. Decompression Sickness during Construction of the Dartford Tunnel

    PubMed Central

    Golding, F. Campbell; Griffiths, P.; Hempleman, H. V.; Paton, W. D. M.; Walder, D. N.

    1960-01-01

    A clinical, radiological and statistical survey has been made of decompression sickness during the construction of the Dartford Tunnel. Over a period of two years, 1,200 men were employed on eight-hour shifts at pressures up to 28 pounds per square inch (p.s.i.). There were 689 cases of decompression sickness out of 122,000 compressions, an incidence of 0·56%. The majority of cases (94·9%) were simple “bends”. The remainder (5·1%) exhibited signs and symptoms other than pain and were more serious. All cases were successfully treated and no fatality or permanent disability occurred. In two serious cases, cysts in the lungs were discovered. It is suggested that these gave rise to air embolism when the subjects were decompressed, and pulmonary changes may contribute more than hitherto believed to the pathogenesis of bends. Some other clinical features are described, including “skin-mottling” and an association between bends and the site of an injury. The bends rate is higher for the back shift (3 p.m. to 11 p.m.) and the night shift (11 p.m. to 7 a.m.) than for the day shift. In the treatment of decompression sickness it appears to be more satisfactory to use the minimum pressure required for relief of symptoms followed by slow decompression with occasional “soaks”, than to attempt to drive the causative bubbles into solution with high pressures. During the contract the decompression tables recently prescribed by the Ministry of Labour were used. Evidence was obtained that they could be made safer, and that the two main assumptions on which they are based (that sickness will not occur at pressures below 18 p.s.i., and that a man saturates in four hours) may be incorrect. It is desirable to test tables based on 15 p.s.i. and eight-hour saturation. The existence of acclimatization to pressure was confirmed; it is such that the bends rate may fall in two to three weeks to 0·1% of the incidence on the first day of exposure. Acclimatization is lost again

  13. Attritional Rupture of the Little Finger Flexor Digitorum Profundus Tendon in the Carpal Tunnel in a Patient with Acromegaly.

    PubMed

    Lee, Munn Yi Tina; Jin, Yeo Chong

    2016-02-01

    Spontaneous rupture of flexor tendons within the carpal tunnel is rare in the absence of rheumatoid arthritis. Other predisposing conditions such as gout, infection, pisotriquetrial osteoarthritis, as well as hook of hamate fracture non-union, have previously been reported. However, tendon ruptures of the hand in the presence of acromegaly, as well as spontaneous ruptures within the carpal tunnel, have not been described in the literature. PMID:27454510

  14. Subsynovial Connective Tissue is Sensitive to Surgical Interventions in a Rabbit Model of Carpal Tunnel Syndrome

    PubMed Central

    Sun, Yu-Long; Moriya, Tamami; Zhao, Chunfeng; Kirk, Ramona L.; Chikenji, Takako; Passe, Sandra M.; An, Kai-Nan; Amadio, Peter C.

    2011-01-01

    The most common histological finding in carpal tunnel syndrome (CTS) is non-inflammatory fibrosis and thickening of the subsynovial connective tissue (SSCT) in the tunnel. While the cause of SSCT fibrosis and the relationship of SSCT fibrosis and CTS are unknown, one hypothesis is that SSCT injury causes fibrosis, and that the fibrosis then leads to CTS. We investigated the sensitivity of the SSCT to injuries. Two types of surgical intervention were performed in a rabbit model: a skin incision with tendon laceration and SSCT stretching sufficient to damage the SSCT, and skin incision alone,. Twelve weeks after surgery, the rabbit carpal tunnel tissues were studied with immunochemistry for TGF-β receptors 1, 2, and 3, collagen III, and collagen VI. All TGF-β receptors were expressed. The percentages of the TGF-β receptors’ expressions were less in the control SSCT fibroblasts than in the fibroblasts from rabbits with surgical interventions. The surgical interventions did not result in any alteration of collagen III expression. However, both surgical interventions resulted in a significant decrease in collagen VI expression compared to the control group. The two surgical interventions achieved similar expression of TGF-β receptors and collagens. Our results provide evidence that the SSCT is sensitive to surgical interventions, even when these are modest. Since SSCT fibrosis is a hallmark of carpal tunnel syndrome, these data also suggest that such fibrosis could result from relatively minor trauma. PMID:22009518

  15. A Comparison of Hand Pain and Hand Function after Z-plasty Reconstruction of the Transverse Carpal Ligament with Traditional Median Neurolysis in Carpal Tunnel Syndrome

    PubMed Central

    Saravi, Majid Sajjadi; Kariminasab, Mohammad Hossein; Bari, Mehdi; Ghaffari, Salman; Razavipour, Mehran; Daneshpoor, Seyed Mohamad Mehdi; Yazdi, Mahsa Vojoudi; Davoudi, Mehrnaz Mohammad; Azar, Masoud Shayesteh

    2016-01-01

    Background: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome. Methods: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period. Results: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213). But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P<0.001). However, at week 12, no patient complained of hand pain in both groups. Considering hand function, no patient had normal hand grip after the first week, but after three weeks, a significantly higher proportion of patients in the Z-plasty reconstruction group had reached near normal hand grip (76.1% vs. 29.1%;). However, at weeks 6 and 12, the differences were not statistically different between the two groups. Conclusion: We observed significant reduction in hand pain, shorter duration of hand pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL. PMID:27200393

  16. Carpal tunnel syndrome in Mucopolysaccharidoses. A report of four cases in child.

    PubMed

    Bona, I; Vial, C; Brunet, P; Couturier, J C; Girard-Madoux, M; Bady, B; Guibaud, P

    1994-12-01

    Carpal tunnel syndrome (CTS) is very uncommon in childhood. Sixty-five cases are reported in the literature, principally due to metabolic diseases. In Mucopolysaccharidoses, prospective studies (Wraith and Alani, 1990) found a bilateral CTS in about 90%. We report four cases of Mucopolysaccharidoses, diagnosed on clinical and biological data (two cases of Hurler disease, and two cases of Hunter disease), in children aged less than five years. Each child had claw hands, without thenar atrophy. Median nerve conduction studies and electromyography confirm the CTS. Motor and sensory nerve conductions are normal in other nerves. Concentric needle studies show in two cases, on abductor pollicis brevis, spontaneous activities as repetitive discharges, fasciculations and multiplets. Median nerve stimulations reveal responses with late potentials during 70 ms due to reinnervation. The physiopathology of those carpal tunnel syndromes is discussed. PMID:7882890

  17. Acute carpal tunnel syndrome of the hand following a cat bite

    PubMed Central

    Sbai, Mohamed Ali; Dabloun, Slim; Benzarti, Sofien; Khechimi, Myriam; Jenzeri, Abdesselem; Maalla, Riadh

    2015-01-01

    Cat bites at the hand are common situation in emergency departments. Neglected or poorly supported, these lesions sometimes lead to serious injuries that may compromise the function of the hand. Pasteurellamultocida is the most offending germ in these lesions, despite their sensitivity to antibiotics; it can sometimes lead to deep infections involving the skin, bones and joints. Acute carpal tunnel syndrome is exceptional after cat bite. We report a case of a 56 Year old female presenting with an acute carpal tunnel syndrome associated with compartment syndrome of the right hand 6 days after a cat bite of her right thumb. The patient was treated by surgery to relieve the median nerve. Microbiology identified PasteurellaMultocida. PMID:26421101

  18. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study.

    PubMed

    Ettema, Anke M; Zhao, Chunfeng; Amadio, Peter C; O'Byrne, Megan M; An, Kai-Nan

    2007-04-01

    The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the ulnar tenosynovial bursa. Fibrosis of the SSCT may well affect its gliding characteristics. To investigate this possibility, the relative motion of the flexor tendon and VS was observed during finger flexion in patients undergoing carpal tunnel surgery, and for comparison in hands without CTS, in an in vitro cadaver model. We used a camera to document the gliding motion of the middle finger flexor digitorum superficialis (FDS III) tendon and SSCT in three patients with CTS during carpal tunnel release and compared this with simulated active flexion in three cadavers with no antemortem history of CTS. The data were digitized with the use of Analyze Software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN). In the CTS patients, the SSCT moved en bloc with the tendon, whereas, in the controls the SSCT moved smoothly and separately from the tendon. The ratio of VS to tendon motion was higher for the patients than in the cadaver controls. These findings suggest that in patients with CTS the synovial fibrosis has altered the gliding characteristics of the SSCT. The alterations in the gliding characteristics of the SSCT may affect the ability of the tendons in the carpal tunnel to glide independently from each other, or from the nearby median nerve. These abnormal tendon mechanics may play a role in the etiology of CTS. PMID:16944527

  19. A cost-utility analysis of open and endoscopic carpal tunnel release

    PubMed Central

    Thoma, Achilleas; Wong, Vanessa H; Sprague, Sheila; Duku, Eric

    2006-01-01

    BACKGROUND Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced. OBJECTIVE To use a decision analytical model to compare ECTR with OCTR in an economic evaluation. METHODS Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature. RESULTS The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the ‘win-win’ quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR. CONCLUSIONS There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively. PMID:19554224

  20. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment

    PubMed Central

    Ghasemi-rad, Mohammad; Nosair, Emad; Vegh, Andrea; Mohammadi, Afshin; Akkad, Adam; Lesha, Emal; Mohammadi, Mohammad Hossein; Sayed, Doaa; Davarian, Ali; Maleki-Miyandoab, Tooraj; Hasan, Anwarul

    2014-01-01

    Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anatomy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation. PMID:24976931

  1. The Clinical Practice Guideline on Carpal Tunnel Syndrome and Workers' Compensation.

    PubMed

    Goldfarb, Charles A

    2016-06-01

    The American Academy of Orthopedic Surgeons has released an updated Clinical Practice Guideline (CPG) on the evaluation and treatment of carpal tunnel syndrome (CTS). In 2007, the initial CPG on CTS evaluated diagnosis and in 2008 and 2011, the CPG on CTS assessed treatment. The most recent CPG assesses both diagnosis and treatment in a generally non-controversial way. We assess the potential impact of this CPG on the care of workers compensation patients. PMID:27113907

  2. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia☆

    PubMed Central

    Barros, Marco Felipe Francisco Honorato; da Rocha Luz Júnior, Aurimar; Roncaglio, Bruno; Queiróz Júnior, Célio Pinheiro; Tribst, Marcelo Fernandes

    2015-01-01

    Objective To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. Material and methods This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. Results The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01). In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. Conclusion Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result. PMID:26962490

  3. Low-power laser therapy for carpal tunnel syndrome: effective optical power

    PubMed Central

    Chen, Yan; Zhao, Cheng-qiang; Ye, Gang; Liu, Can-dong; Xu, Wen-dong

    2016-01-01

    Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efficacy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efficacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside reflection and scattering laser power from human skin at the wrist, the effective laser power can be inferred. Using clinical measurements from 30 cases, we found that the effective laser power differed significantly among cases, with the measured laser reflection coefficient ranging from 1.8% to 54%. The reflection coefficient for 36.7% of these 30 cases was in the range of 10–20%, but for 16.7% of cases, it was higher than 40%. Consequently, monitoring the effective optical power during laser irradiation is necessary for the laser therapy of carpal tunnel syndrome.

  4. Diagnosis of Severe Carpal Tunnel Syndrome Using Nerve Conduction Study and Ultrasonography.

    PubMed

    Fujimoto, Kazuhiro; Kanchiku, Tsukasa; Kido, Kenji; Imajo, Yasuaki; Funaba, Masahiro; Taguchi, Toshihiko

    2015-10-01

    This study investigated the correlation between nerve conduction study and ultrasonographic findings for assessment of the usefulness of ultrasonography in determining carpal tunnel syndrome severity. Hands of adults with carpal tunnel syndrome were assessed using ultrasound and nerve conduction studies and grouped according to median nerve cross-sectional area (CSA). There were significant differences (p < 0.01) in mean median nerve CSA between controls, patients with median sensory nerve conduction velocity ≤40 m/s and patients with absent sensory nerve action potential and between controls, patients with median nerve distal motor latency ≥4.5 ms and patients with absent compound muscle action potentials of the abductor pollicis brevis. This is the first report to define median nerve CSA cutoff values (18 mm(2)) for determining carpal tunnel syndrome severity in patients with absent compound muscle action potentials of the abductor pollicis brevis. Median nerve CSA values below the cutoff values should prompt clinicians to consider other disorders, such as cervical compressive myelopathy. PMID:26111913

  5. Comparison of high-resolution sonography and electrophysiology in the diagnosis of carpal tunnel syndrome

    PubMed Central

    Kanikannan, Meena Angamuthu; Boddu, Demudu Babu; Umamahesh; Sarva, Sailaja; Durga, Padmaja; Borgohain, Rupam

    2015-01-01

    Background: The diagnostic accuracy of high-resolution ultrasonography (HRUS) in comparison to electro-diagnostic testing (EDX) in carpal tunnel syndrome (CTS) is debatable. Objective: The aim of this study was to compare the diagnostic accuracy of HRUS with EDX in patients with various grades of CTS and CTS associated with peripheral neuropathy (CTS + PNP). Materials and Methods: A prospective cohort of 57 patients with possible CTS was studied along with matched controls. The cross-sectional area (CSA) of the median nerve at the inlet of carpal tunnel was assessed by a sonologist blinded to the clinical and EDX data. Palm wrist distal sensory latency difference (PWDSLD), second lumbrical-interosseus distal motor latency difference (2LIDMLD) and CSA were compared in patients with different grades of severity of CTS and CTS+PNP. Results: Total 92 hands of 57 patients met the clinical criteria for CTS. Mean CSA at the inlet of carpal tunnel was 0.11 ± 0.0275 cm2. It had the sensitivity, specificity, positive predictive value and negative predictive values of 76.43%, 72.72%, 89.47% and 68%, respectively (P < 0.0001). Overall, HRUS had good correlation with PWDSLD and 2LIDMLD electro-diagnostic studies in all grades of CTS and CTS + PNP. Conclusion: HRUS can be used as a complementary screening tool to EDX. However, EDX has been found to be more sensitive and specific in mild CTS. PMID:26019423

  6. Prediction of Outcome in Women With Carpal Tunnel Syndrome Who Receive Manual Physical Therapy Interventions: A Validation Study.

    PubMed

    Fernández-de-Las-Peñas, César; Cleland, Joshua A; Salom-Moreno, Jaime; Palacios-Ceña, María; Martínez-Perez, Almudena; Pareja, Juan A; Ortega-Santiago, Ricardo

    2016-06-01

    Study Design Secondary analysis of a randomized trial. Background A clinical prediction rule to identify patients with carpal tunnel syndrome (CTS) most likely to respond to manual physical therapy has been published but requires further testing to determine its validity. Objective To assess the validity of a clinical prediction rule proposed for the management of patients with CTS in a different group of patients with a variety of treating clinicians. Methods A preplanned secondary analysis of a randomized controlled trial investigating the efficacy of manual physical therapies, including desensitization maneuvers of the central nervous system, in 120 women suffering from CTS was performed. Patients were randomized to receive 3 sessions of manual physical therapy (n = 60) or surgical release/decompression of the carpal tunnel (n = 60). Self-perceived improvement with a global rating of change was recorded at 6- and 12-month follow-ups. Pain intensity (mean pain and worst pain on a 0-to-10 numeric pain-rating scale) and scores on the Boston Carpal Tunnel Questionnaire (functional status and symptom severity subscales) were assessed at baseline and at 1, 3, 6, and 12 months. A baseline assessment of status on the clinical prediction rule was performed (positive status on the clinical prediction rule was defined as meeting at least 2 of the following criteria: pressure pain threshold of less than 137 kPa over the affected C5-6 joint; heat pain threshold of less than 39.6°C over the affected carpal tunnel; and general health score [Medical Outcomes Study 36-Item Short-Form Health Survey] of greater than 66 points). Linear mixed models with repeated measures were used to examine the validity of the rule. Results Participants with a positive status on the rule who received manual physical therapy did not experience greater improvements compared to those with a negative status on the rule for mean pain (P = .65), worst pain (P = .86), function (P = .99), or symptom

  7. Open carpal tunnel release with use of a nasal turbinate speculum.

    PubMed

    Muppavarapu, Raghuveer C; Rajaee, Sean S; Ruchelsman, David E; Belsky, Mark R

    2015-11-01

    Incomplete release of the transverse carpal ligament (TCL) and median nerve injury are complications of carpal tunnel release (CTR). In this article, we describe a modified mini-open release using a fine nasal turbinate speculum to aid in the proximal release with direct visualization of the proximal limb of the TCL and the distal volar forearm fascia (DVFF). The technique begins with a 2.5-cm palmar longitudinal incision, and standard distal release of the TCL is completed. A fine nasal turbinate speculum is inserted into the plane above the proximal limb of the TCL and the DVFF. A long-handle scalpel is used to incise the TCL and the DVFF under direct visualization. We retrospectively analyzed a cohort of 101 consecutive CTR cases (63 right, 38 left). Carpal tunnel syndrome symptoms were relieved in all patients with a high degree of satisfaction. This modified mini-open technique provides surgeons with a reproducible and inexpensive method to ensure a safe proximal release of the TCL. PMID:26566548

  8. Single versus repetitive injection of lignocaine in the management of carpal tunnel syndrome--a randomized controlled trial.

    PubMed

    Akarsu, S; Karadaş, Ö; Tok, F; Levent Gül, H; Eroğlu, E

    2015-02-01

    The aim of this study was to determine the efficacy of single versus repetitive injection of lignocaine into the carpal tunnel for the management of carpal tunnel syndrome. The 42 patients included were randomly assigned to two Groups: group 1 was injected with 4 mL of 1% lignocaine once and Group 2 was injected with 4 mL of 1% lignocaine twice a week for 2 weeks. Clinical and electrophysiological evaluations were performed at the study onset, and at 6 and 12 weeks following the final injection. Initially, the groups were similar with respect to clinical and electrophysiological findings. All parameters in Group 2 improved 6 weeks post treatment (p < 0.05), and these improvements persisted at 12 weeks post treatment (p < 0.05). Repetitive local lignocaine injection was effective in reducing the symptoms of carpal tunnel syndrome and improving electrophysiological findings. PMID:25061062

  9. Biomechanical risk factors and flexor tendon frictional work in the cadaveric carpal tunnel.

    PubMed

    Kociolek, Aaron M; Tat, Jimmy; Keir, Peter J

    2015-02-01

    Pathological changes in carpal tunnel syndrome patients include fibrosis and thickening of the subsynovial connective tissue (SSCT) adjacent to the flexor tendons in the carpal tunnel. These clinical findings suggest an etiology of excessive shear-strain force between the tendon and SSCT, underscoring the need to assess tendon gliding characteristics representative of repetitive and forceful work. A mechanical actuator moved the middle finger flexor digitorum superficialis tendon proximally and distally in eight fresh frozen cadaver arms. Eighteen experimental conditions tested the effects of three well-established biomechanical predictors of injury, including a combination of two wrist postures (0° and 30° flexion), three tendon velocities (50, 100, 150mm/sec), and three forces (10, 20, 40N). Tendon gliding resistance was determined with two light-weight load cells, and integrated over tendon displacement to represent tendon frictional work. During proximal tendon displacement, frictional work increased with tendon velocity (58.0% from 50-150mm/sec). There was a significant interaction between wrist posture and tendon force. In wrist flexion, frictional work increased 93.0% between tendon forces of 10 and 40N. In the neutral wrist posture, frictional work only increased 33.5% (from 10-40N). During distal tendon displacement, there was a similar multiplicative interaction on tendon frictional work. Concurrent exposure to multiple biomechanical work factors markedly increased tendon frictional work, thus providing a plausible link to the pathogenesis of work-related carpal tunnel syndrome. Additionally, our study provides the conceptual basis to evaluate injury risk, including the multiplicative repercussions of combined physical exposures. PMID:25553671

  10. Assessment of the Presence of Carpal Tunnel Syndrome in Patients with Diabetes Mellitus, Hypothyroidism and Acromegaly

    PubMed Central

    Nas, Kemal; Kilinç, Faruk; Tasdemir, Nebahat; Bozkurt, Mehtap; Yildiz, Ismail

    2015-01-01

    Introduction Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies of the upper limbs. It results from compromised median nerve function of the wrist that is caused by increased pressure in the carpal tunnel. Repetitive use of the hand and wrist, obesity, pregnancy, rheumatoid diseases, trauma and endocrinopathies are some of the risk factors for CTS. Aim The purpose of this study was to find out whether patients with diabetes mellitus (DM), hypothyroidism and acromegaly have an increased incidence of carpal tunnel syndrome compared to each other and normal population. Materials and Methods Patients were assigned into three groups as follows: patients with type II DM n: 100, patients with hypothyroidism n:48 and patients with acromegaly n:36. In addition, 50 healthy individuals were included in the study as control subjects. Patients were asked if they had any pain, symptoms of paraesthesia and numbness. Patients with peripheral neuropathy were excluded from the study. Boston Symptom Severity Scale and Functional Capacity Scale were used to assess symptom severity and functional capacity. CTS was investigated by performing electrophysiological study for both hands. Results The incidence of CTS was significantly higher in all three groups compared to the control group (p>0.05). In addition, the incidence of CTS was significantly higher in the DM group compared to the hypothyroid and acromegaly groups (p<0.001). The incidence of bilateral CTS in the DM group was significantly higher compared to both hypothyroid and acromegaly groups and the control group (p<0.001). Conclusion CTS has a higher incidence in DM, hypothyroid and acromegaly patients compared to healthy individuals. Clinicians should be careful about development of CTS in DM, hypothyroidism and acromegaly. They should adopt a multidisciplinary approach and co-operate with the psychiatrist. PMID:26266148

  11. Surgical treatment of carpal tunnel syndrome and trigger digits in children with mucopolysaccharide storage disorders.

    PubMed

    Van Heest, A E; House, J; Krivit, W; Walker, K

    1998-03-01

    The role of surgical intervention for carpal tunnel syndrome (CTS) and trigger digits in children with mucopolysaccharide storage disorders (MPSDs) has not been clearly defined, particularly as the treatment of the underlying disease has advanced to include bone marrow transplantation. This study reviews our experience in the treatment of CTS and trigger digits in 22 children with MPSDs who were evaluated for CTS by electromyographic (EMG)/nerve conduction velocity (NCV) testing. Seventeen children were diagnosed with CTS by EMG/NCV testing and were treated with bilateral open surgical release with or without flexor tenosynovectomy. The EMG/NCV testing revealed normal results in 5 patients who are subsequently being monitored. Forty-five digits in 8 children were diagnosed clinically with trigger digits. Nineteen digits were treated by annular pulley release alone. Twenty-six digits were treated by annular pulley release with partial flexor digitorum superficialis tendon resection. The average age at the time of hand surgery was 6.3 years, and at the time of follow-up, 9.6 years. Postoperative EMG/NCV testing in 7 children showed 1 with improvement and 6 with normalization. None of the patients undergoing carpal tunnel release went on to develop thenar atrophy or absent sensibility, as has been reported in untreated cases. Patients were evaluated for triggering digits both by preoperative tendon palpation and by intraoperative flexor tendon excursion at the time of open carpal tunnel release. All patients undergoing trigger release had improved active digital flexion seen at the final follow-up visit. Because of the very high incidence of CTS and trigger digits in this population, the authors currently recommend routine screening of EMG/NCV for all children with MPSDs. Early surgical intervention for nerve compression and stenosing flexor tenosynovitis can maximize hand function in these children. PMID:9556262

  12. Clinical Findings of Asymptomatic Carpal Tunnel Syndrome in Patients With Diabetes Mellitus

    PubMed Central

    2016-01-01

    Objective To evaluate the clinical differences between patients with diabetes mellitus (DM) who have asymptomatic carpal tunnel syndrome (CTS) and those who have symptomatic CTS. Methods Sixty-three patients with DM were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), nerve conduction studies (NCS), and ultrasonographic evaluation of the cross-sectional area (CSA) of the median nerve. According to the BCTQ responses and NCS results, the patients were divided into the following three groups: group 1 (n=16), in which NCS results did not reveal CTS; group 2 (n=19), in which NCS results revealed CTS but the group scored 0 points on the BCTQ (asymptomatic); and group 3 (n=28), in which NCS results revealed CTS and the group scored >1 point on the BCTQ (symptomatic). The clinical findings, NCS results, and CSA of the median nerve were compared among the three groups. Results There were no significant differences in age, DM duration, glycated hemoglobin levels, and presence of diabetic polyneuropathy among the three groups. The peak latency of the median sensory nerve action potential was significantly shorter in group 1 than in groups 2 and 3 (p<0.001); however, no difference was observed between groups 2 and 3. CSA of the median nerve at the carpal tunnel in group 2 was significantly larger than that in group 1 and smaller than that in group 3 (p<0.05). Conclusion The results of our study suggest that the symptoms of CTS in patients with diabetes are related to CSA of the median nerve, which is consistent with swelling of the nerve. PMID:27446786

  13. Wrist flexion as an adjunct to the diagnosis of carpal tunnel syndrome.

    PubMed

    Dunnan, J B; Waylonis, G W

    1991-03-01

    The effects of five minutes of wrist flexion on median motor and sensory evoked potential latencies in 87 individuals were studied. Nineteen subjects had carpal tunnel syndrome (CTS) as diagnosed by increased median nerve latencies across the wrist, and 68 had values in the normal range and were assigned to the control group. A slight prolongation of up to 0.5m sec of evoked potential latencies was observed in both groups after flexion, but the differences between the two groups were not significant to establish the value of adding wrist flexion to conventional screening methods. PMID:1998456

  14. Hand pain other than carpal tunnel syndrome (CTS): the role of occupational factors.

    PubMed

    Andréu, José-Luis; Otón, Teresa; Silva-Fernández, Lucía; Sanz, Jesús

    2011-02-01

    Some occupational factors have been implicated in the development of disorders manifested as hand pain. The associations seem to be well documented in processes such as hand-arm vibration syndrome (HAVS) or writer's cramp. There are contradictory data in the literature about the relationships of trigger finger, De Quervain's tenosynovitis (DQT) and tenosynovitis of the wrist with occupational factors. In this article, we review current knowledge about clinical manifestations, case definition, implicated occupational factors, diagnosis and treatment of the most relevant hand pain disorders that have been associated with occupational factors, excluding carpal tunnel syndrome (CTS). PMID:21663848

  15. Outcomes of Open Carpal Tunnel Release at a Minimum of Ten Years

    PubMed Central

    Louie, Dexter L.; Earp, Brandon E.; Collins, Jamie E.; Losina, Elena; Katz, Jeffrey N.; Black, Eric M.; Simmons, Barry P.; Blazar, Philip E.

    2013-01-01

    Background: There is little research on the long-term outcomes of open carpal tunnel release. The purpose of this retrospective study was to determine the functional and symptomatic outcomes of patients at a minimum of ten years postoperatively. Methods: Two hundred and eleven patients underwent open carpal tunnel release from 1996 to 2000 performed by the same hand fellowship-trained surgeon. Follow-up with validated self-administered questionnaire instruments was conducted an average of thirteen years after surgery. The principal outcomes included the Levine-Katz symptom and function scores, ranging from 1 point (best) to 5 points (worst), and satisfaction with the results of surgery. The patients self-reported current comorbidities. Results: After a mean follow-up of thirteen years (range, eleven to seventeen years), 92% (194) of 211 patients were located. They included 140 who were still living and fifty-four who had died. Seventy-two percent (113) of the 157 located, surviving patients responded to the questionnaire. The mean Levine-Katz symptom score (and standard deviation) was 1.3 ± 0.5 points, and 13% of patients had a poor symptom score (≥2 points). The mean Levine-Katz function score was 1.6 ± 0.8 points, and 26% had a poor function score (≥2 points). The most common symptom-related complaint was weakness in the hand, followed by diurnal pain, numbness, and tingling. The least common symptoms were nocturnal pain and tenderness at the incision. Eighty-eight percent of the patients were either completely satisfied or very satisfied with the surgery. Seventy-four percent reported their symptoms to be completely resolved. Thirty-three percent of men were classified as having poor function compared with 23% of women. Two (1.8%) of 113 patients underwent repeat surgery. Conclusions: At an average of thirteen years after open carpal tunnel release, the majority of patients are satisfied and free of symptoms of carpal tunnel syndrome. Level of Evidence

  16. Parvovirus B19-induced acute bilateral carpal tunnel syndrome in twin girls.

    PubMed

    Sakallı, Hale; Baskın, Esra; Dener, Şefik

    2015-01-01

    We describe 2 cases of 6-year-old twin girls presenting with acute carpal tunnel syndrome (CTS) associated with human parvovirus B19 (HPV-B19) infection, as evidenced by serological data and detection of HPV-B19 DNA in blood with use of polymerase chain reaction (PCR). To our knowledge, this is the first time that HPV-B19 infection has been suggested as the causal agent of simultaneous acute bilateral CTS in twins, thus presenting the possibility that similar immunologic responses can be observed in twins during viral infections. PMID:26422355

  17. Median Nerve Compression in Carpal Tunnel Caused by a Giant Lipoma

    PubMed Central

    Fazilleau, F.; Williams, T.; Richou, J.; Sauleau, V.; Le Nen, D.

    2014-01-01

    A lipoma is a common, benign soft-tissue tumor that rarely arises in the upper limb. When one does occur in the hand, the location of the lipoma can cause nerve compression, which can mimic carpal tunnel symptoms. Magnetic resonance imaging is the visualization modality of choice for diagnosis and surgical planning of lipomas. Surgical resection is recommended to relieve the neurological manifestations of this disease. The surgeon should always suspect liposarcoma first before voluminous, atypical, or recurrent tumors are considered. PMID:24876983

  18. The Effect of Polarized Polychromatic Noncoherent Light (Bioptron) Therapy on Patients with Carpal Tunnel Syndrome

    PubMed Central

    Raeissadat, Seyed Ahmad; Rayegani, Seyed Mansoor; Rezaei, Sajad; Bahrami, Mohammad Hasan; Eliaspour, Dariush; Karimzadeh, Afshin

    2014-01-01

    Introduction: To study the effects of Polarized Polychromatic Noncoherent Light (Bioptron) therapy on patients with carpal tunnel syndrome (CTS). Methods: This study was designed as a randomized clinical trial. Forty four patients with mild or moderate CTS (confirmed by clinical and electrodiagnostic studies) were assigned randomly into two groups (intervention and control goups). At the beginning of the study, both groups received wrist splinting for 8 weeks. Bioptron light was applied for the intervention group (eight sessions, for 3/weeks). Bioptron was applied perpendicularly to the wrist from a 10 centimeter sdistance. Pain severity and electrodiagnostic measurements were compared from before to 8 weeks after initiating each treatment. Results: Eight weeks after starting the treatments, the mean of pain severity based on Visual Analogue Scale (VAS) scores decreased significantly in both groups. Median Sensory Nerve Action Potential (SNAP) latency decreased significantly in both groups. However, other electrophysiological findings (median Compound Motor Action Potential (CMAP) latency and amplitude, also SNAP amplitude) did not change after the therapy in both groups. There was no meaningful difference between two groups regarding the changes in the pain severity. Conclusion: Bioptron with the above mentioned parameters led to therapeutic effects equal to splinting alone in patients with carpal tunnel syndrome. However, applying Bioptron with different therapeutic protocols and light parameters other than used in this study, perhaps longer duration of therapy and long term assessment may reveal different results favoring Bioptron therapy. PMID:25606338

  19. Sensitivity of three median-to-ulnar comparative tests in diagnosis of mild carpal tunnel syndrome.

    PubMed

    Uncini, A; Di Muzio, A; Awad, J; Manente, G; Tafuro, M; Gambi, D

    1993-12-01

    We studied 193 hands of 113 patients referred for typical carpal tunnel syndrome (CTS). Ninety-five (49%) hands had normal median distal motor latency (< or = 4.2 ms) and normal or borderline sensory conduction velocity from digit 2 stimulation (> or = 45 m/s). In these cases we performed three median to ulnar comparative tests: (1) difference between median and ulnar distal motor latencies recorded from the second lumbrical and interossei muscles (2L-INT); (2) difference between median and ulnar sensory latencies from digit 4 stimulation (D4M-D4U); and (3) difference between median and ulnar mixed nerve latencies from palmar stimulation (PM-PU). The 2L-INT difference was > or = 0.6 ms in 10% of hands. PM-PU and D4M-D4U were > or = 0.5 ms in 56% and 77% of hands, respectively. The greater sensitivity of D4M-D4U might be explained by the funicular topography and consequent greater susceptibility to compression of the cutaneous fibers from the third interspace which, at the distal carpal tunnel, are clumped superficially in the anteroulnar portion of the median nerve just beneath the transverse ligament. PMID:8232394

  20. Assessment of Decisional Conflict about the Treatment of carpal tunnel syndrome, Comparing Patients and Physicians

    PubMed Central

    Hageman, Michiel GJS.; Bossen, Jeroen K.; Neuhaus, Valentin; Mudgal, Chaitanya S.; Ring, David

    2016-01-01

    Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict. Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9). Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons. Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America. Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict. PMID:27200394

  1. The SF-6D health utility index in carpal tunnel syndrome.

    PubMed

    Atroshi, I; Gummesson, C; McCabe, S J; Ornstein, E

    2007-04-01

    Cost effectiveness is an important factor to consider when choosing between various hand surgical interventions. Health utility measures can be used to determine cost effectiveness. The SF-6D is a health utility index derived from 11 items of the SF-36 quality of life questionnaire; values range from 0.296 to 1.0 ("perfect" health). We evaluated the validity of the SF-6D in patients with carpal tunnel syndrome (CTS) who completed the SF-36 and the CTS symptom severity and functional status questionnaire before and 3 months after carpal tunnel release. Complete responses to the SF-6D items were available for 100 patients at baseline and 95 patients at baseline and follow-up. The mean SF-6D health utility index was 0.69 (SD 0.13) before surgery and 0.77 (SD 0.13) after surgery (moderate effect size). The SF-6D could discriminate between patient groups differing in self-rated global health and in whether, or not, they had a minimal clinically important improvement in CTS symptom severity after surgery. The SF-6D appears to be a valid measure of health utilities in patients with CTS and can be used in cost effectiveness studies. PMID:17223234

  2. Sensory axons excitability changes in carpal tunnel syndrome after neural mobilization.

    PubMed

    Ginanneschi, Federica; Cioncoloni, David; Bigliazzi, Jacopo; Bonifazi, Marco; Lorè, Cosimo; Rossi, Alessandro

    2015-09-01

    Increased mechanosensitivity of the median nerve in carpal tunnel syndrome (CTS) has been demonstrated during upper limb tension test 1 (ULTT1) when the nerve is passively elongated. However, the neurophysiological changes of the sensory axons during stressing activities are unknown. The aim of present study was to verify possible changes in the excitability of median nerve afferent axons following nerve stress in elongation, in subjects with and without CTS. Eight CTS hands and eight controls were selected. Recruitment properties of the median nerve were studied by analyzing the relationship between the intensity of electrical stimulation and the size of motor response, before and after intermittent-repetitive neural mobilization. Only in CTS hands, after the intervention, the stimulus-response curve was strikingly abnormal: both plateau and slope values were significantly lower. During anatomical stress across the median nerve in elongation, compressive forces may exert mechanical traction on the median nerve, since it is 'tethered' at the carpal tunnel, resulting inactivation of Na(+) channels at the wrist, or impairment of energy-dependent processes which affect axonal conduction block. We conclude that in entrapment neuropathies, neural mobilization during nerve elongation may generate conduction failure in peripheral nerve. Our study supports specific considerations for patient education and therapeutic approaches. PMID:25896622

  3. Motor Unit Number Estimation and Motor Unit Action Potential Analysis in Carpal Tunnel Syndrome

    PubMed Central

    Sohn, Min Kyun; Jee, Sung Ju; Kim, Young-Jae; Shin, Hyun-Dae

    2011-01-01

    Objective To evaluate the clinical significance of motor unit number estimation (MUNE) and quantitative analysis of motor unit action potential (MUAP) in carpal tunnel syndrome (CTS) according to electrophysiologic severity, ultrasonographic measurement and clinical symptoms. Method We evaluated 78 wrists of 45 patients, who had been diagnosed with CTS and 42 wrists of 21 healthy controls. Median nerve conduction studies, amplitude and duration of MUAP, and the MUNE of the abductor pollicis brevis were measured. The cross sectional area (CSA) of the median nerve at the pisiform and distal radioulnar joint level was determined by high resolution ultrasonography. Clinical symptom of CTS was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Results The MUNE, the amplitude and the duration of MUAP of the CTS group were significantly different from those found in the control group. The area under the ROC curve was 0.944 for MUNE, 0.923 for MUAP amplitude and 0.953 for MUAP duration. MUNE had a negative correlation with electrophysiologic stage of CTS, amplitude and duration of MUAP, CSA at pisiform level, and the score of BCTQ. The amplitude and duration of MUAP had a positive correlation with the score of BCTQ. The electrophysiologic stage was correlated with amplitude but not with the duration of MUAP. Conclusion MUNE, amplitude and duration of MUAP are useful tests for diagnosis of CTS. In addition, the MUNE serves as a good indicator of CTS severity. PMID:22506210

  4. Battling Carpal Tunnel Syndrome through Ergonomics: A Case Study of Texas A&M's Library Provides Insights and Answers.

    ERIC Educational Resources Information Center

    Thornton, Joyce K.

    1995-01-01

    Current library automation practices and new technologies have forced library managers to seek some means of reducing carpal tunnel syndrome, and a case study of Texas A&M's library provides insights. Highlights include identifying and assessing the injuries, adjusting work surfaces, testing and selecting new keyboards, and developing adjustable…

  5. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment

    PubMed Central

    Pajardi, Giorgio; Bortot, Paola; Ponti, Veronica; Novelli, Chiara

    2014-01-01

    We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation). Patients in Group C (n = 60) received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05). Moreover, patients in Group B had a significantly lower number of positive Phalen's tests at 3 months compared with the other study groups (P < 0.05). We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve. PMID:24563654

  6. Clinical usefulness of oral supplementation with alpha-lipoic Acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment.

    PubMed

    Pajardi, Giorgio; Bortot, Paola; Ponti, Veronica; Novelli, Chiara

    2014-01-01

    We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation). Patients in Group C (n = 60) received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values <0.05). Moreover, patients in Group B had a significantly lower number of positive Phalen's tests at 3 months compared with the other study groups (P < 0.05). We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve. PMID:24563654

  7. The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis

    PubMed Central

    Roy, Joyeeta; Vikse, Jens; Ramakrishnan, Piravin Kumar; Walocha, Jerzy A.; Tomaszewski, Krzysztof A.

    2015-01-01

    Background and Objective The course and branches of the median nerve (MN) in the wrist vary widely among the population. Due to significant differences in the reported prevalence of such variations, extensive knowledge on the anatomy of the MN is essential to avoid iatrogenic nerve injury. Our aim was to determine the prevalence rates of anatomical variations of the MN in the carpal tunnel and the most common course patterns and variations in its thenar motor branch (TMB). Study Design A systematic search of all major databases was performed to identify articles that studied the prevalence of MN variations in the carpal tunnel and the TMB. No date or language restrictions were set. Extracted data was classified according to Lanz's classification system: variations in the course of the single TMB—extraligamentous, subligamentous, and transligamentous (type 1); accessory branches of the MN at the distal carpal tunnel (type 2); high division of the MN (type 3); and the MN and its accessory branches proximal to the carpal tunnel (type 4). Pooled prevalence rates were calculated using MetaXL 2.0. Results Thirty-one studies (n = 3918 hands) were included in the meta-analysis. The pooled prevalence rates of the extraligamentous, subligamentous, and transligamentous courses were 75.2% (95%CI:55.4%-84.7%), 13.5% (95%CI:3.6%-25.7%), and 11.3% (95%CI:2.4%-23.0%), respectively. The prevalence of Lanz group 2, 3, and 4 were 4.6% (95%CI:1.6%-9.1%), 2.6% (95%CI:0.1%-2.8%), and 2.3% (95%CI:0.3%-5.6%), respectively. Ulnar side of branching of the TMB was found in 2.1% (95%CI:0.9%-3.6%) of hands. The prevalence of hypertrophic thenar muscles over the transverse carpal ligament was 18.2% (95%CI:6.8%-33.0%). A transligamentous course of the TMB was more commonly found in hands with hypertrophic thenar muscles (23.4%, 95%CI:5.0%-43.4%) compared to those without hypertrophic musculature (1.7%, 95%CI:0%-100%). In four studies (n = 423 hands), identical bilateral course of the TMB was

  8. Electroacupuncture and splinting versus splinting alone to treat carpal tunnel syndrome: a randomized controlled trial

    PubMed Central

    Chung, Vincent C.H.; Ho, Robin S.T.; Liu, Siya; Chong, Marc K.C.; Leung, Albert W.N.; Yip, Benjamin H.K.; Griffiths, Sian M.; Zee, Benny C.Y.; Wu, Justin C.Y.; Sit, Regina W.S.; Lau, Alexander Y.L.; Wong, Samuel Y.S.

    2016-01-01

    Background: The effectiveness of acupuncture for managing carpal tunnel syndrome is uncertain, particularly in patients already receiving conventional treatments (e.g., splinting). We aimed to assess the effects of electroacupuncture combined with splinting. Methods: We conducted a randomized parallel-group assessor-blinded 2-arm trial on patients with clinically diagnosed primary carpal tunnel syndrome. The treatment group was offered 13 sessions of electroacupuncture over 17 weeks. The treatment and control groups both received continuous nocturnal wrist splinting. Results: Of 181 participants randomly assigned to electroacupuncture combined with splinting (n = 90) or splinting alone (n = 91), 174 (96.1%) completed all follow-up. The electroacupuncture group showed greater improvements at 17 weeks in symptoms (primary outcome of Symptom Severity Scale score mean difference [MD] −0.20, 95% confidence interval [CI] −0.36 to −0.03), disability (Disability of Arm, Shoulder and Hand Questionnaire score MD −6.72, 95% CI −10.9 to −2.57), function (Functional Status Scale score MD −0.22, 95% CI −0.38 to −0.05), dexterity (time to complete blinded pick-up test MD −6.13 seconds, 95% CI −10.6 to −1.63) and maximal tip pinch strength (MD 1.17 lb, 95% CI 0.48 to 1.86). Differences between groups were small and clinically unimportant for reduction in pain (numerical rating scale −0.70, 95% CI −1.34 to −0.06), and not significant for sensation (first finger monofilament test −0.08 mm, 95% CI −0.22 to 0.06). Interpretation: For patients with primary carpal tunnel syndrome, chronic mild to moderate symptoms and no indication for surgery, electroacupuncture produces small changes in symptoms, disability, function, dexterity and pinch strength when added to nocturnal splinting. Trial registration: Chinese Clinical Trial Register no. ChiCTR-TRC-11001655 (www.chictr.org.cn/showprojen.aspx?proj=7890); subsequently deposited in the World Health

  9. The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics.

    PubMed

    Tanner, Marc A; Conrad, Bryan P; Dell, Paul C; Wright, Thomas W

    2012-01-01

    Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics. Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined. Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly. Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint. PMID:23251808

  10. Intradermal Therapy (Mesotherapy) for the Treatment of Acute Pain in Carpal Tunnel Syndrome: A Preliminary Study

    PubMed Central

    Conforti, Giorgio; Capone, Loredana

    2014-01-01

    Background The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy). Methods In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence. Results The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment. Conclusions With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS. PMID:24478901

  11. Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit.

    PubMed

    Kim, J H; Gong, H S; Lee, H J; Lee, Y H; Rhee, S H; Baek, G H

    2013-01-01

    We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome. PMID:22553311

  12. Spatial-temporal features of thermal images for Carpal Tunnel Syndrome detection

    NASA Astrophysics Data System (ADS)

    Estupinan Roldan, Kevin; Ortega Piedrahita, Marco A.; Benitez, Hernan D.

    2014-02-01

    Disorders associated with repeated trauma account for about 60% of all occupational illnesses, Carpal Tunnel Syndrome (CTS) being the most consulted today. Infrared Thermography (IT) has come to play an important role in the field of medicine. IT is non-invasive and detects diseases based on measuring temperature variations. IT represents a possible alternative to prevalent methods for diagnosis of CTS (i.e. nerve conduction studies and electromiography). This work presents a set of spatial-temporal features extracted from thermal images taken in healthy and ill patients. Support Vector Machine (SVM) classifiers test this feature space with Leave One Out (LOO) validation error. The results of the proposed approach show linear separability and lower validation errors when compared to features used in previous works that do not account for temperature spatial variability.

  13. Wheelchair ergonomic hand drive mechanism use improves wrist mechanics associated with carpal tunnel syndrome.

    PubMed

    Zukowski, Lisa A; Roper, Jaimie A; Shechtman, Orit; Otzel, Dana M; Hovis, Patty W; Tillman, Mark D

    2014-01-01

    Among conventional manual wheelchair (CMW) users, 49% to 63% experience carpal tunnel syndrome (CTS) that is likely induced by large forces transmitted through the wrist and extreme wrist orientations. The ergonomic hand drive mechanism (EHDM) tested in this study has been shown to utilize a more neutral wrist orientation. This study evaluates the use of an EHDM in terms of wrist orientations that may predispose individuals to CTS. Eleven adult full-time CMW users with spinal cord injury participated. Motion data were captured as participants propelled across a flat surface, completing five trials in a CMW and five trials in the same CMW fitted with the EHDM. Average angular wrist orientations were compared between the two propulsion styles. Use of the EHDM resulted in reduced wrist extension and ulnar deviation. The shift to more neutral wrist orientations observed with EHDM use may reduce median nerve compression. PMID:25856042

  14. Carpal tunnel syndrome associated with the use of aromatase inhibitors in breast cancer.

    PubMed

    Nishihori, Taiga; Choi, Jaehyuk; DiGiovanna, Michael P; Thomson, J Grant; Kohler, Peter C; McGurn, Joanne; Chung, Gina G

    2008-08-01

    Aromatase inhibitors (AI) inhibit peripheral conversion of androgens to estradiol and are commonly used as hormonal therapy for postmenopausal women with hormone receptor-positive breast cancer in the metastatic and adjuvant settings. Joint-related symptoms, however, are seen in a significant proportion of patients. Carpal tunnel syndrome (CTS) is a common nerve entrapment disorder affecting the median nerve. We describe 6 patients with newly diagnosed CTS after initiation of adjuvant AI therapy. Aromatase inhibitors were discontinued in several patients secondary to this toxicity with some switching to tamoxifen and most subsequently experiencing relief of their symptoms. Potential pathophysiologic roles of hormonal manipulation with AIs and other risk factors that might contribute to CTS are discussed. Aromatase inhibitors might accentuate the occurrence of CTS and potentially other nerve entrapment syndromes, and a more systematic approach should be used to better understand the clinical significance and incidence of these symptoms. PMID:18757265

  15. Mucopolysaccharidosis type-IS presenting with onset of carpal tunnel syndrome at adolescence.

    PubMed

    Bahadir, Cengiz; Kurtulus, Duygu; Cihandide, Ercan

    2009-12-01

    Mucopolysaccharidosis type I (MPS I) results from deficiency of the lysosomal enzyme alpha-L iduronidase. Three subtypes, based on severity of clinical findings, have been described, of which MPS type IS (also called Scheie syndrome) is the mildest form. A woman (age, 30 years) and her little brother (age, 21 years) presented to our clinic complaining of atrophy of the thenar muscles, numbness in both hands, and contractures in the finger joints. Electrophysiologic examination showed severe carpal tunnel syndrome for both patients. Findings of cardiac and ocular involvements and decreased level of alpha-L iduronidase confirmed the diagnosis of Scheie syndrome. Enzyme replacement therapy was initiated for the further prevention of musculoskeletal and other organ complications. Delayed diagnosis of MPS type-IS and the musculoskeletal findings are discussed in these 2 familial patients. PMID:19955999

  16. Grading severity of carpal tunnel syndrome in electrodiagnostic reports: why grading is recommended.

    PubMed

    Sucher, Benjamin M

    2013-09-01

    Carpal tunnel syndrome (CTS) is not difficult to confirm by electrodiagnosis (EDx), but the challenge lies in whether to grade the severity and the method for doing so. The arguments about grading are discussed, with an emphasis in favor, using a method that relies on the EDx data, but qualifies that it is the median neuropathy being graded and not the syndrome of CTS. Although use of latencies can be arbitrary and misleading, it is possible to apply other criteria, such as low amplitudes or conduction block and denervation, to develop a grading scale that could be applied widely. Several previously published grading schemes are reviewed, and a new method is described that combines the prior ranking criteria into 3 basic categories. Application of a grading system identifies the degree of nerve injury and thus allows the referring physician to utilize optimally the EDx report to manage the patient. PMID:23436589

  17. Precision pinch performance in patients with sensory deficits of the median nerve at the carpal tunnel.

    PubMed

    Yen, Wei-Jang; Kuo, Yao-Lung; Kuo, Li-Chieh; Chen, Shu-Min; Kuan, Ta-Shen; Hsu, Hsiu-Yun

    2014-01-01

    To investigate how sensory symptoms impact the motor control of hands, in this study we examined the differences in conventional sensibility assessments and pinch force control in the pinch-holding-up activity (PHUA) test between carpal tunnel syndrome (CTS) patients and healthy controls. CTS patients (n = 82) with 122 affected hands and an equal number of control subjects were recruited to participate in the threshold, discrimination, and PHUA tests. The patients showed significantly poorer hand sensibility and lower efficiency of force adjustment in the PHUA test as compared with the control subjects. Baseline pinch strength and the percentage of maximal pinch strength for the PHUA were significantly higher for the subgroup of sensory nerve action potential (SNAP) of <16 μV than for the subgroup of SNAP of 16 μV. Using a PHUA perspective to analyze the efficiency of force-adjustment could assist the clinical detection of sensory nerve dysfunction. PMID:24496877

  18. Vibrometry testing for carpal tunnel syndrome: a longitudinal study of daily variations.

    PubMed

    White, K M; Congleton, J J; Huchingson, R D; Koppa, R J; Pendleton, O J

    1994-01-01

    The method of limits procedure was used to obtain 84 120Hz vibration thresholds, over a 3-month period, on four age-matched women with different levels of carpal tunnel syndrome (CTS). Each woman used a keyboard for 4 hours a day during work. Testing was conducted in a room with a temperature of 28 degrees C +/- 2 degrees C after 20 minutes acclimation. Results indicate vibration thresholds vary significantly from day to day and also demonstrate how a single vibrometry measure may falsely identify the participant's true CTS condition. Specifically, a single measure could account for a negative CTS determinations in affected wrists or positive CTS determinations in healthy wrists. Subsequent analysis revealed menses related fluid retention and day of the week increase the vibration thresholds. Analyzing the levels of fluid retention by day of the week indicates a compounding effect of the personal and occupational risk factors. PMID:8291957

  19. The evaluation of vitamin D levels in patients with carpal tunnel syndrome.

    PubMed

    Gürsoy, Azize Esra; Bilgen, Halide Rengin; Dürüyen, Hümeyra; Altıntaş, Özge; Kolukisa, Mehmet; Asil, Talip

    2016-07-01

    The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP- group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP- group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP- groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP- group was lower than EP+ group, statistically difference was not significant between EP+ and EP- groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP- groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results. PMID:26939675

  20. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome

    PubMed Central

    Kuo, Tai-Tzung; Lee, Ming-Ru; Liao, Yin-Yin; Chen, Jiann-Perng; Hsu, Yen-Wei; Yeh, Chih-Kuang

    2016-01-01

    Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS). Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion–extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC) curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for quantitatively estimating

  1. Value of high-frequency ultrasound in diagnosing carpal tunnel syndrome

    PubMed Central

    Lu, Yuji; Meng, Zengdong; Pan, Xuekun; Qin, Libo; Wang, Gang

    2015-01-01

    This study aimed to evaluate the diagnostic value of high-frequency ultrasound examination for carpal tunnel syndrome (CTS). A total of 63 wrists from 45 patients diagnosed with CTS were selected as the study group, and 43 asymptomatic wrists of 40 cases were included as the normal control group. Parameters such as the transverse diameter, vertical diameter, cross-sectional area (CSA), and flattening rate (FR) of the carpal tunnel radioulnar joint, postular bone, and median nerve in the hamate bone hook plane were measured, and the differences between the two groups were compared. The median nerve CSA in the postular bone plate was significantly greater in the study group than in the normal control group (0.17±0.05 vs. 0.09±0.02, P<0.01), and the FR at the hook of the hamate was significantly higher in the study group (3.52±0.86 vs. 3.21±0.26, P<0.01). Our results suggest that ultrasonography can effectively provide dynamic real-time images of the wrist in addition to being painless, non-invasive, and associated with relatively low costs. Based on our findings, we believe that ultrasonography is an effective examination method for CTS. When the threshold of the median nerve CSA in the postular bone plate was set as 10 mm2, the diagnostic sensitivity and specificity were 92% and 86%, respectively. Therefore, the median nerve CSA may represent a good clinical indicator of CTS. PMID:26885222

  2. Interleukin and growth factor gene variants and risk of carpal tunnel syndrome.

    PubMed

    Burger, Marilize C; de Wet, Hanli; Collins, Malcolm

    2015-06-10

    Recent research has identified DNA sequence variants within genes encoding structural components of the collagen fibril, the basic structural unit of tendons, to modify the risk of carpal tunnel syndrome (CTS). Since the expression of these previously associated genes are regulated by cytokine and growth factor signalling pathways, the aim of this study was to determine whether variants within these cell signalling pathway genes, namely interleukin 1β (IL-1β), IL-6, interleukin 6 receptor (IL-6R) and vascular endothelial growth factor A(VEGFA), are also associated with CTS. One hundred and three self-reported Coloured participants, with a history of carpal tunnel release surgery (CTS) and 149 matched control participants (CON) without any reported history of CTS symptoms were genotyped for the functional IL-1β rs16944 (-511C/T), IL-6 rs1800795 (-174G/C), IL-6R rs2228145 (C/A) and VEGFA rs699947 (-2578C/A) variants. Only the IL-6R variant was significantly associated with CTS (p=0.005, OR=0.41, 95% CI 0.22-0.75). When the previously reported associated COL5A1 and BGN variants were included in the analysis, gene-gene interactions were also shown to significantly modulate the risk of CTS. In conclusion, the AA genotype of IL-6R rs2228145 was independently associated with reduced risk of CTS in a South African Coloured population. The IL-6R variant interacted with the previously reported COL5A1 and BGN variants to modulate CTS risk. This highlights that interleukin and growth factor gene variants should also be considered, in addition to the extracellular matrix proteins, for future research in determining the aetiology of CTS. PMID:25813875

  3. Assessment of Median Nerve Mobility by Ultrasound Dynamic Imaging for Diagnosing Carpal Tunnel Syndrome.

    PubMed

    Kuo, Tai-Tzung; Lee, Ming-Ru; Liao, Yin-Yin; Chen, Jiann-Perng; Hsu, Yen-Wei; Yeh, Chih-Kuang

    2016-01-01

    Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy and is characterized by median nerve entrapment at the wrist and the resulting median nerve dysfunction. CTS is diagnosed clinically as the gold standard and confirmed with nerve conduction studies (NCS). Complementing NCS, ultrasound imaging could provide additional anatomical information on pathological and motion changes of the median nerve. The purpose of this study was to estimate the transverse sliding patterns of the median nerve during finger movements by analyzing ultrasound dynamic images to distinguish between normal subjects and CTS patients. Transverse ultrasound images were acquired, and a speckle-tracking algorithm was used to determine the lateral displacements of the median nerve in radial-ulnar plane in B-mode images utilizing the multilevel block-sum pyramid algorithm and averaging. All of the averaged lateral displacements at separate acquisition times within a single flexion-extension cycle were accumulated to obtain the cumulative lateral displacements, which were curve-fitted with a second-order polynomial function. The fitted curve was regarded as the transverse sliding pattern of the median nerve. The R2 value, curvature, and amplitude of the fitted curves were computed to evaluate the goodness, variation and maximum value of the fit, respectively. Box plots, the receiver operating characteristic (ROC) curve, and a fuzzy c-means clustering algorithm were utilized for statistical analysis. The transverse sliding of the median nerve during finger movements was greater and had a steeper fitted curve in the normal subjects than in the patients with mild or severe CTS. The temporal changes in transverse sliding of the median nerve within the carpal tunnel were found to be correlated with the presence of CTS and its severity. The representative transverse sliding patterns of the median nerve during finger movements were demonstrated to be useful for quantitatively estimating

  4. Ultrasound-Guided Pulsed Radiofrequency for Carpal Tunnel Syndrome: A Single-Blinded Randomized Controlled Study

    PubMed Central

    2015-01-01

    Objective We assessed the therapeutic efficiency of ultrasound-guided pulsed radiofrequency (PRF) treatment of the median nerve in patients with carpal tunnel syndrome (CTS). Methods We conducted a prospective, randomized, controlled, single-blinded study. Forty-four patients with CTS were randomized into intervention or control groups. Patients in the intervention group were treated with PRF and night splint, and the control group was prescribed night splint alone. Primary outcome was the onset time of significant pain relief assessed using the visual analog scale (VAS), and secondary outcomes included evaluation of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) results, cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity (SNCV) of the median nerve, and finger pinch strength. All outcome measurements were performed at 1, 4, 8, and 12 weeks after treatment. Results Thirty-six patients completed the study. The onset time of pain relief in the intervention group was significantly shorter (median onset time of 2 days vs. 14 days; hazard ratio = 7.37; 95% CI, 3.04–17.87) compared to the control group (p < 0.001). Significant improvement in VAS and BCTQ scores (p < 0.05) was detected in the intervention group at all follow-up periods compared to the controls (except for the severity subscale of BCTQ at week 1). Ultrasound-guided PRF treatment resulted in a lower VAS score and stronger finger pinch compared to the control group over the entire study. Conclusions Our study shows that ultrasound-guided PRF serves as a better approach for pain relief in patients with CTS. Trial Registration ClinicalTrials.gov NCT02217293 PMID:26067628

  5. The Efficacy of 100 and 300 mg Gabapentin in the Treatment of Carpal Tunnel Syndrome.

    PubMed

    Eftekharsadat, Bina; Babaei-Ghazani, Arash; Habibzadeh, Afshin

    2015-01-01

    Carpal tunnel syndrome (CTS) is a neuropathy due to the compression of the median nerve. It is shown that gabapentin in high doses is effective in treatment of CTS patients. In this study we evaluated the efficacy of low doses of gabapentin in treatment of CTS patients. Ninety patients with CTS were randomly assigned to groups A, B and C. Gabapentin was administered to group A with dose of 100 mg/day and to group B with dose of 300 mg/day for 2 months. Group C received no treatment. Before and after treatment, patients were evaluated using Visual analogue scale (VAS) for pain and parasthesia, Boston carpal tunnel questionnaire (BCTQ) including Symptom Severity Scale (SSS) and Functional Status Scale (FSS) to evaluate the efficacy of the treatment. The pinch and grip strength was also measured. There was significant improvement in VAS, grip strength, pinch strength, SSS, FSS and BCTQ score in all three groups (p < 0.05), but the changes in CMAP and SNAP was not significant. Groups A and B in comparison to group C had significantly better improvement in VAS, pinch strength, SSS, FSS and BCTQ total score (p < 0.05). There was significantly more improvement in pinch strength and SSS score in group B compared to group A (p < 0.05). Gabapentin in low doses is a useful drug in treatment of CTS symptoms with no side effects and intolerance. Gabapentin with dose of 300 mg/day is more effective than the dose of 100 mg/day. PMID:26664397

  6. In situ decompression of the ulnar nerve at the cubital tunnel.

    PubMed

    Waugh, Robert P; Zlotolow, Dan A

    2007-08-01

    Cubital tunnel syndrome is a clinical entity that has been described for more than a century. Numerous conservative and surgical treatments have evolved to address this condition, but a consensus has yet to emerge regarding optimal treatment. Evidence suggests a limited but potentially valuable role for in situ decompression of the ulnar nerve at the cubital tunnel. Future research will undoubtedly clarify this role and contribute to the development of a standard treatment protocol. PMID:17765584

  7. [Two unusual complications of the Klippel-Trénaunay syndrome: carpal tunnel syndrome and cerebral venous thrombosis].

    PubMed

    Awada, A; Al Jumah, M; Al Ayafi, H

    2003-07-01

    Most neurological complications of the Klippel-Trénaunay syndrome are due to the presence of cerebral or spinal arteriovenous malformations and their consequences. We report 2 cases of unusual complications of this syndrome. In the first case, where the anomalies were restricted to the left upper extremity, the occurrence of hand numbness led to the discovery of a carpal tunnel syndrome, probably due to the lymphatic abnormal proliferation within the carpal tunnel. In the second case the disease was much more widespread and affecting, among other localizations, the cephalic extremity. The patient presented with intractable left motor seizures that appeared to be due to an occlusion of the right transverse and sigmoid sinuses. Treatment with heparin and anticonvulsants led to rapid recovery. PMID:12910081

  8. A randomized prospective study to assess the efficacy of two cold-therapy treatments following carpal tunnel release.

    PubMed

    Hochberg, J

    2001-01-01

    A prospective randomized study was performed comparing the efficacy of controlled cold therapy (CCT) with the efficacy of ice therapy in the postoperative treatment of 72 patients with carpal tunnel syndrome. Immediately after surgery, patients applied either a temperature-controlled cooling blanket (CCT) or a standard ice pack over their surgical dressings. Pain was assessed by visual analog scale and swelling by wrist circumference preoperatively, immediately after surgery, and on postoperative day 3. Patients kept log books of daily treatment times. Narcotic use (of Vicodin ES) was determined by pill count at day 3 and by daily log book recordings. Patients who used CCT showed significantly greater reduction in pain, edema (wrist circumference), and narcotic use at postoperative day 3 than did those using ice therapy. This study indicates that after carpal tunnel surgery, the use of CCT, compared with traditional ice therapy, provides patients with greater comfort and lessens the need for narcotics. PMID:11511016

  9. Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions

    PubMed Central

    Chimenti, Peter C.; McIntyre, Allison W.; Childs, Sean M.; Hammert, Warren C.; Elfar, John C.

    2016-01-01

    Background: Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods: 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. Results: Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. Conclusion: This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population. PMID:27347239

  10. Diagnosis of carpal tunnel syndrome: interobserver reliability of the blinded scratch-collapse test.

    PubMed

    Blok, Robin D; Becker, Stéphanie J E; Ring, David C

    2014-06-01

    The reliability of the scratch-collapse test for diagnosis of carpal tunnel syndrome (CTS) has not been tested by independent investigators. This study measured the reliability of the scratch-collapse test comparing the treating hand surgeon and blinded evaluators. We performed a prospective observational study of 41 patients with a provisional diagnosis of CTS or a combination of CTS and cubital tunnel syndrome and prescribed electrodiagnostic testing. The treating hand surgeon performed the scratch-collapse test. Next, the test was administered by one of the six observers, unaware of the patient's symptoms and the diagnosis made by treating hand surgeon. The kappa statistic (κ) was used to calculate the interrater reliability between the treating hand surgeons and blinded scratchers. The agreement between the blinded observers and the hand surgeons on the scratch-collapse test was substantial 0.63 (95 % CI, 0.34-0.87; p < 0.001). The sensitivity of the blinded scratch test in our sample was 32 %. In a small study with a spectrum bias favoring electrophysiologically confirmed CTS the reliability was lower than that reported by the inventors of the test, but was still substantial. We propose a larger study of patients with a greater variety of electrodiagnostic test results using fewer observers with more experience. PMID:24876682

  11. [Carpal tunnel syndrome in workers engaged in the assembly of manufactured products in various industries in the province of Brescia].

    PubMed

    Barbieri, P G

    1996-01-01

    Tests were carried out on five manual assembly departments in a variety of different factories, in order to assess the risks associated with the onset of Carpal Tunnel Syndrome and to describe the prevalence of this disorder among exposed workers. The application of the risk analysis method proposed by the EPM Research Unit in Milan (Italy) demonstrated the presence of numerous jobs featuring both a high frequency of actions per minute and a total lack of recovery times, in addition to a variety of incongrous upper limb postures. The clinical and instrumental investigation diagnosed 76 cases of Carpal Tunnel Syndrome among the 170 exposed workers. 62% of the cases was bilateral and 24% was associated with Guyon Channel Syndrome. In two of the five departments reviewed, the carpal tunnel disorders detected were endemic, and featured unusually high prevalence. The situation had been seriously underestimated by the company technical and medical staff, resulting in a failure to call for the urgent adoption of individual protection and collective prevention measures. The authors recommend that an extensive and adequate occupational risk assessment analysis be performed: the local occupational health services could play a critical role in identifying the highest risk industries and the diseases diagnosed in a hospital environment. PMID:9148125

  12. What Does the Transverse Carpal Ligament Contribute to Carpal Stability?

    PubMed Central

    Vanhees, Matthias; Verstreken, Frederik; van Riet, Roger

    2015-01-01

    Background The transverse carpal ligament is well known for its involvement in carpal tunnel syndrome, and sectioning of this ligament remains the definite treatment for this pathology. Some authors believe that the transverse carpal ligament is an important stabilizer of the carpal arch, whereas others do not consider it to be significant. Several studies have been performed, both in vivo and in in vitro. Sectioning of the transverse carpal ligament does not seem to have any effect on the width of the carpal arch in the unloaded condition. However, patients will load the arch during their activities of daily living. Materials and Methods A cadaveric study was done with distraction of the carpal bones before and after sectioning the transverse carpal ligament. Results With the transverse carpal ligament intact, the carpal arch is mobile, with distraction leading up to 50% widening of the arch. Sectioning of the transverse carpal ligament resulted in a significant widening of the carpal arch by a further 30%. Conclusions Loading of the carpal arch after sectioning of the transeverse carapal ligament leads to a significant increase in intracarpal mobility. This will inevitably influence carpal kinematics in the patient and might be responsible for some complications after simple carpal tunnel releases, such as pillar pain, palmar tenderness, and loss of grip strength. PMID:25709876

  13. Er:YAG laser for the surgical treatment of the carpal tunnel syndrome

    NASA Astrophysics Data System (ADS)

    Russ, Detlef; Ebinger, Thomas; Illich, Wolfgang; Steiner, Rudolf W.

    2003-10-01

    We developed a new surgical procedure to improve the recurrence rate using an Er:YAG laser as dissection tool for the carpal ligament with the objective to ablate a small amount of the carpal ligament and to denaturate its ends. The Er:YAG Laser was transmitted to the applicator via a GeO fiber. With this system we proceeded 10 carpal ligament dissections without any complications in the follow-up period. All patients were free of pain and recurrence.

  14. The Relationship between Nerve Conduction Study and Clinical Grading of Carpal Tunnel Syndrome

    PubMed Central

    Cheluvaiah, Janardhan D.; Agadi, Jagadish B.; Nagaraj, Karthik

    2016-01-01

    Introduction Carpal Tunnel Syndrome (CTS) is the most common nerve entrapment. Subjective sensory symptoms are common place in patients with CTS, but sometimes they are not supported by objective findings in the neurological examination. Electrodiagnostic (EDx) studies are a valid and reliable means of confirming the diagnosis. The amplitudes along with the conduction velocities of the sensory nerve action potential and motor nerve action potential reflect the functional state of axons, and are useful parameters and complement the clinical grading in the assessment of severity of CTS. Aim To conduct median nerve sensory and motor conduction studies on patients with carpal tunnel syndrome and correlate the relationship between nerve conduction study parameters and the clinical severity grading. Materials and Methods Based on clinical assessment, the study patients were divided into 03 groups with mild CTS, moderate CTS and severe CTS respectively as per Mackinnson’s classification. Median and ulnar nerve conduction studies were performed on bilateral upper limbs of 50 patients with symptoms of CTS and 50 age and sex matched healthy control subjects. The relationship between the clinical severity grade and various nerve conduction study parameters were correlated. Results In this prospective case control study, 50 patients with symptoms consistent with CTS and 50 age and sex matched healthy control subjects were examined over a 10 month period. A total of 30 patients had unilateral CTS (right upper limb in 19 and left upper limb in 11) and 20 patients had bilateral CTS. Female to male ratio was 3.54 to 1. Age ranged from 25 to 81 years. The mean age at presentation was 49.68±11.7 years. Tingling paresthesias of hand and first three fingers were the most frequent symptoms 48 (98%). Tinel’s and Phalen’s sign were positive in 36 (72%) and 44 (88%) patients respectively. The mean duration of symptoms at presentation was 52.68±99.81 weeks. 16 patients (32%) had

  15. Radial tunnel syndrome caused by ganglion cyst: treatment by arthroscopic cyst decompression.

    PubMed

    Mileti, Joseph; Largacha, Mauricio; O'Driscoll, Shawn W

    2004-05-01

    Compressive neuropathies of the radial nerve at the elbow can lead to one of 2 clinical entities. Posterior interosseous syndrome is primarily a motor deficiency of the posterior interosseous nerve, and radial tunnel syndrome presents as pain along the radial tunnel and extensor muscle mass. The radial nerve can be compressed at a number of sites around the elbow. In addition, numerous mass lesions reported in the literature can cause compressive neuropathy of the radial nerve at the elbow. Standard surgical management for persistent radial tunnel syndrome that is refractory to nonsurgical treatment is open decompression of the radial nerve. Cysts occurring in other joints are commonly treated arthroscopically. Supraglenoid cysts of the shoulder, meniscal cysts in the knee, and dorsal wrist ganglia are routinely treated with arthroscopic decompression or excision with management of the underlying etiology of the cyst. We present a case of radial tunnel syndrome caused by a ganglion cyst of the proximal radioulnar joint that was treated using arthroscopic excision of the cyst and decompression of the radial nerve. PMID:15122155

  16. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory.

    PubMed

    Roquelaure, Y; Mariel, J; Dano, C; Fanello, S; Penneau-Fontbonne, D

    2001-01-01

    The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand. PMID:11885919

  17. Extracorporeal shock wave therapy in pillar pain after carpal tunnel release: a preliminary study.

    PubMed

    Romeo, Pietro; d'Agostino, M Cristina; Lazzerini, A; Sansone, Valerio C

    2011-10-01

    "Pillar pain" is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density-focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for treating this condition. Our results show that in all of the treated patients, there was a marked improvement: the mean visual analogue scale (VAS) score decreased from 6.18 (±1.02) to 0.44 (±0.63) 120 d after treatment, and redness and swelling of the surgical scar had also decreased significantly. PMID:21856074

  18. Occupational Overuse Syndrome (Technological Diseases): Carpal Tunnel Syndrome, a Mouse Shoulder, Cervical Pain Syndrome

    PubMed Central

    Tiric-Campara, Merita; Krupic, Ferid; Biscevic, Mirza; Spahic, Emina; Maglajlija, Kerima; Masic, Zlatan; Zunic, Lejla; Masic, Izet

    2014-01-01

    ABSTRACT Technological diseases are diseases of the modern era. Some are caused by occupational exposures, and are marked with direct professional relation, or the action of harmful effects in the workplace. Due to the increasing incidence of these diseases on specific workplaces which may be caused by one or more causal factors present in the workplace today, these diseases are considered as professional diseases. Severity of technological disease usually responds to the level and duration of exposure, and usually occurs after many years of exposure to harmful factor. Technological diseases occur due to excessive work at the computer, or excessive use of keyboards and computer mice, especially the non-ergonomic ones. This paper deals with the diseases of the neck, shoulder, elbow and wrist (cervical radiculopathy, mouse shoulder and carpal tunnel syndrome), as is currently the most common diseases of technology in our country and abroad. These three diseases can be caused by long-term load and physical effort, and are tied to specific occupations, such as occupations associated with prolonged sitting, working at the computer and work related to the fixed telephone communication, as well as certain types of sports (tennis, golf and others). PMID:25568584

  19. Carpal Tunnel Syndrome and Peripheral Polyneuropathy in Patients with End Stage Kidney Disease

    PubMed Central

    Pyun, Sung-Bom; Cho, Won Yong; Boo, Chang Su

    2011-01-01

    This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS. PMID:21935280

  20. General population job exposure matrix applied to a pooled study of prevalent carpal tunnel syndrome.

    PubMed

    Dale, Ann Marie; Zeringue, Angelique; Harris-Adamson, Carisa; Rempel, David; Bao, Stephen; Thiese, Matthew S; Merlino, Linda; Burt, Susan; Kapellusch, Jay; Garg, Arun; Gerr, Fred; Hegmann, Kurt T; Eisen, Ellen A; Evanoff, Bradley

    2015-03-15

    A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title-based exposure data from a public data source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14-2.95) followed by intermediate values (odds ratio = 1.09-2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable. PMID:25700886

  1. Effect of Wrist Angle on Median Nerve Appearance at the Proximal Carpal Tunnel

    PubMed Central

    Loh, Ping Yeap; Muraki, Satoshi

    2015-01-01

    This study investigated the effects of wrist angle, sex, and handedness on the changes in the median nerve cross-sectional area (MNCSA) and median nerve diameters, namely longitudinal diameter (D1) and vertical diameter (D2). Ultrasound examination was conducted to examine the median nerve at the proximal carpal tunnel in both dominant and nondominant hands of men (n = 27) and women (n = 26). A total of seven wrist angles were examined: neutral; 15°, 30°, and 45° extension; and 15°, 30°, and 45° flexion. Our results indicated sexual dimorphism and bilateral asymmetry of MNCSA, D1 and D2 measurements. MNCSA was significantly reduced when the wrist angle changed from neutral to flexion or extension positions. At flexion positions, D1 was significantly smaller than that at neutral. In contrast, at extension positions, D2 was significantly smaller than that at neutral. In conclusion, this study showed that MNCSA decreased as the wrist angle changed from neutral to flexion or extension positions in both dominant and nondominant hands of both sexes, whereas deformation of the median nerve differed between wrist flexion and extension. PMID:25658422

  2. General Population Job Exposure Matrix Applied to a Pooled Study of Prevalent Carpal Tunnel Syndrome

    PubMed Central

    Dale, Ann Marie; Zeringue, Angelique; Harris-Adamson, Carisa; Rempel, David; Bao, Stephen; Thiese, Matthew S.; Merlino, Linda; Burt, Susan; Kapellusch, Jay; Garg, Arun; Gerr, Fred; Hegmann, Kurt T.; Eisen, Ellen A.; Evanoff, Bradley

    2015-01-01

    A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title–based exposure data from a public data source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14–2.95) followed by intermediate values (odds ratio = 1.09–2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable. PMID:25700886

  3. Utility of MRI Diffusion Tensor Imaging in Carpal Tunnel Syndrome: A Meta-Analysis.

    PubMed

    Wang, Hong; Ma, Jingxu; Zhao, Liping; Wang, Yunling; Jia, Xiaowen

    2016-01-01

    BACKGROUND After successful utilization of diffusion tensor imaging (DTI) in detecting brain pathologies, it is now being examined for use in the detection of peripheral neuropathies. The aim of this meta-analysis was to evaluate the diagnostic potentials of DTI in carpal tunnel syndrome (CTS). MATERIAL AND METHODS The literature search was performed in multiple electronic databases using a keyword search and final selection of the studies was based on predetermined inclusion and exclusion criteria. We performed a meta-analyses of mean differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between CTS patient and healthy subjects. Publication bias detection was done with Begg's test and sensitivity analyses were performed to explore the source/s of higher heterogeneity and the authenticity of results. RESULTS FA was significantly lower in CTS patients in comparison with healthy subjects (mean and the difference [95% confidence interval] was -0.06 [-0.10, -0.02] (p=0.003). The ADC was significantly higher in CTS patients (mean difference [95% CI] was 0.10 [0.02, 0.18], p=0.02). Overall sensitivity of FA-based diagnosis was 82.82%, with 77.83% specificity. CONCLUSIONS DTI can be a valuable tool in diagnosing CTS. PMID:26942911

  4. Clinical and electrophysiological evaluation of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome

    PubMed Central

    Weng, Chao; Dong, Hongjuan; Chu, Hong; Lu, Zuneng

    2016-01-01

    [Purpose] To prospectively assess the effectiveness of neutral wrist nocturnal splinting in patients with carpal tunnel syndrome (CTS) by using clinical scores and nerve conduction studies (NCS). [Subjects and Methods] Forty-one patients enrolled in the study were clinically evaluated by a symptom severity scale (SSS) and functional status scale (FSS), and were electrophysiologically evaluated by conventional NCS; distal motor latency (DML), sensory conduction velocity (SCV), and difference in sensory latency between the median and ulnar nerves (ΔDSL) were measured. Subjects were treated with wrist splinting. Patients who showed no improvement in symptoms were treated with other conservative treatments, the remaining patients continued to wear splints. SSS, FSS, and NCS were evaluated after splinting as well. [Results] The follow-up was completed in 20 patients (31 wrists) with splinting. SSS and FSS decreased, the DML shortened and ΔDSL decreased significantly after splinting for 3.03 ± 1.16 months. There were significant correlations between SSS and DML, SCV of wrist digit 2, and SCV of wrist digit 4. No correlations were found between SSS and ΔDSL, and FSS and the parameters of NCS. [Conclusion] Neutral wrist nocturnal splinting is effective in at least short term for CTS patients. There is a weak correlation between clinical scores and NCS, which suggests that both approaches should be used to effectively assess the therapeutic effect of CTS treatment.

  5. Evaluation of the scratch collapse test for the diagnosis of carpal tunnel syndrome.

    PubMed

    Makanji, H S; Becker, S J E; Mudgal, C S; Jupiter, J B; Ring, D

    2014-02-01

    This prospective study measured and compared the diagnostic performance characteristics of various clinical signs and physical examination manoeuvres for carpal tunnel syndrome (CTS), including the scratch collapse test. Eighty-eight adult patients that were prescribed electrophysiological testing to diagnose CTS were enrolled in the study. Attending surgeons documented symptoms and results of standard clinical manoeuvres. The scratch collapse test had a sensitivity of 31%, which was significantly lower than the sensitivity of Phalen's test (67%), Durkan's test (77%), Tinel's test (43%), CTS-6 lax (88%), and CTS-6 stringent (54%). The scratch test had a specificity of 61%, which was significantly lower than the specificity of thenar atrophy (96%) and significantly higher than the specificity of Durkan's test (18%) and CTS-6 lax (13%). The sensitivity of the scratch collapse test was not superior to other clinical signs and physical examination manoeuvers for CTS, and the specificity of the scratch collapse test was superior to that of Durkan's test and CTS-6 lax. Further studies should seek to limit the influence of a patient's clinical presentation on scratch test performance and assess the scratch test's inter-rater reliability. PMID:23855039

  6. New advances in the mechanisms and etiology of carpal tunnel syndrome.

    PubMed

    de-la-Llave-Rincón, Ana I; Puentedura, Emilio J; Fernández-de-las-Peñas, César

    2012-05-01

    In recent years, knowledge about the etiological mechanisms of carpal tunnel syndrome (CTS) has evolved significantly, allowing for a better understanding of this pain syndrome. Some studies have demonstrated that patients with CTS exhibit sensory symptoms not only within the areas innervated by the median nerve but also in extra-median regions, i.e., forearm or shoulder. It has also been demonstrated that patients with CTS may exhibit widespread pressure hypersensitivity and generalized thermal hyperalgesia, but not hypoesthesia, which is not related to electro-diagnostic findings. In addition, fine motor control and pinch grip force disturbances have been found to be commonly observed in this patient population. All these data suggest that central sensitization mechanisms are involved in the somato-sensory and motor disturbances found in CTS, probably related to cortical plastic changes. The presence of sensitization mechanisms could play an important role in the development of bilateral sensory symptoms in CTS and also can determine the therapeutic strategies for this condition. We propose that therapeutic interventions applied to individuals with CTS should include approaches that would modulate nociceptive barrage into the central nervous system. PMID:22642915

  7. Mechanosensitivity of the median nerve in patients with chronic carpal tunnel syndrome.

    PubMed

    Jaberzadeh, Shapour; Zoghi, Maryam

    2013-04-01

    The aim was to investigate the relationship between the effects of median nerve strain during the elbow extension component of the upper limb neurodynamic test 1 (ULNT1) and the evoked musculoskeletal changes. 11 patients with chronic carpal tunnel syndrome (CTS) and 11 matched asymptomatic controls participated in the study. In all subjects, elbow extension was carried out in both ULNT1 and neutral positions of the shoulder and arm. From these two starting positions a KIN-COM(®) dynamometer carried out passive elbow extension while EMG activity of 10 arm and shoulder muscles, elbow-flexor resistive torque and elbow extension ROM were measured concurrently. The result showed that, in the ULNT1 position, increased EMG activity of the involved muscles, increased elbow extension resistive torque and pain responses occurred much earlier in the range of elbow extension in the CTS group compared to healthy controls. These findings demonstrated increased mechanosensitivity of the median nerve in CTS patients compared to healthy controls. PMID:23561861

  8. Multidimensional ultrasound imaging of the wrist: Changes of shape and displacement of the median nerve and tendons in carpal tunnel syndrome.

    PubMed

    Filius, Anika; Scheltens, Marjan; Bosch, Hans G; van Doorn, Pieter A; Stam, Henk J; Hovius, Steven E R; Amadio, Peter C; Selles, Ruud W

    2015-09-01

    Dynamics of structures within the carpal tunnel may alter in carpal tunnel syndrome (CTS) due to fibrotic changes and increased carpal tunnel pressure. Ultrasound can visualize these potential changes, making ultrasound potentially an accurate diagnostic tool. To study this, we imaged the carpal tunnel of 113 patients and 42 controls. CTS severity was classified according to validated clinical and nerve conduction study (NCS) classifications. Transversal and longitudinal displacement and shape (changes) were calculated for the median nerve, tendons and surrounding tissue. To predict diagnostic value binary logistic regression modeling was applied. Reduced longitudinal nerve displacement (p≤ 0.019), increased nerve cross-sectional area (p≤ 0.006) and perimeter (p≤ 0.007), and a trend of relatively changed tendon displacements were seen in patients. Changes were more convincing when CTS was classified as more severe. Binary logistic modeling to diagnose CTS using ultrasound showed a sensitivity of 70-71% and specificity of 80-84%. In conclusion, CTS patients have altered dynamics of structures within the carpal tunnel. PMID:25865180

  9. Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel.

    PubMed

    Main, Erin K; Goetz, Jessica E; Rudert, M James; Goreham-Voss, Curtis M; Brown, Thomas D

    2011-03-15

    Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome. PMID:21194695

  10. Ultrasound assessment of the median nerve: a biomarker that can help in setting a treat to target approach tailored for carpal tunnel syndrome patients.

    PubMed

    El Miedany, Yasser; El Gaafary, Maha; Youssef, Sally; Ahmed, Ihab; Nasr, Annie

    2015-01-01

    Ultrasonography (US) is a valuable tool for confirming the diagnosis of carpal tunnel syndrome (CTS) as it enables the detection of changes in the median nerve shape and rule out anatomic variants as well as space-occupying lesions such as ganglion cysts or tenosynovitis. This work was carried out aiming at: 1. Ultrasonography assessment of the median nerve and its neurovascular blood-flow in CTS patients before and after management. 2. Verify the possibility of using baseline US parameters as a biomarker to predict likely outcomes and frame a treatment plan for CTS patients. 233 CTS subjects diagnosed based on clinical and electrophysiological (NCS) testing were included in this work. US measures at the tunnel inlet included: cross sectional area, flattening ratio and neural Power Doppler (PD) signals. Patients who had severe NCS outcomes or neurological deficit were referred for open surgical decompression; the remaining patients were given the choice of either conservative or surgical management. The main outcome variable was improvement >70% in CTS symptoms. Assessments were carried out at baseline, 1-week, 1-month and 6-months post treatment. Results revealed an inverse relation between the neural vasculature and CTS severity defined by NCS (r = - 0.648). In CTS cases treated conservatively, the US measures started to improve within 1-week, whereas in the surgically treated cohort there was an initial phase of post-operative nerve measures increase, before settling at 1-month time of follow-up. The risk of poor outcomes was significantly higher (RR 3.3) in patients with high median nerve flattening ratio. This risk was most marked in the cohort with nerve flattening associated with longer duration of illness (RR 4.3) and low PD signal (RR 4.1). The results revealed that in addition to the diagnostic value of US in CTS, the detection of increased median nerve neuro-vasculature has a good prognostic value as an indicator of early median nerve affection. PMID

  11. Carpal tunnel syndrome due to a plexiform neurofibroma of the median nerve in a neurofibromatosis type 1 patient: clinical approach.

    PubMed

    Freitas, Daniel; Aido, Ricardo; Sousa, Marco; Costa, Luís; Oliveira, Vânia; Cardoso, Pedro

    2013-01-01

    The authors report the case of a 56-year-old male patient with neurofibromatosis type 1 (NF1) diagnosed during adolescence and with an insidious clinical evolution, characterised by an exuberant cutaneous involvement, referred to the orthopaedics outpatient clinic presenting with carpal tunnel syndrome secondary to a plexiform neurofibroma of the median nerve. A comprehensive clinical approach is discussed, considering the natural history of the disease and its potential complications, as well as the lack of consensus regarding standard therapeutic options for the compressive peripheral neuropathies in the NF1 disease. PMID:23853185

  12. Screening for Acromegaly in Patients with Carpal Tunnel Syndrome: A Prospective Study (ACROCARP).

    PubMed

    Zoicas, F; Kleindienst, A; Mayr, B; Buchfelder, M; Megele, R; Schöfl, C

    2016-07-01

    Early diagnosis of acromegaly prevents irreversible comorbidities and facilitates surgical cure. Carpal tunnel syndrome (CTS) is common in acromegaly and patients have often undergone surgery for CTS prior to the diagnosis of acromegaly. We hypothesized that screening CTS-patients for acromegaly could facilitate active case-finding. We prospectively enrolled 196 patients [135 women, 56.9 (range 23-103) years] who presented with CTS for surgery. Patients were asked about 6 symptoms suggestive of acromegaly using a questionnaire calculating a symptom score (0-6 points), and insulin-like-growth factor 1 (IGF-1) was measured. If IGF-1 was increased, IGF-1 measurement was repeated, and random growth hormone (GH) and/or an oral glucose tolerance test (OGTT) with assessment of GH-suppression were performed. The mean symptom score was 1.7±1.3 points. Three patients reported the maximal symptom score of 6 points, but none of them had an increased IGF-1. There was no correlation between the symptom score and IGF-1-SDS (standard deviation score) (r=0.026; p=0.71). Four patients had an IGF-1>2 SDS. In 2 patients acromegaly was ruled out using random GH and OGTT. One patient had normal IGF-1 and random GH at follow-up. One patient refused further diagnostics. In this prospective cohort of patients with CTS, the observed frequency of acromegaly was at most 0.51% (95% CI 0.03 to 2.83%). In this prospective study, none of the 196 patients with CTS had proven acromegaly. Thus, we see no evidence to justify general screening of patients with CTS for acromegaly. PMID:26849823

  13. Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments

    PubMed Central

    Zhao, Huan-Li; Wang, Gui-Bin; Jia, Yue-Qing; Zhu, Shi-Cai; Zhang, Feng-Fang; Liu, Hong-Mei

    2015-01-01

    Background To compare risk of carpal tunnel syndrome (CTS) in distal radius fracture (DRF) patients after 7 treatments using bridging external fixation (BrEF), non-bridging external fixation (non-BrEF), plaster fixation, K-wire fixation, dorsal plating fixation, volar plating fixation, and dorsal and volar plating by performing a network meta-analysis. Material/Methods An exhaustive search of electronic databases identified randomized controlled trails (RCTs) closely related to our study topic. The published articles were screened, based on predefined inclusion and exclusion criteria, to select high-quality studies for the present network meta-analysis. Data extracted from the selected studies were analyzed using STATA version 12.0 software. Results The literature search and selection process identified 12 eligible RCTs that contained a total of 1370 DRF patients (394 patients with BrEF, 377 patients with non-BrEF, 89 patients with K-wire fixation, 192 patients with plaster fixation, 42 patients with dorsal plating fixation, 152 patients with volar plating fixation, and 124 patients with dorsal and volar plating fixation). Our network meta-analysis results demonstrated no significant differences in CTS risk among the 7 treatments (P>0.05). The value of surface under the cumulative ranking curve (SUCRA), however, suggested that dorsal plating fixation is the optimal treatment, with the lowest risk of CTS in DRF patients (dorsal plating fixation: 89.2%; dorsal and volar plating: 57.8%; plaster fixation: 50.9%; non-BrEF: 50.6%; volar plating fixation: 39.6%; BrEF: 38.4%; K-wire fixation: 23.6%). Conclusions Our network meta-analysis provides evidence that dorsal plating fixation significantly decreases the risk of CTS and could be the method of choice in DRF patients. PMID:26391617

  14. Carpal Tunnel Syndrome: The Role of Occupational Factors Among 906 Workers

    PubMed Central

    Ghasemi, Mohammad; Rezaee, Maryam; Chavoshi, Farzaneh; Mojtahed, Mohammad; Shams Koushki, Ehsan

    2012-01-01

    Background Carpal tunnel syndrome (CTS) is common in the industrial setting. However,there is a controversy about the sole role of occupational ergonomic hazards in CTS. Objectives This study was conducted among assembling workers of a detergent factory and computer users with the aims of A) determination of CTS prevalence and B) evaluation of personal risk factors and level of exposure to occupational risk factors via Quick Exposure Check (QEC). Materials and Methods In this descriptive cross-sectional study, 906 cases (332 assembling workers and 574 computer workers) were enrolled. CTS was assessed by symptoms on the Katz hand diagram and physical examination. QEC technique was applied to evaluate physical exposure to the risk factors. Results According to this study, the prevalence of probable CTS was 14% in men and 8.9% in women; the rate of probable CTS was significantly higher in assembly workers than in computer users (P < 0.001). Mean age and work duration in the probable CTS group was statistically higher than in non-CTS group. But both groups were in the same range (fewer than 30, P = 0.024, 0.004); BMI in the probable CTS group was slightly lower than in non CTS group, but BMI in both groups were in the normal range. Wrist ratio > 0.7 correlated with increased risk of probable CTS (P < 0.001) Prevalence of probable CTS was significantly higher in third and fourth levels of QEC (P < 0.001). Conclusions Although this article had limitations, our findings suggest that the level of occupational exposure is an indicator of CTS development. PMID:24350110

  15. Relationship of age, body mass index, wrist and waist circumferences to carpal tunnel syndrome severity.

    PubMed

    Komurcu, Hatice Ferhan; Kilic, Selim; Anlar, Omer

    2014-01-01

    Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18-35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36-64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference. PMID:24257492

  16. Relationship of Age, Body Mass Index, Wrist and Waist Circumferences to Carpal Tunnel Syndrome Severity

    PubMed Central

    KOMURCU, Hatice Ferhan; KILIC, Selim; ANLAR, Omer

    2014-01-01

    Carpal tunnel syndrome (CTS) has a multifactorial etiology involving systemic, anatomical, idiopathic, and ergonomic characteristics. In this study, an investigation of the relationship between the CTS degree established by electrophysiological measurements in patients with clinical CTS prediagnosis, and age, gender, body mass index (BMI), hand wrist circumference, and waist circumference measurements has been done. On 547 patients included in the study, motor and sensory conduction examinations of the median and ulnar nerve were done on one or two upper extremities thought to have CTS. In terms of CTS severity, the patients were divided into four groups (normal, mild, medium, and severe CTS). A total of 843 electrophysiological examinations were done consisting of 424 on the right hand wrist and 419 on the left hand wrist. When the age group of 18–35 years is taken as the reference group, the CTS development risk independent of BMI has been found to have increased by a factor of 1.86 for ages 36–64 years, and by 4.17 for ages 65 years and higher after adjustment for BMI. With respect to normal degree CTS group, the BMI were significantly different in groups with mild, medium, and severe CTS. The waist circumferences of groups with mild, medium, and severe CTS severity were found to be significantly higher in comparison to the normal reference group. When this value was corrected with BMI and re-examined the statistically significant differences persisted. The study identified a significant relationship between the CTS severity and age, BMI, waist circumference. PMID:24257492

  17. Carpal tunnel syndrome and computer exposure at work in two large complementary cohorts

    PubMed Central

    Mediouni, Z; Bodin, J; Dale, A M; Herquelot, E; Carton, M; Leclerc, A; Fouquet, N; Dumontier, C; Roquelaure, Y; Evanoff, B A; Descatha, A

    2015-01-01

    Objectives The boom in computer use and concurrent high rates in musculoskeletal complaints and carpal tunnel syndrome (CTS) among users have led to a controversy about a possible link. Most studies have used cross-sectional designs and shown no association. The present study used longitudinal data from two large complementary cohorts to evaluate a possible relationship between CTS and the performance of computer work. Settings and participants The Cosali cohort is a representative sample of a French working population that evaluated CTS using standardised clinical examinations and assessed self-reported computer use. The PrediCTS cohort study enrolled newly hired clerical, service and construction workers in several industries in the USA, evaluated CTS using symptoms and nerve conduction studies (NCS), and estimated exposures to computer work using a job exposure matrix. Primary and secondary outcome measures During a follow-up of 3–5 years, the association between new cases of CTS and computer work was calculated using logistic regression models adjusting for sex, age, obesity and relevant associated disorders. Results In the Cosali study, 1551 workers (41.8%) completed follow-up physical examinations; 36 (2.3%) participants were diagnosed with CTS. In the PrediCTS study, 711 workers (64.2%) completed follow-up evaluations, whereas 31 (4.3%) had new cases of CTS. The adjusted OR for the group with the highest exposure to computer use was 0.39 (0.17; 0.89) in the Cosali cohort and 0.16 (0.05; 0.59) in the PrediCTS cohort. Conclusions Data from two large cohorts in two different countries showed no association between computer work and new cases of CTS among workers in diverse jobs with varying job exposures. CTS is far more common among workers in non-computer related jobs; prevention efforts and work-related compensation programmes should focus on workers performing forceful hand exertion. PMID:26353869

  18. Sensitivity and specificity of vibrometry for detection of carpal tunnel syndrome.

    PubMed

    Gerr, F; Letz, R; Harris-Abbott, D; Hopkins, L C

    1995-09-01

    A cross-sectional study was performed to assess the utility of vibrotactile thresholds (VTs) obtained before and after a 10-minute period of wrist flexion as a method for detection of carpal tunnel syndrome (CTS) among adult subjects. Subjects with hand discomfort were recruited from patients referred to a university-based electromyography laboratory. Asymptomatic subjects were recruited from among office and technical staff at a professional school. In addition to electrophysiologic evaluation (EP), all subjects were offered VT measurement of the index and small fingers, bilaterally, before and after a 10-minute period of wrist flexion. A total of 144 subjects were recruited, and three hand-condition groups were established: 57 hands had symptoms and EP results compatible with CTS (Group 1), 58 hands had symptoms compatible with CTS and normal EP results (Group 2), and 123 hands had no symptoms and normal EP results (Group 3). Group 1 was considered the "disease-positive" group, and Groups 2 and 3 were both considered "disease-negative" groups. Analyses were performed separately for dominant and nondominant hands, and results were pooled when appropriate. Outcomes of interest were the VTs obtained from the index and small fingers before and after 10 minutes of maximal voluntary wrist flexion as well as variables calculated from them. Significant differences in mean VT were observed between the three hand-condition groups for most of the outcomes evaluated. At any given level of specificity, the sensitivity of vibrometry performed after 10 minutes of wrist flexion was approximately two times that obtained before wrist flexion for detection of electrophysiologically confirmed CTS.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8528719

  19. Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome

    PubMed Central

    Vahdatpour, Babak; Kiyani, Abolghasem; Dehghan, Farnaz

    2016-01-01

    Background: The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS. Materials and Methods: This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student’s t-test, and Chi-square test. Results: All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period. Conclusion: It is recommended to use ESWT as a conservative treatment in patients with CTS. PMID:27563630

  20. Sickness Absence from Work among Persons with New Physician-Diagnosed Carpal Tunnel Syndrome: A Population-Based Matched-Cohort Study

    PubMed Central

    Atroshi, Isam; Zhou, Caddie; Jöud, Anna; Petersson, Ingemar F.; Englund, Martin

    2015-01-01

    Background Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. Methods In Skåne region in Sweden we identified all subjects, aged 17–57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004–2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27–45) for women and 41 days (IQR 28–50) for men. Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis. Gender differences were small. PMID:25803841

  1. The effect of tendon excursion velocity on longitudinal median nerve displacement: differences between carpal tunnel syndrome patients and controls.

    PubMed

    Filius, Anika; Thoreson, Andrew R; Wang, Yuexiang; Passe, Sandra M; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C

    2015-04-01

    The subsynovial connective tissue (SSCT) is a viscoelastic structure connecting the median nerve (MN) and the flexor tendons in the carpal tunnel. Increased strain rates increases stiffness in viscoelastic tissues, and thereby its capacity to transfer shear load. Therefore, tendon excursion velocity may impact the MN displacement. In carpal tunnel syndrome (CTS) the SSCT is fibrotic and may be ruptured, and this may affect MN motion. In this study, ultrasonography was performed on 14 wrists of healthy controls and 25 wrists of CTS patients during controlled finger motions performed at three different velocities. Longitudinal MN and tendon excursion were assessed using a custom speckle tracking algorithm and compared across the three different velocities. CTS patients exhibited significantly less MN motion than controls (p ≤ 0.002). While in general, MN displacement increased with increasing tendon excursion velocity (p ≤ 0.031). These findings are consistent with current knowledge of SSCT mechanics in CTS, in which in some patients the fibrotic SSCT appears to have ruptured from the tendon surface. PMID:25640903

  2. Ulcero-osteolytic lesions in a woman with type 2 diabetes and carpal tunnel syndrome: A case report and literature review.

    PubMed

    Romeo, Elisabetta L; Previti, Marcello; Giandalia, Annalisa; Russo, Giuseppina T; Cucinotta, Domenico

    2016-03-01

    We describe the case of a 73-year-old woman with type 2 diabetes presenting with ulcers and ostelytic lesions on distal phalanges of left hand, who was diagnosed with the rare "ulcero-mutilating" variant of carpal tunnel syndrome. A review of literature on cutaneous manifestations associated with the syndrome is also presented. PMID:26830858

  3. Anatomic delineation of the ulnar nerve and ulnar artery in relation to the carpal tunnel by axial magnetic resonance imaging scanning.

    PubMed

    Netscher, D; Polsen, C; Thornby, J; Choi, H; Udeh, J

    1996-03-01

    In a number of publications the distal branches of both the ulnar artery and ulnar nerve have been identified as being positioned ulnar to the hook of the hamate. We undertook a magnetic resonance imaging project in patients who presented for carpal tunnel release to determine how far radially vital structures of Guyon's canal may be located and if they may overlap the carpal tunnel at the hook of the hamate. Cross-sectional magnetic resonance imaging scans of 20 patients were performed prior to carpal tunnel release with the wrist positioned in neutral, flexed, and extended positions. Linear measurements were made either radial or ulnar to the hook of the hamate taken as the reference point. In the neutral position, the ulnar nerve was found to be, on average, 3.6 mm ulnar to the hook of the hamate (range of 5.8 mm radial to 7.5 mm ulnar). The ulnar artery averaged 0.7 mm to the radial side of the hook of the hamate (range 7.8 mm radial to 2.8 mm ulnar). Guyon's canal extended 28% of the way across the carpal ligament (range 9 to 63%). With the wrist in flexion and extension, there was an ulnar displacement and a radial displacement, respectively, of these structures relative to the hook of the hamate. PMID:8683062

  4. Radial tunnel syndrome. A retrospective review of 30 decompressions of the radial nerve.

    PubMed

    Lawrence, T; Mobbs, P; Fortems, Y; Stanley, J K

    1995-08-01

    Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery. PMID:7594982

  5. Clinical course, costs and predictive factors for response to treatment in carpal tunnel syndrome: the PALMS study protocol

    PubMed Central

    2014-01-01

    Background Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb and a significant contributor to hand functional impairment and disability. Effective treatment options include conservative and surgical interventions, however it is not possible at present to predict the outcome of treatment. The primary aim of this study is to identify which baseline clinical factors predict a good outcome from conservative treatment (by injection) or surgery in patients diagnosed with carpal tunnel syndrome. Secondary aims are to describe the clinical course and progression of CTS, and to describe and predict the UK cost of CTS to the individual, National Health Service (NHS) and society over a two year period. Methods/Design In this prospective observational cohort study patients presenting with clinical signs and symptoms typical of CTS and in whom the diagnosis is confirmed by nerve conduction studies are invited to participate. Data on putative predictive factors are collected at baseline and follow-up through patient questionnaires and include standardised measures of symptom severity, hand function, psychological and physical health, comorbidity and quality of life. Resource use and cost over the 2 year period such as prescribed medications, NHS and private healthcare contacts are also collected through patient self-report at 6, 12, 18 and 24 months. The primary outcome used to classify treatment success or failures will be a 5-point global assessment of change. Secondary outcomes include changes in clinical symptoms, functioning, psychological health, quality of life and resource use. A multivariable model of factors which predict outcome and cost will be developed. Discussion This prospective cohort study will provide important data on the clinical course and UK costs of CTS over a two-year period and begin to identify predictive factors for treatment success from conservative and surgical interventions. PMID:24507749

  6. Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double-blind, placebo-controlled trial.

    PubMed

    Wu, Yung-Tsan; Ke, Ming-Jen; Chou, Yu-Ching; Chang, Chih-Ya; Lin, Ching-Yueh; Li, Tsung-Ying; Shih, Feng-Mei; Chen, Liang-Cheng

    2016-06-01

    Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo-controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double-blinded study to assess the effect of rESWT for treating CTS. Thirty-four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo-controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:977-984, 2016. PMID:26610183

  7. Effect of Linum usitatissimum L. (linseed) oil on mild and moderate carpal tunnel syndrome: a randomized, double-blind, placebo-controlled clinical trial

    PubMed Central

    2014-01-01

    Background Carpal tunnel syndrome is known as the most common entrapment neuropathy. Conservative treatments cannot reduce the symptomatic severity satisfactorily; therefore, effectiveness of Linum usitatissimum L. (linseed) oil on carpal tunnel syndrome, as a complementary treatment, was evaluated in the current study. Linseed oil is a well-known preparation in Iranian traditional medicine and its analgesic, anti-inflammatory and anti-oxidative effects have been shown in previous studies. Methods A randomized, double-blind, placebo-controlled clinical trial was conducted. One hundred patients (155 hands) with idiopathic mild to moderate carpal tunnel syndrome aged between 18 and 65 years old were randomized in two parallel groups. These two groups were treated during 4 weeks with topical placebo and linseed oil. In addition, a night wrist splint was prescribed for both groups. Symptomatic severity and functional status were measured using Boston Carpal Tunnel Questionnaire. In addition, median sensory nerve conduction velocity, motor distal latency, sensory distal latency and compound latency as electrodiagnostic parameters were measured at baseline and after the intervention period. Results After the intervention, significant improvement was observed regarding Boston Carpal Tunnel Questionnaire symptomatic severity and functional status mean differences (p <0.001) in the linseed oil group compared with those in the placebo group. Also, regarding the mean differences of both groups, significant improvement of nerve conduction velocity of the median nerve was seen in the linseed oil group by a value of 2.38 m/sec (p < 0.05). However, motor distal latency and sensory distal latency of the median nerve showed no between-group significant changes (p = 0.14 for both items). Finally, compound latency was improved slightly in the case group, comparing mean differences between the groups (p <0.05). No significant adverse events were reported from using linseed

  8. Mild leptospirosis with three-year persistence of IgG- and IgM-antibodies, initially manifesting as carpal tunnel syndrome.

    PubMed

    Finsterer, Josef; Stöllberger, Claudia; Sehnal, Ernst; Stanek, Gerold

    2005-08-01

    Long-term persistence of IgG- and IgM-antibodies against leptospira after mild leptospirosis has not been reported. In a 45-year-old female pet-shop worker with carpal tunnel syndrome, accompanied by arthralgias, coughing, repeatedly elevated temperature, followed by easy fatigability, personality change, memory and speech disturbance, blurred vision, myalgia and swollen lymph nodes, leptospirosis was diagnosed, based upon history, clinical findings, and serological investigations. After the described symptoms had disappeared following doxycyclin for 2 weeks, IgG- and IgM-antibodies against leptospira remained positive during the next three years. This case illustrates that leptospirosis may start as carpal tunnel syndrome and that the severity of leptospirosis does not seem to be related to the intensity of the humoral immune response against the causative agent. PMID:16038755

  9. The diagnostic value of ultrasonography in carpal tunnel syndrome: a comparison between diabetic and non-diabetic patients

    PubMed Central

    2013-01-01

    Background To compare the value of ultrasonography for diagnosing carpal tunnel syndrome (CTS) in patients with and without diabetes mellitus (DM). Methods Eighty non-DM and 40 DM patients with electromyography-confirmed CTS were assessed and underwent high-resolution ultrasonography of the wrists. Cross-sectional area (CSA) and flattening ratio (FR) of the median nerve were measured at the carpal tunnel outlet (D) and wrist crease (W). Results The 80 non-DM and 40 DM patients had 81 and 59 CTS-hands, respectively. The CSA_D and CSA_W were significantly larger in the CTS-hands and DM-CTS-hands compared to the normal control (p < 0.001). However, there is no difference of CSA_D and CSA_W between DM and non-DM CTS patients. Receiver operating characteristics [ROC] curve analysis revealed that CSA_W ≥13 mm2 was the most powerful predictor of CTS in DM (area under curve [AUC] = 0.72; sensitivity 72.9%, specificity 61.9%) and non-DM (AUC = 0.72; sensitivity 78.5%, specificity 53.2%) patients. The CSA positively correlated with the distal motor latency of the median compound motor action potential (CMAP), distal sensory latency of the median sensory nerve action potential (SNAP), and latency of the median F wave, but negatively correlated with the amplitude of the median CMAP, amplitude of the median SNAP, and sensory NCV of the median nerve. Stepwise logistic regression revealed that CSA_W (OR 1.21, 95% CI 1.07-1.38; p = 0.003) was independently associated with CTS in DM patients and any 1 mm2 increase in CSA_W increased the rate of CTS by 28%. Conclusions The CSA of the median nerve at the outlet and wrist crease are significantly larger in CTS hands in both DM and non-DM patients compared to normal hands. The CSA of the median nerve by ultrasonography may be a diagnostic tool for evaluating CTS in DM and non-DM patients. PMID:23800072

  10. "…you earn money by suffering pain:" Beliefs About Carpal Tunnel Syndrome Among Latino Poultry Processing Workers.

    PubMed

    Arcury, Thomas A; Mora, Dana C; Quandt, Sara A

    2015-06-01

    The nature of poultry processing puts workers at risk for developing neurological injuries, particularly carpal tunnel syndrome (CTS). Many poultry processing workers are Latino immigrants. This qualitative analysis uses an explanatory models of illness (EMs) framework to describe immigrant Latino poultry processing workers' (Guatemalan and Mexican) beliefs of CTS. Understanding these workers' CTS EMs provides a foundation for recommendations to reduce the risk factors for this occupational injury. In-depth interviews were completed with 15 poultry processing workers diagnosed with CTS. Systematic qualitative analysis was used to delineate beliefs about causes, symptoms, physiology, treatments, quality-of-life and health implications of CTS. Participants' EMs largely reflect current biomedical understanding of CTS. These EMs are similar for Guatemalan and Mexican workers. Beliefs about causes include factors in the work environment (e.g., repetition, cold) and individual physical weakness. Treatments include over-the-counter medicine, as well as traditional remedies. Most know the future impact of CTS will include chronic pain. These workers know what causes CTS and that curing it would require quitting their jobs, but feel that they must endure CTS to support their families. Latino poultry processing workers, whether Guatemalan or Mexican, have a fairly complete understanding of what causes CTS, how to treat it, and what they must do to cure it. However, situational factors force them to endure CTS. Policy changes are needed to change the structure of work in poultry processing, particularly line speed and break frequency, if the prevalence of CTS is to be reduced. PMID:24363119

  11. Carpal tunnel syndrome (CTS) and exposure to vibration, repetitive wrist movements, and heavy manual work: a case-referent study.

    PubMed Central

    Wieslander, G; Norbäck, D; Göthe, C J; Juhlin, L

    1989-01-01

    Possible connections between carpal tunnel syndrome (CTS) and exposure to vibrating handheld tools, repetitive wrist movements, and heavy manual work were examined in a case-referent study. The cases were 38 men operated on for CTS between 1974 and 1980. For each case, two referents were drawn from among other surgical cases (hospital referents) and two further referents from the population register and telephone directory, respectively (population referents). Thirty four of 38 cases (89%) and 143 of 152 referents (94%) were interviewed by telephone. An increased prevalence of obesity, rheumatoid disease, diabetes, or thyroid disease was observed among the cases but most did not suffer from any of these disorders. CTS was significantly correlated with exposure to vibration from handheld tools and to repetitive wrist movements but showed a weaker correlation with work producing a heavy load on the wrist. A cause-effect relation between CTS and exposures to handheld vibrating tools and to work causing repetitive movements of the wrist seems probable. Some differences between hospital and population referents indicate that a case-referent study of this type could be biased by inappropriate selection of referents. PMID:2920142

  12. A pooled job physical exposure dataset from multiple independent studies in a consortium study of carpal tunnel syndrome

    PubMed Central

    Bao, Stephen S.; Kapellusch, Jay M.; Garg, Arun; Silverstein, Barbara A.; Harris-Adamson, Carisa; Burt, Susan E.; Dale, Ann Marie; Evanoff, Bradley A.; Gerr, Frederic E.; Hegmann, Kurt T.; Merlino, Linda A.; Thiese, Matthew S.; Rempel, David M.

    2016-01-01

    Background Six research groups independently conducted prospective studies of carpal tunnel syndrome (CTS) incidence in 54 US workplaces in 10 US States. Physical exposure variables were collected by all research groups at the individual worker level. Data from these research groups were pooled to increase the exposure spectrum and statistical power. Objective This paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies. Methods Physical exposure data were inspected and prepared by each of the individual research studies according to detailed instructions provided by an exposure sub-committee of the research consortium. Descriptive analyses were performed on the pooled physical exposure dataset. Correlation analyses were performed among exposure variables estimating similar exposure aspects. Results At baseline, there were a total of 3010 subjects in the pooled physical exposure dataset. Overall, the pooled data meaningfully increased the spectra of most exposure variables. The increased spectra were due to the wider range in exposure data of different jobs provided by the research studies. The correlations between variables estimating similar exposure aspects showed different patterns among data provided by the research studies. Conclusions The increased spectra of the physical exposure variables among the data pooled likely improved the possibility of detecting potential associations between these physical exposure variables and CTS incidence. It is also recognized that methods need to be developed for general use by all researchers for standardization of physical exposure variable definition, data collection, processing and reduction. PMID:25504866

  13. Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome

    PubMed Central

    Kapellusch, Jay M.; Garg, Arun; Bao, Stephen S.; Silverstein, Barbara A.; Burt, Susan E.; Dale, Ann Marie; Evanoff, Bradley A.; Gerr, Frederic E.; Harris-Adamson, Carisa; Hegmann, Kurt T.; Merlino, Linda A.; Rempel, David M.

    2015-01-01

    Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure–response relationships for MSDs. The pooling process is difficult and time-consuming, and small methodological differences could lead to different exposure–response relationships. A subcommittee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed. PMID:23697792

  14. An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal, India

    PubMed Central

    Gangopadhyay, Somnath; Chakrabarty, Sabarni; Sarkar, Krishnendu; Dev, Samrat; Das, Tamal; Banerjee, Sunetra

    2015-01-01

    Background: Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery. Objectives: The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS). Methods: The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS. Results: Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group. Conclusions: Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS. PMID:25658674

  15. Diagnostic Significance of Ultrasonographic Measurements and Median-Ulnar Ratio in Carpal Tunnel Syndrome: Correlation with Nerve Conduction Studies

    PubMed Central

    Mesci, Nilgün; Çetinkaya, Yilmaz; Geler Külcü, Duygu

    2016-01-01

    Background and Purpose We determined the reliability of ultrasonography (US) measurements for diagnosing carpal tunnel syndrome (CTS) and their correlation with symptom duration and electrophysiology findings. We determined whether the ratio of the median-to-ulnar cross-sectional areas (CSAs) can support CTS diagnoses. Methods The pisiform CSA (CSApisiform), swelling ratio (SR), palmar bowing, and CSApisiform/ulnar CSA (CSAulnar) measurements made in two subgroups of CTS patients (having sensory affection alone or having both sensory and motor affection) were compared with controls. CSAulnar was measured in Guyon's canal at the level of most-protuberant portion of the pisiform bone. Results The values of all of the measured US parameters were higher in patients with CTS (n=50) than in controls (n=62). CSApisiform could be used to diagnose CTS of mild severity. All of the parameters were positively correlated with the distal latency of the compound muscle action potential, and all of them except for SR were negatively correlated with the sensory nerve conduction velocity. A CSApisiform/CSAulnar ratio of ≥1.79 had a sensitivity of 70% and a specificity of 76% for diagnosing CTS. Conclusions Only CSApisiform measurements were reliable for diagnosing early stages of CTS, and CSApisiform/CSAulnar had a lower diagnostic value for diagnosing CTS. PMID:27095524

  16. Acupuncture-Evoked Response in Somatosensory and Prefrontal Cortices Predicts Immediate Pain Reduction in Carpal Tunnel Syndrome

    PubMed Central

    Maeda, Yumi; Kettner, Norman; Lee, Jeungchan; Kim, Jieun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Im, Jaehyun; Libby, Alexandra; Mezzacappa, Pia; Morse, Leslie R.; Park, Kyungmo; Audette, Joseph; Napadow, Vitaly

    2013-01-01

    The linkage between brain response to acupuncture and subsequent analgesia remains poorly understood. Our aim was to evaluate this linkage in chronic pain patients with carpal tunnel syndrome (CTS). Brain response to electroacupuncture (EA) was evaluated with functional MRI. Subjects were randomized to 3 groups: (1) EA applied at local acupoints on the affected wrist (PC-7 to TW-5), (2) EA at distal acupoints (contralateral ankle, SP-6 to LV-4), and (3) sham EA at nonacupoint locations on the affected wrist. Symptom ratings were evaluated prior to and following the scan. Subjects in the local and distal groups reported reduced pain. Verum EA produced greater reduction of paresthesia compared to sham. Compared to sham EA, local EA produced greater activation in insula and S2 and greater deactivation in ipsilateral S1, while distal EA produced greater activation in S2 and deactivation in posterior cingulate cortex. Brain response to distal EA in prefrontal cortex (PFC) and brain response to verum EA in S1, SMA, and PFC were correlated with pain reduction following stimulation. Thus, while greater activation to verum acupuncture in these regions may predict subsequent analgesia, PFC activation may specifically mediate reduced pain when stimulating distal acupoints. PMID:23843881

  17. Geographic variation in surgical treatment for work-related carpal tunnel syndrome: does improved return to work matter?

    PubMed

    Wasiak, Radoslaw; Pransky, Glenn; Yao, Peikang

    2006-01-01

    Medical treatment of compensated work-related conditions has two objectives--improve injured workers' health status and allow safe and sustained return to work (RTW). Theoretically, the choice of treatment method should be based primarily on these objectives. Surgical treatment of work-related carpal tunnel syndrome (CTS) provides an opportunity to evaluate whether this occurs. The traditional method of open release has been complemented by an endoscopic procedure, particularly useful in work-related cases due to the anticipated benefit of earlier RTW. The objective of this study was to investigate the differences in surgical treatment for work-related CTS across eight US workers' compensation (WC) jurisdictions, and the factors associated with these differences. From all WC claims reported to a single insurer during the 1995-1999 period, we identified individuals with a one or two surgical procedures for work-related CTS. Among selected individuals (n=4,421), about 20% were treated using the endoscopic procedure; this percentage had a ten-fold variation across the eight jurisdictions. However, utilization of endoscopic release did not increase during the study period, despite reports of better RTW outcomes. The highly jurisdictional nature of the US WC system, with significant differences in reimbursement levels for endoscopic procedures, and geographical differences in medical training were among the potential contributors to the observed variation in utilization. PMID:16373974

  18. Diagnostic Value of the Second Lumbrical-Interosseous Distal Motor Latency Comparison Test in Severe Carpal Tunnel Syndrome

    PubMed Central

    Lee, SangHun; Kim, DongHyun; Cho, Hee-Mun; Nam, Ho-Sung

    2016-01-01

    Objective To examine the usefulness of the second lumbrical-interosseous (2L-INT) distal motor latency (DML) comparison test in localizing median neuropathy to the wrist in patients with absent median sensory and motor response in routine nerve conduction studies. Methods Electrodiagnostic results from 1,705 hands of patients with carpal tunnel syndrome (CTS) symptoms were reviewed retrospectively. All subjects were evaluated using routine nerve conduction studies: median sensory conduction recorded from digits 1 to 4, motor conduction from the abductor pollicis brevis muscle, and the 2L-INT DML comparison test. Results Four hundred and one hands from a total of 1,705 were classified as having severe CTS. Among the severe CTS group, 56 hands (14.0%) showed absent median sensory and motor response in a routine nerve conduction study, and, of those hands, 42 (75.0%) showed an abnormal 2L-INT response. Conclusion The 2L-INT DML comparison test proved to be a valuable electrodiagnostic technique in localizing median mononeuropathy at the wrist, even in the most severe CTS patients. PMID:26949669

  19. One-year Incidence of Carpal Tunnel Syndrome in Latino Poultry Processing Workers and Other Latino Manual Workers

    PubMed Central

    Cartwright, Michael S.; Walker, Francis O.; Newman, Jill C.; Schulz, Mark R.; Arcury, Thomas A.; Grzywacz, Joseph G.; Mora, Dana; Chen, Haiying; Eaton, Bethany; Quandt, Sara A.

    2013-01-01

    Objective To determine the incidence of carpal tunnel syndrome (CTS) over one year in Latino poultry processing workers. Methods Symptoms and nerve conduction studies were used to identify Latino poultry processing workers (106 wrists) and Latinos in other manual labor occupations (257 wrists) that did not have CTS at baseline, and these individuals were then evaluated in the same manner one year later. Results Based on wrists, the one-year incidence of CTS was higher in poultry processing workers than non-poultry manual workers (19.8% vs. 11.7%, p = 0.022). Poultry workers had a higher odds (1.89; p = 0.089) of developing CTS over one year compared to non-poultry manual workers. Discussion Latino poultry processing workers have an incidence of CTS that is possibly higher than Latinos in other manual labor positions. Latino poultry workers’ high absolute and relative risk of CTS likely results from the repetitive and strenuous nature of poultry processing work. PMID:23996875

  20. Diagnostic value of median nerve ultrasonography for screening of carpal tunnel syndrome in hypothyroid patients: A cross-sectional study

    PubMed Central

    Mehrpour, Masoud; Mirzaasgari, Zahra; Rohani, Mohammad; Safdarian, Mahdi

    2016-01-01

    Background: Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy in patients with hypothyroid. The diagnosis of CTS is usually clinical and confirmed by electrodiagnostic (EDX) procedures. This study aimed to describe the diagnostic accuracy of high-resolution ultrasonography (US) as an alternative method to nerve conduction study (NCS) for the diagnosis of subclinical CTS in patients with hypothyroidism. Methods: Between April 2013 and November 2014, from the patients with the diagnosis of hypothyroidism referring to the institute of endocrinology and metabolism of Firoozgar Hospital, Tehran, Iran, those who met our inclusion criteria entered this cross-sectional study. The patients divided into two groups of subclinical CTS with the age- and gender-matched control group. US measurements of the median nerve cross-sectional area (CSA) in the CT inlet were compared with the NCS results as the gold standard diagnostic test. Results: A total number of 152 wrists of 76 hypothyroid patients were examined in this study. The mean of median nerve CSA at the tunnel inlet was 9.96 ± 2.20 mm2 for the CTS group and 7.08 ± 1.38 mm2 for the control group (P < 0.05). 31 wrists (20.4%) were diagnosed as CTS using NCS while US diagnosed 19 wrists (12.5%) as CTS. Using receiver-operating-characteristics analysis, the sensitivity and specificity of US at the diagnosis of CTS were 45.0 and 95.8%, respectively, with a median nerve CSA cutoff point of 9.8 mm2. Positive and negative predictive values of US were 87.2 and 85.5%, respectively, with a test accuracy of 85.5%. Conclusion: According to our findings, US has an acceptable diagnostic value to confirm CTS in hypothyroid patients. However, it may not replace NCS due to low sensitivity. PMID:27326360

  1. Carpal tunnel syndrome, diabetic neuropathy, fibromyalgia, glucosamine and chondroitin, hypnosis in pain management, marijuana for pain.

    PubMed

    Fishman, Scott M

    2007-01-01

    This feature presents information for patients in a question and answer format. It is written to simulate actual questions that many pain patients ask and to provide answers in a context and language that most pain patients will comprehend. Issues addressed in this issue are carpel tunnel syndrome, fibromyalgia, glucosamine and chondroitin, hypnosis, marijuana. PMID:17844729

  2. Escharotomies, fasciotomies and carpal tunnel release in burn patients--review of the literature and presentation of an algorithm for surgical decision making.

    PubMed

    Piccolo, N S; Piccolo, M S; Piccolo, P D P; Piccolo-Daher, R; Piccolo, N D P; Piccolo, M T S

    2007-06-01

    Escharotomies are usually performed in patients with circumferential third degree burns of the extremities or anterior trunk. Fasciotomies are recommended for patients who sustained high voltage (or associated crush) injuries, with entrance or exit wounds in one or more extremities. Carpal tunnel release is practiced routinely in some services for cases of electrical injury. We have reviewed the literature which provides relatively little information as to when should these procedures actually be performed and what would happen if they were not done. We present a series of patients treated at our institution when an algorithm was used for surgical decision making as to when (or not) to operate (perform an escharotomy, a fasciotomy or a carpal tunnel release), based on clinical signs and monitoring alternatives, using the oximeter and the Doppler flowmeter. 13 938 burn patients were treated at our institution during the year of 2005. Of these, 571, with an average of 22.3 % TBSA, were treated as inpatients. Of these, 58 (10.3 %) had circumferential or electrical burns of one or more extremities. Patients were monitored hourly from admission and decision to operate was based on clinical signs and in absent or below 90 % oximetry, regardless of Doppler flow signs. 68 % were males, 6 (11.3 %) patients had immediate escharotomies, while 4 (7.5 %) had immediate fasciotomies. 2 of these patients were operated regardless of positive Doppler sign but no oximetry. All patients recovered oximetry over 90 % immediately after the operations. 3 patients had negative Doppler sign but oximetry > 90 % and were not operated. 3 patients had carpal tunnel releases based on oximetry < 90 % and symptoms of compression of the median nerve. Patients who were not operated fared well with no signs or symptoms of impairment of circulation or nerve damage up to their 3 and 6 months reevaluations. PMID:17602377

  3. Results after simple decompression of the ulnar nerve in cubital tunnel syndrome

    PubMed Central

    Harder, Kristina; Lukschu, Sandra; Dunda, Sebastian E.; Krapohl, Björn Dirk

    2015-01-01

    Cubital tunnel syndrome represents the second most common compression neuropathy of the upper limb. For more than four decades there has been a controversy about the best surgical treatment modality for cubital tunnel syndrome. In this study the results of 28 patients with simple ulnar nerve decompression are presented. Data analyses refers to clinical examination, personal interview, DASH-questionnaire, and electrophysiological measurements, which were assessed pre- and postoperatively. 28 patients (15 females, 13 males) were included in this study. The average age at time of surgery was 47.78 years (31.68–73.10 years). The period from onset of symptoms to surgery ranged from 2 to 24 months (mean 6 months). The mean follow-up was 2.11 years (0.91–4.16 years). Postoperatively there was a significant decrease in DASH score from 52.6 points to 13.3 points (p<0.001). Also the electrophysiological findings improved significantly: motor nerve conduction velocity increased from 36.0 m/s to 44.4 m/s (p=0.008) and the motor nerve action potential reached 5,470 mV compared to 3,665 mV preoperatively (p=0.018). A significant increase of grip strength from 59% (in comparison to the healthy hand) to 80% was observed (p=0.002). Pain was indicated by means of a visual analog scale from 0 to 100. Preoperatively the median level of pain was 29 and postoperatively it was 0 (p=0.001). The decrease of the two-point-discrimination of the three ulnar finger nerves was also highly significant (p<0.001) from 11.3 mm to 5.0 mm. Significant postoperative improvement was also observed in the clinical examination concerning muscle atrophy (p=0.002), clawing (p=0.008), paresthesia (p=0.004), the sign of Froment (p=0.004), the sign of Hoffmann-Tinel (p=0.021), and clumsiness (p=0.002). Overall nearly 90% of all patients were satisfied with the result of the operation. In 96.4% of all cases, surgery improved the symptoms and in one patient (3.6%) the success was noted as “poor” because

  4. Complex regional pain syndrome and acute carpal tunnel syndrome following radial artery cannulation: a neurological perspective and review of the literature.

    PubMed

    Lazaro, Reynaldo P

    2015-01-01

    Complex regional pain syndrome (CRPS) associated with acute carpal tunnel syndrome (aCTS) developed in a 38-year-old right-handed man following radial artery cannulation (RAC) during the course of lumbar spine surgery. Inciting events and risk factors that might have led to these complications included: multiple arterial punctures and subsequent hematoma formation, radial artery spasm compounded by aggressive hemostasis, anatomical changes in the wrists related to repetitive manual activities in the workplace, and possible protracted hyperextension of the wrists during perioperative and operative procedure. Although CRPS is considered a rare complication of RAC, the condition is disabling and debilitating, especially when associated with aCTS. PMID:25621693

  5. Effectiveness of splinting and splinting plus local steroid injection in severe carpal tunnel syndrome: A Randomized control clinical trial

    PubMed Central

    Khosrawi, Saeid; Emadi, Masoud; Mahmoodian, Amir Ebrahim

    2016-01-01

    Background: The Study aimed to compare the effectiveness of two commonly used conservative treatments, splinting and local steroid injection in improving clinical and nerve conduction findings of the patients with severe carpal tunnel syndrome (CTS). Materials and Methods: In this randomized control clinical trial, the patients with severe CTS selected and randomized in two interventional groups. Group A was prescribed to use full time neutral wrist splint and group B was injected with 40 mg Depo-Medrol and prescribed to use the full time neutral wrist splint for 12 weeks. Clinical and nerve conduction findings of the patients was evaluated at baseline, 4 and 12 weeks after interventions. Results: Twenty-two and 21 patients were allocated in group A and B, respectively. Mean of clinical symptoms and functional status scores, nerve conduction variables and patients’ satisfaction score were not significant between group at baseline and 4 and 12 weeks after intervention. Within the group comparison, there was significant improvement in the patients’ satisfaction, clinical and nerve conduction items between the baseline level and 4 weeks after intervention and between the baseline and 12 weeks after intervention (P < 0.01). The difference was significant for functional status score between 4 and 12 weeks after intervention in group B (P = 0.02). Conclusion: considering some findings regarding the superior effect of splinting plus local steroid injection on functional status scale and median nerve distal motor latency, it seems that using combination therapy could be more effective for long-term period specially in the field of functional improvement of CTS. PMID:26962518

  6. Primary somatosensory/motor cortical thickness distinguishes paresthesia-dominant from pain-dominant carpal tunnel syndrome.

    PubMed

    Maeda, Yumi; Kettner, Norman; Kim, Jieun; Kim, Hyungjun; Cina, Stephen; Malatesta, Cristina; Gerber, Jessica; McManus, Claire; Libby, Alexandra; Mezzacappa, Pia; Mawla, Ishtiaq; Morse, Leslie R; Audette, Joseph; Napadow, Vitaly

    2016-05-01

    Paresthesia-dominant and pain-dominant subgroups have been noted in carpal tunnel syndrome (CTS), a peripheral neuropathic disorder characterized by altered primary somatosensory/motor (S1/M1) physiology. We aimed to investigate whether brain morphometry dissociates these subgroups. Subjects with CTS were evaluated with nerve conduction studies, whereas symptom severity ratings were used to allocate subjects into paresthesia-dominant (CTS-paresthesia), pain-dominant (CTS-pain), and pain/paresthesia nondominant (not included in further analysis) subgroups. Structural brain magnetic resonance imaging data were acquired at 3T using a multiecho MPRAGE T1-weighted pulse sequence, and gray matter cortical thickness was calculated across the entire brain using validated, automated methods. CTS-paresthesia subjects demonstrated reduced median sensory nerve conduction velocity (P = 0.05) compared with CTS-pain subjects. In addition, cortical thickness in precentral and postcentral gyri (S1/M1 hand area) contralateral to the more affected hand was significantly reduced in CTS-paresthesia subgroup compared with CTS-pain subgroup. Moreover, in CTS-paresthesia subjects, precentral cortical thickness was negatively correlated with paresthesia severity (r(34) = -0.40, P = 0.016) and positively correlated with median nerve sensory velocity (r(36) = 0.51, P = 0.001), but not with pain severity. Conversely, in CTS-pain subjects, contralesional S1 (r(9) = 0.62, P = 0.042) and M1 (r(9) = 0.61, P = 0.046) cortical thickness were correlated with pain severity, but not median nerve velocity or paresthesia severity. This double dissociation in somatotopically specific S1/M1 areas suggests a neuroanatomical substrate for symptom-based CTS subgroups. Such fine-grained subgrouping of CTS may lead to improved personalized therapeutic approaches, based on superior characterization of the linkage between peripheral and central neuroplasticity. PMID:26761384

  7. Palmitoylethanolamide, a neutraceutical, in nerve compression syndromes: efficacy and safety in sciatic pain and carpal tunnel syndrome

    PubMed Central

    Keppel Hesselink, Jan M; Kopsky, David J

    2015-01-01

    Palmitoylethanolamide (PEA) is an endogenous lipid modulator in animals and humans, and has been evaluated since the 1970s as an anti-inflammatory and analgesic drug in more than 30 clinical trials, in a total of ~6,000 patients. PEA is currently available worldwide as a nutraceutical in different formulations, with and without excipients. Here we describe the results of all clinical trials evaluating PEA’s efficacy and safety in nerve compression syndromes: sciatic pain and pain due to carpal tunnel syndrome, and review preclinical evidence in nerve impingement models. Both the pharmacological studies as well as the clinical trials supported PEA’s action as an analgesic compound. In total, eight clinical trials have been published in such entrapment syndromes, and 1,366 patients have been included in these trials. PEA proved to be effective and safe in nerve compression syndromes. In one pivotal, double blind, placebo controlled trial in 636 sciatic pain patients, the number needed to treat to reach 50% pain reduction compared to baseline was 1.5 after 3 weeks of treatment. Furthermore, no drug interactions or troublesome side effects have been described so far. Physicians are not always aware of PEA as a relevant and safe alternative to opioids and co-analgesics in the treatment of neuropathic pain. Especially since the often prescribed co-analgesic pregabaline has been proven to be ineffective in sciatic pain in a double blind enrichment trial, PEA should be considered as a new and safe treatment option for nerve compression syndromes. PMID:26604814

  8. Associations analysis of GSTM1, T1 and P1 Ile105Val polymorphisms with carpal tunnel syndrome.

    PubMed

    Eroğlu, Pınar; Erkol İnal, Esra; Sağ, Şebnem Özemri; Görükmez, Özlem; Topak, Ali; Yakut, Tahsin

    2016-05-01

    Oxidative stress was related with carpal tunnel syndrome (CTS). We aimed to clarify the associations between glutathione S-transferase (GST)M1, GSTT1 and GSTP1-Ile105Val polymorphisms and CTS. One hundred-forty patients with CTS and 97 healthy controls were enrolled in this study. Tinel and Phalen signs were noted as positive or negative. Functional and clinical status of patients was evaluated by the Boston Questionnaire. The intensity of hand and/or wrist pain was evaluated on 10 cm visual analog scale (VAS). We applied the polymerase chain reaction (PCR) to determine the polymorphisms of the GSTM1 and GSTT1 and the PCR-restriction fragment length polymorphism method for detecting the GSTP1-Ile105Val polymorphism. The M1 null genotype was significantly higher in patients with CTS compared to healthy controls, and the M1 null genotype seemed to increase the risk of CTS approximately two-fold (P = 0.011; odds ratio (OR) = 1.98; 95 % confidence interval (CI) 1.17-3.36). The M1 null, T1 present combined genotype was significantly higher in patients with CTS compared to healthy controls (P = 0.043); however, it seemed not to increase the risk of CTS (P = 0.14; OR = 0.62; 95 % CI 0.33-1.76). We found significantly higher levels of the VAS, Boston Symptom Severity Scale and Phalen sign in patients with the Ile/Val or the Val/Val genotypes compared to those in patients with the Ile/Ile genotype (P = 0.003, 0.004 and 0.044, respectively). We proposed that genes involved in the protection from oxidative stress may influence the susceptibility, clinical and functional status of CTS. The GSTM1 null genotype may be related with the development of CTS, whereas the Val allele of GSTP1-Ile105Val polymorphism may be associated with worse functional and clinical status in CTS. PMID:25566970

  9. Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients.

    PubMed

    Huang, Wen-Hung; Hsu, Ching-Wei; Weng, Cheng-Hao; Yen, Tzung-Hai; Lin, Jui-Hsiang; Lee, Meng

    2016-06-01

    Carpal tunnel syndrome (CTS) is the most common mononeuropathy in patients with end-stage renal disease (ESRD). The association between chronic inflammation and CTS in hemodialysis (HD) patients has rarely been investigated. HD patients with a high normalized protein catabolic rate (nPCR) and low serum albumin level likely have adequate nutrition and inflammation. In this study, we assume that a low serum albumin level and high nPCR is associated with CTS in HD patients. We recruited 866 maintenance hemodialysis (MHD) patients and divided them into 4 groups according to their nPCR and serum albumin levels: (1) nPCR <1.2 g/kg/d and serum albumin level <4 g/dL; (2) nPCR ≥1.2 g/kg/d and serum albumin level <4 g/dL; (3) nPCR <1.2 g/kg/d and serum albumin level ≥4 g/dL; and (4) nPCR ≥1.2 g/kg/d and serum albumin level ≥4 g/dL. After adjustment for related variables, HD duration and nPCR ≥1.2 g/kg/d and serum albumin level <4 g/dL were positively correlated with CTS. By calculating the area under the receiver-operating characteristic curve, we calculated that the nPCR and HD duration cut-off points for obtaining the most favorable Youden index were 1.29 g/kg/d and 7.5 years, respectively. Advance multivariate logistic regression analysis revealed that in MHD patients, nPCR ≥1.29 g/kg/d and serum albumin <4 g/dL, and also HD duration >7.5 years were associated with CTS. A high nPCR and low serum albumin level, which likely reflect adequate nutrition and inflammation, were associated with CTS in MHD patients. PMID:27368039

  10. Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients

    PubMed Central

    Huang, Wen-Hung; Hsu, Ching-Wei; Weng, Cheng-Hao; Yen, Tzung-Hai; Lin, Jui-Hsiang; Lee, Meng

    2016-01-01

    Abstract Carpal tunnel syndrome (CTS) is the most common mononeuropathy in patients with end-stage renal disease (ESRD). The association between chronic inflammation and CTS in hemodialysis (HD) patients has rarely been investigated. HD patients with a high normalized protein catabolic rate (nPCR) and low serum albumin level likely have adequate nutrition and inflammation. In this study, we assume that a low serum albumin level and high nPCR is associated with CTS in HD patients. We recruited 866 maintenance hemodialysis (MHD) patients and divided them into 4 groups according to their nPCR and serum albumin levels: (1) nPCR <1.2 g/kg/d and serum albumin level <4 g/dL; (2) nPCR ≥1.2 g/kg/d and serum albumin level <4 g/dL; (3) nPCR <1.2 g/kg/d and serum albumin level ≥4 g/dL; and (4) nPCR ≥1.2 g/kg/d and serum albumin level ≥4 g/dL. After adjustment for related variables, HD duration and nPCR ≥1.2 g/kg/d and serum albumin level <4 g/dL were positively correlated with CTS. By calculating the area under the receiver-operating characteristic curve, we calculated that the nPCR and HD duration cut-off points for obtaining the most favorable Youden index were 1.29 g/kg/d and 7.5 years, respectively. Advance multivariate logistic regression analysis revealed that in MHD patients, nPCR ≥1.29 g/kg/d and serum albumin <4 g/dL, and also HD duration >7.5 years were associated with CTS. A high nPCR and low serum albumin level, which likely reflect adequate nutrition and inflammation, were associated with CTS in MHD patients. PMID:27368039

  11. Effectiveness of mechanical traction as a non-surgical treatment for carpal tunnel syndrome compared to care as usual: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Carpal tunnel syndrome (CTS) is a common condition (prevalence of 4%) where the median nerve is compressed within the carpal tunnel resulting in numbness, tingling, and pain in the hand. Current non-surgical treatment options (oral medication, corticosteroid injections, splinting, exercise, and mobilization) show limited effects, especially in the long-term. Carpal tunnel release (CTR) surgery is effective in 70 to 75% of patients, but is relatively invasive and can be accompanied by complications. In an observational study, mechanical traction proved to be effective in up to 70% of patients directly after treatment and in 60% after two years follow-up. This randomized controlled trial (RCT) will examine the effectiveness of mechanical traction compared to care as usual in CTS. Methods/Design Patients diagnosed with CTS will be recruited from an outpatient neurology clinic and randomly assigned to the intervention group (mechanical traction) or the control group (care as usual). Participants in the intervention group will receive 12 treatments with mechanical traction during six consecutive weeks. Primary outcome is symptom severity and functional status, which are measured with the Boston Carpel Tunnel Questionnaire (BCTQ). Secondary outcomes are quality of life (WHOQOL-BREF), health related resource utilization, and absenteeism from work. Outcomes will be assessed at baseline, and at 3, 6, and 12 months after inclusion. Linear mixed effect models will be used to determine the change from baseline at 12 months on the BCTQ, WHOQOL-BREF, absenteeism from work and health related resource utilization. The baseline measurement, change from baseline at three and six months, as well as duration of symptoms until inclusion, age, gender, and co-morbidity will be included as covariates The Pearson’s correlation coefficient will be generated to assess the correlation between depression and anxiety and treatment outcome. Discussion Since current non

  12. Carpal osteoarthrosis.

    PubMed

    Peterson, Brett; Szabo, Robert M

    2006-11-01

    Despite improved understanding of carpal mechanics, increased awareness of intercarpal ligament injuries, and improved techniques for treating carpal instability, post-traumatic intercarpal osteoarthrosis remains a common problem. Osteoarthritis of the carpal bones, including scapholunate advance collapse wrist, scaphotrapeziotrapezoid arthritis, lunotriquetral arthritis, triquetrohamate arthritis, and pisotriquetral arthritis, follows specific unique patterns, but in each, the final common pathway leads to degenerative change. Injury or deformity leads to instability and altered kinematics, producing abnormal joint contact pressures. Cartilage injury and eventual degeneration of the join follow. The etiology, prevalence, and current evaluation and treatment of these conditions are of importance to hand surgeons. PMID:17097471

  13. Correlation between Female Sex Hormones and Electrodiagnostic Parameters and Clinical Function in Post-menopausal Women with Idiopathic Carpal Tunnel Syndrome

    PubMed Central

    Mohammadi, Azam; Naseri, Mahshid; Namazi, Hamid; Ashraf, Mohammad Javad

    2016-01-01

    Objectives To investigate the role of sex-hormonal changes in idiopathic carpal tunnel syndrome (CTS) among post-menopausal women through measuring estrogen receptor (ER) expression in their transverse carpal ligament (TCL) and serum estrogen level, as well as determine the correlation between these factors and electrodiagnostic parameters and Boston score. Methods Biopsy samples of TCL were collected from 12 postmenopausal women who had undergone surgery for severe idiopathic CTS; control specimens were collected from 10 postmenopausal women without CTS who had undergone surgery for the other hand pathologies. To determine the distributions of ER in TCL, histological and immunohistochemical examinations were performed. Serum estrogen level was also measured. Electrodiagnosis and Boston questionnaire were used for CTS severity and determination of the patients' function. Results ER expression in TCL and serum estrogen level were not significantly different in the case group compared to the control group (P = 0.79 and P = 0.88, respectively). Also, there was no correlation between ER expression or serum estrogen level and electrodiagnostic parameters or Boston score. Conclusions Sex hormones cannot still be considered as the etiology of idiopathic CTS in postmenopausal women. The role of other factors such as wrist ratio and narrower outlet in females compared to the males should be considered along with hormonal changes. PMID:27617242

  14. Carpal Tunnel Syndrome

    MedlinePlus

    ... American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only. ... Lists Supporters About Us Leadership Careers at ACR Social Media Newsroom Annual Reports & Financial Statements Policies & Guidelines ...

  15. Carpal Tunnel Syndrome

    MedlinePlus

    ... 226-4267 Toll-Free; (301) 565-2966 TTY Internet Address: http://www.niams.nih.gov/ National Institute ... 352-9424 Toll-Free; (301) 468-5981 TTY Internet Address: http://www.ninds.nih.gov/ National Institute ...

  16. Carpal Tunnel Syndrome

    MedlinePlus

    ... or too far from your body. Don't rest your wrists on hard surfaces for long periods of time. Switch hands during work tasks. Make sure the tools you use aren't too big for your hands. ... give your hands and wrists time to rest. Don't sit or stand in the same ...

  17. Carpal Tunnel Syndrome

    MedlinePlus

    ... Safety & Health Administration U.S. Department of Labor 200 Constitution Avenue, NW Washington, DC 20210 http://www.osha. ... of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of ...

  18. Carpal tunnel repair - slideshow

    MedlinePlus

    ... Go to slide 4 out of 4 Normal anatomy Overview The tendons and nerve to the hand ( ... M. is among the first to achieve this important distinction for online health information and services. Learn ...

  19. Carpal tunnel syndrome

    MedlinePlus

    ... caused by typing on a computer, using a mouse, or repeating movements while working, playing a musical ... devices, such as keyboards, different types of computer mouse, cushioned mouse pads, and keyboard drawers Having someone ...

  20. Carpal Tunnel Syndrome Assessment with Ultrasonography: Value of Inlet-to-Outlet Median Nerve Area Ratio in Patients versus Healthy Volunteers

    PubMed Central

    Liu, Fang; Zhu, Jiaan; Ye, Dongmei; Feng, Xianxuan; Xu, Yiming; Wang, Gang; Bai, Yuehong

    2015-01-01

    Objective To evaluate the diagnostic value of the Inlet-to-outlet median nerve area ratio (IOR) in patients with clinically and electrophysiologically confirmed carpal tunnel syndrome (CTS). Methods Forty-six wrists in 46 consecutive patients with clinical and electrodiagnostic evidence of CTS and forty-four wrists in 44 healthy volunteers were examined with ultrasonography. The cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel inlet (the level of scaphoid-pisiform) and outlet (the level of the hook of the hamate), and the IOR was calculated for each wrist. Ultrasonography and electrodiagnostic tests were performed under blinded conditions. Electrodiagnostic testing combined with clinical symptoms were considered to be the gold standard test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic value between the inlet CSA and IOR. Results The study population included 16 men and 30 women (mean age, 45.3 years; range, 18–83 years). The control population included 18 men and 26 women (mean age, 50.4 years; range, 18–79 years). The mean inlet CSA was 8.7 mm2 in healthy controls and 14.6mm2 in CTS group (P<0.001). The mean IOR in healthy volunteers (1.0) was smaller than that in patients (1.6, P<0.001). Receiver operating characteristic analysis revealed a diagnostic advantage to using the IOR rather than the inlet CSA (P<0.01). An IOR cutoff value of ≥ 1.3 would yield 93% specificity and 91% sensitivity in the diagnosis of CTS. Conclusion The IOR of median nerve area promises to be an effective means in the diagnosis of CTS. A large-scale, randomized controlled trial is required to determine how and when this parameter will be used. PMID:25617835

  1. Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation – incidence, risk factors and results of surgical treatment

    PubMed Central

    Kopeć, Jerzy; Gądek, Artur; Drożdż, Maciej; Miśkowiec, Krzysztof; Dutka, Julian; Sydor, Antoni; Chowaniec, Eve; Sułowicz, Władysław

    2011-01-01

    Summary Background Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. Material/Methods The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken. Results Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20–30 years), 100% required surgical release procedures, while 66.66% of those treated for 15–19 years, 42.1% of those treated for 10–14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula. Conclusions Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS. PMID:21873947

  2. Surveillance and prevention of work-related carpal tunnel syndrome: an application of the Sentinel Events Notification System for Occupational Risks.

    PubMed

    Maizlish, N; Rudolph, L; Dervin, K; Sankaranarayan, M

    1995-05-01

    In response to limitations in state-based, occupational disease surveillance, the California Department of Health Services developed a model for provider- and case-based surveillance of work-related carpal tunnel syndrome. The objectives were to enhance case reporting, identify risk factors and high-risk work sites, and link preventive interventions to work sites and the broader community. Using elements from surveillance of communicable diseases and sentinel health events, a model was integrated into the pre-existing reporting system in one California county. Between 1989 and 1991, 54 Santa Clara County health care providers reported 382 suspected cases, of which 365 from 195 work sites met reporting guidelines. Risk factors were profiled from interviews of 135 prioritized cases and 38 employers. Of 24 work sites prioritized for a free, voluntary, nonenforcement inspection, 18 refused and 6 completed an on-site visit. Sentinel Event Notification System for Occupational Risks (SENSOR) captured many cases not reported to the pre-existing reporting system. Case interviews indicated a profile of symptoms and signs, treatment, and exposure to uncontrolled occupational risk factors, including a lack of training on ergonomics hazards. Employer health insurance, rather than workers' compensation, was the apparent source of payment for most medical bills. Employers lacked knowledge and motivation to reduce ergonomic risks. Governmentally mandated occupational ergonomics standards are urgently needed. PMID:7611307

  3. Heightened pain sensitivity in individuals with signs and symptoms of carpal tunnel syndrome and the relationship to clinical outcomes following a manual therapy intervention.

    PubMed

    Bialosky, Joel E; Bishop, Mark D; Robinson, Michael E; Price, Donald D; George, Steven Z

    2011-12-01

    Neurophysiological responses related to lessening of pain sensitivity are a suggested mechanism of manual therapy. Prior studies have observed generalized lower pain thresholds associated with carpal tunnel syndrome (CTS) in comparison to healthy controls. The present study sought to determine whether similar findings were present in suprathreshold measures and measures specific to central integration of pain (temporal summation and after sensations). Additionally, we wished to determine whether measures of pain sensitivity were related to clinical outcomes in participants with signs and symptoms of CTS receiving a manual therapy intervention. Individuals with signs and symptoms of CTS reported greater pain sensitivity to suprathreshold measures of mechanical pain, temporal summation, and after sensation in comparison to healthy controls. Immediate lessening of mechanical pain sensitivity and after sensations in response to a manual therapy intervention and 3-week attenuation of temporal summation following a 3-week course of manual therapy were associated with 3-week changes in clinical pain intensity in participants with signs and symptoms of CTS. These findings suggest heightened pain sensitivity across several parameters may be associated with CTS. Furthermore, changes in mechanical pain, after sensation, and temporal summation may be related to improvements in clinical outcomes. PMID:21764354

  4. Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome.

    PubMed

    Notarnicola, Angela; Maccagnano, Giuseppe; Tafuri, Silvio; Fiore, Alessandra; Pesce, Vito; Moretti, Biagio

    2015-06-01

    Even though the initial treatment of carpal tunnel syndrome (CTS) is conservative, knowledge of the clinical effects of supplements and of some methods of physiotherapy is still preliminary. Many biological mechanisms can support the administration of shock wave therapy (ESWT) or of alpha lipoic acid (ALA) based nutraceutical, conjugated linoleic acid (GLA), anti-oxidants and Echinacea angustifolia for CTS. The shock waves reduce the nerve compression, produce an anti-inflammatory action, and accelerate the regeneration of neuropathy. ALA and GLA induce antioxidant protective actions, reduce inflammation, promote neuroregeneration, and decrease pain. The Echinacea modulates the endogenous cannabinoid system.The aim of study is to verify the efficiency of shock wave therapy versus nutraceutical composed of ALA, GLA, and Echinacea in CTS. Sixty patients were enrolled in this study and they were randomly assigned to one of two treatments. Both groups showed significant improvements in pain, symptoms' severity and functional scores, and electrodiagnostic results until the sixth month. We verified a trend to a better pain regression in the nutraceutical group. The presence of the medicinal Echinacea represents an added value to the antioxidant effect in ALA and GLA, which can justify this result. ESWT or the association of ALA, GLA, and Echinacea proved to be two effective treatments for controlling symptoms and improving the evolution of CTS. PMID:25953494

  5. Acute Effect of Topical Menthol on Chronic Pain in Slaughterhouse Workers with Carpal Tunnel Syndrome: Triple-Blind, Randomized Placebo-Controlled Trial

    PubMed Central

    Jakobsen, Markus D.; Jay, Kenneth; Colado, Juan Carlos

    2014-01-01

    Topical menthol gels are classified “topical analgesics” and are claimed to relieve minor aches and pains of the musculoskeletal system. In this study we investigate the acute effect of topical menthol on carpal tunnel syndrome (CTS). We screened 645 slaughterhouse workers and recruited 10 participants with CTS and chronic pain of the arm/hand who were randomly distributed into two groups to receive topical menthol (Biofreeze) or placebo (gel with a menthol scent) during the working day and 48 hours later the other treatment (crossover design). Participants rated arm/hand pain intensity during the last hour of work (scale 0–10) immediately before 1, 2, and 3 hours after application. Furthermore, global rating of change (GROC) in arm/hand pain was assessed 3 hours after application. Compared with placebo, pain intensity and GROC improved more following application of topical menthol (P = 0.026 and P = 0.044, resp.). Pain intensity of the arm/hand decreased by −1.2 (CI 95%: −1.7 to −0.6) following topical menthol compared with placebo, corresponding to a moderate effect size of 0.63. In conclusion, topical menthol acutely reduces pain intensity during the working day in slaughterhouse workers with CTS and should be considered as an effective nonsystemic alternative to regular analgesics in the workplace management of chronic and neuropathic pain. PMID:25298894

  6. Decompression sickness and aseptic necrosis of bone: Investigations carried out during and after the construction of the Tyne Road Tunnel (1962-66)

    PubMed Central

    1971-01-01

    Report of Decompression Sickness Panel, Medical Research Council (1971). Brit. J. industr. Med., 28, 1-21. Decompression sickness and aseptic necrosis of bone: Investigations carried out during and after the construction of the Tyne Road Tunnel (1962-66). This paper describes investigations into the health of compressed air workers during and after the construction of a road tunnel under the River Tyne. Altogether 641 men were exposed to the compressed air environment over a period of approximately 31 months. The maximum working pressure was 42 psig (289·6 kN/m2), and the overall decompression sickness rate for work at pressures of 18 psig (124·1 kN/m2) and above was 2%. Radiological examination of the chest was carried out on 183 men to detect lung cysts but only one was found. Thus lung cysts were not shown to be a common factor in the causation of decompression sickness but the possibility of small sub-radiological collections of trapped air being involved was not excluded. Radiological examinations of the shoulders, hips and knee joints were carried out on 171 men. There was evidence of aseptic necrosis in one or more bones of 44 men (26%). Fifteen of the men with definite lesions of aseptic necrosis of bone and 7 of the men with suspected lesions had never worked in compressed air before this contract. The remaining 14 men with definite lesions and the 8 with suspected lesions had worked elsewhere in compressed air prior to this contract, but a definite lesion in one of these men and a suspected lesion in another can almost certainly be attributed to their work in compressed air on this contract. Images PMID:5543625

  7. A wakeboarding injury presented as acute carpal syndrome and median nerve contusion after wrist strangulation: a case report

    PubMed Central

    2009-01-01

    Background We present a case of combined median nerve contusion with immediate loss of sensation after the strangulation with a wakeboarding rope and prolonged referral to our department 72 hours after the injury accompanied by an acute carpal tunnel syndrome with immediate relief of numbness of a significant proportion of the median nerve following surgical decompression. Case presentation The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve. Conclusion In case of acute median neuropathy, urgent surgical intervention with exploration, decompression of both, the median nerve and the superficial branch of the median nerve, accompanied by compartment measurements of the forearm should be performed to regain or re-establish neurological integrity. PMID:19178709

  8. Exposure–response relationships for the ACGIH threshold limit value for hand-activity level: results from a pooled data study of carpal tunnel syndrome

    PubMed Central

    Kapellusch, Jay M; Gerr, Frederic E; Malloy, Elizabeth J; Garg, Arun; Harris-Adamson, Carisa; Bao, Stephen S; Burt, Susan E; Dale, Ann Marie; Eisen, Ellen A; Evanoff, Bradley A; Hegmann, Kurt T; Silverstein, Barbara A; Theise, Matthew S; Rempel, David M

    2014-01-01

    Objective This paper aimed to quantify exposure–response relationships between the American Conference of Governmental Industrial Hygienists’ (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS). Methods Manufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions. Results The longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11–1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2–2.5) and 1.5 (95% CI 1.0–2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05–1.25), and 1.04 per unit (95% CI 0.93–1.15), respectively. Conclusion Those with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS. PMID:25266844

  9. The role of median nerve terminal latency index in the diagnosis of carpal tunnel syndrome in comparison with other electrodiagnostic parameters

    PubMed Central

    Vahdatpour, Babak; Khosrawi, Saeid; Chatraei, Maryam

    2016-01-01

    Background: Carpal tunnel syndrome (CTS) considers the most common compression neuropathy, which nerve conduction studies (NCSs) used for its detection routinely and universally. This study was performed to determine the value of the median TLI and other NCS variables and to investigate their sensitivity and specificity in the diagnosis of CTS. Materials and Methods: The study was carried out among 100 hands of healthy volunteers and 50 hands of patients who had a positive history of paresthesia and numbness in upper extremities. Information including age, gender, and result of sensory and motor nerve conduction velocity (MNCV), peak latency difference of median and ulnar nerves of fourth digit (M4-U4 peak latency difference), and TLI were recorded for analysis. Sensitivity and specificity of electro diagnostic parameters in the diagnosis of CTS was investigated. Results: Normal range of the median nerve TLI was 0.43 ± 0.077. There was no significant difference between two groups for MNCV means (P = 0. 45). Distal sensory latency and distal motor latency (DML) of median nerve and fourth digit median-ulnar peak latency differences (PM4-PU4) for CTS group was significantly higher (P < 0.001) and mean for sensory nerve conduction velocity was significantly higher in control group (P < 0.001). The most sensitive electrophysiological finding in CTS patients was median TLI (82%), but the most specific one was DML (98%). Conclusion: Although in early stages of CTS, we usually expect only abnormalities in the sensory studies, but TLI may better demonstrate the effect on median nerve motor fiber even in mild cases of CTS. PMID:27376049

  10. The usefulness of terminal latency index of median nerve and f-wave difference between median and ulnar nerves in assessing the severity of carpal tunnel syndrome.

    PubMed

    Park, Kang Min; Shin, Kyong Jin; Park, Jinse; Ha, Sam Yeol; Kim, Sung Eun

    2014-04-01

    The calculated electrophysiological parameters, such as terminal latency index (TLI), residual latency, modified F ratio, and F-wave inversion, have been investigated as a diagnostic tool for detection of early stage of carpal tunnel syndrome (CTS) in the literature. However, the correlation of these calculated electrophysiological parameters with the clinical severity of CTS has not been reported. The aim of this study was to determine the correlation of the calculated electrophysiological parameters and clinical severity in patients with CTS. A retrospective study was performed with 212 hands of 106 CTS patients. The CTS hands were classified as asymptomatic, mild, moderate, and severe according to the clinical severity. The distal motor latency and distal motor conduction velocity of median nerve, minimal F-wave latency of median and ulnar nerves, and sensory nerve conduction velocity in the finger-wrist and palm-wrist segment of median nerve (SNCV f-w and SNCV p-w) were obtained in a conventional nerve conduction study. The TLI, residual latency, and modified F ratio of the median nerve and the difference of minimal F-wave latencies between the median and ulnar nerves (F-diff M-U) were calculated. The distal motor latency, residual latency, and F-diff M-U were significantly increased according to the clinical severity of CTS. The motor conduction velocity, SNCV p-w, SNCV f-w, TLI, and modified F ratio were significantly decreased according to the clinical severity of CTS. In analyses of variance and Kruskal-Wallis test, we used the Scheffe test as a post-hoc comparison analysis. The TLI, F-diff M-U, and SNCV f-w showed a significant difference among all groups of each CTS severity. The sensitivity, specificity, and cut-off value of TLI, F-diff M-U, and SNCV f-w between asymptomatic and mild, mild and moderate, and moderate and severe CTS groups were calculated by using receiver operating characteristic curve analysis. The cut-off values of TLI, F-diff M-U, and

  11. Movement of the Distal Carpal Row during Narrowing and Widening of the Carpal Arch Width

    PubMed Central

    Gabra, Joseph N.; Domalain, Mathieu; Li, Zong-Ming

    2013-01-01

    Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3°, 5.3 ± 1.3°, and 5.5 ± 3.5°, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components. PMID:23083195

  12. Direct “Cystoscopic” Approach for Arthroscopic Decompression of an Intraosseous Ganglion of the Lunate

    PubMed Central

    Bhatia, Deepak N.

    2015-01-01

    Intraosseous ganglion cysts (IOGs) are uncommon lesions of the carpal bones and can present with persistent pain and stiffness of the wrist. Surgical decompression is recommended, and a variety of approaches to decompress symptomatic IOGs of the wrist have been described. We describe an arthroscopic approach that can be performed with only 2 portals and offers excellent access for visualization and instrumentation. The procedure involves creating a 3.2-mm tunnel into the lunate cyst; this is performed through the dorsal non-articular surface of the lunate, under direct vision, and the position is confirmed with fluoroscopy. A 2.4-mm arthroscope is passed through the drill hole, and a direct “cystoscopic” view of the IOG is obtained. Biopsy of the cyst contents is performed under direct vision, and small-joint shavers and burrs are used for effective debridement. Advantages of this technique are actual visualization of the pathology, complete intracystic debridement, and simultaneous treatment of any coexistent intra-articular pathology. In addition, the minimal 3.2-mm lunate tunnel access maintains the structural integrity of the lunate and reduces the need for additional bone graft supplementation. PMID:26258034

  13. Direct "Cystoscopic" Approach for Arthroscopic Decompression of an Intraosseous Ganglion of the Lunate.

    PubMed

    Bhatia, Deepak N

    2015-06-01

    Intraosseous ganglion cysts (IOGs) are uncommon lesions of the carpal bones and can present with persistent pain and stiffness of the wrist. Surgical decompression is recommended, and a variety of approaches to decompress symptomatic IOGs of the wrist have been described. We describe an arthroscopic approach that can be performed with only 2 portals and offers excellent access for visualization and instrumentation. The procedure involves creating a 3.2-mm tunnel into the lunate cyst; this is performed through the dorsal non-articular surface of the lunate, under direct vision, and the position is confirmed with fluoroscopy. A 2.4-mm arthroscope is passed through the drill hole, and a direct "cystoscopic" view of the IOG is obtained. Biopsy of the cyst contents is performed under direct vision, and small-joint shavers and burrs are used for effective debridement. Advantages of this technique are actual visualization of the pathology, complete intracystic debridement, and simultaneous treatment of any coexistent intra-articular pathology. In addition, the minimal 3.2-mm lunate tunnel access maintains the structural integrity of the lunate and reduces the need for additional bone graft supplementation. PMID:26258034

  14. Decompression illness.

    PubMed

    Vann, Richard D; Butler, Frank K; Mitchell, Simon J; Moon, Richard E

    2011-01-01

    Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression). The term covers both arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation, and decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas. Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression. Risk of decompression illness is affected by immersion, exercise, and heat or cold. Manifestations range from itching and minor pain to neurological symptoms, cardiac collapse, and death. First-aid treatment is 100% oxygen and definitive treatment is recompression to increased pressure, breathing 100% oxygen. Adjunctive treatment, including fluid administration and prophylaxis against venous thromboembolism in paralysed patients, is also recommended. Treatment is, in most cases, effective although residual deficits can remain in serious cases, even after several recompressions. PMID:21215883

  15. [Injury to the median nerve after minimally invasive decompression: discrepancy between the surgical report and actual course of surgery].

    PubMed

    Kernt, B; Neu, J

    2011-06-01

    A 72-year-old man suffering from carpal tunnel syndrome had undergone minimally invasive decompression by using a SafeGuard® Mini-Open Carpal Tunnel Release System. After the operation the patient presented with a paraesthesia in the median nerve distribution. Two months later an operative revision was performed in another hospital. A partial transection of the median nerve and an incomplete release was seen. The surgeon of the first operation stated that detailed informed consent including the risk of iatrogenic nerve injury had been obtained. Furthermore he referred to the operative report, which mentioned the accuracy of the procedure without any problems or complications during surgery. The Arbitration Board stated that the operative report could not exculpate the surgeon because the findings of the operative revision disagreed with the first operative report. The expert opinion declared that the lesion was a result of an inaccurate operative procedure as the surgeon was not able to demonstrate an anatomical variation of the median nerve. PMID:21604030

  16. [Decompression sickness].

    PubMed

    Sipinen, Seppo

    2010-01-01

    Decompression sickness will develop, when excess concentrations of nitrogen or helium from the respiratory gas have dissolved into the body. The dissolved gases are removed from the body with exhalation. If the level of dissolved gases exceeds their natural rate of removal, bubbles are formed in the circulation and tissues as the pressure surrounding the diver decreases. The bubbles will cause decompression sickness typically manifested as skin symptoms, musculoskeletal pains and disturbances of the central nervous system. The only known and effective treatment is recompression and inhalation of pure oxygen. PMID:20486494

  17. Evaluation of a new tourniquet for hand surgery: Comparison of 76 carpal tunnel syndrome cases operated using a Hemaclear(®) Model-F tourniquet versus a pneumatic tourniquet.

    PubMed

    Pereira, A; Hendriks, S; Facca, S; Bodin, F; Gay, A; Liverneaux, P

    2015-04-01

    The aim of this study was to compare a forearm-specific, sterile, single-use, non-pneumatic tourniquet to a conventional pneumatic tourniquet during carpal tunnel syndrome procedures. Patients with a systolic blood pressure exceeding 160 mmHg were excluded. The study included 76 patients. In 38 patients, surgery was performed with a pneumatic tourniquet on the forearm. In the remaining 38 patients, surgery was performed with a Hemaclear(®) Model-F tourniquet. There were no significant differences between the two groups in terms of quality of the exsanguination or pain experienced by the patient. The duration of surgery was significantly faster by 30 seconds with the Hemaclear(®) tourniquet but the procedure cost was about €30 more. The forearm-specific Hemaclear(®) tourniquet has several theoretical advantages, but our clinical results do not support these advantages in terms of quality of the surgical exsanguination and pain experienced by the patient. The duration of surgery was significantly shorter, but at the price of a higher surgery cost. PMID:25772086

  18. Morphological and positional changes of the carpal arch and median nerve during wrist compression

    PubMed Central

    Marquardt, Tamara L.; Gabra, Joseph N.; Li, Zong-Ming

    2015-01-01

    Background The carpal tunnel is a fibro-osseous structure containing the median nerve and flexor tendons. Its cross-sectional area has been shown to increase during compressive force application to the carpal bones in modeling and in vitro studies. The purpose of this study was to investigate the morphological and positional changes of the carpal arch and median nerve while in vivo compressive force was applied in the radioulnar direction across the wrist. Methods Ultrasound images of the carpal tunnel and its contents were captured for 11 healthy, female volunteers at the distal tunnel level prior to force application and during force application of 10 and 20 N. Findings With applied force, the carpal arch width significantly decreased, while the carpal arch height and area significantly increased (P < 0.001). The median nerve shape became more rounded as the compressive force magnitude increased, reflected by decreases in the nerve’s flattening ratio and increases in its circularity (P < 0.001). The applied force also resulted in nerve displacement in the radial-volar direction. Interpretation This study demonstrates that noninvasively applying radioulnar compressive force across the wrist may potentially provide relief of median nerve compression to patients suffering from carpal tunnel syndrome. PMID:25661267

  19. Biomechanical properties of the transverse carpal ligament under biaxial strain.

    PubMed

    Holmes, Michael W R; Howarth, Samuel J; Callaghan, Jack P; Keir, Peter J

    2012-05-01

    The transverse carpal ligament (TCL) influences carpal stability and carpal tunnel mechanics, yet little is known about its mechanical properties. We investigated the tissue properties of TCLs extracted from eight cadaver arms and divided into six tissue samples from the distal radial, distal middle, distal ulnar, proximal radial, proximal middle, and proximal ulnar regions. The 5% and 15% strains were applied biaxially to each sample at rates of 0.1, 0.25, 0.5, and 1%/s. Ligament thickness ranged from 1.22 to 2.90 mm. Samples from the middle of the TCL were thicker proximally than distally (p < 0.013). Tissue location significantly affected elastic modulus (p < 0.001). Modulus was greatest in the proximal radial samples (mean 2.8 MPa), which were 64% and 44% greater than the distal radial and proximal ulnar samples, respectively. Samples from the middle had a modulus that was 20-39% greater in the proximal versus more distal samples. The TCL exhibited different properties within different locations and in particular greater moduli were found near the carpal bone attachments. These properties contribute to the understanding of carpal tunnel mechanics that is critical to understanding disorders of the wrist. PMID:22042748

  20. Movement of the distal carpal row during narrowing and widening of the carpal arch width.

    PubMed

    Gabra, Joseph N; Domalain, Mathieu; Li, Zong-Ming

    2012-10-01

    Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3 deg, 5.3 ± 1.3 deg, and 5.5 ± 3.5 deg, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components. PMID:23083195

  1. Three-dimensional stiffness of the carpal arch.

    PubMed

    Gabra, Joseph N; Li, Zong-Ming

    2016-01-01

    The carpal arch of the wrist is formed by irregularly shaped carpal bones interconnected by numerous ligaments, resulting in complex structural mechanics. The purpose of this study was to determine the three-dimensional stiffness characteristics of the carpal arch using displacement perturbations. It was hypothesized that the carpal arch would exhibit an anisotropic stiffness behavior with principal directions that are oblique to the conventional anatomical axes. Eight (n=8) cadavers were used in this study. For each specimen, the hamate was fixed to a custom stationary apparatus. An instrumented robot arm applied three-dimensional displacement perturbations to the ridge of trapezium and corresponding reaction forces were collected. The displacement-force data were used to determine a three-dimensional stiffness matrix using least squares fitting. Eigendecomposition of the stiffness matrix was used to identify the magnitudes and directions of the principal stiffness components. The carpal arch structure exhibited anisotropic stiffness behaviors with a maximum principal stiffness of 16.4±4.6N/mm that was significantly larger than the other principal components of 3.1±0.9 and 2.6±0.5N/mm (p<0.001). The principal direction of the maximum stiffness was pronated within the cross section of the carpal tunnel which is accounted for by the stiff transverse ligaments that tightly bind distal carpal arch. The minimal principal stiffness is attributed to the less constraining articulation between the trapezium and scaphoid. This study provides advanced characterization of the wrist׳s three-dimensional structural stiffness for improved insight into wrist biomechanics, stability, and function. PMID:26617368

  2. Carpal Ligament Anatomy and Biomechanics.

    PubMed

    Pulos, Nicholas; Bozentka, David J

    2015-08-01

    A fundamental understanding of the ligamentous anatomy of the wrist is critical for any physician attempting to treat carpal instability. The anatomy of the wrist is complex, not only because of the number of named structures and their geometry but also because of the inconsistencies in describing these ligaments. The complex anatomy of the wrist is described through a review of the carpal ligaments and their effect on normal carpal motion. Mastery of this topic facilitates the physician's understanding of the patterns of instability that are seen clinically. PMID:26205699

  3. Morphological Analysis of the Transverse Carpal Ligament

    PubMed Central

    Pacek, Corey A.; Chakan, Matthew; Goitz, Robert J.; Kaufmann, Robert A.

    2009-01-01

    Transection of the transverse carpal ligament (TCL) for carpal tunnel syndrome is commonly performed, yet actual knowledge of TCL morphology is rudimentary and the anatomical terminology is inconsistently used. The purpose of this study was to perform a morphological analysis of the TCL, to redefine the anatomical terminology concerning the TCL and surrounding structures, and to evaluate any correlation between external, measurable hand dimensions, and TCL dimensions. A silicone casting technique and digitization were employed to measure the morphology of the TCL in cadaveric specimens and to construct a three-dimensional TCL model. The TCL was the thickest distally at the midline and ulnar segments and the thickest proximally at the radial segment. External hand dimensions did not significantly correlate with TCL dimensions. The TCL thickness distribution is variable along the radioulnar axis. The thickness of the TCL was 2.1 ± 0.8 mm, ranging from 1.3 to 3.0 mm. PMID:19701670

  4. Electroacupuncture Helped Ease Carpal Tunnel in Study

    MedlinePlus

    ... raises the possibility that an electrical form of acupuncture could become a useful treatment for the common ... are often only temporary, said Longhurst, who studies acupuncture. "Surgery is the final option used after conservative ...

  5. [First therapy of decompression injuries].

    PubMed

    Castan, Jan; Wirtz, Sebastian; Moecke, Heinzpeter; Schmidbauer, Willi; Ahlers, Olaf; Kerner, Thoralf

    2010-02-01

    The diving accident is a rare incident for an emergency physician which requires special physical and patho-physiological knowledge. With increasing recreational activities and the fascination of diving also for older persons diving accidents are expected to occur more often. There can be several reasons for diving accidents such as the ignorance of the physics of diving, a trauma under water as well as internistical illnesses like heart attach, stroke or hypoglycaemia. The therapy of the underlying illness should not be left aside while dealing with the patient. The careful rescue and the immobilisation are most important for the initial therapy. The patient should receive oxygen, if possible via a demand valve, until a hyperbaric chamber is reached. There is no specific medical therapy for decompression illness. It is very important that a pre-information is sent to the closest hyperbaric chamber as soon as possible since often the chamber needs some time to be properly prepared for usage. In order to receive information regarding the depth where the diving incident occured, the duration of the diving trip and the decompression stops, it is important to secure the diving computer of the victim for the hyperbaric chamber. Also outside diving, decompression illness can occur, for example working in a tunnel under hyperbaric conditions. These accidents have to be treated according to the same guidelines. PMID:20155636

  6. Volar/dorsal compressive mechanical behavior of the transverse carpal ligament.

    PubMed

    Main, Erin K; Goetz, Jessica E; Baer, Thomas E; Klocke, Noelle F; Brown, Thomas D

    2012-04-30

    Mechanical insult to the median nerve caused by contact with the digital flexor tendons and/or carpal tunnel boundaries may contribute to the development of carpal tunnel syndrome. Since the transverse carpal ligament (TCL) comprises the volar boundary of the carpal tunnel, its mechanics in part govern the potential insult to the median nerve. Using unconfined compression testing in combination with a finite element-based optimization process, nominal stiffness measurements and first-order Ogden hyperelastic material coefficients (μ and α ) were determined to describe the volar/dorsal compressive behavior of the TCL. Five different locations on the TCL were tested, three of which were deep to the origins of the thenar and hypothenar muscles. The average (± standard deviation) low-strain and high-strain TCL stiffness values in compression sites outside the muscle attachment region were 3.6 N/mm (±2.7) and 28.0 N/mm (±20.2), respectively. The average stiffness values at compression sites with muscle attachments were notably lower, with low-strain and high-strain stiffness values of 1.2 N/mm (±0.5) and 9.7 N/mm (±4.8), respectively. The average Ogden coefficients for the muscle attachment region were 51.6 kPa (±16.5) for μ and 16.5 (±2.0) for α, while coefficients for the non-muscle attachment region were 117.8 kPa (±86.8) for μ and 17.2 (±1.6) for α. These TCL compressive mechanical properties can help inprove computational models, which can be used to provide insight into the mechanisms of median nerve injury leading to the onset of carpal tunnel syndrome symptoms. PMID:22381735

  7. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal. PMID:27284515

  8. Decompressive craniectomy: technical note.

    PubMed

    Quinn, T M; Taylor, J J; Magarik, J A; Vought, E; Kindy, M S; Ellegala, D B

    2011-04-01

    Decompressive craniectomy is a neurosurgical technique in which a portion of the skull is removed to reduce intracranial pressure. The rationale for this procedure is based on the Monro-Kellie Doctrine; expanding the physical space confining edematous brain tissue after traumatic brain injury will reduce intracranial pressure. There is significant debate over the efficacy of decompressive craniectomy despite its sound rationale and historical significance. Considerable variation in the employment of decompressive craniectomy, particularly for secondary brain injury, explains the inconsistent results and mixed opinions of this potentially valuable technique. One way to address these concerns is to establish a consistent methodology for performing decompressive craniectomies. The purpose of this paper is to begin accomplishing this goal and to emphasize the critical points of the hemicraniectomy and bicoronal (Kjellberg type) craniectomy. PMID:20637010

  9. [Decompression of deep divers].

    PubMed

    Gardette, B

    1989-08-01

    For industrial saturation dives over 50 m, Heliox (He-O2) is now used routinely as respiratory gas mix. The decompression after such dives has been investigated thoroughly as well on the animal (minipig, monkeys) as on humans. Results show that for a given ascending speed, the number of bubbles detectable by the Doppler method in the bloodstream rises according to the maximal depth. The incidence of decompression accidents follows the same trend. This finding prompted us to adopt since 1979 slower decompression speeds. Moreover we modified the ascension profile, using henceforth a linear decompression in maintaining a constant speed for a given partial oxygen pressure. For our research program Hydra, we replaced in part Helium by Hydrogen in the respiratory gas mix. We were thus able to do the first hydrogen saturation decompression between 450 and 200 meters, during our Hydra V (1985) experiment. During our following diving research program Hydra VI (1986), 8 divers were decompressed under Hydreliox (H2-He-O2) mix from 500 to 300 m by eliminating hydrogen by chemical means. We used for this purpose a dehydrogenation apparatus developed by our engineering team. These decompressions took place without any difficulty and only a low number of bubbles detected. It is therefore possible to use decompression speeds for hydrogen and helium which are very similar. A confirmatory experiment on mice, where we exposed them to a 2000 m depth dive under Hydreliox (H2-He-O2), gave good results. This gives us the possibility, to perform gas exchange studies on small animals and to extrapolate the results to humans. PMID:2799362

  10. The role of the transverse carpal ligament in carpal stability: an in vitro study.

    PubMed

    Tengrootenhuysen, Mike; van Riet, Roger; Pimontel, Paul; Bortier, Hilde; Van Glabbeek, Francis

    2009-08-01

    A biomechanical in vitro study was performed on 16 fresh frozen cadaver forearms to investigate the role of the transverse carpal ligament (TCL) in carpal stability. The distance between the scaphoid and hamate was measured, as a reference for the length of the TCL. Distances were recorded in both loaded and unloaded conditions after gradual sectioning of the transverse carpal ligament, the palmar scapholunate, long radiolunate ligament and radioscapholunate ligament. The largest increase in spread of the carpal bones (55.3% of total spread) was noted after loading with the ligament intact. Thereafter, sectioning of the TCL resulted in a further 32.9% increase in the distance between the scaphoid and the hamate. We conclude that the intact carpal bones-ligament complex displays some elasticity. Progressive sectioning of the TCL ligament under loading further opens the palmar arch. Nevertheless it appears that the carpal arch will still retain reasonable intrinsic stability even without an intact TCL. PMID:19774812

  11. Cutaneous decompression sickness.

    PubMed

    Tasios, Konstantinos; Sidiras, Georgios Gr; Kalentzos, Vasileios; Pyrpasopoulou, Athina

    2014-03-01

    A probable case of decompression illness with associated cutis marmorata is presented, which regressed over a few hours with oxygen breathing and after intravenous methylprednisolone and fluid resuscitation without recompression. He was eventually transferred for hyperbaric treatment some 10 hours post dive. Cutaneous decompression illness is not associated with high mortality per se, but prompt and accurate recognition is warranted, as it may represent a prodromal feature of potentially life-threatening complications. However, in this case, as differential diagnosis, an allergic reaction remains possible. PMID:24687485

  12. Adaptation of the Transverse Carpal Ligament Associated with Repetitive Hand Use in Pianists

    PubMed Central

    Mhanna, Christiane; Marquardt, Tamara L.; Li, Zong-Ming

    2016-01-01

    The transverse carpal ligament (TCL) plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL’s mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI) imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV). ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p < 0.05). Additionally, the increased SWV was location dependent for both pianist and non-pianist groups (p < 0.05), with the rTCL having a significantly greater SWV than the uTCL. Between groups, the rTCL SWV of pianists was 22.2% greater than that of the non-pianists (p < 0.001). This localized increase of TCL SWV, i.e. stiffening, may be primarily attributable to focal biomechanical interactions that occur at the radial TCL aspect where the thenar muscles are anchored. Progressive stiffening of the TCL may become constraining to the carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome. PMID:26953892

  13. Adaptation of the Transverse Carpal Ligament Associated with Repetitive Hand Use in Pianists.

    PubMed

    Mhanna, Christiane; Marquardt, Tamara L; Li, Zong-Ming

    2016-01-01

    The transverse carpal ligament (TCL) plays a critical role in carpal tunnel biomechanics through interactions with its surrounding tissues. The purpose of this study was to investigate the in vivo adaptations of the TCL's mechanical properties in response to repetitive hand use in pianists using acoustic radiation force impulse (ARFI) imaging. It was hypothesized that pianists, in comparison to non-pianists, would have a stiffer TCL as indicated by an increased acoustic shear wave velocity (SWV). ARFI imagining was performed for 10 female pianists and 10 female non-pianists. The median SWV values of the TCL were determined for the entire TCL, as well as for its radial and ulnar portions, rTCL and uTCL, respectively. The TCL SWV was significantly increased in pianists relative to non-pianists (p < 0.05). Additionally, the increased SWV was location dependent for both pianist and non-pianist groups (p < 0.05), with the rTCL having a significantly greater SWV than the uTCL. Between groups, the rTCL SWV of pianists was 22.2% greater than that of the non-pianists (p < 0.001). This localized increase of TCL SWV, i.e. stiffening, may be primarily attributable to focal biomechanical interactions that occur at the radial TCL aspect where the thenar muscles are anchored. Progressive stiffening of the TCL may become constraining to the carpal tunnel, leading to median nerve compression in the tunnel. TCL maladaptation helps explain why populations who repeatedly use their hands are at an increased risk of developing musculoskeletal pathologies, e.g. carpal tunnel syndrome. PMID:26953892

  14. Carpal Ligament Injuries, Pathomechanics, and Classification.

    PubMed

    Lee, Daniel J; Elfar, John C

    2015-08-01

    Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including 2 of the most common malalignment patterns: volar intercalated segment instability and the more common dorsal intercalated segment instability. Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research is likely to unify the disparate paradigms used to describe wrist instability. PMID:26205700

  15. Carpal ligament injuries, pathomechanics, and classification

    PubMed Central

    Lee, Daniel J.

    2015-01-01

    SYNOPSIS Carpal instability is a complex array of maladaptive and post-traumatic conditions that leads to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including two of the most common malalignment patterns of volar intercalated segment instability (VISI) and the more common dorsal intercalated segment instability (DISI). Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research will likely unify the disparate paradigms used to describe wrist instability. PMID:26205700

  16. Ultrasound assessment of transverse carpal ligament thickness: a validity and reliability study.

    PubMed

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-06-01

    The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiologic factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measure the TCL thickness and to test the validity and reliability of this method. Three operators conducted two sessions of ultrasound examination on eight cadaveric specimens and eight healthy volunteers. A custom script was used to calculate TCL thickness along the TCL length from the ultrasound images. The ultrasound based TCL thickness of the cadaveric specimens was compared with the dissection based TCL thickness for validation. The results showed Pearson's correlation coefficients of 0.867-0.928, intraclass correlation coefficient (ICC) values of 0.726-0.865, a standard error of measurement of 0.02-0.07 mm and a minimal detectable difference of 0.05-0.15 mm. The high correlation coefficients and small errors indicate that the ultrasound based method is valid for measuring TCL thickness. Furthermore, ultrasound measurements showed excellent intraoperator and interoperator reliability with ICC values as 0.826-0.933 and 0.840-0.882, respectively. The ultrasound based TCL thickness was in the range of 0.93-2.34 (1.54 ± 0.33) mm and agreed well with previous studies. The ultrasound method developed in this study is a valuable tool to examine morphologic properties of healthy and pathologic TCLs. PMID:22502882

  17. In vivo study of transverse carpal ligament stiffness using acoustic radiation force impulse (ARFI) imaging.

    PubMed

    Shen, Zhilei Liu; Vince, D Geoffrey; Li, Zong-Ming

    2013-01-01

    The transverse carpal ligament (TCL) forms the volar boundary of the carpal tunnel and may provide mechanical constraint to the median nerve, leading to carpal tunnel syndrome. Therefore, the mechanical properties of the TCL are essential to better understand the etiology of carpal tunnel syndrome. The purpose of this study was to investigate the in vivo TCL stiffness using acoustic radiation force impulse (ARFI) imaging. The shear wave velocity (SWV) of the TCL was measured using Virtual Touch IQ(TM) software in 15 healthy, male subjects. The skin and the thenar muscles were also examined as reference tissues. In addition, the effects of measurement location and ultrasound transducer compression on the SWV were studied. The SWV of the TCL was dependent on the tissue location, with greater SWV values within the muscle-attached region than those outside of the muscle-attached region. The SWV of the TCL was significantly smaller without compression (5.21 ± 1.08 m/s) than with compression (6.62 ± 1.18 m/s). The SWV measurements of the skin and the thenar muscles were also affected by transducer compression, but to different extents than the SWV of the TCL. Therefore to standardize the ARFI imaging procedure, it is recommended that a layer of ultrasound gel be maintained to minimize the effects of tissue compression. This study demonstrated the feasibility of ARFI imaging for assessing the stiffness characteristics of the TCL in vivo, which has the potential to identify pathomechanical changes of the tissue. PMID:23861919

  18. Ultrasound Assessment of Transverse Carpal Ligament Thickness: A Validity and Reliability Study

    PubMed Central

    Shen, Zhilei Liu; Li, Zong-Ming

    2012-01-01

    The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiological factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measure the TCL thickness and to test the validity and reliability of this method. Three operators conducted two sessions of ultrasound examination on 8 cadaveric specimens and 8 healthy volunteers. A custom script was used to calculate TCL thickness along the TCL length from the ultrasound images. The ultrasound based TCL thickness of the cadaveric specimens was compared to the dissection based TCL thickness for validation. The results showed Pearson’s correlation coefficients of 0.867–0.928, intraclass correlation coefficient (ICC) values of 0.726–0.865, a standard error of measurement of 0.02–0.07 mm, and a minimal detectable difference of 0.05–0.15 mm. The high correlation coefficients and small errors indicate that the ultrasound based method is valid for measuring TCL thickness. Furthermore, ultrasound measurements showed excellent intra-operator and inter-operator reliability with ICC values as 0.826–0.933 and 0.840–0.882, respectively. The ultrasound based TCL thickness was in the range of 0.93–2.34 (1.54 ± 0.33) mm and agreed well with previous studies. The ultrasound method developed in this study is a valuable tool to examine morphological properties of healthy and pathological TCLs. PMID:22502882

  19. Percutaneous laser disc decompression.

    PubMed

    Choy, D S

    1995-06-01

    Herniated disc disease has an incidence of 1.7% in the U.S. Heretofore, open operative procedures were the rule for this condition when conservative measures were ineffective. Choy and Ascher introduced this new technique in February 1986 using a Nd:YAG laser introduced into the disc through an optical fiber in a needle. Percutaneous laser disc decompression is based on the principle that in an enclosed hydraulic space, such as an intact disc, a small reduction in volume is associated with a disproportionate fall in pressure. In the disc, this partial vacuum causes the herniated portion to move away from the nerve root back toward the center of the disc. This technique has been taught worldwide and is being performed in most of Europe, Japan, the United States, and Korea. In this special issue devoted to percutaneous laser disc decompression (PLDD), we will set forth the basic science of PLDD, patient selection, use of the holmium:YAG, and the Nd:YAG lasers, operative technique, and results. PMID:10150634

  20. Understanding carpal instability: a radiographic perspective.

    PubMed

    Kani, Kimia Khalatbari; Mulcahy, Hyojeong; Chew, Felix S

    2016-08-01

    The wrist is disposed to a variety of instability patterns owing to its complex anatomical and biomechanical properties. Various classification schemes have been proposed to describe the different patterns of carpal instability, of which the Mayo classification is the most commonly used. Understanding the concepts and pertinent terminology of this classification scheme is important for the correct interpretation of images and optimal communication with referring physicians. Standard wrist radiographs are the first line of imaging in carpal instability. Additional information may be obtained with the use of stress radiographs and other imaging modalities. PMID:27085694

  1. Dorsal wrist mass: the carpal boss.

    PubMed

    Boggess, Blake; Berkoff, David

    2011-01-01

    The carpal boss is an osseous overgrowth that is occasionally mistaken for a ganglion cyst. This report highlights the case a 36-year-old patient who was originally diagnosed by his primary care physician with a ganglion cyst and was sent to an orthopaedist for aspiration. Upon further evaluation with a plain radiograph, the dorsal wrist mass was found to be a carpal boss. The patient was treated with rest and a wrist brace, and was informed that a corticosteroid injection or surgical excision would be necessary if conservative treatment failed. The patient was asymptomatic on follow-up and invasive procedures were not necessary. PMID:22707539

  2. Validation of diving decompression tables.

    PubMed

    Kłos, Ryszard; Nishi, Ron; Olszański, Roman

    2002-01-01

    Research on the validation of decompression tables is one of the common subject areas of the co-operation undertaken between the Defence and Civil Institute of Environmental Medicine, Toronto, Canada, and The Naval Academy of Gdynia, Poland. For several years now, a systematic survey of diving technologies has been conducted among the target projects financed by the Polish State Committee for Scientific Research and the Polish Navy. Among the most important problems discussed have been various aspects of decompression safety. The present paper shows a study to standardise and unify validation procedures for decompression in the Polish Navy. PMID:12608591

  3. Microvascular decompression for intractable singultus.

    PubMed

    Saito, Atsushi; Hatayama, Toru; Kon, Hiroyuki; Nakamura, Taigen; Sasaki, Tatsuya

    2016-10-01

    Intractable singultus due to cerebrovascular disease is very rare. We report a case of intractable singultus that improved after microvascular decompression and present a literature review. The patient was a 58-year-old man with a 30-year history of persistent singultus. Its frequency and duration gradually increased and it was resistant to multiple medical treatments. Microvascular decompression to relieve pressure on the anterolateral surface of the lower medulla oblongata from the vertebral artery resulted in the resolution of singultus. Patients with intractable idiopathic singultus who fail to respond to medical therapy need to be considered for the evaluation of cerebrovascular diseases and microvascular decompression. PMID:27335312

  4. Homologies and homeotic transformation of the theropod 'semilunate' carpal.

    PubMed

    Xu, Xing; Han, Fenglu; Zhao, Qi

    2014-01-01

    The homology of the 'semilunate' carpal, an important structure linking non-avian and avian dinosaurs, has been controversial. Here we describe the morphology of some theropod wrists, demonstrating that the 'semilunate' carpal is not formed by the same carpal elements in all theropods possessing this feature and that the involvement of the lateralmost distal carpal in forming the 'semilunate' carpal of birds is an inheritance from their non-avian theropod ancestors. Optimization of relevant morphological features indicates that these features evolved in an incremental way and the 'semilunate' structure underwent a lateral shift in position during theropod evolution, possibly as a result of selection for foldable wings in birds and their close theropod relatives. We propose that homeotic transformation was involved in the evolution of the 'semilunate' carpal. In combination with developmental data on avian wing digits, this suggests that homeosis played a significant role in theropod hand evolution in general. PMID:25116378

  5. Carpal arthrodesis in cats. Long-term functional outcome.

    PubMed

    Calvo, I; Farrell, M; Chase, D; Aisa, J; Rayward, R; Carmichael, S

    2009-01-01

    Pancarpal and partial carpal arthrodesis were performed in 22 carpi (20 cats) using various surgical methods. Short and long-term outcomes were assessed using a retrospective review of the case notes and via owner questionnaires. Carpal arthrodesis was associated with complications that did not affect the functional outcome, and in most cases, did not necessitate major revision surgery. Following arthrodesis, the cats did not jump as high, and showed a reduction in their willingness to jump and climb. Based on our results, carpal arthrodesis is a suitable salvage surgery to treat severe carpal injuries in the cat. PMID:19876518

  6. Factors Affecting the Outcomes of Carpal Tunnel Surgery: A Review.

    PubMed

    Zyluk-Gadowska, P; Zyluk, A

    2016-08-01

    Ziel der vorliegenden Arbeit war es, unter Berücksichtigung der in Pubmed und Medline veröffentlichten Ergebnisse nach Eingriffen am Karpalkanal zu ermitteln, inwieweit ausgewählte Faktoren wie das Patientenalter, die Dauer der Symptome, die Ausprägung der klinischen und elektrophysiologischen Befunde, das Vorliegen von Begleiterkrankungen und medikolegale Momente die Ergebnisse beeinflussen. Letztlich konnte für keinen der zahlreichen untersuchten Faktoren ein signifikanter Einfluss auf das Langzeitergebnis nachgewiesen werden. Bestehen die Beschwerden länger, sind die klinischen und elektrophysiologischen Befunde ausgeprägter und liegen Begleiterkrankungen vor, so fallen die Ergebnisse weniger gut aus, was darauf hindeutet, dass die betroffenen Patienten etwas weniger von der Operation profitieren. Nur bei Vorliegen von medikolegalen Faktoren wie Rechtsstreit oder Schadenersatzansprüchen lässt sich definitiv ein schlechtes Ergebnis voraussagen. PMID:27580438

  7. The Light at the End of the Carpal Tunnel.

    ERIC Educational Resources Information Center

    Kusack, James M.

    1990-01-01

    Reports results of a survey of large public libraries on incidents of muscular-skeletal injuries associated with use of computer keyboards in libraries. Personnel policies and practices that can minimize injuries are outlined. Sidebars describe the importance of adjustable workstations, steps that employees can take to minimize injuries, and…

  8. Decompressive craniectomy in neurocritical care.

    PubMed

    Wang, Jia-Wei; Li, Jin-Ping; Song, Ying-Lun; Tan, Ke; Wang, Yu; Li, Tao; Guo, Peng; Li, Xiong; Wang, Yan; Zhao, Qi-Huang

    2016-05-01

    Recently, several randomized controlled trials (RCT) investigating the effectiveness of decompressive craniectomy in the context of neurocritical illnesses have been completed. Thus, a meta-analysis to update the current evidence regarding the effects of decompressive craniectomy is necessary. We searched PUBMED, EMBASE and the Cochrane Central Register of Controlled Trials. Other sources, including internet-based clinical trial registries and grey literature, were also searched. After searching the literature, two investigators independently performed literature screening, assessing the quality of the included trials and extracting the data. The outcome measures included the composite outcome of death or dependence and the risk of death. Ten RCT were included: seven RCT were on malignant middle cerebral artery infarction (MCAI) and three were on severe traumatic brain injury (TBI). Decompressive craniectomy significantly reduced the risk of death for patients suffering malignant MCAI (risk ratio [RR] 0.46, 95% confidence interval [CI]: 0.36-0.59, P<0.00001) in comparison with no reduction in the risk of death for patients with severe TBI (RR: 0.83, 95% CI: 0.48-1.42, P=0.49). However, there was no significant difference in the composite risk of death or dependence at the final follow-up between the decompressive craniectomy group and the conservative treatment group for either malignant MCAI or severe TBI. The present meta-analysis indicates that decompressive craniectomy can significantly reduce the risk of death for patients with malignant MCAI, although no evidence demonstrates that decompressive craniectomy is associated with a reduced risk of death or dependence for TBI patients. PMID:26879572

  9. Recognising and managing decompression illness.

    PubMed

    Caton-Richards, Michelle

    2013-11-01

    Seen primarily in scuba divers who have breathed compressed air, decompression illness is a rare but potentially fatal condition. Prompt recognition and treatment of the illness, and urgent referral of patients to hyperbaric chambers, can mean the difference between full recovery and paralysis or death. This article describes decompression illness and how to recognise it, and discusses the treatment that patients require for the best chance of recovery with no adverse effects. It also includes a case study of a patient who developed this condition after a dive. PMID:24219686

  10. A Start Toward Micronucleus-Based Decompression Models; Altitude Decompression

    NASA Technical Reports Server (NTRS)

    Van Liew, H. D.; Conkin, Johnny

    2007-01-01

    Do gaseous micronuclei trigger the formation of bubbles in decompression sickness (DCS)? Most previous instructions for DCS prevention have been oriented toward supersaturated gas in tissue. We are developing a mathematical model that is oriented toward the expected behavior of micronuclei. The issue is simplified in altitude decompressions because the aviator or astronaut is exposed only to decompression, whereas in diving there is a compression before the decompression. The model deals with four variables: duration of breathing of 100% oxygen before going to altitude (O2 prebreathing), altitude of the exposure, exposure duration, and rate of ascent. Assumptions: a) there is a population of micronuclei of various sizes having a range of characteristics, b) micronuclei are stable until they grow to a certain critical nucleation radius, c) it takes time for gas to diffuse in or out of micronuclei, and d) all other variables being equal, growth of micronuclei upon decompression is more rapid at high altitude because of the rarified gas in the micronuclei. To estimate parameters, we use a dataset of 4,756 men in altitude chambers exposed to various combinations of the model s variables. The model predicts occurrence of DCS symptoms quite well. It is notable that both the altitude chamber data and the model show little effect of O2 prebreathing until it lasts more than 60 minutes; this is in contrast to a conventional idea that the benefit of prebreathing is directly due to exponential washout of tissue nitrogen. The delay in response to O2 prebreathing can be interpreted as time required for outward diffusion of nitrogen; when the micronuclei become small enough, they are disabled, either by crushing or because they cannot expand to a critical nucleation size when the subject ascends to altitude.

  11. Diagnosis and Treatment of Symptomatic Carpal Bossing

    PubMed Central

    Radmer, Sebastian; Fresow, Robert; Tabibzada, Arash Mehdi; Kamusella, Peter; Scheer, Fabian; Andresen, Reimer

    2015-01-01

    Context Carpal bossing is an osseous formation at the dorsal portion of the quadrangular joint, which rarely becomes symptomatic. However, in some patients it causes pain, restricted mobility and can lead to complications like tendon rupture, inflammatory and degenerative joint disease. Aim In this article, we present our experiences with this rare disorder in order to improve diagnostic and therapeutic proceedings. Settings Design This is a multicenter and interdisciplinary observation made by orthopaedic surgeons and radiologists in the years 2010 to 2015. Retrospective observational study. The follow up period was 2 years. Materials and Methods In the observed time period, eight patients were diagnosed with symptomatic carpal bossing. Symptoms were pain at palmar flexion and limited mobility of the wrist in combination with a palpable protuberance over the quadrangular joint. All patients underwent X-ray, CT and MRI examinations. A conservative treatment strategy was initiated for 6 weeks in all patients, followed by a wedge resection when symptoms were persisting and disabling. Results After the conservative treatment schedule, five patients were asymptomatic. Three patients had persisting pain and were thus recommended for surgery. In the postoperative course, two patients were asymptomatic. One patient developed a type 1 complex regional pain syndrome (CRPS) in the first postoperative year, which was successfully treated with pain-adapted physiotherapy, pharmacotherapy with analgesics and calcitonin, and a triple CT-guided thoracic sympathetic nerve blockade. Conclusion Carpal bossing is a mostly asymptomatic entity, which in our experience gets symptomatic due to direct trauma or repetitive stress, especially in competitive racket sports players. It can be diagnosed by thorough clinical examination and multimodal diagnostic imaging. Conservative treatment comprises an excellent prognosis, however surgery, either wedge resection or arthrodesis, must be

  12. [Radio-carpal amputation and prosthesis].

    PubMed

    Cauquil, C; Thaury, M N; de Godebout, J; Ster, J; Ster, F; Bouzigues, B; Ducros, P

    1992-01-01

    Radio-carpal amputation was rejected for a long time because of the difficulties of fitting both myoelectrical and mechanical prostheses, only allowing a purely aesthetic prosthesis. As a result of miniaturization of control systems and the progress in computers, we believe that this now constitutes the best site for amputation whenever it is possible. Preservation of the antero-posterior bony contours of the radius allows the use of short sockets attached by a system of clips. In this way, flexion-extension of the elbow is left free and the movements of pronation and supination can be used. Liberation of the proximal joints facilitates integration of the prosthetic hand. PMID:1375500

  13. Spaceflight Decompression Sickness Contingency Plan

    NASA Technical Reports Server (NTRS)

    Dervay, Joseph P.

    2007-01-01

    A viewgraph presentation on the Decompression Sickness (DCS) Contingency Plan for manned spaceflight is shown. The topics include: 1) Approach; 2) DCS Contingency Plan Overview; 3) Extravehicular Activity (EVA) Cuff Classifications; 4) On-orbit Treatment Philosophy; 5) Long Form Malfunction Procedure (MAL); 6) Medical Checklist; 7) Flight Rules; 8) Crew Training; 9) Flight Surgeon / Biomedical Engineer (BME) Training; and 10) DCS Emergency Landing Site.

  14. Cardiopulmonary Changes with Moderate Decompression in Rats

    NASA Technical Reports Server (NTRS)

    Robinson, R.; Little, T.; Doursout, M.-F.; Butler, B. D.; Chelly, J. E.

    1996-01-01

    Sprague-Dawley rats were compressed to 616 kPa for 120 min then decompressed at 38 kPa/min to assess the cardiovascular and pulmonary responses to moderate decompression stress. In one series of experiments the rats were chronically instrumented with Doppler ultrasonic probes for simultaneous measurement of blood pressure, cardiac output, heart rate, left and right ventricular wall thickening fraction, and venous bubble detection. Data were collected at base-line, throughout the compression/decompression protocol, and for 120 min post decompression. In a second series of experiments the pulmonary responses to the decompression protocol were evaluated in non-instrumented rats. Analyses included blood gases, pleural and bronchoalveolar lavage (BAL) protein and hemoglobin concentration, pulmonary edema, BAL and lung tissue phospholipids, lung compliance, and cell counts. Venous bubbles were directly observed in 90% of the rats where immediate post-decompression autopsy was performed and in 37% using implanted Doppler monitors. Cardiac output, stroke volume, and right ventricular wall thickening fractions were significantly decreased post decompression, whereas systemic vascular resistance was increased suggesting a decrease in venous return. BAL Hb and total protein levels were increased 0 and 60 min post decompression, pleural and plasma levels were unchanged. BAL white blood cells and neutrophil percentages were increased 0 and 60 min post decompression and pulmonary edema was detected. Venous bubbles produced with moderate decompression profiles give detectable cardiovascular and pulmonary responses in the rat.

  15. [Severe decompression sickness in divers].

    PubMed

    Beuster, W; van Laak, U

    1999-01-01

    The term "decompression illness (DCI)" is a disorder which arises from the presence of ectopic gas bubbles following decompression. Scuba diving poses the risk of two typically clinical syndromes: decompression sickness (DCS) and arterial gas embolism (AGE). DCS results from the formation of gas bubbles in the tissues of the body and in the blood due to rapid reduction of the environmental pressure. AGE is caused by pulmonary overinflation if the breathing gas cannot be exhaled adequately during the ascent. Although the pathophysiological mechanisms of these two disorders are quite different, both of them lead to the same result: inert gas bubbles that may cause impairment of vital functions due to hypoxia. Recognizing the signs and symptoms of DCI is the first step of the therapy. The emergency treatment contains: basic life support, advanced life support--if necessary, horizontal positioning of the victim, administration of 100% normobaric oxygen via face mask or endotracheal tube, rehydration, rapid transportation to the nearest emergency department/hyperbaric facility for definitive treatment in order to prevent serious neurological sequelae. PMID:11315407

  16. [Radio-carpal and medio-carpal arthroscopy in instability of the wrist].

    PubMed

    Sennwald, G; Fischer, M; Jacob, H A

    1993-01-01

    Forty-one arthroscopies were performed on previously asymptomatic wrists following trauma. In about 25% of the wrists there was only one specific ligamentous lesion. In 75% however a combination of 2 or several distinct lesions was observed. These lesions, localised on the ulnar aspect of the mid-carpal joint, are more complex than those on the radio-carpal joint on the radial aspect of the carpus. These observations would tend to confirm our present day knowledge of wrist biomechanics but disagree with the currently proposed concepts of instability by several American authors. "Instability" seems to be inadequate to define complex lesions, more adequate would be the simple description of a "dysfunctional state" of the wrist complex. This statement must be related to the position of the carpal bones, which do not show any significant change despite the tears shown. The arthroscopy appears to range first in a series of diagnostic tools. However it concerns mainly the ligamentous layers facing the interior of the joint while lacking information about time elapsed since the actual trauma. We therefore state that arthroscopy may decrease but not exclude diagnostic failures. Type and risk of therapeutic decisions are also appreciated with increased accuracy. No doubt there still remain discrepancies when clinical, arthrographic and arthroscopic examination are compared, which indicates the complementary nature of the technics of investigation, especially in the light of the current state of the biomechanic sciences of the wrist. PMID:7683900

  17. [Treatment of pseudoarthrosis of the carpal scaphoid with fibrin glue].

    PubMed

    Carozzi, S

    1983-08-01

    The author think that "Fibrin Seal Glue" and mechanical syntesis is an opimal method for osteosintesis of the Carpal scaphoid. He speaks about 5 patients treated with optimal results in 50 days mean. PMID:6395974

  18. Recurrent Keratocystic Odontogenic Tumor After Effective Decompression.

    PubMed

    Zhang, Qian; Li, Wei; Han, Fangkai; Huang, Xiaofeng; Yang, Xudong

    2016-07-01

    Keratocystic odontogenic tumor (KCOT) has potential aggressive and infiltrative behavior. Decompression has been widely preferred for large KCOTs due to safety and lower recurrence rates. However, KCOT is still likely to recur even after effective decompression. Here, we present a rare and interesting case of recurrent KCOT after effective decompression with adjunctive enucleation. Redecompression was then performed again, and the effect was still satisfactory on long-term follow-up. PMID:27391520

  19. Endoscopic and Microscopic Microvascular Decompression.

    PubMed

    Piazza, Matthew; Lee, John Y K

    2016-07-01

    The introduction of the endoscope into the neurosurgeon's armamentarium has revolutionized ventral and anterior skull-base surgery and, more recently, has been used in the surgical treatment of cerebellopontine angle (CPA) pathology. The utilization of the endoscope in microvascular decompression (MVD) for trigeminal neuralgia and other associated cranial nerve hyperactivity syndromes allows for unparalleled panoramic views and illumination of the neurovascular structures within the CPA and identification of vessel-nerve contact traditionally unseen using the microscope. In this article, the technical advantages and challenges of using the endoscope for MVD, operative technique, and patient outcomes of endoscopic MVD are discussed. PMID:27324997

  20. Graphics processing unit-assisted lossless decompression

    DOEpatents

    Loughry, Thomas A.

    2016-04-12

    Systems and methods for decompressing compressed data that has been compressed by way of a lossless compression algorithm are described herein. In a general embodiment, a graphics processing unit (GPU) is programmed to receive compressed data packets and decompress such packets in parallel. The compressed data packets are compressed representations of an image, and the lossless compression algorithm is a Rice compression algorithm.

  1. Traumatic Carpal Axial Instability in a Professional Football Player: A Case Report.

    PubMed

    Rettig, Lance; Rettig, Arthur; Cleland, Kirk

    2016-05-01

    This is a case of traumatic carpal axial instability in a professional football player. Traumatic carpal axial instability characteristically involves longitudinal separation of the ulnar or radial distal carpal row along with intermetacarpal injury. Rarely, pancarpal ligament disruption occurs, as in this case. Early diagnosis and treatment of unstable wrist injuries is important in achieving a satisfactory outcome. PMID:26502186

  2. Xenon Blocks Neuronal Injury Associated with Decompression.

    PubMed

    Blatteau, Jean-Eric; David, Hélène N; Vallée, Nicolas; Meckler, Cedric; Demaistre, Sebastien; Lambrechts, Kate; Risso, Jean-Jacques; Abraini, Jacques H

    2015-01-01

    Despite state-of-the-art hyperbaric oxygen (HBO) treatment, about 30% of patients suffering neurologic decompression sickness (DCS) exhibit incomplete recovery. Since the mechanisms of neurologic DCS involve ischemic processes which result in excitotoxicity, it is likely that HBO in combination with an anti-excitotoxic treatment would improve the outcome in patients being treated for DCS. Therefore, in the present study, we investigated the effect of the noble gas xenon in an ex vivo model of neurologic DCS. Xenon has been shown to provide neuroprotection in multiple models of acute ischemic insults. Fast decompression compared to slow decompression induced an increase in lactate dehydrogenase (LDH), a well-known marker of sub-lethal cell injury. Post-decompression administration of xenon blocked the increase in LDH release induced by fast decompression. These data suggest that xenon could be an efficient additional treatment to HBO for the treatment of neurologic DCS. PMID:26469983

  3. Xenon Blocks Neuronal Injury Associated with Decompression

    PubMed Central

    Blatteau, Jean-Eric; David, Hélène N.; Vallée, Nicolas; Meckler, Cedric; Demaistre, Sebastien; Lambrechts, Kate; Risso, Jean-Jacques; Abraini, Jacques H.

    2015-01-01

    Despite state-of-the-art hyperbaric oxygen (HBO) treatment, about 30% of patients suffering neurologic decompression sickness (DCS) exhibit incomplete recovery. Since the mechanisms of neurologic DCS involve ischemic processes which result in excitotoxicity, it is likely that HBO in combination with an anti-excitotoxic treatment would improve the outcome in patients being treated for DCS. Therefore, in the present study, we investigated the effect of the noble gas xenon in an ex vivo model of neurologic DCS. Xenon has been shown to provide neuroprotection in multiple models of acute ischemic insults. Fast decompression compared to slow decompression induced an increase in lactate dehydrogenase (LDH), a well-known marker of sub-lethal cell injury. Post-decompression administration of xenon blocked the increase in LDH release induced by fast decompression. These data suggest that xenon could be an efficient additional treatment to HBO for the treatment of neurologic DCS. PMID:26469983

  4. libpolycomp: Compression/decompression library

    NASA Astrophysics Data System (ADS)

    Tomasi, Maurizio

    2016-04-01

    Libpolycomp compresses and decompresses one-dimensional streams of numbers by means of several algorithms. It is well-suited for time-ordered data acquired by astronomical instruments or simulations. One of the algorithms, called "polynomial compression", combines two widely-used ideas (namely, polynomial approximation and filtering of Fourier series) to achieve substantial compression ratios for datasets characterized by smoothness and lack of noise. Notable examples are the ephemerides of astronomical objects and the pointing information of astronomical telescopes. Other algorithms implemented in this C library are well known and already widely used, e.g., RLE, quantization, deflate (via libz) and Burrows-Wheeler transform (via libbzip2). Libpolycomp can compress the timelines acquired by the Planck/LFI instrument with an overall compression ratio of ~9, while other widely known programs (gzip, bzip2) reach compression ratios less than 1.5.

  5. A carpal ligament substitute part 1: polyester suture.

    PubMed

    Martin, John A; Wehbé, Marwan A

    2013-02-01

    We have searched for a synthetic substitute for the carpal ligaments, which would be widely available and easy to use. Four loops of 2-0 polyester fiber suture (Mersilene) were found to exceed the ultimate tensile strength of the scapholunate interosseous ligament. This construct approximates a normal ligament stress/strain curve and can theoretically facilitate fibrous tissue ingrowth. It is readily available, easy to handle, and inexpensive. Based on these findings, we recommend the use of polyester suture in the reconstruction of carpal and other ligaments. PMID:23168035

  6. Pyrophosphate arthropathy in the carpal and metacarpophalangeal joints.

    PubMed Central

    Bourqui, M; Vischer, T L; Stasse, P; Docquier, C; Fallet, G H

    1983-01-01

    The hand x-rays of group of patients with generalised osteoarthrosis alone were compared with those patients with generalised osteoarthrosis and chondrocalcinosis (CC). An arthropathy seemingly specific for CC could be identified in the metacarpophalangeal (MCP) and carpal joints. In the MCP joints it was characterised by subchondral rarefactions, deviation of the joint axis, joint space narrowing, and osteophytosis. Usually only the second and/or third MCP joints are affected. In the carpal joints similar subchondral cysts, sometimes associated with joint space narrowing, were found much more frequently in the group with CC. There was no direct relation with the presence of calcification. Images PMID:6651367

  7. The carpal boss: a review of different sonographic findings*

    PubMed Central

    Arend, Carlos Frederico

    2014-01-01

    Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss. PMID:25741059

  8. The carpal boss: a review of different sonographic findings.

    PubMed

    Arend, Carlos Frederico

    2014-01-01

    Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss. PMID:25741059

  9. New mini-invasive decompression for pronator teres syndrome.

    PubMed

    Zancolli, Eduardo R; Zancolli, Eduardo P; Perrotto, Christian Jorge

    2012-08-01

    The pronator teres syndrome is a set of signs and symptoms that result from compression of the median nerve in the upper forearm. It is a dynamic syndrome that is frequently associated with compression of the same nerve at the carpal tunnel. The literature describes different anatomic structures that can cause this syndrome. Experience showed us that the deep fascia of the superficial head of the pronator teres is the only anatomic structure that causes compression of the median nerve in the upper forearm. If the flexor digitorum test is negative, selective release of the deep fascia of the superficial head of the pronator teres ends the symptoms. Our surgical technique uses a mini-invasive approach that takes into account the anatomic knowledge of this region. A 3.5-cm oblique skin incision is done 6 cm distal to the medial epicondyle, over the flexor/pronator muscle mass. The medial cutaneous nerve is atraumatically retracted. The superficial fascia of the flexor/pronator muscles is opened transversely. With the section of the septum between the pronator teres and the flexor carpi radialis, access to the deep fascia of the superficial head of the pronator teres is obtained. This structure is released. The median nerve is now easily visualized, and other types of possible compression causes are excluded. The same surgeon treated 44 cases with this technique. Two assistants were always needed for this mini-invasive approach. Pronator teres symptoms disappeared in 93% of cases. PMID:22835590

  10. Evidence Report: Risk of Decompression Sickness (DCS)

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Norcross, Jason R.; Wessel, James H., III; Klein, Jill S.; Dervay, Joseph P.; Gernhardt, Michael L.

    2016-01-01

    Given that tissue inert gas partial pressure is often greater than ambient pressure during phases of a mission, primarily during extravehicular activity (EVA), there is a possibility of decompression sickness (DCS).

  11. Revision surgery for Chiari malformation decompression.

    PubMed

    Mazzola, Catherine A; Fried, Arno H

    2003-09-15

    Chiari malformations comprise four different hindbrain anomalies originally described by Hans Chiari, a professor of pathology at the German University in Prague. There are four basic Chiari malformations. The reasons for revision of Chiari malformation decompression may be for conservative or inadequate initial decompression or the development of postoperative complications. Another reason involves cases of both hindbrain herniation and syringomyelia in patients who have undergone adequate posterior fossa decompression without resolution of symptoms, signs, or radiological appearance of their syrinx cavity. Additionally, symptom recurrence has been reported in association with various types of dural grafts. Reoperation or revision surgery for patients with Chiari malformations is common and may not be due to technical error or inadequate decompression. The types of revision surgeries, their indications, and initial presentations will be reviewed. PMID:15347221

  12. Orbital decompression in thyroid eye disease.

    PubMed

    Fichter, N; Guthoff, R F; Schittkowski, M P

    2012-01-01

    Though enlargement of the bony orbit by orbital decompression surgery has been known for about a century, surgical techniques vary all around the world mostly depending on the patient's clinical presentation but also on the institutional habits or the surgeon's skills. Ideally every surgical intervention should be tailored to the patient's specific needs. Therefore the aim of this paper is to review outcomes, hints, trends, and perspectives in orbital decompression surgery in thyroid eye disease regarding different surgical techniques. PMID:24558591

  13. Orbital Decompression in Thyroid Eye Disease

    PubMed Central

    Fichter, N.; Guthoff, R. F.; Schittkowski, M. P.

    2012-01-01

    Though enlargement of the bony orbit by orbital decompression surgery has been known for about a century, surgical techniques vary all around the world mostly depending on the patient's clinical presentation but also on the institutional habits or the surgeon's skills. Ideally every surgical intervention should be tailored to the patient's specific needs. Therefore the aim of this paper is to review outcomes, hints, trends, and perspectives in orbital decompression surgery in thyroid eye disease regarding different surgical techniques. PMID:24558591

  14. [Arthroscopic distal ulna resection after post traumatic ulno carpal abutment].

    PubMed

    Mathoulin, C; Pagnotta, A

    2006-11-01

    Ulno carpal abutments secondary to the sequels of a fracture of the radius are often due to the inversion of the distal radio ulnar index by shortening relative to the radius. This positive ulnar variance eventually leads to an abutment between the head of the ulnar and the proximal articular face of the lunate with alteration of the cartilaginous carpal surfaces. The wrist arthroscopy makes diagnosis and treatment possible in a less invasive way. The patients are operated on as outpatients under local regional anaesthetic using a pneumatic tourniquet. The arthroscope is positioned using the 3-4 radio carpal opening permitting exploration of the joint. The surgical treatment is performed by arthroscopy using a burr and going in through the 6R radio carpal opening. In this way we use the technique of partial resection of the distal ulna. We have a series of 62 patients who have benefited from the technique of partial resection of the ulnar head by arthroscopy. There were 30 men and 32 women. The average age was 66 years old (between 45 and 82). Our average follow-up is 32 months (between 12 and 60 months). Recovery of mobility was immediate in all cases with persistent pain in the radio ulnar joint in 8 cases. Arthroscopic treatment of ulno carpal abutment has proved itself effective and innocuous. It should nevertheless be reserved for operations on small sized inversions of the distal radio ulnar index (less than 5 mm). In the event of larger ulnar variances we prefer ulnar shortening osteotomy. The other techniques will be restricted to cases where the distal radio ulnar joint has been impaired. PMID:17361890

  15. [Arthroscopic distal ulna resection after post traumatic ulno carpal abutment.

    PubMed

    Mathoulin, C; Pagnotta, A

    2006-11-01

    Ulno carpal abutments secondary to the sequels of a fracture of the radius are often due to the inversion of the distal radio ulnar index by shortening relative to the radius. This positive ulnar variance eventually leads to an abutment between the head of the ulnar and the proximal articular face of the lunate with alteration of the cartilaginous carpal surfaces. The wrist arthroscopy makes diagnosis and treatment possible in a less invasive way. The patients are operated on as outpatients under local regional anaesthetic using a pneumatic tourniquet. The arthroscope is positioned using the 3-4 radio carpal opening permitting exploration of the joint. The surgical treatment is performed by arthroscopy using a burr and going in through the 6R radio carpal opening. In this way we use the technique of partial resection of the distal ulna. We have a series of 62 patients who have benefited from the technique of partial resection of the ulnar head by arthroscopy. There were 30 men and 32 women. The average age was 66 years old (between 45 and 82). Our average follow-up is 32 months (between 12 and 60 months). Recovery of mobility was immediate in all cases with persistent pain in the radio ulnar joint in 8 cases. Arthroscopic treatment of ulno carpal abutment has proved itself effective and innocuous. It should nevertheless be reserved for operations on small sized inversions of the distal radio ulnar index (less than 5 mm). In the event of larger ulnar variances we prefer ulnar shortening osteotomy. The other techniques will be restricted to cases where the distal radio ulnar joint has been impaired. PMID:17349395

  16. Use of psychological decompression in military operational environments.

    PubMed

    Hughes, Jamie G H Hacker; Earnshaw, N Mark; Greenberg, Neil; Eldridge, Rod; Fear, Nicola T; French, Claire; Deahl, Martin P; Wessely, Simon

    2008-06-01

    This article reviews the use of psychological decompression as applied to troops returning from active service in operational theaters. Definitions of the term are considered and a brief history is given. Current policies and practices are described and the question of mandatory decompression is considered. Finally, the evidence base for the efficacy of decompression is examined and some conclusions are drawn. This article highlights variations in the definition and practice of decompression and its use. Although there is, as yet, no evidence that decompression works, there is also no evidence to the contrary. Given the lack of knowledge as to the balance of risks and benefits of decompression and the absence of any definitive evidence that decompression is associated with improved mental health outcomes or that lack of decompression is associated with the reverse, it is argued that the use of decompression should remain a matter for discretion. PMID:18595415

  17. A new biophysical decompression model for estimating the risk of articular bends during and after decompression.

    PubMed

    Hugon, J; Rostain, J-C; Gardette, B

    2011-08-21

    The biophysical models that intend to predict the risk of decompression sickness after a change of pressure are not numerous. Few approaches focus in particular on joints as target tissues, with the aim to describe properly the mechanisms inducing pain. Nevertheless, for this type of decompression incidents, called articular bends, no model proved to fit the empirical results for a broad range of exposures and decompression procedures. We present here an original biophysical decompression model for describing the occurrence of articular bends. A target joint is broken down into two parts that exchange inert gases with the blood by perfusion and with each other by diffusion over distances of a few millimetres. This diffusion pathway allows the slow amplification of microbubbles growing during and after decompression, consistent with the possible delayed occurrence of bends. The diffusion coefficients introduced into this model are larger than those introduced into most modern decompression models. Their value remains physical (#10(-9)m(2)/s). Inert gas exchanges and the formation, amplification and resorption of microbubbles during and after decompression were simulated. We used a critical gas volume criterion for predicting the occurrence of bends. A risk database extracted from COMEX experience and other published studies were used for the correlation of model parameters not known a priori. We considered a large range of exposure, and the commonly used inert gases nitrogen and helium. This correlation phase identified the worst biophysical conformations most likely to lead to the formation, in tissues such as tendons, of a large number of microbubbles recruited from pre-existing gas nuclei during decompression. The risk of bends occurrence was found to be linked to the total separated gas volume generated during and after decompression. A clamping phenomenon occurs soon after the start of decompression, greatly slowing the gas exchanges controlled especially by

  18. Conservative management of symptomatic Carpal Bossing in an elite hockey player: a case report

    PubMed Central

    Kissel, Peter

    2009-01-01

    Objective: To present the characteristics and create awareness of symptomatic carpal bossing and discuss potential etiologies and the role of conservative management through the presentation of an athlete with traumatic onset of symptomatic carpal bossing. Clinical features: This case report outlines the presentation and conservative management of an elite eighteen year old hockey player with symptomatic carpal bossing after a traumatic on ice collision. Carpal bossing is a bony, dorsal prominence in the quadrangular joint of the wrist that is inconsistently symptomatic. Intervention and outcome: A conservative treatment plan consisting of education, reassurance, avoidance of aggravation, and soft tissue therapy allowed return to play in two weeks without restrictions or need for surgical consultation. Conclusion: With inconsistent recurrence rates and surgical complications, the role of conservative management for symptomatic carpal bossing deserves further exploration. The conservative practitioner should be aware of the signs and symptoms of symptomatic carpal bossing to institute suitable treatment. PMID:20037693

  19. [Emergency treatment in decompression accidents in shipyards].

    PubMed

    Comet, M

    1989-08-01

    The Comex company has underwater workplaces scattered over the whole world, which are therefore very often far away from a medical center equipped for the treatment of decompression sickness. However, the subsequent evolution of such an event depends mainly on how fast the first aid is given to the patient. Therefore, the scientific and medical departments of our company developed a medical handbook to be used by chiefs of working platforms. The text which has to be easily understandable, mentions: a cursory description of the clinical signs of the different decompression accidents the measures which have to be taken in each case, depending on: the moment of the emergency: after or during decompression, the presence of an insufficient decompression, or a "blow-up". The handbook contains several recompression tables, first aid treatment recommendations and drugs. It has to be stressed that these procedures are only emergency steps. They should be performed before the patient can be transferred to a medical center with expertise in the treatment of decompression accidents. PMID:2799360

  20. Delayed facial nerve decompression for Bell's palsy.

    PubMed

    Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

    2016-07-01

    Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity. PMID:26319412

  1. [Decompression illness: minor symptoms, major consequences].

    PubMed

    Gho, J M I H Ing Han; Kramer, Irene Fleur; van Hulst, Rob A; Kramer, William L M

    2012-01-01

    Nowadays, diving is being performed ever more frequently; it is thus important to take diving injuries into consideration in patients presenting with even minor complaints after diving. Every dive is risky and could result in decompression illness, barotrauma and/or death. We report on two cases of decompression illness: a 30-year old man, an occupational diver, and a 46-year old man, an experienced diver, who were both clinically suspected of having decompression illness and were treated with hyperbaric oxygen in a recompression chamber. Both were eventually symptom-free after several treatments. Decompression illness is caused by a reduction in ambient pressure, which results in intra- or extravascular bubbles. Symptoms vary and are dependent on the site affected: from minor pain to neurological symptoms and death. If patients are suspected of having diving injuries, we recommend contacting a centre specialised in diving and hyperbaric medicine. Recompression in a hyperbaric chamber is the definitive treatment for decompression illness and should be performed as soon as possible. PMID:22951132

  2. Complete dorsal dislocation of the carpal scaphoid with perilunate dorsal dislocation

    PubMed Central

    Kang, Jong Woo; Park, Jong Hoon; Suh, Dong Hun; Park, Jong Woong

    2016-01-01

    Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient's wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid. PMID:27512229

  3. Acute kidney injury due to decompression illness.

    PubMed

    Viecelli, Andrea; Jamboti, Jagadish; Waring, Andrew; Banham, Neil; Ferrari, Paolo

    2014-08-01

    Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. We report the first case of acute kidney injury in a 27-year-old diver following three rapid ascents. He presented with transient neurological symptoms and abdominal pain followed by rapidly progressive acute kidney injury (creatinine peak 1210 µmol/L) due to arterial air emboli. He received supportive care and 100% oxygen followed by hyperbaric therapy and recovered fully. Arterial air emboli caused by rapid decompression can affect multiple organs including the kidneys. Early transfer to a hyperbaric unit is important as complications may present delayed. PMID:25852912

  4. Hypobaric decompression prebreathe requirements and breathing environment

    NASA Technical Reports Server (NTRS)

    Webb, James T.; Pilmanis, Andrew A.

    1993-01-01

    To reduce incidence of decompression sickness (DCS), prebreathing 100 percent oxygen to denitrogenate is required prior to hypobaric decompressions from a sea level pressure breathing environment to pressures lower than 350 mm Hg (20,000 ft; 6.8 psia). The tissue ratio (TR) of such exposures equals or exceeds 1.7; TR being the tissue nitrogen pressure prior to decompression divided by the total pressure after decompression (((0.781)(14.697))/6.758). Designing pressure suits capable of greater pressure differentials, lower TR's, and procedures which limit the potential for DCS occurrence would enhance operational efficiency. The current 10.2 psia stage decompression prior to extravehicular activity (EVA) from the Shuttle in the 100 percent oxygen, 4.3 psia suit, results in a TR of 1.65 and has proven to be relatively free of DCS. Our recent study of zero-prebreathe decompressions to 6.8 psia breathing 100 percent oxygen (TR = 1.66) also resulted in no DCS (N = 10). The level of severe, Spencer Grades 3 or 4, venous gas emboli (VGE) increased from 0 percent at 9.5 psia to 40 percent at 6.8 psia yielding a Probit curve of VGE risk for the 51 male subjects who participated in these recent studies. Earlier, analogous decompressions using a 50 percent oxygen, 50 percent nitrogen breathing mixture resulted in one case of DCS and significantly higher levels of severe VGE, e.g., at 7.8 psia, the mixed gas breathing environment resulted in a 56 percent incidence of severe VGE versus 10 percent with use of 100 percent oxygen. The report of this study recommended use of 100 percent oxygen during zero-prebreathe exposure to 6.8 psia if such a suit could be developed. For future, long-term missions, we suggest study of the effects of decompression over several days to a breathing environment of 150 mmHg O2 and approximately 52 mmHg He as a means of eliminating DCS and VGE hazards during subsequent excursions. Once physiologically adapted to a 4 psia vehicle, base, or space

  5. Acute kidney injury due to decompression illness

    PubMed Central

    Viecelli, Andrea; Jamboti, Jagadish; Waring, Andrew; Banham, Neil; Ferrari, Paolo

    2014-01-01

    Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. We report the first case of acute kidney injury in a 27-year-old diver following three rapid ascents. He presented with transient neurological symptoms and abdominal pain followed by rapidly progressive acute kidney injury (creatinine peak 1210 µmol/L) due to arterial air emboli. He received supportive care and 100% oxygen followed by hyperbaric therapy and recovered fully. Arterial air emboli caused by rapid decompression can affect multiple organs including the kidneys. Early transfer to a hyperbaric unit is important as complications may present delayed. PMID:25852912

  6. Evidence Report: Risk of Decompression Sickness (DCS)

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Norcross, Jason R.; Wessel, James H. III; Abercromby, Andrew F. J.; Klein, Jill S.; Dervay, Joseph P.; Gernhardt, Michael L.

    2013-01-01

    The Risk of Decompression Sickness (DCS) is identified by the NASA Human Research Program (HRP) as a recognized risk to human health and performance in space, as defined in the HRP Program Requirements Document (PRD). This Evidence Report provides a summary of the evidence that has been used to identify and characterize this risk. Given that tissue inert gas partial pressure is often greater than ambient pressure during phases of a mission, primarily during extravehicular activity (EVA), there is a possibility that decompression sickness may occur.

  7. Bilateral Second Carpal Row Duplication Associated with Multiple Epiphyseal Dysplasia.

    PubMed

    Cladiere-Nassif, Victoire; Delaroche, Caroline; Pottier, Edwige; Feron, Jean-Marc

    2015-11-01

    We report a case of a 75-year-old woman presenting a hitherto undescribed condition of bilateral second carpal row duplication. She was diagnosed in childhood with both Marfan and Ehlers-Danlos syndromes, with no clear evidence and no further medical follow-up. She presented throughout her life with various articular symptoms, which appeared to be compatible with a diagnosis of multiple epiphyseal dysplasia, and underwent several surgical procedures on her knees and hips. Most recently, she was reporting pain at the base of the fifth metacarpal bone of the left hand. X-ray images and computed tomography (CT) were obtained for exploration and showed a total second row duplication in both carpi, with a total number of 18 carpal bones in each wrist. PMID:26649258

  8. Microsurgical endonasal decompression in dysthyroid orbitopathy.

    PubMed

    May, A; Fries, U; Reimold, I; Weber, A

    1999-01-01

    Diagnosis of thyroid eye disease can be established by its history, signs, symptoms, clinical and laboratory findings of an autoimmune thyroid disease. Therapy for this disease is limited to a few options, which should be administered depending on its stage and inflammatory activity. When medication and radiation therapy fail indications for decompression are: loss of visual acuity or visual field defects, increasing strabism and severe keratopathy due to eyelid retraction. Numerous surgical decompression techniques have been described in endocrine orbitopathy. We have adopted endonasal microsurgery, because this technique gives the freedom to work bimanually, ensures a stereomicoscopic view of the intranasal landmarks of orbital walls and allows simultaneous decompression of the medial and inferior orbital wall as well as a good relief of pressure at the orbital apex. Decompressions were performed on 27 orbits in 17 patients, via the endonasal microsurgical, 3 via external approach. The microscopic approach was entirely comparable with regard to reduction of proptosis with a mean improvement of 4.1 mm against a mean of 4.7 mm by external approach and a mean 0.2 of better visual acuity in both procedures. The microsurgical technique is considered superior to an external approach avoiding external scars, neural pains and reportedly less diplopia. Also, trauma to the nalolacrimal and nasofrontal ducts are avoided. The healing phase and the hospitalization time is shorter. PMID:10687942

  9. Long arm decompression osteotomy for hallux limitus.

    PubMed

    Robinson, Stephen C; Frank, Ryan P

    2005-04-01

    This article presents a new osteotomy for stage I or II hallux limitus. The long arm decompression osteotomy can be used to shorten and plantarflex the first metatarsal. The indications, surgical technique, advantages, and disadvantages are described in detail. PMID:15833423

  10. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  11. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  12. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  13. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  14. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  15. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  16. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  17. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  18. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  19. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  20. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  1. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  2. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a...

  3. 21 CFR 888.3750 - Wrist joint carpal lunate polymer prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint carpal lunate polymer prosthesis. 888.3750 Section 888.3750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... lunate polymer prosthesis. (a) Identification. A wrist joint carpal lunate prosthesis is a...

  4. 21 CFR 888.3770 - Wrist joint carpal trapezium polymer prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Wrist joint carpal trapezium polymer prosthesis. 888.3770 Section 888.3770 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... trapezium polymer prosthesis. (a) Identification. A wrist joint carpal trapezium polymer prosthesis is a...

  5. Endothelial dysfunction correlates with decompression bubbles in rats.

    PubMed

    Zhang, Kun; Wang, Dong; Jiang, Zhongxin; Ning, Xiaowei; Buzzacott, Peter; Xu, Weigang

    2016-01-01

    Previous studies have documented that decompression led to endothelial dysfunction with controversial results. This study aimed to clarify the relationship between endothelial dysfunction, bubble formation and decompression rate. Rats were subjected to simulated air dives with one of four decompression rates: one slow and three rapid. Bubble formation was detected ultrasonically following decompression for two hours, before measurement of endothelial related indices. Bubbles were found in only rapid-decompressed rats and the amount correlated with decompression rate with significant variability. Serum levels of ET-1, 6-keto-PGF1α, ICAM-1, VCAM-1 and MDA, lung Wet/Dry weight ratio and histological score increased, serum NO decreased following rapid decompression. Endothelial-dependent vasodilatation to Ach was reduced in pulmonary artery rings among rapid-decompressed rats. Near all the above changes correlated significantly with bubble amounts. The results suggest that bubbles may be the causative agent of decompression-induced endothelial damage and bubble amount is of clinical significance in assessing decompression stress. Furthermore, serum levels of ET-1 and MDA may serve as sensitive biomarkers with the capacity to indicate endothelial dysfunction and decompression stress following dives. PMID:27615160

  6. Ambulation Increases Decompression Sickness in Altitude Exposure

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Pollock, N. W.; Natoli, M. J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    INTRODUCTION - Exercise accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of exercise are likely critical to the net effect. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a 4.3 psi exposure in non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity (CEVIS and ISLE). Additional work is required to investigate whether exercise normal to 1 G environments increases the risk of DCS over microgravity simulation. METHODS - The CEVIS protocol was replicated with one exception. Our subjects completed controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining non-ambulatory throughout. Decompression stress was graded with aural Doppler (Spencer 0-IV scale). Two-dimensional echocardiographic imaging was used to look for left heart gas emboli (the presence of which prompted test termination). Venous blood was collected at three points to correlate Doppler measures of decompression stress with microparticle (cell fragment) accumulation. Fisher Exact Tests compared test and control groups. Trial suspension would occur when DCS risk >15% or grade IV venous gas emboli (VGE) risk >20% (at 70% confidence). RESULTS - Eleven person-trials were completed (9 male, 2 female) when DCS prompted suspension. DCS was greater than in CEVIS trials (3/11 [27%] vs. 0/45 [0%], respectively, p=0.03). Statistical significance was not reached for peak grade IV VGE (2/11 [18%] vs. 3/45 [7%], p=0.149) or cumulative grade IV VGE observations per subject-trial (8/128 [6%] vs. 26/630 [4%], p=0.151). Microparticle data were collected for 5/11 trials (3 with DCS outcomes), with widely varying patterns that could not be resolved statistically

  7. Pathology: whales, sonar and decompression sickness.

    PubMed

    Piantadosi, Claude A; Thalmann, Edward D

    2004-04-15

    We do not yet know why whales occasionally strand after sonar has been deployed nearby, but such information is important for both naval undersea activities and the protection of marine mammals. Jepson et al. suggest that a peculiar gas-forming disease afflicting some stranded cetaceans could be a type of decompression sickness (DCS) resulting from exposure to mid-range sonar. However, neither decompression theory nor observation support the existence of a naturally occurring DCS in whales that is characterized by encapsulated, gas-filled cavities in the liver. Although gas-bubble formation may be aggravated by acoustic energy, more rigorous investigation is needed before sonar can be firmly linked to bubble formation in whales. PMID:15085881

  8. Space Flight Decompression Sickness Contingency Plan

    NASA Technical Reports Server (NTRS)

    Dervay, Joseph; Gernhardt, Michael L.; Ross, Charles E.; Hamilton, Douglas; Homick, Jerry L. (Technical Monitor)

    2000-01-01

    The purpose was to develop an enhanced plan to diagnose, treat, and manage decompression sickness (DCS) during extravehicular activity (EVA). This plan is merited by the high frequency of upcoming EVAs necessary to construct and maintain the International Space Station (ISS). The upcoming ISS era will demand a significant increase in EVA. The DCS Risk and Contingency Plan provided a new and improved approach to DCS reporting, treatment, management, and training.

  9. Cerebrospinal Fluid Leakage after Thoracic Decompression

    PubMed Central

    Hu, Pan-Pan; Liu, Xiao-Guang; Yu, Miao

    2016-01-01

    Objective: The objective of this study is to review cerebrospinal fluid leakage (CSFL) after thoracic decompression and describe its regular and special features. Data Sources: Literature cited in this review was retrieved from PubMed and Medline and was primarily published during the last 10 years. “Cerebrospinal fluid”, “leakage”, “dural tears”, and “thoracic decompression” were the indexed terms. Relevant citations in the retrieved articles were also screened to include more data. Study Selection: All retrieved literature was scrutinized, and four categories were recorded: incidence and risk factors, complications, treatment modalities, and prognosis. Results: CSFL is much more frequent after thoracic decompression than after cervical and lumbar spinal surgeries. Its occurrence is related to many clinical factors, especially the presence of ossified ligaments and the adhesion of the dural sac. While its impact on the late neurological recovery is currently controversial, CSFL increases the risk of other perioperative complications, such as low intracranial pressure symptoms, infection, and vascular events. The combined use of primary repairs during the operation and conservative treatment postoperatively is generally effective for most CSFL cases, whereas lumbar drains and reoperations should be implemented as rescue options for refractory cases only. Conclusions: CSFL after thoracic decompression has not been specifically investigated, so the present study provides a systematic and comprehensive review of the issue. CSFL is a multi-factor-related complication, and pathological factors play a decisive role. The importance of CSFL is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In addition, though the required treatment resources are not special for CSFL after thoracic decompression, most CSFL cases are conservatively curable, and surgeons should be

  10. Magma chamber paradox: decompression upon replenishment

    NASA Astrophysics Data System (ADS)

    Papale, Paolo; Longo, Antonella; Montagna, Chiara Paola

    2013-04-01

    The invasion of active magma chambers by fresh magma of deeper provenance is invariably assumed to cause chamber pressurization. Pressure increase thus stands as an intuitive consequence of magma chamber replenishment. However, new numerical simulations demonstrate that pressure evolution is highly non-linear, and that decompression dominates when large density contrasts exist between injected and resident magmas. This apparent paradox originates from the compressible nature of volatile-rich magma and the dynamics of convection associated with injections of buoyant magma. While decompression can dominate in a shallow chamber, pressure increase develops in the connected deep regions of magma provenance. These results contradict classical views adopted to interpret observations at active as well as fossil magma chambers, and demonstrate that a simple reliance on intuition is insufficient: what may be perceived as a paradox - magma chamber decompression upon replenishment - is instead likely, and rooted in the complex physics that governs the multiphase, multi-component dynamics of magma transport in geometrically composite, spatially extended magmatic systems.

  11. Recreational technical diving part 2: decompression from deep technical dives.

    PubMed

    Doolette, David J; Mitchell, Simon J

    2013-06-01

    Technical divers perform deep, mixed-gas 'bounce' dives, which are inherently inefficient because even a short duration at the target depth results in lengthy decompression. Technical divers use decompression schedules generated from modified versions of decompression algorithms originally developed for other types of diving. Many modifications ostensibly produce shorter and/or safer decompression, but have generally been driven by anecdote. Scientific evidence relevant to many of these modifications exists, but is often difficult to locate. This review assembles and examines scientific evidence relevant to technical diving decompression practice. There is a widespread belief that bubble algorithms, which redistribute decompression in favour of deeper decompression stops, are more efficient than traditional, shallow-stop, gas-content algorithms, but recent laboratory data support the opposite view. It seems unlikely that switches from helium- to nitrogen-based breathing gases during ascent will accelerate decompression from typical technical bounce dives. However, there is evidence for a higher prevalence of neurological decompression sickness (DCS) after dives conducted breathing only helium-oxygen than those with nitrogen-oxygen. There is also weak evidence suggesting less neurological DCS occurs if helium-oxygen breathing gas is switched to air during decompression than if no switch is made. On the other hand, helium-to-nitrogen breathing gas switches are implicated in the development of inner-ear DCS arising during decompression. Inner-ear DCS is difficult to predict, but strategies to minimize the risk include adequate initial decompression, delaying helium-to-nitrogen switches until relatively shallow, and the use of the maximum safe fraction of inspired oxygen during decompression. PMID:23813463

  12. Bone age assessment for young children from newborn to 7-year-old using carpal bones

    NASA Astrophysics Data System (ADS)

    Zhang, Aifeng; Gertych, Arkadiusz; Liu, Brent J.; Huang, H. K.

    2007-03-01

    A computer-aided-diagnosis (CAD) method has been previously developed based on features extracted from phalangeal regions of interest (ROI) in a digital hand atlas, which can assess bone age of children from ages 7 to 18 accurately. Therefore, in order to assess the bone age of children in younger ages, the inclusion of carpal bones is necessary. In this paper, we developed and implemented a knowledge-based method for fully automatic carpal bone segmentation and morphological feature analysis. Fuzzy classification was then used to assess the bone age based on the selected features. Last year, we presented carpal bone segmentation algorithm. This year, research works on procedures after carpal bone segmentation including carpal bone identification, feature analysis and fuzzy system for bone age assessment is presented. This method has been successfully applied on all cases in which carpal bones have not overlapped. CAD results of total about 205 cases from the digital hand atlas were evaluated against subject chronological age as well as readings of two radiologists. It was found that the carpal ROI provides reliable information in determining the bone age for young children from newborn to 7-year-old.

  13. Spatial domain entertainment audio decompression/compression

    NASA Astrophysics Data System (ADS)

    Chan, Y. K.; Tam, Ka Him K.

    2014-02-01

    The ARM7 NEON processor with 128bit SIMD hardware accelerator requires a peak performance of 13.99 Mega Cycles per Second for MP3 stereo entertainment quality decoding. For similar compression bit rate, OGG and AAC is preferred over MP3. The Patent Cooperation Treaty Application dated 28/August/2012 describes an audio decompression scheme producing a sequence of interleaving "min to Max" and "Max to min" rising and falling segments. The number of interior audio samples bound by "min to Max" or "Max to min" can be {0|1|…|N} audio samples. The magnitudes of samples, including the bounding min and Max, are distributed as normalized constants within the 0 and 1 of the bounding magnitudes. The decompressed audio is then a "sequence of static segments" on a frame by frame basis. Some of these frames needed to be post processed to elevate high frequency. The post processing is compression efficiency neutral and the additional decoding complexity is only a small fraction of the overall decoding complexity without the need of extra hardware. Compression efficiency can be speculated as very high as source audio had been decimated and converted to a set of data with only "segment length and corresponding segment magnitude" attributes. The PCT describes how these two attributes are efficiently coded by the PCT innovative coding scheme. The PCT decoding efficiency is obviously very high and decoding latency is basically zero. Both hardware requirement and run time is at least an order of magnitude better than MP3 variants. The side benefit is ultra low power consumption on mobile device. The acid test on how such a simplistic waveform representation can indeed reproduce authentic decompressed quality is benchmarked versus OGG(aoTuv Beta 6.03) by three pair of stereo audio frames and one broadcast like voice audio frame with each frame consisting 2,028 samples at 44,100KHz sampling frequency.

  14. Analytic gain in probabilistic decompression sickness models.

    PubMed

    Howle, Laurens E

    2013-11-01

    Decompression sickness (DCS) is a disease known to be related to inert gas bubble formation originating from gases dissolved in body tissues. Probabilistic DCS models, which employ survival and hazard functions, are optimized by fitting model parameters to experimental dive data. In the work reported here, I develop methods to find the survival function gain parameter analytically, thus removing it from the fitting process. I show that the number of iterations required for model optimization is significantly reduced. The analytic gain method substantially improves the condition number of the Hessian matrix which reduces the model confidence intervals by more than an order of magnitude. PMID:24209920

  15. Radiological considerations: percutaneous laser disc decompression.

    PubMed

    Botsford, J A

    1993-10-01

    Diagnostic radiology is an integral part of percutaneous laser disc decompression (PLDD). All physicians involved in PLDD patient selection and treatment must be familiar with the imaging techniques unique to this procedure to ensure a successful outcome. The following review is based on the cumulative experience gained in performing over 150 PLDD procedures. It discusses the function of diagnostic radiology in all facets of PLDD including patient selection, intraoperative imaging, postoperative evaluation, and analysis of complications. Fundamental radiologic concepts that apply to PLDD are explained and protocols suggested to optimize results and avoid complications. PMID:10146513

  16. Radiographic imaging and possible causes of a carpal varus deformity in an Asian elephant (Elephas maximus).

    PubMed

    Kaulfers, Carola; Geburek, Florian; Feige, Karsten; Knieriem, Andreas

    2010-12-01

    The carpal region of an Asian elephant (Elephas maximus) with a clinically obvious varus deformity of the carpus was examined radiographically with a standard portable x-ray unit. Several dorsopalmar radiographs were taken at a short source-to-image distance, moving the beam center along the carpus. To obtain a single image of the carpal region, radiographs were assembled digitally using a composite technique. Radiographs revealed a deviation of the limb's axis of approximately 25 degrees in the region of distal physis of the radius and ulna and a wedge-shaped epiphysis of the ulna. Healed physitis due to trauma and subluxation of the middle carpal joint are discussed as possible causes of the deformity. The radiographic technique described proved to be helpful to evaluate a relatively large anatomic area in the carpal region of an adult Asian elephant with a varus deformity and may be an alternative tool to previously described single image radiography. PMID:21370652

  17. Water tunnels

    NASA Technical Reports Server (NTRS)

    Bjarke, Lisa J.

    1991-01-01

    Some of the uses of water tunnels are demonstrated through the description of the NASA Ames-Dryden Flow Visualization Facility. It is concluded that water tunnels are capable of providing a quick and inexpensive means of flow visualization and can aid in the understanding of complex fluid mechanics phenomena.

  18. Double crush syndrome due to plating of humeral shaft fracture

    PubMed Central

    Huang, Yi-Gang; Chang, Shi-Min

    2014-01-01

    Median nerve injury is rarely associated with the humeral shaft fracture. A Sixty two year old woman with a displaced humeral shaft fracture, developed a symptomatic carpal tunnel syndrome after plating with a screw protruding medially. 16 months later, the implants were removed and the symptoms gradually improved without carpal tunnel release surgery. A double crush syndrome resulted due to the proximal compression by the medially protruding screw and the distal compression by carpal tunnel. The proximal decompression produced by removal of the screw led to relief of the symptoms. PMID:24741148

  19. Colonic Fermentation Promotes Decompression sickness in Rats.

    PubMed

    de Maistre, Sébastien; Vallée, Nicolas; Gempp, Emmanuel; Lambrechts, Kate; Louge, Pierre; Duchamp, Claude; Blatteau, Jean-Eric

    2016-01-01

    Massive bubble formation after diving can lead to decompression sickness (DCS). During dives with hydrogen as a diluent for oxygen, decreasing the body's H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. So we set out to investigate if colonic fermentation leading to endogenous hydrogen production promotes DCS in fasting rats. Four hours before an experimental dive, 93 fasting rats were force-fed, half of them with mannitol and the other half with water. Exhaled hydrogen was measured before and after force-feeding. Following the hyperbaric exposure, we looked for signs of DCS. A higher incidence of DCS was found in rats force-fed with mannitol than in those force-fed with water (80%, [95%CI 56, 94] versus 40%, [95%CI 19, 64], p < 0.01). In rats force-fed with mannitol, metronidazole pretreatment reduced the incidence of DCS (33%, [95%CI 15, 57], p = 0.005) at the same time as it inhibited colonic fermentation (14 ± 35 ppm versus 118 ± 90 ppm, p = 0.0001). Pre-diveingestion of mannitol increased the incidence of DCS in fasting rats when colonic fermentation peaked during the decompression phase. More generally, colonic fermentation in rats on a normal diet could promote DCS through endogenous hydrogen production. PMID:26853722

  20. Microsurgical Decompression for Peroneal Nerve Entrapment Neuropathy

    PubMed Central

    MORIMOTO, Daijiro; ISU, Toyohiko; KIM, Kyongsong; SUGAWARA, Atsushi; YAMAZAKI, Kazuyoshi; CHIBA, Yasuhiro; IWAMOTO, Naotaka; ISOBE, Masanori; MORITA, Akio

    2015-01-01

    Peroneal nerve entrapment neuropathy (PNEN) is one cause of numbness and pain in the lateral lower thigh and instep, and of motor weakness of the extensors of the toes and ankle. We report a less invasive surgical procedure performed under local anesthesia to treat PNEN and our preliminary outcomes. We treated 22 patients (33 legs), 7 men and 15 women, whose average age was 66 years. The mean postoperative follow-up period was 40 months. All patients complained of pain or paresthesia of the lateral aspect of affected lower thigh and instep; all manifested a Tinel-like sign at the entrapment point. As all had undergone unsuccessful conservative treatment, we performed microsurgical decompression under local anesthesia. Of 19 patients who had undergone lumbar spinal surgery (LSS), 9 suffered residual symptoms attributable to PNEN. While complete symptom abatement was obtained in the other 10 they later developed PNEN-induced new symptoms. Motor weakness of the extensors of the toes and ankle [manual muscle testing (MMT) 4/5] was observed preoperatively in 8 patients; it was relieved by microsurgical decompression. Based on self-assessments, all 22 patients were satisfied with the results of surgery. PNEN should be considered as a possible differential diagnosis in patients with L5 neuropathy due to lumbar degenerative disease, and as a causative factor of residual symptoms after LSS. PNEN can be successfully addressed by less-invasive surgery performed under local anesthesia. PMID:26227056

  1. Microsurgical Decompression for Peroneal Nerve Entrapment Neuropathy.

    PubMed

    Morimoto, Daijiro; Isu, Toyohiko; Kim, Kyongsong; Sugawara, Atsushi; Yamazaki, Kazuyoshi; Chiba, Yasuhiro; Iwamoto, Naotaka; Isobe, Masanori; Morita, Akio

    2015-01-01

    Peroneal nerve entrapment neuropathy (PNEN) is one cause of numbness and pain in the lateral lower thigh and instep, and of motor weakness of the extensors of the toes and ankle. We report a less invasive surgical procedure performed under local anesthesia to treat PNEN and our preliminary outcomes. We treated 22 patients (33 legs), 7 men and 15 women, whose average age was 66 years. The mean postoperative follow-up period was 40 months. All patients complained of pain or paresthesia of the lateral aspect of affected lower thigh and instep; all manifested a Tinel-like sign at the entrapment point. As all had undergone unsuccessful conservative treatment, we performed microsurgical decompression under local anesthesia. Of 19 patients who had undergone lumbar spinal surgery (LSS), 9 suffered residual symptoms attributable to PNEN. While complete symptom abatement was obtained in the other 10 they later developed PNEN-induced new symptoms. Motor weakness of the extensors of the toes and ankle [manual muscle testing (MMT) 4/5] was observed preoperatively in 8 patients; it was relieved by microsurgical decompression. Based on self-assessments, all 22 patients were satisfied with the results of surgery. PNEN should be considered as a possible differential diagnosis in patients with L5 neuropathy due to lumbar degenerative disease, and as a causative factor of residual symptoms after LSS. PNEN can be successfully addressed by less-invasive surgery performed under local anesthesia. PMID:26227056

  2. Submarine tower escape decompression sickness risk estimation.

    PubMed

    Loveman, G A M; Seddon, E M; Thacker, J C; Stansfield, M R; Jurd, K M

    2014-01-01

    Actions to enhance survival in a distressed submarine (DISSUB) scenario may be guided in part by knowledge of the likely risk of decompression sickness (DCS) should the crew attempt tower escape. A mathematical model for DCS risk estimation has been calibrated against DCS outcome data from 3,738 exposures of either men or goats to raised pressure. Body mass was used to scale DCS risk. The calibration data included more than 1,000 actual or simulated submarine escape exposures and no exposures with substantial staged decompression. Cases of pulmonary barotrauma were removed from the calibration data. The calibrated model was used to estimate the likelihood of DCS occurrence following submarine escape from the United Kingdom Royal Navy tower escape system. Where internal DISSUB pressure remains at - 0.1 MPa, escape from DISSUB depths < 200 meters is estimated to have DCS risk < 6%. Saturation at raised DISSUB pressure markedly increases risk, with > 60% DCS risk predicted for a 200-meter escape from saturation at 0.21 MPa. Using the calibrated model to predict DCS for direct ascent from saturation gives similar risk estimates to other published models. PMID:25109085

  3. Hyperbaric oxygen treatment for decompression sickness.

    PubMed

    Moon, R E

    2014-01-01

    Decompression sickness (DCS) is a clinical syndrome occurring usually within 24 hours of a reduction in ambient pressure. DCS occurs most commonly in divers ascending from a minimum depth of 20 feet (6 meters) of sea water, but can also occur during rapid decompression from sea level to altitude (typically > 17,000 feet / 5,200 meters). Manifestations are one or more of the following: most commonly, joint pain, hypesthesia, generalized fatigue or rash; less common but more serious, motor weakness, ataxia, pulmonary edema, shock and death. The cause of DCS is in situ bubble formation in tissues, causing mechanical disruption of tissue, occlusion of blood flow, platelet activation, endothelial dysfunction and capillary leakage. High inspired concentration of oxygen (O2) is recommended as first aid for all cases and can be definitive treatment for most altitude DCS. For most other cases, hyperbaric oxygen is recommended,most commonly 100% O2 breathing at 2.82 atmospheres absolute (U.S.Navy Treatment Table 6 or equivalent). Additional treatments (generally no more than one to two) are used for residual manifestations until clinical stability; some severe cases may require more treatments. Isotonic, glucose-free fluids are recommended for prevention and treatment of hypovolemia. An evidence-based review of adjunctive therapies is presented. PMID:24851553

  4. Colonic Fermentation Promotes Decompression sickness in Rats

    PubMed Central

    de Maistre, Sébastien; Vallée, Nicolas; Gempp, Emmanuel; Lambrechts, Kate; Louge, Pierre; Duchamp, Claude; Blatteau, Jean-Eric

    2016-01-01

    Massive bubble formation after diving can lead to decompression sickness (DCS). During dives with hydrogen as a diluent for oxygen, decreasing the body’s H2 burden by inoculating hydrogen-metabolizing microbes into the gut reduces the risk of DCS. So we set out to investigate if colonic fermentation leading to endogenous hydrogen production promotes DCS in fasting rats. Four hours before an experimental dive, 93 fasting rats were force-fed, half of them with mannitol and the other half with water. Exhaled hydrogen was measured before and after force-feeding. Following the hyperbaric exposure, we looked for signs of DCS. A higher incidence of DCS was found in rats force-fed with mannitol than in those force-fed with water (80%, [95%CI 56, 94] versus 40%, [95%CI 19, 64], p < 0.01). In rats force-fed with mannitol, metronidazole pretreatment reduced the incidence of DCS (33%, [95%CI 15, 57], p = 0.005) at the same time as it inhibited colonic fermentation (14 ± 35 ppm versus 118 ± 90 ppm, p = 0.0001). Pre-diveingestion of mannitol increased the incidence of DCS in fasting rats when colonic fermentation peaked during the decompression phase. More generally, colonic fermentation in rats on a normal diet could promote DCS through endogenous hydrogen production. PMID:26853722

  5. Bone age assessment in young children using automatic carpal bone feature extraction and support vector regression.

    PubMed

    Somkantha, Krit; Theera-Umpon, Nipon; Auephanwiriyakul, Sansanee

    2011-12-01

    Boundary extraction of carpal bone images is a critical operation of the automatic bone age assessment system, since the contrast between the bony structure and soft tissue are very poor. In this paper, we present an edge following technique for boundary extraction in carpal bone images and apply it to assess bone age in young children. Our proposed technique can detect the boundaries of carpal bones in X-ray images by using the information from the vector image model and the edge map. Feature analysis of the carpal bones can reveal the important information for bone age assessment. Five features for bone age assessment are calculated from the boundary extraction result of each carpal bone. All features are taken as input into the support vector regression (SVR) that assesses the bone age. We compare the SVR with the neural network regression (NNR). We use 180 images of carpal bone from a digital hand atlas to assess the bone age of young children from 0 to 6 years old. Leave-one-out cross validation is used for testing the efficiency of the techniques. The opinions of the skilled radiologists provided in the atlas are used as the ground truth in bone age assessment. The SVR is able to provide more accurate bone age assessment results than the NNR. The experimental results from SVR are very close to the bone age assessment by skilled radiologists. PMID:21347746

  6. Homologies and homeotic transformation of the theropod ‘semilunate' carpal

    PubMed Central

    Xu, Xing; Han, Fenglu; Zhao, Qi

    2014-01-01

    The homology of the ‘semilunate' carpal, an important structure linking non-avian and avian dinosaurs, has been controversial. Here we describe the morphology of some theropod wrists, demonstrating that the ‘semilunate' carpal is not formed by the same carpal elements in all theropods possessing this feature and that the involvement of the lateralmost distal carpal in forming the ‘semilunate' carpal of birds is an inheritance from their non-avian theropod ancestors. Optimization of relevant morphological features indicates that these features evolved in an incremental way and the ‘semilunate' structure underwent a lateral shift in position during theropod evolution, possibly as a result of selection for foldable wings in birds and their close theropod relatives. We propose that homeotic transformation was involved in the evolution of the ‘semilunate' carpal. In combination with developmental data on avian wing digits, this suggests that homeosis played a significant role in theropod hand evolution in general. PMID:25116378

  7. A New Measure of Decompression Sickness in the Rat

    PubMed Central

    Wang, Qiong; Lambrechts, Kate; Mansourati, Jacques

    2014-01-01

    In this study we assessed the reliability of a tilting-board grip score as a measure of decompression sickness in rats. In experiments using a hyperbaric compression/decompression protocol, rats were observed for signs of decompression sickness and their grip strength measured on a tilting particle board hinged to a metal frame. Angles at which rats lost grip were converted to gravitational vectors. Decreased mean grip scores following decompression were fitted to a logistic regression model with strain, age, and weight. Decrease in grip score was significantly associated with observed decompression sickness (P = 0.0036). The log odds ratio for decompression sickness = 1.40 (decrease in grip score). In rats with no decrease in mean grip score there was a 50% probability of decompression sickness (pDCS). This increased steadily with decreases in mean grip score. A decrease of 0.3 had a 60% pDCS, a decrease of 0.6 had a 70% pDCS, and a decrease of 2.1 had a 95% pDCS. The tilting board grip score is a reliable measure of the probability of decompression sickness. PMID:24963469

  8. 29 CFR Appendix A to Subpart S of... - Decompression Tables

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... rate not greater than 5 pounds per minute. Further reduction in pressure will take place during stage 2... minute. Decompression Table No. 1 indicates in the body of the table the total decompression time in... rate of 5 pounds per minute. Elapsed time stage 1: 16/5 3 Stage 2 (final stage): Reduce pressure at...

  9. Cardiovascular Pressures with Venous Gas Embolism and Decompression

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Robinson, R.; Sutton, T.; Kemper, G. B.

    1995-01-01

    Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.

  10. Crystallization kinetics in magmas during decompression

    NASA Astrophysics Data System (ADS)

    Arzilli, Fabio; Burton, Mike; Carroll, Michael R.

    2016-04-01

    Many variables play a role during magma crystallization at depth or in a volcanic conduit, and through experimentally derived constraints we can better understand pre- and syn-eruptive magma crystallization behavior. The thermodynamic properties of magmas have been extensively investigated as a function of T, P, fO2 and magma composition [1], and this allows estimation of the stability of equilibrium phases and physical parameters (e.g., density, viscosity). However, many natural igneous rocks contain geochemical, mineralogical and textural evidence of disequilibrium, suggesting that magmas frequently follow non-equilibrium, time-dependent pathways that are recorded in the geochemical and petrographic characteristics of the rocks. There are currently no suitable theoretical models capable of calculating nucleation and growth rates in disequilibrium conditions without experimental constraints. The aim of this contribution is provide quantitative data on growth and nucleation rates of feldspar crystals in silicate melts obtained through decompression experiments, in order to determine the magma evolution in pre- and sin-eruptive conditions. Decompression is one of the main processes that induce the crystallization of feldspar during the magma ascent in the volcanic conduit. Decompression experiments have been carried out on trachytic and basaltic melts to investigate crystallization kinetics of feldspar as a function of the effect of the degassing, undercooling and time on nucleation and crystal growth process [2; 3]. Furthermore, feldspar is the main crystals phase present in magmas, and its abundance can strongly vary with small changes in pressure, temperature and water content in the melt, implying appreciable variations in the textures and in the crystallization kinetics. Crystallization kinetics of trachytic melts show that long experiment durations involve more nucleation events of alkali feldspar than short experiment durations [2]. This is an important

  11. Three-dimensional computed tomography of the carpal ligaments.

    PubMed

    Nanno, Mitsuhiko; Viegas, Steven F

    2009-03-01

    This article details a current perspective and accurate anatomical three-dimensional descriptions of the ligaments of the wrist. The carpometacarpal ligaments, the intercarpal ligaments, and the radiocarpal ligaments are described and illustrated using a unique combination of detailed dissection, computed tomography, and a three-dimensional digitization technique. Detailed information is also provided about the ligamentous attachments of the carpometacarpal joints, the carpal bones, and the distal radius. This study improves knowledge and understanding of the normal anatomy and mechanics of the radiocarpal and intercarpal ligaments and the carpometacarpal joints, and it should help in the assessment of radiographic images and treatment of various injuries and degenerative changes seen in the wrist. The knowledge of the ligaments will further serve as a foundation for understanding the anatomy of the ligaments, the biomechanics of the wrist, and the function of the individual ligaments and their roles in joint motion and stability. PMID:19235667

  12. Three-dimensional imaging of the carpal ligaments.

    PubMed

    Nanno, Mitsuhiko; Patterson, Rita M; Viegas, Steven F

    2006-11-01

    This article provides a new perspective and detailed anatomic description of the attachments of the carpometacarpal (CMC) ligaments, intercarpal ligaments, and radiocarpal ligaments, which are described and illustrated using a unique combination of detailed dissection, CT imaging, and three-dimensional digitization. Detailed information is also provided about the ligamentous attachments of the CMC joints, carpal bones, and distal radius. This information advances the current knowledge and understanding of the normal anatomy and its impact on the mechanics of the radiocarpal intercarpal ligaments and the CMC joints, and should help surgeons to assess and treat injuries and degenerative changes seen in the wrist and CMC joints. Furthermore, this additional knowledge of the ligaments will help to further understand wrist kinematics and, more precisely, the function of the individual ligaments and their roles in joint motion and stability and injuries. PMID:17097462

  13. Tenosynovitis and carpal tunnel syndrome from mycobacterium tuberculosis - a rare manifestation of extrapulmonary tuberculosis.

    PubMed

    Marques, V B; Vieira, H P; Alcantara, A C C; Braga, F N; Rocha, F A; Medeiros, M C

    2010-01-01

    Tenosynovitis caused by tuberculosis (TB) is a rare presentation of this disease usually reported in immunocompromised patients. We describe a patient diagnosed with TB tenosynovitis of the left upper limb with no history of immunodeficiency. Although appearing in an endemic area the time to diagnosis was 6 years due to the absence of acid-fast stained bacilli in the first cultures despite histopathology showing a granulomatous lesion. Institution of pharmacological treatment and surgical debridément led to improvement within one month. The authors emphasize the need for early intervention in order to halt disease progression and avoid sequelae. PMID:20518148

  14. Tunneling machine

    SciTech Connect

    Snyder, L.L.

    1980-02-19

    A diametrically compact tunneling machine for boring tunnels is disclosed. The machine includes a tubular support frame having a hollow piston mounted therein which is movable from a retracted position in the support frame to an extended position. A drive shaft is rotatably mounted in the hollow piston and carries a cutter head at one end. The hollow piston is restrained against rotational movement relative to the support frame and the drive shaft is constrained against longitudinal movement relative to the hollow piston. A plurality of radially extendible feet project from the support frame to the tunnel wall to grip the tunnel wall during a tunneling operation wherein the hollow piston is driven forwardly so that the cutter head works on the tunnel face. When the hollow piston is fully extended, a plurality of extendible support feet, which are fixed to the rearward and forward ends of the hollow piston, are extended, the radially extendible feet are retracted and the support frame is shifted forwardly by the piston so that a further tunneling operation may be initiated.

  15. Ambulation Increases Decompression Sickness in Spacewalk Simulations

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is

  16. Threshold altitude resulting in decompression sickness

    NASA Technical Reports Server (NTRS)

    Kumar, K. V.; Waligora, James M.; Calkins, Dick S.

    1990-01-01

    A review of case reports, hypobaric chamber training data, and experimental evidence indicated that the threshold for incidence of altitude decompression sickness (DCS) was influenced by various factors such as prior denitrogenation, exercise or rest, and period of exposure, in addition to individual susceptibility. Fitting these data with appropriate statistical models makes it possible to examine the influence of various factors on the threshold for DCS. This approach was illustrated by logistic regression analysis on the incidence of DCS below 9144 m. Estimations using these regressions showed that, under a noprebreathe, 6-h exposure, simulated EVA profile, the threshold for symptoms occurred at approximately 3353 m; while under a noprebreathe, 2-h exposure profile with knee-bends exercise, the threshold occurred at 7925 m.

  17. [Percutaneous laser disk decompression. Experience since 1989].

    PubMed

    Siebert, W E; Berendsen, B T; Tollgaard, J

    1996-02-01

    Since 1987/1988 percutaneous laser disc decompression (PLDD) has been used clinically for treatment of intervertebral disc prolapses. Credible prospective investigations that have been conducted since 1989 with large patient collectives are now available for analysis of their medium-term results and comparison with other minimally invasive procedures. Our follow-up examination of the first 180 patients treated with PLDD from 1989 to 1993 shows a success rate of 72.8%, similar to that with other percutaneous techniques (automated percutaneous lumbar discectomy, percutaneous lumbar discectomy, chemonucleolysis). To guarantee success, the spinal surgeon must have command of the correct technique and also use the appropriate instruments. Good results with the PLDD procedure can be procured when contraindications and indications for patient selection are strictly observed. Overall, our 5 year results seem encouraging. PMID:8622845

  18. Recognition Tunneling

    PubMed Central

    Lindsay, Stuart; He, Jin; Sankey, Otto; Hapala, Prokop; Jelinek, Pavel; Zhang, Peiming; Chang, Shuai; Huang, Shuo

    2010-01-01

    Single molecules in a tunnel junction can now be interrogated reliably using chemically-functionalized electrodes. Monitoring stochastic bonding fluctuations between a ligand bound to one electrode and its target bound to a second electrode (“tethered molecule-pair” configuration) gives insight into the nature of the intermolecular bonding at a single molecule-pair level, and defines the requirements for reproducible tunneling data. Simulations show that there is an instability in the tunnel gap at large currents, and this results in a multiplicity of contacts with a corresponding spread in the measured currents. At small currents (i.e. large gaps) the gap is stable, and functionalizing a pair of electrodes with recognition reagents (the “free analyte” configuration) can generate a distinct tunneling signal when an analyte molecule is trapped in the gap. This opens up a new interface between chemistry and electronics with immediate implications for rapid sequencing of single DNA molecules. PMID:20522930

  19. Transcranial Doppler ultrasound and the etiology of neurologic decompression sickness during altitude decompression

    NASA Technical Reports Server (NTRS)

    Norfleet, W. T.; Powell, M. R.; Kumar, K. Vasantha; Waligora, J.

    1993-01-01

    The presence of gas bubbles in the arterial circulation can occur from iatrogenic mishaps, cardiopulmonary bypass devices, or following decompression, e.g., in deep-sea or SCUBA diving or in astronauts during extravehicular activities (EVA). We have examined the pathophysiology of neurological decompression sickness in human subjects who developed a large number of small gas bubbles in the right side of the heart as a result of hypobaric exposures. In one case, gas bubbles were detected in the middle cerebral artery (MCA) and the subject developed neurological symptoms; a 'resting' patent foramen ovalae (PFO) was found upon saline contrast echocardiography. A PFO was also detected in another individual who developed Spencer Grade 4 precordial Doppler ultrasound bubbles, but no evidence was seen of arterialization of bubbles upon insonation of either the MCA or common carotid artery. The reason for this difference in the behavior of intracardiac bubbles in these two individuals is not known. To date, we have not found evidence of right-to-left shunting of bubbles through pulmonary vasculature. The volume of gas bubbles present following decompression is examined and compared with the number arising from saline contrast injection. The estimates are comparable.

  20. Ocular bubble formation as a method of assessing decompression stress.

    PubMed

    Mekjavić, I B; Campbell, D G; Jaki, P; Dovsak, P A

    1998-01-01

    Tear film bubble formation and ultrasound reflectivity of the lens-vitreous humor compartments were monitored following simulated dives in a hyperbaric chamber. the sensitivity of these methods in determining decompression stress was compared with the results of precordial Doppler ultrasound. In addition, the utility of these diagnostic techniques in testing decompression dive profiles was evaluated. Eleven divers completed two series of chamber dives according to the decompression schedule of the Professional Association of Diving Instructors. The first dive series comprised dives to 70 feet of seawater (fsw) for 15, 29, and 40 min. The second series comprised maximum duration no-stop decompression dives to 40 fsw for 140 min, 70 fsw for 40 min, 90 fsw for 25 min, and 120 fsw for 13 min. Before and immediately after each dive, the following measurements were obtained from each subject: eye surface tear film bubble counts with a slit-lamp microscope, lens and vitreous humor reflectivity using A- and B-mode ophthalmic ultrasonic scan, and precordial Doppler ultrasonic detection of venous gas bubbles. Tear film bubble assessment and ocular scanning ultrasound were observed to be more sensitive in detecting decompression stress than the conventional Doppler ultrasonic surveillance of the precordial region. In contrast to precordial Doppler ultrasonic surveillance, which failed to detect any significant changes in circulating bubbles, tear film bubble formation displayed a dose-response relationship with increasing duration of the 70-fsw dives. Reflectivity changes of the lens-vitreous humor interface were not significant until the no-stop decompression limit was reached. In addition, for each of the no-stop decompression limit dives, increases in the average tear film bubble formation and lens-vitreous humor interface reflectivity were similar. Ocular bubble observations may provide a practical and objective ocular bubble index for analyzing existing decompression

  1. Histopathologic findings in autogenous saphenous vein graft wrapping for recurrent tarsal tunnel syndrome: a case report.

    PubMed

    Campbell, J T; Schon, L C; Burkhardt, L D

    1998-11-01

    Autogenous saphenous vein graft wrapping of the tibial nerve has been described as an effective treatment option for failed tarsal tunnel decompression. Various theories have been proposed to explain how this method works, with little histologic evidence to date. A pathologic investigation of a sectioned nerve that had been previously wrapped provides some insight into these proposals. PMID:9840207

  2. Decompression for management of keratocystic odontogenic tumor in the mandible.

    PubMed

    Morais de Melo, Willian; Pereira-Santos, Darklilson; Sonoda, Celso Koogi; Hochuli-Vieira, Eduardo

    2012-11-01

    Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of odontogenic origin with high recurrence rate. To date, various conservative or aggressive management strategies have been suggested as a method of treatment. Decompression is a conservative method that has been used in the treatment of large odontogenic cysts. The present paper reports a case of KCOT located in the mandible and discusses the importance of its management using conservative methods. The authors present a case of a 38-year-old patient with a KCOT located in the right mandibular angle and ascending ramus, which was treated by decompression followed by enucleation and curettage. The lesion did not recur during a follow-up period of 3 years after surgery. Preserving important structures of the bone and soft tissue decompression is a method with low morbidity. In addition, according to the literature, decompression has a success rate at least as high as the one of most aggressive treatments. PMID:23172507

  3. Minimally invasive lumbar decompression-the surgical learning curve.

    PubMed

    Kim, Choll W

    2016-08-01

    Commentary On: Ahn J, Iqbal A, Manning BT, Leblang S, Bohl DD, Mayo BC, et al. Minimally invasive lumbar decompression-the surgical learning curve. Spine J 2016:16:909-16. (in this issue). PMID:27545398

  4. [Theoretical analysis of recompression-based therapies of decompression illness].

    PubMed

    Nikolaev, V P; Sokolov, G M; Komarevtsev, V N

    2011-01-01

    Theoretical analysis is concerned with the benefits of oxygen, air and nitrogen-helium-oxygen recompression schedules used to treat decompression illness in divers. Mathematical modeling of tissue bubbles dynamics during diving shows that one-hour oxygen recompression to 200 kPa does not diminish essentially the size of bubble enclosed in a layer that reduces tenfold the intensity of gas diffusion from bubbles. However, these bubbles dissolve fully in all the body tissues equally after 2-hr. air compression to 800 kPa and ensuing 2-d decompression by the Russian navy tables, and 1.5-hr. N-He-O2 compression to this pressure followed by 5-day decompression. The overriding advantage of the gas mixture recompression is that it obviates the narcotic action of nitrogen at the peak of chamber pressure and does not create dangerous tissue supersaturation and conditions for emergence of large bubbles at the end of decompression. PMID:21970044

  5. Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

    PubMed Central

    Espinosa, Jose

    2016-01-01

    Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option. PMID:27446619

  6. Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting.

    PubMed

    Michael, Alex P; Espinosa, Jose

    2016-01-01

    Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option. PMID:27446619

  7. Patterns and Variations in Microvascular Decompression for Trigeminal Neuralgia

    PubMed Central

    TODA, Hiroki; GOTO, Masanori; IWASAKI, Koichi

    2015-01-01

    Microvascular decompression (MVD) is a highly effective surgical treatment for trigeminal neuralgia (TN). Although there is little prospective clinical evidence, accumulated observational studies have demonstrated the benefits of MVD for refractory TN. In the current surgical practice of MVD for TN, there have been recognized patterns and variations in surgical anatomy and various decompression techniques. Here we provide a stepwise description of surgical procedures and relevant anatomical characteristics, as well as procedural options. PMID:25925756

  8. Decompression sickness in breath-hold divers: a review.

    PubMed

    Lemaitre, Frederic; Fahlman, Andreas; Gardette, Bernard; Kohshi, Kiyotaka

    2009-12-01

    Although it has been generally assumed that the risk of decompression sickness is virtually zero during a single breath-hold dive in humans, repeated dives may result in a cumulative increase in the tissue and blood nitrogen tension. Many species of marine mammals perform extensive foraging bouts with deep and long dives interspersed by a short surface interval, and some human divers regularly perform repeated dives to 30-40 m or a single dive to more than 200 m, all of which may result in nitrogen concentrations that elicit symptoms of decompression sickness. Neurological problems have been reported in humans after single or repeated dives and recent necropsy reports in stranded marine mammals were suggestive of decompression sickness-like symptoms. Modelling attempts have suggested that marine mammals may live permanently with elevated nitrogen concentrations and may be at risk when altering their dive behaviour. In humans, non-pathogenic bubbles have been recorded and symptoms of decompression sickness have been reported after repeated dives to modest depths. The mechanisms implicated in these accidents indicate that repeated breath-hold dives with short surface intervals are factors that predispose to decompression sickness. During deep diving, the effect of pulmonary shunts and/or lung collapse may play a major role in reducing the incidence of decompression sickness in humans and marine mammals. PMID:19967580

  9. Surgical options in ICH including decompressive craniectomy.

    PubMed

    Mitchell, Patrick; Gregson, Barbara A; Vindlacheruvu, Raghu R; Mendelow, A David

    2007-10-15

    Intracerebral haemorrhage (ICH) accounts for 15 to 20% of strokes. The condition carries a higher morbidity and mortality than occlusive stroke. Despite considerable research effort, no therapeutic modality either medical or surgical has emerged with clear evidence of benefit other than in rare aneurysmal cases. Intracerebral haemorrhages can be divided into those that arise from pre-existing macroscopic vascular lesions - so called "ictohaemorrhagic lesions", and those that do not; the latter being the commoner. Most of the research that has been done on the benefits of surgery has been in this latter group. Trial data available to date precludes a major benefit from surgical evacuation in a large proportion of cases however there are hypotheses of benefit still under investigation, specifically superficial lobar ICH treated by open surgical evacuation, deeper ICH treated with minimally invasive surgical techniques, and decompressive craniectomy. When an ICH arises from an ictohaemorrhagic lesion, therapy has two goals: to treat the effects of the acute haemorrhage and to prevent a recurrence. Three modalities are available for treating lesions to prevent recurrence: stereotactic radiosurgery, endovascular embolisation, and open surgical resection. As with ICH without an underlying lesion there is no evidence to support surgical removal of the haemorrhage in most cases. An important exception is ICHs arising from intracranial aneurysms where there is good evidence to support evacuation of the haematoma as well as repair of the aneurysm. PMID:17543995

  10. Arthroscopic Decompression for a Giant Meniscal Cyst.

    PubMed

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    The authors report the case of a giant medial meniscal cyst in an osteoarthritic knee of an 82-year-old woman that was successfully treated with only arthroscopic cyst decompression. The patient noticed a painful mass on the medial side of the right knee that had been gradually growing for 5 years. Magnetic resonance imaging showed an encapsulated large medial cystic mass measuring 80×65×40 mm that was adjacent to the medial meniscus. An accompanying horizontal tear was also detected in the middle and posterior segments of the meniscus. The medial meniscus was resected up to the capsular attachment to create bidirectional flow between the joint and the cyst with arthroscopic surgery. Magnetic resonance imaging performed 14 months postoperatively showed that the cyst had completely disappeared, and no recurrence was observed during a 2-year follow-up period. An excellent result could be obtained by performing limited meniscectomy to create a channel leading to the meniscal cyst, even though the cyst was large. Among previously reported cases of meniscal cysts, this case is the largest to be treated arthroscopically without open excision. PMID:26726987

  11. Effective Decompression of JPEG Document Images.

    PubMed

    Pham, The-Anh; Delalandre, Mathieu

    2016-08-01

    This paper concentrates on developing an effective approach for decompressing JPEG document images. Our main goal is targeted to time-critical applications, especially to those situated on mobile network infrastructures. To this aim, the proposed approach is designed to work either in the transform domain or image spatial plane. Specifically, the image blocks are first classified into smooth blocks (e.g., background and uniform regions) and non-smooth blocks (e.g., text, graphics, and line-drawings). Next, the smooth blocks are fully decoded in the transform domain by minimizing the total block boundary variation, which is very efficient to compute. For decoding non-smooth blocks, a novel text model is presented that accounts for the specifics of document content. In addition, an efficient optimization algorithm is introduced to reconstruct the non-smooth blocks. The proposed approach has been validated by extensive experiments, demonstrating a significant improvement of visual quality, assuming that document images have been encoded at low bit rates and thus are subject to severe distortion. PMID:27295665

  12. Use of ultrasound in altitude decompression modeling

    NASA Technical Reports Server (NTRS)

    Olson, Robert M.; Pilmanis, Andrew A.

    1993-01-01

    A model that predicts the probability of developing decompression sickness (DCS) with various denitrogenation schedules is being developed by the Armstrong Laboratory, using human data from previous exposures. It was noted that refinements are needed to improve the accuracy and scope of the model. A commercially developed ultrasonic echo imaging system is being used in this model development. Using this technique, bubbles images from a subject at altitude can be seen in the gall bladder, hepatic veins, vena cava, and chambers of the heart. As judged by their motion and appearance in the vena cava, venous bubbles near the heart range in size from 30 to 300 M. The larger bubbles skim along the top, whereas the smaller ones appear as faint images near the bottom of the vessel. Images from growing bubbles in a model altitude chamber indicate that they grow rapidly, going from 20 to 100 M in 3 sec near 30,000 ft altitude. Information such as this is valuable in verifying those aspects of the DCS model dealing with bubble size, their growth rate, and their site of origin.

  13. Orthostatic mesodiencephalic dysfunction after decompressive craniectomy.

    PubMed

    Bijlenga, Philippe; Zumofen, Daniel; Yilmaz, Hasan; Creisson, Eric; de Tribolet, Nicolas

    2007-04-01

    An extreme syndrome of the trephined after decompressive craniectomy is reported here. The most extensive clinical syndrome observed was established over 4 weeks and consisted of bradypsychia, dysartria, and limb rigidity with equine varus feet predominating on the right. The syndrome was aggravated when the patient was sitting with the sequential appearance over minutes of a typical parkinsonian levodopa-resistant tremor starting on the right side, extending to all four limbs, followed by diplopia resulting from a left abducens nerve palsy followed by a left-sided mydriasis. All signs recovered within 1-2 h after horizontalisation. It was correlated with an orthostatic progressive sinking of the skin flap, MRI and CT scan mesodiencephalic distortion without evidence of parenchymal lesion. Brain stem auditory evoked potential wave III latency increases were observed on the right side on verticalisation of the patient. EEG exploration excluded any epileptic activity. Symptoms were fully recovered within 2 days after cranioplasty was performed. The cranioplasty had to be removed twice due to infection. Bradypsychia, speech fluency, limb rigidity and tremor reappeared within a week after removal of the prosthesis. While waiting for sterilisation of the operative site, the symptoms were successfully prevented by a custom-made transparent suction-cup helmet before completion of cranioplasty. PMID:17119005

  14. Arthrography of the traumatized wrist: correlation with radiography and the carpal instability series

    SciTech Connect

    Levinsohn, E.M.; Palmer, A.K.

    1983-03-01

    Arthrography with fluoroscopic monitoring was used to assess the soft tissues of the wrist in 100 patients who had chronic traumatic pain but did not have rheumatoid arthritis. Findings were correlated with plain radiographs and the carpal instability series. Arthrograms were normal in 26% of cases and demonstrated perforation of the triangular fibrocartilage in 26%, radiocarpal-midcarpal communication in 30%, capsular lesions in 31%, lymphatic opacification in 12%, and tendon sheath filling in 10%. Communication between the radiocarpal and pisiform-troiquetral compartments, a normal finding, was seen in 69%. There was a significant association between perforation of the triangular fibrocartilage and both ulna-plus variance and carpal instability.

  15. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy

    PubMed Central

    Bonilla, Alvaro G.; Santschi, Elizabeth M.

    2015-01-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging. PMID:25694665

  16. [Lesions of the radio-carpal joint in patients with rheumatoid arthritis and its surgical treatment].

    PubMed

    Herasymenko, S I; Babko, A M

    2014-08-01

    Affection of radio-carpal joint is most frequently revealed in patients, suffering rheumatoid arthritis. While the disease progressing in almost 75% of patients the inflammatory changes in radio-carpal joint occur. An acute and chronic synovitis, damage of a cartilage constitute a cause of a typical erosion of bones inside a joint, weakening of a tendo-ligamentous apparatus and its further deformity. Operative treatment was aimed for the inflammatory focus elimination, reduction of the pain syndrome severity, the function loss, and the joint deformity correction. The mostly used operative interventions are tenoectomy, synovectomy, arthrodesis, total endoprosthesis. PMID:25417294

  17. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy.

    PubMed

    Bonilla, Alvaro G; Santschi, Elizabeth M

    2015-02-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging. PMID:25694665

  18. Dynamic Heating and Decompression Experiments on Dacite and Rhyolite Magmas

    NASA Astrophysics Data System (ADS)

    Andrews, B. J.; Waters, L.; Grocke, S. B.

    2015-12-01

    Mineral reaction rims, zoned crystals, and myriad growth or dissolution textures provide evidence for changes in magma pressure, temperature, or composition. Quantifying the magnitudes, timescales and length scales of those variations is a fundamental challenge of volcanology and igneous petrology; experiments provide quantitative insights into how magmas react to changes in pressure and temperature that can be used to address that challenge. We use single-step and dynamic experiments conducted in cold seal pressure vessels to study the responses of dacite and rhyolite magmas to heating and decompression events. During single-step decompression (or heating) experiments, conditions are changed nearly instantaneously from the initial to final state in one step, or several smaller steps, whereas "dynamic experiments" have continuous variation in pressure and/or temperature. These two types of experiments yield useful and complementary information describing crystal nucleation, growth, and reaction rates in response to changing (as opposed to steady state) conditions. Here we discuss isothermal decompression experiments that show substantial path-dependence for runs with equivalent time-averaged decompression rates as slow as 0.27 MPa/h for >500 h. Continuous decompression experiments often contain fewer but larger plagioclase crystals than are present in single-step runs, and those new crystals often show complex growth textures. Our results suggest that even slow changes in storage conditions can disrupt melt structure and greatly retard nucleation provided the changes are steady. We hypothesize that if the decompression path remains steady and continuous (absent a stall on and/or rapid decompression), the magma can remain in a growth-dominated regime even though it is far from equilibrium.

  19. Decompression alone versus decompression with limited fusion for treatment of degenerative lumbar scoliosis in the elderly patient

    PubMed Central

    Daubs, Michael D.; Lenke, Lawrence G.; Bridwell, Keith H.; Cheh, Gene; Kim, Yongjung J.; Stobbs, Georgia

    2012-01-01

    Study design: Retrospective cohort study. Objective: To analyze the surgical results of a group of patients older than 65 years treated for mild degenerative lumbar scoliosis (<30°) with stenosis, treated with decompression alone or decompression and limited fusion. Methods: We evaluated 55 patients, all older than 65 years from our prospectively collected database with mild degenerative scoliosis (<30°) and stenosis who underwent surgery. Laminectomy alone was performed in 16 patients, and laminectomy and limited fusion in 39 patients. Mean follow-up was 4.6 years in the decompression group and 5.0 years in the fusion group. Clinical results were graded by patients' self-reported satisfaction and length of symptom-free period to recurrence. Results: In the decompression alone group, 6 (37%) of 16 patients developed recurrent stenosis at the previously decompressed level and five developed recurrence within 6 months postoperatively versus the decompression and fusion group where 3 (8%) of 39 (P = .0476) developed symptomatic stenosis supra adjacent to the fusion. Of 16 patients in the decompression alone group, 12 (75%) had recurrence of symptoms by the 5-year follow-up period versus only 14 (36%) patients in the decompression and fusion group (P = .016). Adjacent segment degenerative changes were common in the fusion group, but only 7% developed symptomatic stenosis. Conclusions: Decompression with limited fusion prevents early return of stenotic symptoms compared with decompression alone in the setting of mild degenerative scoliosis (<30°) and symptomatic stenosis in patients 65 years and older. Final class of evidence–prognosis Study design  RCT  Cohort •  Case control  Case series Methods  Concealed allocation (RCT)  Intention to treat (RCT)  Blinded/independent evaluation of primary outcome  F/U ≥ 85% •  Adequate sample size  Control for confounding Overall class of evidence III The definiton of the different classes of

  20. Delayed Recompression for Decompression Sickness: Retrospective Analysis

    PubMed Central

    Hadanny, Amir; Fishlev, Gregori; Bechor, Yair; Bergan, Jacob; Friedman, Mony; Maliar, Amit; Efrati, Shai

    2015-01-01

    Introduction Most cases of decompression sickness (DCS) occur soon after surfacing, with 98% within 24 hours. Recompression using hyperbaric chamber should be administrated as soon as feasible in order to decrease bubble size and avoid further tissue injury. Unfortunately, there may be a significant time delay from surfacing to recompression. The time beyond which hyperbaric treatment is non effective is unclear. The aims of the study were first to evaluate the effect of delayed hyperbaric treatment, initiated more than 48h after surfacing for DCS and second, to evaluate the different treatment protocols. Methods From January 2000 to February 2014, 76 divers had delayed hyperbaric treatment (≥48h) for DCS in the Sagol center for Hyperbaric medicine and Research, Assaf-Harofeh Medical Center, Israel. Data were collected from their medical records and compared to data of 128 patients treated earlier than 48h after surfacing at the same hyperbaric institute. Results There was no significant difference, as to any of the baseline characteristics, between the delayed and early treatment groups. With respect to treatment results, at the delayed treatment divers, complete recovery was achieved in 76% of the divers, partial recovery in 17.1% and no improvement in 6.6%. Similar results were achieved when treatment started early, where 78% of the divers had complete recovery, 15.6% partial recovery and 6.2% no recovery. Delayed hyperbaric treatment using US Navy Table 6 protocol trended toward a better clinical outcome yet not statistically significant (OR=2.786, CI95%[0.896-8.66], p=0.07) compared to standard hyperbaric oxygen therapy of 90 minutes at 2 ATA, irrespective of the symptoms severity at presentation. Conclusions Late recompression for DCS, 48 hours or more after surfacing, has clinical value and when applied can achieve complete recovery in 76% of the divers. It seems that the preferred hyperbaric treatment protocol should be based on US Navy Table 6. PMID

  1. Decompression sickness following breath-hold diving.

    PubMed

    Schipke, J D; Gams, E; Kallweit, Oliver

    2006-01-01

    Despite convincing evidence of a relationship between breath-hold diving and decompression sickness (DCS), the causal connection is only slowly being accepted. Only the more recent textbooks have acknowledged the risks of repetitive breath-hold diving. We compare four groups of breath-hold divers: (1) Japanese and Korean amas and other divers from the Pacific area, (2) instructors at naval training facilities, (3) spear fishers, and (4) free-dive athletes. While the number of amas is likely decreasing, and Scandinavian Navy training facilities recorded only a few accidents, the number of spear fishers suffering accidents is on the rise, in particular during championships or using scooters. Finally, national and international associations (e.g., International Association of Free Drives [IAFD] or Association Internationale pour Le Developpment De L'Apnee [AIDA]) promote free-diving championships including deep diving categories such as constant weight, variable weight, and no limit. A number of free-diving athletes, training for or participating in competitions, are increasingly accident prone as the world record is presently set at a depth of 171 m. This review presents data found after searching Medline and ISI Web of Science and using appropriate Internet search engines (e.g., Google). We report some 90 cases in which DCS occurred after repetitive breath-hold dives. Even today, the risk of suffering from DCS after repetitive breath-hold diving is often not acknowledged. We strongly suggest that breath-hold divers and their advisors and physicians be made aware of the possibility of DCS and of the appropriate therapeutic measures to be taken when DCS is suspected. Because the risk of suffering from DCS increases depending on depth, bottom time, rate of ascent, and duration of surface intervals, some approaches to assess the risks are presented. Regrettably, none of these approaches is widely accepted. We propose therefore the development of easily manageable

  2. Influence of decompression sickness on vasomotion of isolated rat vessels.

    PubMed

    Mazur, A; Lambrechts, K; Buzzacott, P; Wang, Q; Belhomme, M; Theron, M; Mansourati, J; Guerrero, F

    2014-06-01

    Several studies have demonstrated that endothelial function is impaired following a dive even without decompression sickness. During this study we determined the effect of decompression sickness on endothelium-dependent and independent vasoreactivity. For this purpose twenty-seven male Sprague-Dawley rats were submitted to a simulated dive up to 1,000 kPa absolute pressure and divided into 3 groups: safe diving without decompression sickness or dives provoking mild or severe sickness. A fourth control group remained at atmospheric pressure. Endothelium-dependent and independent vasomotion was assessed ex vivo by measuring isometric tension in rings of abdominal aorta and mesenteric arteries. Dose-response curves were obtained with phenylephrine, acetylcholine and sodium nitroprusside. Acetylcholine-induced relaxation was measured in the presence of L-NAME, indometacin or both of them at once.Contraction was significantly decreased after each protocol compared with the control rats. Additionally, the response in animals from the severe group was significantly different from that of the safe and mild groups. Dose response curves for acetylcholine alone and in the presence of inhibitors remained unchanged. We did not observe differences in endothelium-dependent vasodilation after diving or in the presence of decompression sickness. Contractile response to phenylephrine was progressively impaired with increased decompression stress. These results may indicate smooth muscle injury. PMID:24258471

  3. Tunneling Nanotubes

    PubMed Central

    Lou, Emil; Fujisawa, Sho; Barlas, Afsar; Romin, Yevgeniy; Manova-Todorova, Katia; Moore, Malcolm A.S.; Subramanian, Subbaya

    2012-01-01

    Tunneling nanotubes are actin-based cytoplasmic extensions that function as intercellular channels in a wide variety of cell types.There is a renewed and keen interest in the examination of modes of intercellular communication in cells of all types, especially in the field of cancer biology. Tunneling nanotubes –which in the literature have also been referred to as “membrane nanotubes,” “’intercellular’ or ‘epithelial’ bridges,” or “cytoplasmic extensions” – are under active investigation for their role in facilitating direct intercellular communication. These structures have not, until recently, been scrutinized as a unique and previously unrecognized form of direct cell-to-cell transmission of cellular cargo in the context of human cancer. Our recent study of tunneling nanotubes in human malignant pleural mesothelioma and lung adenocarcinomas demonstrated efficient transfer of cellular contents, including proteins, Golgi vesicles, and mitochondria, between cells derived from several well-established cancer cell lines. Further, we provided effective demonstration that such nanotubes can form between primary malignant cells from human patients. For the first time, we also demonstrated the in vivo relevance of these structures in humans, having effectively imaged nanotubes in intact solid tumors from patients. Here we provide further analysis and discussion on our findings, and offer a prospective ‘road map’ for studying tunneling nanotubes in the context of human cancer. We hope that further understanding of the mechanisms, methods of transfer, and particularly the role of nanotubes in tumor-stromal cross-talk will lead to identification of new selective targets for cancer therapeutics. PMID:23060969

  4. Biomechanical properties of third carpal articular cartilage in exercised and nonexercised horses.

    PubMed

    Palmer, J L; Bertone, A L; Mansour, J; Carter, B G; Malemud, C J

    1995-11-01

    The relevance of site and exercise on the biomechanical properties of the articular cartilage from the equine third carpal bone were assessed by creep indentation testing. Six horses were exercised for 30 minutes three times weekly. Another six horses were housed in box stalls and were not exercised. At the conclusion of the study, one third carpal bone from each horse was harvested and the KLM biphasic material properties of cartilage were determined at 12 sites. There was a significant (p < 0.01) effect of site but not exercise on the cartilage aggregate modulus, which was significantly lower for sites on the dorsal aspect of the radial facet and for all sites on the intermediate facet as compared with sites on the palmar aspect of the radial facet of the third carpal bone. Exercise significantly increased the permeability constant at all sites when compared with the nonexercised group, but there was no difference between sites within groups. Exercise also significantly increased Poisson's ratio, but only at sites located on the palmar aspect of the radial facet. In general, both site and exercise influence the biomechanical behavior of third carpal articular cartilage. Inherent differences in cartilage biomechanical properties within a joint correlate with the location specificity of cartilaginous lesions in the equine midcarpal joint. PMID:8544021

  5. High-altitude decompression illness: case report and discussion

    PubMed Central

    Allan, G. Michael; Kenny, David

    2003-01-01

    DECOMPRESSION ILLNESS (DCI) CAN OCCUR in a variety of contexts, including scuba diving and flight in nonpressurized aircraft. It is characterized by joint pain, neurologic injury, and respiratory or constitutional symptoms. To prepare flight crews for accidental decompression events, the Canadian Armed Forces regularly conducts controlled and supervised depressurization exercises in specialized chambers. We present the cases of 3 Canadian Armed Forces personnel who successfully completed such decompression exercises but experienced DCI after they took a 3-hour commercial flight 6 hours after the completion of training. All 3 patients were treated in a hyperbaric oxygen chamber. The pathophysiology, diagnosis and management of DCI and the travel implications for military personnel who have undergone such training exercises are discussed. Although DCI is relatively uncommon, physicians may see it and should be aware of its presentation and treatment. PMID:14557320

  6. The Risks of Scuba Diving: A Focus on Decompression Illness

    PubMed Central

    2014-01-01

    Decompression Illness includes both Decompression Sickness (DCS) and Pulmonary Overinflation Syndrome (POIS), subsets of diving-related injury related to scuba diving. DCS is a condition in which gas bubbles that form while diving do not have adequate time to be resorbed or “off-gassed,” resulting in entrapment in specific regions of the body. POIS is due to an overly rapid ascent to the surface resulting in the rupture of alveoli and subsequent extravasation of air bubbles into tissue planes or even the cerebral circulation. Divers must always be cognizant of dive time and depth, and be trained in the management of decompression. A slow and controlled ascent, plus proper control of buoyancy can reduce the dangerous consequences of pulmonary barotrauma. The incidence of adverse effects can be diminished with safe practices, allowing for the full enjoyment of this adventurous aquatic sport. PMID:25478296

  7. Decompression sickness in simulated Apollo-Soyuz space missions

    NASA Technical Reports Server (NTRS)

    Cooke, J. P.; Robertson, W. G.

    1974-01-01

    Apollo-Soyuz docking module atmospheres were evaluated for incidence of decompression sickness in men simulating passage from the Russian spacecraft atmosphere, to the U.S. spacecraft atmosphere, and then to the American space suit pressure. Following 8 hr of 'shirtsleeve' exposure to 31:69::O2:N2 gas breathing mixture, at 10 psia, subjects were 'denitrogenated' for either 30 or 60 min with 100% O2 prior to decompression directly to 3.7 psia suit equivalent while performing exercise at fixed intervals. Five of 21 subjects experienced symptoms of decompression sickness after 60 min of denitrogenation compared to 6 among 20 subjects after 30 min of denitrogenation. A condition of Grade I bends was reported after 60 min of denitrogenation, and 3 of these 5 subjects noted the disappearance of all symptoms of bends at 3.7 psia. After 30 min of denitrogenation, 2 out of 6 subjects developed Grade II bends at 3.7 psia.

  8. A computerized databank of decompression sickness incidence in altitude chambers

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny; Bedahl, Sharon R.; Van Liew, Hugh D.

    1992-01-01

    This report describes a hypobaric decompression sickness databank (HDSD) for use with personal computers. The databank consolidates some of the decompression sickness (DCS) information that has accumulated from altitude chamber tests from 1942 to the present. The information was transcribed to a data collection form, screened for accuracy and duplication, and then added to the databank through a computer keyboard. The databank consists of two files; 63 fields contain details of the test conditions in the altitude chamber, the outcome of the test in terms of DCS and venous gas emboli, the physical characteristics of the group of subjects who underwent the test, and the denitrogenation procedures prior to decompression. The HDSD currently contains 378 records that represent 130,012 altitude exposures from 80 sources: scientific journal articles, government and contractor reports, and chapters from books.

  9. Surgical decompression in lower-extremity diabetic peripheral neuropathy.

    PubMed

    Rader, Andrew J

    2005-01-01

    Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation. PMID:16166461

  10. Arthroscopic Suprascapular Nerve Decompression: Transarticular and Subacromial Approach

    PubMed Central

    Bhatia, Sanjeev; Chalmers, Peter N.; Yanke, Adam B.; Romeo, Anthony A.; Verma, Nikhil N.

    2012-01-01

    Entrapment of the suprascapular nerve (SSN) is an increasingly recognized entity that can occur due to traction or compression-related etiology. Traction injuries of the SSN are unlikely to respond to surgical management and frequently improve with rest and avoidance of overhead activity. Compression injuries, on the other hand, frequently require surgical decompression for pain relief. SSN entrapment caused by compression at the suprascapular notch by the transverse scapular ligament gives rise to pain and atrophy of both the supraspinatus and infraspinatus muscles. However, compression at the spinoglenoid notch is more insidious because pain fibers may not be involved, causing isolated external rotation weakness. We present our preferred surgical technique for safe decompression of the SSN at the suprascapular and spinoglenoid notch using a subacromial and intra-articular approach, respectively. The key to ensuring efficient and uncomplicated decompression of the SSN relies on an intimate knowledge of the neurovascular anatomy and related landmarks. PMID:23766994

  11. Bubble formation in crabs induced by limb motions after decompression.

    PubMed

    McDonough, P M; Hemmingsen, E A

    1984-07-01

    In vivo bubble formation was studied in the megalopal stage of the crab Pachygrapsus crassipes. The animals were equilibrated with elevated argon, nitrogen, or helium pressures then rapidly decompressed to atmospheric pressure. Voluntary motions induced bubble nucleation in leg joints after exposures to as low as 2 atm nitrogen (gauge pressure). Delays of several minutes sometimes passed between decompression and bubble formation. Mechanically stimulating the animals to move their legs increased this bubble formation, whereas immobilizing the legs before gas equilibration prevented it, even in animals decompressed from 150 atm nitrogen. We conclude that preformed nuclei are not responsible for bubbles developing in the legs of this animal. Instead, tribonucleation of bubbles apparently occurs as a result of limb motions at relatively low gas supersaturations. PMID:6469773

  12. The risks of scuba diving: a focus on Decompression Illness.

    PubMed

    Hall, Jennifer

    2014-11-01

    Decompression Illness includes both Decompression Sickness (DCS) and Pulmonary Overinflation Syndrome (POIS), subsets of diving-related injury related to scuba diving. DCS is a condition in which gas bubbles that form while diving do not have adequate time to be resorbed or "off-gassed," resulting in entrapment in specific regions of the body. POIS is due to an overly rapid ascent to the surface resulting in the rupture of alveoli and subsequent extravasation of air bubbles into tissue planes or even the cerebral circulation. Divers must always be cognizant of dive time and depth, and be trained in the management of decompression. A slow and controlled ascent, plus proper control of buoyancy can reduce the dangerous consequences of pulmonary barotrauma. The incidence of adverse effects can be diminished with safe practices, allowing for the full enjoyment of this adventurous aquatic sport. PMID:25478296

  13. A critical review of physiological bubble formation in hyperbaric decompression.

    PubMed

    Papadopoulou, Virginie; Eckersley, Robert J; Balestra, Costantino; Karapantsios, Thodoris D; Tang, Meng-Xing

    2013-05-01

    Bubbles are known to form in the body after scuba dives, even those done well within the decompression model limits. These can sometimes trigger decompression sickness and the dive protocols should therefore aim to limit bubble formation and growth from hyperbaric decompression. Understanding these processes physiologically has been a challenge for decades and there are a number of questions still unanswered. The physics and historical background of this field of study is presented and the latest studies and current developments reviewed. Heterogeneous nucleation is shown to remain the prime candidate for bubble formation in this context. The two main theories to account for micronuclei stability are then to consider hydrophobicity of surfaces or tissue elasticity, both of which could also explain some physiological observations. Finally the modeling relevance of the bubble formation process is discussed, together with that of bubble growth as well as multiple bubble behavior. PMID:23523006

  14. Studying primate carpal kinematics in three dimensions using a computed-tomography-based markerless registration method.

    PubMed

    Orr, Caley M; Leventhal, Evan L; Chivers, Spencer F; Marzke, Mary W; Wolfe, Scott W; Crisco, Joseph J

    2010-04-01

    The functional morphology of the wrist pertains to a number of important questions in primate evolutionary biology, including that of hominins. Reconstructing locomotor and manipulative capabilities of the wrist in extinct species requires a detailed understanding of wrist biomechanics in extant primates and the relationship between carpal form and function. The kinematics of carpal movement, and the role individual joints play in providing mobility and stability of the wrist, is central to such efforts. However, there have been few detailed biomechanical studies of the nonhuman primate wrist. This is largely because of the complexity of wrist morphology and the considerable technical challenges involved in tracking the movements of the many small bones that compose the carpus. The purpose of this article is to introduce and outline a method adapted from human clinical studies of three-dimensional (3D) carpal kinematics for use in a comparative context. The method employs computed tomography of primate cadaver forelimbs in increments throughout the wrist's range of motion, coupled with markerless registration of 3D polygon models based on inertial properties of each bone. The 3D kinematic principles involved in extracting motion axis parameters that describe bone movement are reviewed. In addition, a set of anatomically based coordinate systems embedded in the radius, capitate, hamate, lunate, and scaphoid is presented for the benefit of other primate functional morphologists interested in studying carpal kinematics. Finally, a brief demonstration of how the application of these methods can elucidate the mechanics of the wrist in primates illustrates the closer-packing of carpals in chimpanzees than in orangutans, which may help to stabilize the midcarpus and produce a more rigid wrist beneficial for efficient hand posturing during knuckle-walking locomotion. PMID:20235325

  15. Decompression to altitude: assumptions, experimental evidence, and future directions.

    PubMed

    Foster, Philip P; Butler, Bruce D

    2009-02-01

    Although differences exist, hypobaric and hyperbaric exposures share common physiological, biochemical, and clinical features, and their comparison may provide further insight into the mechanisms of decompression stress. Although altitude decompression illness (DCI) has been experienced by high-altitude Air Force pilots and is common in ground-based experiments simulating decompression profiles of extravehicular activities (EVAs) or astronauts' space walks, no case has been reported during actual EVAs in the non-weight-bearing microgravity environment of orbital space missions. We are uncertain whether gravity influences decompression outcomes via nitrogen tissue washout or via alterations related to skeletal muscle activity. However, robust experimental evidence demonstrated the role of skeletal muscle exercise, activities, and/or movement in bubble formation and DCI occurrence. Dualism of effects of exercise, positive or negative, on bubble formation and DCI is a striking feature in hypobaric exposure. Therefore, the discussion and the structure of this review are centered on those highlighted unresolved topics about the relationship between muscle activity, decompression, and microgravity. This article also provides, in the context of altitude decompression, an overview of the role of denitrogenation, metabolic gases, gas micronuclei, stabilization of bubbles, biochemical pathways activated by bubbles, nitric oxide, oxygen, anthropometric or physiological variables, Doppler-detectable bubbles, and potential arterialization of bubbles. These findings and uncertainties will produce further physiological challenges to solve in order to line up for the programmed human return to the Moon, the preparation for human exploration of Mars, and the EVAs implementation in a non-zero gravity environment. PMID:19074573

  16. The 1990 Hypobaric Decompression Sickness Workshop: Summary and conclusions

    NASA Technical Reports Server (NTRS)

    Pilmanis, Andrew A.; Stegmann, Barbara J.; Scoggins, Terrell E.

    1992-01-01

    Decompression sickness resulting from exposure to the hypobaric environment was reviewed and discussed at a three day workshop in Oct. 1990. This milestone meeting, attended by over 50 participants representing the Dept. of Defense, NASA, ESA, and academia, updated the current understanding of altitude decompression sickness (DCS). Both research and operational aspects of this illness were addressed through presentations on the pathophysiology and clinical manifestations of DCS, its incidence in aviation and space operations, and existing and proposed measures for DCS prevention. Specific areas requiring further research were also identified. A summary is presented for the material given at the workshop.

  17. Decompression surgery for spinal metastases: a systematic review.

    PubMed

    Bakar, Dara; Tanenbaum, Joseph E; Phan, Kevin; Alentado, Vincent J; Steinmetz, Michael P; Benzel, Edward C; Mroz, Thomas E

    2016-08-01

    OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that

  18. Non-equilibrium and unsteady fluid degassing during slow decompression

    NASA Astrophysics Data System (ADS)

    Hammer, Julia E.; Manga, Michael; Cashman, Katharine V.

    Decompression experiments were performed on corn syrup-water solutions in order to investigate the effect of viscosity on processes of vesiculation and degassing at low to moderate degrees of volatile supersaturation. Repeat experiments demonstrated similar long term vesiculation behavior at moderate decompression rates despite highly variable initial nucleation styles. Results suggest that magmas may not necessarily achieve chemical equilibrium by vapor exsolution and may require viscosity-dependent critical supersaturations in order to vesiculate. Vesiculation also increased the ambient pressure and decreased supersaturations, resulting in unsteady degassing.

  19. Decompression experiments identify kinetic controls on explosive silicic eruptions

    USGS Publications Warehouse

    Mangan, M.T.; Sisson, T.W.; Hankins, W.B.

    2004-01-01

    Eruption intensity is largely controlled by decompression-induced release of water-rich gas dissolved in magma. It is not simply the amount of gas that dictates how forcefully magma is propelled upwards during an eruption, but also the rate of degassing, which is partly a function of the supersaturation pressure (??Pcritical) triggering gas bubble nucleation. High temperature and pressure decompression experiments using rhyolite and dacite melt reveal compositionally-dependent differences in the ??Pcritical of degassing that may explain why rhyolites have fueled some of the most explosive eruptions on record.

  20. Domino Tunneling.

    PubMed

    Schreiner, Peter R; Wagner, J Philipp; Reisenauer, Hans Peter; Gerbig, Dennis; Ley, David; Sarka, János; Császár, Attila G; Vaughn, Alexander; Allen, Wesley D

    2015-06-24

    Matrix-isolation experiments near 3 K and state-of-the-art quantum chemical computations demonstrate that oxalic acid [1, (COOH)2] exhibits a sequential quantum mechanical tunneling phenomenon not previously observed. Intensities of numerous infrared (IR) bands were used to monitor the temporal evolution of the lowest-energy O-H rotamers (1cTc, 1cTt, 1tTt) of oxalic acid for up to 19 days following near-infrared irradiation of the matrix. The relative energies of these rotamers are 0.0 (1cTc), 2.6 (1cTt), and 4.0 (1tTt) kcal mol(-1). A 1tTt → 1cTt → 1cTc isomerization cascade was observed with half-lives (t1/2) in different matrix sites ranging from 30 to 360 h, even though the sequential barriers of 9.7 and 10.4 kcal mol(-1) are much too high to be surmounted thermally under cryogenic conditions. A general mathematical model was developed for the complex kinetics of a reaction cascade with species in distinct matrix sites. With this model, a precise, global nonlinear least-squares fit was achieved simultaneously on the temporal profiles of nine IR bands of the 1cTc, 1cTt, and 1tTt rotamers. Classes of both fast (t(1/2) = 30-50 h) and slow (t(1/2) > 250 h) matrix sites were revealed, with the decay rate of the former in close agreement with first-principles computations for the conformational tunneling rates of the corresponding isolated molecules. Rigorous kinetic and theoretical analyses thus show that a "domino" tunneling mechanism is at work in these oxalic acid transformations. PMID:26027801

  1. Looking into Tunnel Books.

    ERIC Educational Resources Information Center

    Hinshaw, Craig

    1999-01-01

    Describes how to make tunnel books, which are viewed by looking into a "tunnel" created by accordion-folded expanding sides. Suggests possible themes. Describes how to create a walk-through tunnel book for first grade students. (CMK)

  2. Eruptive dynamics during magma decompression: a laboratory approach

    NASA Astrophysics Data System (ADS)

    Spina, L.; Cimarelli, C.; Scheu, B.; Wadsworth, F.; Dingwell, D. B.

    2013-12-01

    A variety of eruptive styles characterizes the activity of a given volcano. Indeed, eruptive styles can range from effusive phenomena to explosive eruptions, with related implications for hazard management. Rapid changes in eruptive style can occur during an ongoing eruption. These changes are, amongst other, related to variations in the magma ascent rate, a key parameter affecting the eruptive style. Ascent rate is in turn dependent on several factors such as the pressure in the magma chamber, the physical properties of the magma and the rate at which these properties change. According to the high number of involved parameters, laboratory decompression experiments are the best way to achieve quantitative information on the interplay of each of those factors and the related impact on the eruption style, i.e. by analyzing the flow and deformation behavior of the transparent volatile-bearing analogue fluid. We carried out decompression experiments following different decompression paths and using silicone oil as an analogue for the melt, with which we can simulate a range of melt viscosity values. For a set of experiments we added rigid particles to simulate the presence of crystals in the magma. The pure liquid or suspension was mounted into a transparent autoclave and pressurized to different final pressures. Then the sample was saturated with argon for a fixed amount of time. The decompression path consists of a slow decompression from the initial pressure to the atmospheric condition. Alternatively, samples were decompressed almost instantaneously, after established steps of slow decompression. The decompression path was monitored with pressure transducers and a high-speed video camera. Image analysis of the videos gives quantitative information on the bubble distribution with respect to depth in the liquid, pressure and time of nucleation and on their characteristics and behavior during the ongoing magma ascent. Furthermore, we also monitored the evolution of

  3. 46 CFR Appendix A to Part 197 - Air No-Decompression Limits

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Air No-Decompression Limits A Appendix A to Part 197... STANDARDS GENERAL PROVISIONS Pt. 197, App. A Appendix A to Part 197—Air No-Decompression Limits The following table gives the depth versus bottom time limits for single, no-decompression, air dives...

  4. 46 CFR Appendix A to Part 197 - Air No-Decompression Limits

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Air No-Decompression Limits A Appendix A to Part 197... STANDARDS GENERAL PROVISIONS Pt. 197, App. A Appendix A to Part 197—Air No-Decompression Limits The following table gives the depth versus bottom time limits for single, no-decompression, air dives...

  5. Hyperbaric oxygen pre-breathe modifies the outcome of decompression sickness.

    PubMed

    Butler, B D; Little, T; Cogan, V; Powell, M

    2006-01-01

    Deep sea divers, aviators and astronauts are at risk of decompression sickness when the ambient pressure reductions exceed a critical threshold. Venous bubbles associated with decompression sickness have the potential to react with the vascular membrane and adjacent blood products, eliciting an inflammatory cascade. Preventive measures usually involve careful decompression procedures to avoid or reduce bubble formation. De-nitrogenation with 100% oxygen pre-breathing as a preventive measure has been well established at least in altitude decompression exposures. The objective of this study was to determine the physiological and biochemical effects of Hyperbaric Oxygen Pre-breathe (HBOP) upon decompression from a hyperbaric exposure. Male Sprague-Dawley rats were randomly assigned to one of eight groups. Two experimental groups received HBOP at 1 and 18 hours prior to decompression, as compared with ground level oxygen or non-treated groups that still experienced decompression stress, and the associated non-decompressed controls. The results showed decreased extravascular lung water (pulmonary edema), bronchoalveolar lavage and pleural protein and arterial, broncho-alveolar lavage, and urine leukotriene E4 (LKE4) levels in both the 1Hr and 18Hr HBOP decompressed rats compared to non-oxygenated decompressed rats, as well as a decreased overall expression of signs of decompression sickness. This study indicates that HBOP-treated rats exhibit fewer signs and complications of decompression sickness compared with non-treated or ground level oxygen treated rats. PMID:17274310

  6. A Log Logistic Survival Model Applied to Hypobaric Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Conkin, Johnny

    2001-01-01

    Decompression sickness (DCS) is a complex, multivariable problem. A mathematical description or model of the likelihood of DCS requires a large amount of quality research data, ideas on how to define a decompression dose using physical and physiological variables, and an appropriate analytical approach. It also requires a high-performance computer with specialized software. I have used published DCS data to develop my decompression doses, which are variants of equilibrium expressions for evolved gas plus other explanatory variables. My analytical approach is survival analysis, where the time of DCS occurrence is modeled. My conclusions can be applied to simple hypobaric decompressions - ascents lasting from 5 to 30 minutes - and, after minutes to hours, to denitrogenation (prebreathing). They are also applicable to long or short exposures, and can be used whether the sufferer of DCS is at rest or exercising at altitude. Ultimately I would like my models to be applied to astronauts to reduce the risk of DCS during spacewalks, as well as to future spaceflight crews on the Moon and Mars.

  7. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Equipment § 197.332 PVHO—Decompression chambers... minimum pressure capability of— (1) 6 ATA, when used for diving to 300 fsw; or (2) The maximum depth of the dive, when used for diving operations deeper than 300 fsw, unless a closed bell meeting...

  8. Does temperature increase or decrease in adiabatic decompression of magma?

    NASA Astrophysics Data System (ADS)

    Kilinc, A. I.; Ghiorso, M. S.; Khan, T.

    2011-12-01

    We have modeled adiabatic decompression of an andesitic and a basaltic magma as an isentropic process using the Melts algorithm. Our modeling shows that during adiabatic decompression temperature of andesitic magma increases but temperature of basaltic magma decreases. In an isentropic process entropy is constant so change of temperature with pressure can be written as dT/dP=T (dV/dT)/Cp where T (dV/dT)/Cp is generally positive. If delta P is negative so is delta T. In general, in the absence of phase change, we expect the temperature to decrease with adiabatic decompression. The effect of crystallization is to turn a more entropic phase (liquid) into a less entropic phase (solid), which must be compensated by raising the temperature. If during adiabatic decompression there is small amount or no crystallization, T (dV/dT)/Cp effect which lowers the temperature overwhelms the small amount of crystallization, which raises the temperature, and overall system temperature decreases.

  9. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... minimum pressure capability of— (1) 6 ATA, when used for diving to 300 fsw; or (2) The maximum depth of the dive, when used for diving operations deeper than 300 fsw, unless a closed bell meeting the... minute to 60 fsw and at least 1 ATA per minute thereafter; (j) Have a decompression rate of 1 ATA...

  10. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... minimum pressure capability of— (1) 6 ATA, when used for diving to 300 fsw; or (2) The maximum depth of the dive, when used for diving operations deeper than 300 fsw, unless a closed bell meeting the... minute to 60 fsw and at least 1 ATA per minute thereafter; (j) Have a decompression rate of 1 ATA...

  11. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... minimum pressure capability of— (1) 6 ATA, when used for diving to 300 fsw; or (2) The maximum depth of the dive, when used for diving operations deeper than 300 fsw, unless a closed bell meeting the... minute to 60 fsw and at least 1 ATA per minute thereafter; (j) Have a decompression rate of 1 ATA...

  12. Pediatric traumatic brain injuries treated with decompressive craniectomy

    PubMed Central

    Patel, Neil; West, Michael; Wurster, Joanie; Tillman, Cassie

    2013-01-01

    Background: Traumatic brain injury (TBI) occurs in an estimated 80% of all pediatric trauma patients and is the leading cause of death and disability in the pediatric population. Decompressive craniectomy is a procedure used to decrease intracranial pressure by allowing the brain room to swell and therefore increase cerebral perfusion to the brain. Methods: This is a retrospective study done at St. Mary's Medical Center/Palm Beach Children's Hospital encompassing a 3 year 7 month period. All the pediatric patients who sustained a TBI and who were treated with a decompressive craniectomy were included. The patients’ outcomes were monitored and scored according to the Rancho Los Amigos Score at the time of discharge from the hospital and 6 months postdischarge. Results: A total of 379 pediatric patients with a diagnosis of TBI were admitted during this time. All these patients were treated according to the severity of their injury. A total of 49 pediatric patients required neurosurgical intervention and 7 of these patients met the criteria for a decompressive craniectomy. All seven patients returned home with favorable outcomes. Conclusion: This study supports the current literature that decompressive craniectomy is no longer an intervention used as a last resort but an effective first line treatment to be considered. PMID:24232244

  13. 46 CFR 197.332 - PVHO-Decompression chambers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... requirements of § 197.330(a) (3), (4), and (5) is used; (i) Have a minimum pressurization rate of 2 ATA per minute to 60 fsw and at least 1 ATA per minute thereafter; (j) Have a decompression rate of 1 ATA per... capability to supply breathing mixtures at the maximum rate required by each occupant doing heavy work;...

  14. Ventral Decompression in Chiari Malformation, Basilar Invagination, and Related Disorders.

    PubMed

    Ridder, Thomas; Anderson, Richard C E; Hankinson, Todd C

    2015-10-01

    Ventral brainstem compression is an uncommon clinical diagnosis seen by pediatric neurosurgeons and associated with Chiari malformation, type I. Presenting clinical symptoms often include headaches, lower cranial neuropathies, myelopathy, central sleep apnea, ataxia, and nystagmus. When ventral decompression is required, both open and endoscopic transoral/transnasal approaches are highly effective. PMID:26408067

  15. Decompressive Craniectomy and Traumatic Brain Injury: A Review

    PubMed Central

    Alvis-Miranda, Hernando; Castellar-Leones, Sandra Milena; Moscote-Salazar, Luis Rafael

    2013-01-01

    Intracranial hypertension is the largest cause of death in young patients with severe traumatic brain injury. Decompressive craniectomy is part of the second level measures for the management of increased intracranial pressure refractory to medical management as moderate hypothermia and barbiturate coma. The literature lack of concepts is their indications. We present a review on the state of the art. PMID:27162826

  16. Percutaneous laser disc decompression with the holmium: YAG laser.

    PubMed

    Casper, G D; Hartman, V L; Mullins, L L

    1995-06-01

    This article discusses the evolution of the percutaneous laser disc decompression (PLDD) method using a holmium:YAG laser. Advantages of using this wavelength and several techniques for its use in PLDD are reviewed. The article also discusses the current devices and delivery systems available for this application. PMID:10150646

  17. 29 CFR Appendix A to Subpart S of... - Decompression Tables

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 8 2014-07-01 2014-07-01 false Decompression Tables A Appendix A to Subpart S of Part 1926 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION Underground Construction, Caissons, Cofferdams and Compressed Air Pt....

  18. Role of Inflammatory Reponse in Experimental Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Little, T.

    1999-01-01

    Decompression to altitude can result in gas bubble formation both in tissues and in the systemic veins. The venous gas emboli (VGE) are often monitored during decompression exposures to assess risk for decompression sickness (DCS). Astronauts are at risk for DCS during extravehicular activities (EVA), where decompression occurs from the Space Shuttle or Space Station atmospheric pressure of 14.7 pounds per square inch (PSI) to that of the space suit pressure of 4.3 PSI. DCS symptoms include diffuse pain, especially around joints, inflammation and edema. Pathophysiological effects include interstitial inflammatory responses and recurring injury to the vascular endothelium. Such responses can result in vasoconstriction and associated hemodynamic changes.The granulocyte cell activation and chemotaxin release results in the formation of vasoactive and microvascular permeability altering mediators, especially from the lungs which are the principal target organ for the venous bubbles, and from activated cells (neutrophils, platelets, macrophages). Such mediators include free arachidonic acid and the byproducts of its metabolism via the cyclooxygenase and lipoxygenase pathways (see figure). The cyclooxygenase pathway results in formation of prostacyclin and other prostaglandins and thromboxanes that cause vasoconstriction, bronchoconstriction and platelet aggregation. Leukotrienes produced by the alternate pathway cause pulmonary and bronchial smooth muscle contraction and edema. Substances directly affecting vascular tone such as nitric oxide may also play a role in the respose to DCS. We are studying the role and consequent effects of the release inflammatory bioactive mediators as a result of DCS and VGE. More recent efforts are focused on identifying the effects of the body's circadian rhythm on these physiological consequences to decompression stress. al

  19. Cervical Cord Decompression Using Extended Anterior Cervical Foraminotomy Technique

    PubMed Central

    Kim, Sung-Duk; Lee, Cheol-Young; Kim, Hyun-Woo; Jung, Chul-Ku; Kim, Jong Hyun

    2014-01-01

    Objective At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. Methods Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. Results In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was 9.77 mm2 (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. Conclusions Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed. PMID:25328648

  20. Paradoxical Herniation After Unilateral Decompressive Craniectomy Predicts Better Patient Survival

    PubMed Central

    Chen, Weiqiang; Guo, Jingfang; Wu, Jin; Peng, Guoyi; Huang, Mindong; Cai, Chuwei; Yang, Yingming; Wang, Shousen

    2016-01-01

    Abstract Paradoxical herniation (PH) is a life-threatening emergency after decompressive craniectomy. In the current study, we examined patient survival in patients who developed PH after decompressive craniectomy versus those who did not. Risk factors for, and management of, PH were also analyzed. This retrospective analysis included 429 consecutive patients receiving decompressive craniectomy during a period from January 2007 to December 2012. Mortality rate and Glasgow Outcome Scale (GOS) were compared between those who developed PH (n = 13) versus those who did not (n = 416). A stepwise multivariate logistic regression analysis was carried out to examine the risk factors for PH. The overall mortality in the entire sample was 22.8%, with a median follow-up of 6 months. Oddly enough, all 13 patients who developed PH survived beyond 6 months. Glasgow Coma Scale did not differ between the 2 groups upon admission, but GOS was significantly higher in subjects who developed PH. Both the disease type and coma degree were comparable between the 13 PH patients and the remaining 416 patients. In all PH episodes, patients responded to emergency treatments that included intravenous hydration, cerebral spinal fluid drainage discontinuation, and Trendelenburg position. A regression analysis indicated the following independent risk factors for PH: external ventriculostomy, lumbar puncture, and continuous external lumbar drainage. The rate of PH is approximately 3% after decompressive craniectomy. The most intriguing findings of the current study were the 0% mortality in those who developed PH versus 23.6% mortality in those who did not develop PH and significant difference of GOS score at 6-month follow-up between the 2 groups, suggesting that PH after decompressive craniectomy should be managed aggressively. The risk factors for PH include external ventriculostomy, ventriculoperitoneal shunt, lumbar puncture, and continuous external lumbar drainage. PMID:26945365

  1. Comparison of clinical outcomes in decompression and fusion versus decompression only in patients with ossification of the posterior longitudinal ligament: a meta-analysis.

    PubMed

    Mehdi, Syed K; Alentado, Vincent J; Lee, Bryan S; Mroz, Thomas E; Benzel, Edward C; Steinmetz, Michael P

    2016-06-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a pathological calcification or ossification of the PLL, predominantly occurring in the cervical spine. Although surgery is often necessary for patients with symptomatic neurological deterioration, there remains controversy with regard to the optimal surgical treatment. In this systematic review and meta-analysis, the authors identified differences in complications and outcomes after anterior or posterior decompression and fusion versus after decompression alone for the treatment of cervical myelopathy due to OPLL. METHODS A MEDLINE, SCOPUS, and Web of Science search was performed for studies reporting complications and outcomes after decompression and fusion or after decompression alone for patients with OPLL. A meta-analysis was performed to calculate effect summary mean values, 95% CIs, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 2630 retrieved articles, 32 met the inclusion criteria. There was no statistically significant difference in the incidence of excellent and good outcomes and of fair and poor outcomes between the decompression and fusion and the decompression-only cohorts. However, the decompression and fusion cohort had a statistically significantly higher recovery rate (63.2% vs 53.9%; p < 0.0001), a higher final Japanese Orthopaedic Association score (14.0 vs 13.5; p < 0.0001), and a lower incidence of OPLL progression (< 1% vs 6.3%; p < 0.0001) compared with the decompression-only cohort. There was no statistically significant difference in the incidence of complications between the 2 cohorts. CONCLUSIONS This study represents the only comprehensive review of outcomes and complications after decompression and fusion or after decompression alone for OPLL across a heterogeneous group of surgeons and patients. Based on these results, decompression and fusion is a superior surgical technique compared with posterior

  2. Electron tunnel sensor technology

    NASA Technical Reports Server (NTRS)

    Waltman, S. B.; Kaiser, W. J.

    1989-01-01

    The recent development of Scanning Tunneling Microscopy technology allows the application of electron tunneling to position detectors for the first time. The vacuum tunnel junction is one of the most sensitive position detection mechanisms available. It is also compact, simple, and requires little power. A prototype accelerometer based on electron tunneling, and other sensor applications of this promising new technology are described.

  3. The occult dorsal carpal ganglion: usefulness of magnetic resonance imaging and ultrasound in diagnosis.

    PubMed

    Blam, O; Bindra, R; Middleton, W; Gelberman, R

    1998-02-01

    Both magnetic resonance imaging and ultrasonography of the wrist have been advocated for the diagnosis of occult dorsal carpal ganglia. This clinical series compares the utility of the two techniques for confirming clinical suspicion of such occult ganglia. Four wrists in three patients with suspected occult dorsal ganglia were identified prospectively over a 12-month period. Each patient underwent imaging with both techniques on the same day. Subsequently, the wrist was operatively explored and the excised tissue was microscopically evaluated. All wrists in this series had positive magnetic resonance imaging and ultrasound findings, with operative and histologic confirmation of the diagnosis. No diagnostic advantage of one imaging study over the other was identified. With its lower cost and lack of contraindications, ultrasound may be the more suitable technique for establishing the diagnosis of occult dorsal carpal ganglion when clinical findings are inconclusive. PMID:9506195

  4. Effects of State and Decompression Rate on the Decompressive Response of Volatile- and Crystal-Bearing Analogue Magmas.

    NASA Astrophysics Data System (ADS)

    Spina, L.; Cimarelli, C.; Scheu, B.; Dingwell, D. B.

    2014-12-01

    Volcanic eruptive styles are influenced both by the physical properties of the ascending magma as well as the decompression rates involved. Systematic experimental investigations of both state and rate have been performed here on analogue basaltic systems. Controlled decompression experiments were performed in a shock tube system, using a silicon oil basis as the basalt proxy. The samples were saturated with 10 MPa of Ar for 72h, followed by controlled decompression. Four series of experiments were performed: 1) Pure liquids with viscosities ranging from 1 to 1000 Pa s were used to map the liquid response. 2) Micrometric spherical particles were added to the liquid to evaluate the effect of crystal fraction. 3) The role of crystal shape was examined by using particles with different aspect ratios. 4) Finally, the effects of saturation time and of pressure were examined via a series of experiments at 24 h, performed over a range of saturation pressure. The dynamics of foaming and flow of the bubbly fluid during decompression were constrained using image analysis, by measuring the height of the expanding column, as well as analyzing the bubble size distribution. At the onset a delayed nucleation event is observed. When the amount of nucleated bubbles approaches a critical thickness, a foam develops. Finally, the foam reaches equilibrium, and starts oscillating in response to the balance between foam disruption and growth. These observation may have important implications for oscillatory eruptive phenomena observed in active volcanoes (i.e. gas piston activity). Finally, the effect of crystals was investigated. In their presence, heterogeneous nucleation enhances the number of bubble nuclei, even at low crystal fractions. As a consequence, the foam develops earlier, and is able to ascend with major upward speed, in comparison to the pure oil. Experimental decompression of silicon oil has proven to be a unique tool to unravel the hidden dynamics of magma into the

  5. 15-Foot Spin Tunnel

    NASA Technical Reports Server (NTRS)

    1934-01-01

    Constructing the forms for the foundation of the 15-Foot Spin Tunnel. Charles Zimmerman was given the assignment to design and build a larger spin tunnel that would supplant the 5-foot Vertical Wind Tunnel. Authorization to build the tunnel using funds from the Federal Public Works Administration (PWA) came in June 1933. Construction started in late winter 1934 and the tunnel was operational in April 1935. The initial construction costs were $64,000. The first step was to pour the foundation for the tunnel and the housing which would encase the wind tunnel.

  6. On diver thermal status and susceptibility to decompression sickness.

    PubMed

    Gerth, Wayne A

    2015-09-01

    In a recent Letter to the Editor, Clarke, et al, indicated that divers who deliberately chill themselves on a dive to reduce risk of decompression sickness (DCS) may be misinterpreting our 2007 Navy Experimental Diving Unit (NEDU) report. Indeed, we did not advocate that divers should risk hypothermia on bottom to reduce risk of DCS, nor do we dispute the authors' overall admonition to avoid diving cold unnecessarily. However, Clarke, et al, imply more generally that results of our study are not applicable to recreational or technical divers because the dives we tested were atypical of dives undertaken by such divers. We wish to clarify that our study does have implications for recreational and technical divers, implications that should not be ignored. The dives we tested were not intended to be typical of dives undertaken in any actual operational context. Instead, we chose to expose divers to temperatures at the extremes of their thermal tolerance in order to ensure that effects of diver thermal status on DCS susceptibility would be found if such effects existed. Our initial test dive profile provided appreciable time both on bottom and during decompression to allow any differential thermal effects during these two dive phases to manifest, while affording a baseline risk of DCS that could be altered by thermal effects without exposing subjects to inordinately high risks of DCS. Our results strongly indicate that the optimal diver thermal conditions for mitigation of DCS risk or minimization of decompression time entail remaining cool during gas uptake phases of a dive and warm during off-gassing phases. While the dose-response characteristics of our observed thermal effects are almost certainly non-linear in both exposure temperature and duration, it is only reasonable to presume that the effects vary monotonically with these factors. We have no reason to presume that such responses and effects under less extreme conditions would be in directions opposite to

  7. [A single metastasis in the carpal bones as the first clinical manifestation of a hepatocellular carcinoma].

    PubMed

    Corrales Pinzón, R; Alonso Sánchez, J M; de la Mano González, S; El Karzazi Tarazona, K

    2014-01-01

    Hepatocellular carcinoma is the most common primary tumor of the liver. Spreading outside the liver usually takes place in advanced stages of the disease, and bone is the third most common site of metastases. We present a case of hepatocellular carcinoma in which the first clinical manifestation was a single metastasis to the carpal bones. The interest of this case lies in the way this hepatocellular carcinoma manifested as well as in the unusual site of the metastasis. PMID:23092693

  8. Risk of decompression sickness in the presence of circulating microbubbles

    NASA Technical Reports Server (NTRS)

    Kumar, K. Vasantha; Powell, Michael R.

    1993-01-01

    In this study, we examined the association between microbubbles formed in the circulation from a free gas phase and symptoms of altitude decompression sickness (DCS). In a subgroup of 59 males of mean (S.D) age 31.2 (5.8) years who developed microbubbles during exposure to 26.59 kPa (4.3 psi) under simulated extravehicular activities (EVA), symptoms of DCS occurred in 24 (41 percent) individuals. Spencer grade 1 microbubbles occurred in 4 (7 percent), grade 2 in 9 (15 percent), grade 3 in 15 (25 percent), and grade 4 in 31 (53 percent) of subjects. Survival analysis using Cox proportional hazards regression showed that individuals with less than grade 3 CMB showed 2.46 times (95 percent confidence interval = 1.26 to 5.34) higher risk of symptoms. This information is crucial for defining the risk of DCS for inflight Doppler monitoring under space EVA. Altitude decompression sickness (DCS) occurs when there is acute reduction in ambient pressure. The symptoms of DCS are due to the formation of a free gas phase (in the form of gas microbubbles) in tissues during decompression. Musculo-skeletal pain of bends is the commonest form of DCS in altitude exposures. In the space flight environment, there is a risk of DCS when astronauts decompress from the normobaric shuttle pressure into the hypobaric space suit pressure (currently about 29.65 kPa (4.3 psi) for extra-vehicular activities (EVA). This risk is counterbalanced by a judicious combination of prior denitrogenation and staged decompression. Studies of DCS are limited by the duration of the test at reduced pressure. Since only a proportion of subjects tested develop symptoms, the information on DCS is generally incomplete or 'censored'. Many studies employ Doppler ultrasound monitoring of the precordial area for detecting circulating microbubbles (CMB). Although the association between CMB and bends pain is not causal, CMB are frequently monitored during decompression. In this paper, we examine the association

  9. Investigating degassing dynamics into the shallow conduit through decompression experiments

    NASA Astrophysics Data System (ADS)

    Spina, Laura; Scheu, Bettina; Cimarelli, Corrado; Dingwell, Donald

    2014-05-01

    The history of bubbles' growth and interaction, as well as their spatial distribution in the shallow conduit, is deeply interconnected with the style of the eruptions. According to the fundamental role played by volatiles in the eruptive process, more effort is required in determining how the key factors of volcanic systems (i.e., magma properties, decompression rate) influence the dynamics of degassing. Therefore, our aim is to provide, through the analysis of decompression experiments on analogue materials, insights on such relations. We performed several decompression experiments with a shock-tube apparatus, and using silicon oil as laboratory-analogue for the magmatic melt. The sample was placed in a transparent autoclave, saturated with Argon for an established amount of time under a fixed pressure (up to a maximum of 10 MPa). Successively it was decompressed to atmospheric conditions, by releasing gas through a control valve. The dynamics of gas exsolution processes were recorded by using pressure sensors and a high speed camera. A range of viscosity values (1, 10, 100, 1000 Pa s) was investigated, for the same decompression path. Furthermore, some experiments were carried out with the addition of glass beads, as analogue to crystals, to the pure liquid. The height of the expanding column was monitored, in conjunction with images recorded during the experiments, and the growth rate of bubbles was measured at different times and depth. Finally, bubble size distribution has been evaluated at various stages for some experiments, in order to achieve a spatial map of the ongoing degassing phenomena. Results allowed us to define different regimes occurring during the decompression, whose features and characteristics are strongly affected by fluid viscosity. Indeed, several degassing phases were observed, from bubbly fluid to the eventual buildup of a more or less "foamy" phase, which ultimately experiences periodical oscillations around an average equilibrium level

  10. Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones

    PubMed Central

    Yu, Kunlun; Shao, Xinzhong; Tian, Dehu; Bai, Jiangbo; Zhang, Bing; Zhang, Yingze

    2016-01-01

    The aim of the present study was to treat intraosseous ganglia of the carpal bones with injectable bone cement grafting. Between January 2012 and December 2013, 4 patients (3 men and 1 woman) presenting with wrist pain and activity limitation were diagnosed with intraosseous ganglion of the carpal bones by radiography. The patients were treated with minimal invasive curettage and bone cement injection surgery. All patients were followed up for a mean time of 17 months (range, 12–22 months). The wrist pain was significantly reduced in all patients following surgery. In addition, the activity range and grip strength were also improved compared with the preoperative parameters. Subsequent to treatment, the Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score presented mean values of 78.8 (range, 75–80) and 11 (range, 7.7–15.0), respectively. These results suggested that the patients showed a good recovery. All patients were satisfied with the postoperative results and returned to work within 4 weeks. In conclusion, bone cement injection is an effective and safe therapeutic strategy for the treatment of intraosseous ganglia of the carpal bone. PMID:27588074

  11. Operative Technique and Clinical Outcome in Endoscopic Core Decompression of Osteochondral Lesions of the Talus: A Pilot Study

    PubMed Central

    Beck, Sascha; Claßen, Tim; Haversath, Marcel; Jäger, Marcus; Landgraeber, Stefan

    2016-01-01

    Background Revitalizing the necrotic subchondral bone and preserving the intact cartilage layer by retrograde drilling is the preferred option for treatment of undetached osteochondral lesions of the talus (OLT). We assessed the effectiveness of Endoscopic Core Decompression (ECD) in treatment of OLT. Material/Methods Seven patients with an undetached OLT of the medial talar dome underwent surgical treatment using an arthroscopically-guided transtalar drill meatus for core decompression of the lesion. Under endoscopic visualization the OLT was completely debrided while preserving the cartilage layer covering the defect. The drill tunnel and debrided OLT were filled using an injectable bone graft substitute. Various clinical scores, radiographic imaging, and MRI were evaluated after a mean follow-up of 24.1 months. Results The American Orthopedic Foot and Ankle Society Score significantly improved from 71.0±2.4 to 90.3±5.9, and the Foot and Ankle Disability Index improved from 71.8±11.1 to 91.7±4.8. Radiographically, we observed good bone remodelling of the medial talar dome contour within 3 months. In MRI, an alteration of the bony signal of the drill tunnel and the excised OLT remained for more than 12 months. Conclusions First follow-up results for the surgical technique described in this study are highly promising for treatment of undetached stable OLT grade II or transitional stage II–III according to the Pritsch classification. Even lesions larger than 150 mm2 showed good clinical scores, with full restoration of the medial talar dome contour in radiographic imaging. PMID:27362485

  12. Operative Technique and Clinical Outcome in Endoscopic Core Decompression of Osteochondral Lesions of the Talus: A Pilot Study.

    PubMed

    Beck, Sascha; Claßen, Tim; Haversath, Marcel; Jäger, Marcus; Landgraeber, Stefan

    2016-01-01

    BACKGROUND Revitalizing the necrotic subchondral bone and preserving the intact cartilage layer by retrograde drilling is the preferred option for treatment of undetached osteochondral lesions of the talus (OLT). We assessed the effectiveness of Endoscopic Core Decompression (ECD) in treatment of OLT. MATERIAL AND METHODS Seven patients with an undetached OLT of the medial talar dome underwent surgical treatment using an arthroscopically-guided transtalar drill meatus for core decompression of the lesion. Under endoscopic visualization the OLT was completely debrided while preserving the cartilage layer covering the defect. The drill tunnel and debrided OLT were filled using an injectable bone graft substitute. Various clinical scores, radiographic imaging, and MRI were evaluated after a mean follow-up of 24.1 months. RESULTS The American Orthopedic Foot and Ankle Society Score significantly improved from 71.0±2.4 to 90.3±5.9, and the Foot and Ankle Disability Index improved from 71.8±11.1 to 91.7±4.8. Radiographically, we observed good bone remodelling of the medial talar dome contour within 3 months. In MRI, an alteration of the bony signal of the drill tunnel and the excised OLT remained for more than 12 months. CONCLUSIONS First follow-up results for the surgical technique described in this study are highly promising for treatment of undetached stable OLT grade II or transitional stage II-III according to the Pritsch classification. Even lesions larger than 150 mm2 showed good clinical scores, with full restoration of the medial talar dome contour in radiographic imaging. PMID:27362485

  13. Vascular hyperpermeability in pulmonary decompression illness: 'the chokes'.

    PubMed

    Kondo, Yutaka; Shiohira, Shinya; Kamizato, Kota; Teruya, Koji; Fuchigami, Tatsuya; Kakinohana, Manabu; Kukita, Ichiro

    2012-08-01

    Decompression illness (DCI) develops during or after diving. Pulmonary decompression illness ('Chokes') is rarely seen because the affected individual usually dies in the water. We encountered a rare and interesting case. A 60-year-old man complained of leg pain after diving. Despite rapid transfer to a nearby hospital, advanced respiratory failure and shock had set in. He was then transferred to our hospital for hyperbaric oxygen therapy (HBOT). On account of his poor general condition, we initially treated him in the intensive care unit without HBOT, where he showed extreme hyperpermeability and a high level of serum procalcitonin (PCT; 20.24 ng/mL). Despite large-volume fluid therapy, severe intravascular dehydration and shock status remained. We assume that the injured endothelial cells induced vascular hyperpermeability and increased levels of inflammatory cytokines leading to the high serum PCT level. PCT might be a useful stress marker of endothelial damage and severity in DCI, including Chokes. PMID:22862767

  14. Isentropic decompression of fluids from crustal and mantle pressures

    NASA Technical Reports Server (NTRS)

    Kieffer, S. W.; Delany, J. M.

    1979-01-01

    Criteria are derived according to which the flow of single-phase magmatic fluids and the rarefaction expansion of low-viscosity liquids and gases may be considered approximately isentropic. Graphs of entropy vs. density with contours of constant pressure and mass fraction are used to examine the possible thermodynamic histories of H2O and CO2 decompressing isentropically from crustal and upper mantle pressures; these graphs offer a simple visual representation of a number of thermodynamic variables involved in isentropic processes. It is shown how the graphs can be used to examine the behavior of volatiles that (1) ascend in volcanic systems originating at different depths within the earth, and (2) decompress from a shock Hugoniot state. Entropy-density graphs are presented separately for H2O and CO2.

  15. Prevention of decompression sickness during a simulated space docking mission

    NASA Technical Reports Server (NTRS)

    Cooke, J. P.; Bollinger, R. R.; Richardson, B.

    1975-01-01

    This study has shown that repetitive exchanges between the Apollo space vehicle atmosphere of 100% oxygen at 5 psia (258 torr) and the Soyuz spacecraft atmosphere of 30% oxygen-70% nitrogen at 10 psia (533 torr), as simulated in altitude chambers, will not likely result in any form of decompression sickness. This conclusion is based upon the absence of any form of bends in seven crewmen who participated in 11 tests distributed over three 24-h periods. During each period, three transfers from the 5 to the 10 psia environments were performed by simulating passage through a docking module which served as an airlock where astronauts and cosmonauts first adapted to each other's cabin gases and pressures before transfer. Biochemical tests, subjective fatigue scores, and the complete absence of any form of pain were also indicative that decompression sickness should not be expected if this spacecraft transfer schedule is followed.

  16. Denitrogenation interruptions with air. [resulting in decompression sickness

    NASA Technical Reports Server (NTRS)

    Cooke, J. P.

    1976-01-01

    A 3-h denitrogenation period at ground-level pressure with 95% O2-5% N2, with an air interruption of 5 min or more and matched with additional denitrogenation time equal to the interruption, will later result occasionally in altitude decompression sickness ('bends') during a 2-h decompression exposure at 3.8 psia (10,058 m equivalent) with 92% O2- 8% N2. Thus the equal time or 'mirror-image' make-up time for loss of denitrogenation did not prevent bends 7 times in 17 subjects during 71 exposures with air interruptions; on the other hand, no case of bends was reported after uninterrupted denitrogenation periods. Nitrogen-loading during the interruptive period is believed to resupply the bends sites with additional nitrogen, which re-establishes conditions favoring a return to a high incidence of bends.

  17. Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction.

    PubMed

    Ohya, Junichi; Chikuda, Hirotaka; Nakatomi, Hirofumi; Sakamoto, Ryuji; Saito, Nobuhito; Tanaka, Sakae

    2016-01-01

    Obstructive hydrocephalus has been described as a rare complication following foramen magnum decompression for Chiari malformation. However, there are few reports of obstructive hydrocephalus after spinal surgery for other pathologies of the craniovertebral junction (CVJ). The authors herein report a 52-year-old female with achondroplasia presenting with an 8-month history of myelopathy due to spinal cord compression at CVJ. She underwent resection of the C1 posterior arch and part of the edge of the occipital bone. A computed tomography (CT) scan obtained 1-week after the surgery revealed bilateral infratentorial fluid collection. The patient was first managed conservatively; however, on the 17(th) day, her consciousness level showed sudden deterioration. Emergency CT demonstrated marked hydrocephalus due to obstruction of the cerebral aqueduct. Acute obstructive hydrocephalus can occur late after decompression surgery at the CVJ, and thus should be included in the differential diagnosis of a deteriorating mental status. PMID:27366268

  18. Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction

    PubMed Central

    Ohya, Junichi; Chikuda, Hirotaka; Nakatomi, Hirofumi; Sakamoto, Ryuji; Saito, Nobuhito; Tanaka, Sakae

    2016-01-01

    Obstructive hydrocephalus has been described as a rare complication following foramen magnum decompression for Chiari malformation. However, there are few reports of obstructive hydrocephalus after spinal surgery for other pathologies of the craniovertebral junction (CVJ). The authors herein report a 52-year-old female with achondroplasia presenting with an 8-month history of myelopathy due to spinal cord compression at CVJ. She underwent resection of the C1 posterior arch and part of the edge of the occipital bone. A computed tomography (CT) scan obtained 1-week after the surgery revealed bilateral infratentorial fluid collection. The patient was first managed conservatively; however, on the 17th day, her consciousness level showed sudden deterioration. Emergency CT demonstrated marked hydrocephalus due to obstruction of the cerebral aqueduct. Acute obstructive hydrocephalus can occur late after decompression surgery at the CVJ, and thus should be included in the differential diagnosis of a deteriorating mental status. PMID:27366268

  19. Client side decompression technique provides faster DNA sequence data delivery.

    PubMed

    Sufi, Fahim; Fang, Qiang; Cosic, Irena; Ferguson, Roy

    2005-01-01

    DNA sequences are generally very long chains of sequentially linked nucleotides. There are four different nucleotides and combinations of these build the nucleotide information of sequence files contained in data sources. When a user searches for any sequence for an organism, a compressed sequence file can be sent from the data source to the user. The compressed file then can be decompressed at the client end resulting in reduced transmission time over the Internet. A compression algorithm that provides a moderately high compression rate with minimal decompression time is proposed in this paper. We also compare a number of different compression techniques for achieving efficient delivery methods from an intelligent genomic search agent over the Internet. PMID:17282828

  20. Urgent Intracranial Carotid Artery Decompression after Penetrating Head Injury

    PubMed Central

    Kim, Seong Joon

    2013-01-01

    We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient. PMID:23634269

  1. Report on computation of repetitive hyperbaric-hypobaric decompression tables

    NASA Technical Reports Server (NTRS)

    Edel, P. O.

    1975-01-01

    The tables were constructed specifically for NASA's simulated weightlessness training program; they provide for 8 depth ranges covering depths from 7 to 47 FSW, with exposure times of 15 to 360 minutes. These tables were based up on an 8 compartment model using tissue half-time values of 5 to 360 minutes and Workmanline M-values for control of the decompression obligation resulting from hyperbaric exposures. Supersaturation ratios of 1.55:1 to 2:1 were used for control of ascents to altitude following such repetitive dives. Adequacy of the method and the resultant tables were determined in light of past experience with decompression involving hyperbaric-hypobaric interfaces in human exposures. Using these criteria, the method showed conformity with empirically determined values. In areas where a discrepancy existed, the tables would err in the direction of safety.

  2. Predictive modeling of altitude decompression sickness in humans

    NASA Technical Reports Server (NTRS)

    Kenyon, D. J.; Hamilton, R. W., Jr.; Colley, I. A.; Schreiner, H. R.

    1972-01-01

    The coding of data on 2,565 individual human altitude chamber tests is reported as part of a selection procedure designed to eliminate individuals who are highly susceptible to decompression sickness, individual aircrew members were exposed to the pressure equivalent of 37,000 feet and observed for one hour. Many entries refer to subjects who have been tested two or three times. This data contains a substantial body of statistical information important to the understanding of the mechanisms of altitude decompression sickness and for the computation of improved high altitude operating procedures. Appropriate computer formats and encoding procedures were developed and all 2,565 entries have been converted to these formats and stored on magnetic tape. A gas loading file was produced.

  3. On-the-Fly Decompression and Rendering of Multiresolution Terrain

    SciTech Connect

    Lindstrom, P; Cohen, J D

    2009-04-02

    We present a streaming geometry compression codec for multiresolution, uniformly-gridded, triangular terrain patches that supports very fast decompression. Our method is based on linear prediction and residual coding for lossless compression of the full-resolution data. As simplified patches on coarser levels in the hierarchy already incur some data loss, we optionally allow further quantization for more lossy compression. The quantization levels are adaptive on a per-patch basis, while still permitting seamless, adaptive tessellations of the terrain. Our geometry compression on such a hierarchy achieves compression ratios of 3:1 to 12:1. Our scheme is not only suitable for fast decompression on the CPU, but also for parallel decoding on the GPU with peak throughput over 2 billion triangles per second. Each terrain patch is independently decompressed on the fly from a variable-rate bitstream by a GPU geometry program with no branches or conditionals. Thus we can store the geometry compressed on the GPU, reducing storage and bandwidth requirements throughout the system. In our rendering approach, only compressed bitstreams and the decoded height values in the view-dependent 'cut' are explicitly stored on the GPU. Normal vectors are computed in a streaming fashion, and remaining geometry and texture coordinates, as well as mesh connectivity, are shared and re-used for all patches. We demonstrate and evaluate our algorithms on a small prototype system in which all compressed geometry fits in the GPU memory and decompression occurs on the fly every rendering frame without any cache maintenance.

  4. Sidenafil Pre-Treatment Promotes Decompression Sickness in Rats

    PubMed Central

    Blatteau, Jean-Eric; Brubakk, Alf O.; Gempp, Emmanuel; Castagna, Olivier; Risso, Jean-Jacques; Vallée, Nicolas

    2013-01-01

    Vascular bubble formation after decompression contributes to endothelial injuries which form the basis for the development of decompression sickness (DCS). Nitric oxide (NO) is a powerful vasodilator that contributes to vessel homeostasis. It has been shown that NO-releasing agent may reduce bubble formation and prevent serious decompression sickness. The use of sildenafil, a well-known, phosphodiesterase-5 blocker, which act by potentiating the vasodilatory effect on smooth muscle relaxation, has never been studied in DCS. The purpose of the present study was to evaluate the clinical effects of sildenafil pre-treatment on DCS in a rat model. 67 rats were subjected to a simulated dive at 90 msw for 45 min before staged decompression. The experimental group received 10 mg/kg of sildenafil one hour before exposure (n = 35) while controls were not treated (n = 32). Clinical assessment took place over a period of 30 min after surfacing. At the end, blood samples were collected for blood cells counts and the level of circulating bubbles in the right cavities was quantified. There were significantly more manifestations of DCS in the sildenafil group than in the controls (34.3% vs 6.25%, respectively, p = 0.012). Platelet count was more reduced in treated rats than in controls (−21.7% vs −7%, respectively, p = 0.029), whereas bubble grades did not differ between groups. We concluded that pre-treatment with sildenafil promotes the onset and severity of neurological DCS. When considering the use of phosphodiesterase-5 blockers in the context of diving, careful discussion with physician should be recommended. PMID:23580342

  5. 29 CFR Appendix A to Subpart S of... - Decompression Tables

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 8 2010-07-01 2010-07-01 false Decompression Tables A Appendix A to Subpart S of Part 1926..., Caissons, Cofferdams and Compressed Air Pt. 1926, Subpt. S, App. A Appendix A to Subpart S of Part 1926... pressure p.s.i.g. Working period hours 1/2 1 11/2 2 3 4 5 6 7 8 Over 8 9 to 12 3 3 3 3 3 3 3 3 3 3 3 14 6...

  6. Architecture for hardware compression/decompression of large images

    NASA Astrophysics Data System (ADS)

    Akil, Mohamed; Perroton, Laurent; Gailhard, Stephane; Denoulet, Julien; Bartier, Frederic

    2001-04-01

    In this article, we present a popular loseless compression/decompression algorithm, GZIP, and the study to implement it on a FPGA based architecture. The algorithm is loseless, and applied to 'bi-level' images of large size. It insures a minimum compression rate for the images we are considering. The proposed architecture for the compressor is based ona hash table and the decompressor is based on a parallel decoder of the Huffman codes.

  7. Cryogenic wind tunnels. II

    NASA Technical Reports Server (NTRS)

    Kilgore, Robert A.

    1987-01-01

    The application of the cryogenic concept to various types of tunnels including Ludwieg tube tunnel, Evans clean tunnel, blowdown, induced-flow, and continuous-flow fan-driven tunnels is discussed. Benefits related to construction and operating costs are covered, along with benefits related to new testing capabilities. It is noted that cooling the test gas to very low temperatures increases Reynolds number by more than a factor of seven. From the energy standpoint, ambient-temperature fan-driven closed-return tunnels are considered to be the most efficient type of tunnel, while a large reduction in the required tunnel stagnation pressure can be achieved through cryogenic operation. Operating envelopes for three modes of operation for a cryogenic transonic pressure tunnel with a 2.5 by 2.5 test section are outlined. A computer program for calculating flow parameters and power requirements for wind tunnels with operating temperatures from saturation to above ambient is highlighted.

  8. Process for decompression control in internal combustion engine and apparatus therefor

    SciTech Connect

    Matsuki, I.; Kamiya, N.; Ikeda, T.; Takagi, Y.; Iizuka, Y.; Yamaguchi, Y.; Funai, H.; Terasawa; Tasaka, S.

    1986-05-27

    A process is described for use in controlled decompression in internal combustion engine operation used for driving compressors, electric generator, and the like, comprising the steps of starting the engine with the decompression control engaged and the engine operating decompressed, increasing the speed of the engine with the decompression control engaged and the engine operating decompressed until the engine reaches a first predetermined speed, while increasing the engine speed above the first predetermined speed disengaging the decompression control to a first stage of disengagement to operate the engine compressed, while the engine is operating compressed, increasing the engine speed to an operating speed above the first predetermined speed and disengaging the decompression control to a second stage of disengagement while continuing to operate the engine compressed and, after the engine has completed the compressed operation with the decompression control disengaged, reducing the engine speed to a second predetermined speed above the first predetermined speed but below the operating speed, reengaging the decompression control and, with the engine operating decompressed further reducing the speed of the engine until the engine stops.

  9. Musculoskeletal-induced Nucleation in Altitude Decompression Sickness

    NASA Technical Reports Server (NTRS)

    Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

    2014-01-01

    Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. There are limited data available to evaluate cost-benefit relationships. Understanding the relationship is important to improve our understanding of the underlying mechanisms of nucleation in exercise prebreathe protocols and to quantify risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS.

  10. White matter changes linked to visual recovery after nerve decompression

    PubMed Central

    Paul, David A.; Gaffin-Cahn, Elon; Hintz, Eric B.; Adeclat, Giscard J.; Zhu, Tong; Williams, Zoë R.; Vates, G. Edward; Mahon, Bradford Z.

    2015-01-01

    The relationship between the integrity of white matter tracts and cortical function in the human brain remains poorly understood. Here we use a model of reversible white matter injury, compression of the optic chiasm by tumors of the pituitary gland, to study the structural and functional changes that attend spontaneous recovery of cortical function and visual abilities after surgical tumor removal and subsequent decompression of the nerves. We show that compression of the optic chiasm leads to demyelination of the optic tracts, which reverses as quickly as 4 weeks after nerve decompression. Furthermore, variability across patients in the severity of demyelination in the optic tracts predicts visual ability and functional activity in early cortical visual areas, and pre-operative measurements of myelination in the optic tracts predicts the magnitude of visual recovery after surgery. These data indicate that rapid regeneration of myelin in the human brain is a significant component of the normalization of cortical activity, and ultimately the recovery of sensory and cognitive function, after nerve decompression. More generally, our findings demonstrate the utility of diffusion tensor imaging as an in vivo measure of myelination in the human brain. PMID:25504884

  11. Decryption-decompression of AES protected ZIP files on GPUs

    NASA Astrophysics Data System (ADS)

    Duong, Tan Nhat; Pham, Phong Hong; Nguyen, Duc Huu; Nguyen, Thuy Thanh; Le, Hung Duc

    2011-10-01

    AES is a strong encryption system, so decryption-decompression of AES encrypted ZIP files requires very large computing power and techniques of reducing the password space. This makes implementations of techniques on common computing system not practical. In [1], we reduced the original very large password search space to a much smaller one which surely containing the correct password. Based on reduced set of passwords, in this paper, we parallel decryption, decompression and plain text recognition for encrypted ZIP files by using CUDA computing technology on graphics cards GeForce GTX295 of NVIDIA, to find out the correct password. The experimental results have shown that the speed of decrypting, decompressing, recognizing plain text and finding out the original password increases about from 45 to 180 times (depends on the number of GPUs) compared to sequential execution on the Intel Core 2 Quad Q8400 2.66 GHz. These results have demonstrated the potential applicability of GPUs in this cryptanalysis field.

  12. Protective Effects of Fluoxetine on Decompression Sickness in Mice

    PubMed Central

    Blatteau, Jean-Eric; Barre, Sandrine; Pascual, Aurelie; Castagna, Olivier; Abraini, Jacques H.; Risso, Jean-Jacques; Vallee, Nicolas

    2012-01-01

    Massive bubble formation after diving can lead to decompression sickness (DCS) that can result in central nervous system disorders or even death. Bubbles alter the vascular endothelium and activate blood cells and inflammatory pathways, leading to a systemic pathophysiological process that promotes ischemic damage. Fluoxetine, a well-known antidepressant, is recognized as having anti-inflammatory properties at the systemic level, as well as in the setting of cerebral ischemia. We report a beneficial clinical effect associated with fluoxetine in experimental DCS. 91 mice were subjected to a simulated dive at 90 msw for 45 min before rapid decompression. The experimental group received 50 mg/kg of fluoxetine 18 hours before hyperbaric exposure (n = 46) while controls were not treated (n = 45). Clinical assessment took place over a period of 30 min after surfacing. At the end, blood samples were collected for blood cells counts and cytokine IL-6 detection. There were significantly fewer manifestations of DCS in the fluoxetine group than in the controls (43.5% versus 75.5%, respectively; p = 0.004). Survivors showed a better and significant neurological recovery with fluoxetine. Platelets and red cells were significantly decreased after decompression in controls but not in the treated mice. Fluoxetine reduced circulating IL-6, a relevant marker of systemic inflammation in DCS. We concluded that fluoxetine decreased the incidence of DCS and improved motor recovery, by limiting inflammation processes. PMID:23145072

  13. The Advantage of Throwing the First Stone: How Understanding the Evolutionary Demands of Homo sapiens Is Helping Us Understand Carpal Motion

    PubMed Central

    Rohde, Rachel S.; Crisco, Joseph J.; Wolfe, Scott W.

    2012-01-01

    Unlike any other diarthrodial joint in the human body, the “wrist joint” is composed of numerous articulations between eight carpal bones, the distal radius, the distal ulna, and five metacarpal bones. The carpal bones articulate with each other as well as with the distal radius, distal ulna, and the metacarpal bases. Multiple theories explaining intercarpal motion have been proposed; however, controversy exists concerning the degree and direction of motion of the individual carpal bones within the two carpal rows during different planes of motion. Recent investigations have suggested that traditional explanations of carpal bone motion may not entirely account for carpal motion in all planes. Better understanding of the complexities of carpal motion through the use of advanced imaging techniques and simultaneous appreciation of human anatomic and functional evolution have led to the hypothesis that the “dart thrower’s motion” of the wrist is uniquely human. Carpal kinematic research and current developments in both orthopaedic surgery and anthropology underscore the importance of the dart thrower’s motion in human functional activities and the clinical implications of these concepts for orthopaedic surgery and rehabilitation. PMID:20044492

  14. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.

    PubMed

    Laronde, Pascale; Christiaens, Nicolas; Aumar, Aurélien; Chantelot, Christophe; Fontaine, Christian

    2016-04-01

    Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P<0.0001). Our clinical results and analysis of the literature indicate that 4CA is not superior to PRC when it comes to grip strength, whereas carpal height is significantly decreased after PRC. The decreased tendon excursion after PRC is balanced by an increase in joint stresses after 4CA. PMID:27117123

  15. Cryogenic wind tunnels. III

    NASA Technical Reports Server (NTRS)

    Kilgore, Robert A.

    1987-01-01

    Specific problems pertaining to cryogenic wind tunnels, including LN(2) injection, GN(2) exhaust, thermal insulation, and automatic control are discussed. Thermal and other physical properties of materials employed in these tunnels, properties of cryogenic fluids, storage and transfer of liquid nitrogen, strength and toughness of metals and nonmetals at low temperatures, and material procurement and qualify control are considered. Safety concerns with cryogenic tunnels are covered, and models for cryogenic wind tunnels are presented, along with descriptions of major cryogenic wind-tunnel facilities the United States, Europe, and Japan. Problems common to wind tunnels, such as low Reynolds number, wall and support interference, and flow unsteadiness are outlined.

  16. The cubital tunnel: a radiologic and histotopographic study

    PubMed Central

    Macchi, Veronica; Tiengo, Cesare; Porzionato, Andrea; Stecco, Carla; Sarasin, Gloria; Tubbs, Shane; Maffulli, Nicola; De Caro, Raffaele

    2014-01-01

    Entrapment of the ulnar nerve at the elbow is the second most common compression neuropathy in the upper limb. The present study evaluates the anatomy of the cubital tunnel. Eighteen upper limbs were analysed in unembalmed cadavers using ultrasound examination in all cases, dissection in nine cases, and microscopic study in nine cases. In all cases, thickening of the fascia at the level of the tunnel was found at dissection. From the microscopic point of view, the ulnar nerve is a multifascicular trunk (mean area of 6.0 ± 1.5 mm2). The roof of the cubital tunnel showed the presence of superimposed layers, corresponding to fascial, tendineous and muscular layers, giving rise to a tri-laminar structure (mean thickness 523 ± 235 μm). This multilayered tissue was hyperechoic (mean thickness 0.9 ± 0.3 mm) on ultrasound imaging. The roof of the cubital tunnel is elastic, formed by a myofascial trilaminar retinaculum. The pathological fusion of these three layers reduces gliding of the ulnar nerve during movements of the elbow joint. This may play a role in producing the symptoms typical of cubital tunnel syndrome. Independent from the surgical technique, decompression should span the ulnar nerve from the triceps brachii muscle to the flexor carpi ulnaris fascia. PMID:24917209

  17. 4. 'Ring Stones & Tunnel Sections, Tunnel #33,' Southern Pacific ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. 'Ring Stones & Tunnel Sections, Tunnel #33,' Southern Pacific Standard Double-Track Tunnel, ca. 1913. Compare to photos in documentation sets for Tunnel 18 (HAER No. CA-197), Tunnel 34 (HAER No. CA-206), and Tunnel 1 (HAER No. CA-207). - Central Pacific Transcontinental Railroad, Sacramento to Nevada state line, Sacramento, Sacramento County, CA

  18. [The anterior tarsal tunnel syndrome: a case report].

    PubMed

    Milants, C; Wang, F C; Gomulinski, L; Ledon, F; Petrover, D; Bonnet, R; Crielaard, J M; Kaux, J F

    2015-01-01

    The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is frequently unrecognized and may lead to misdiagnosis and delayed treatment. We report the case of a 77 year old patient complaining of symptoms of an anterior tarsal tunnel syndrome with neuropathic pain located at the dorsal part of the foot, without any sensorimotor loss. The ENMG was in favour of a motor impairment of the deep peroneal nerve. MRI exploration of the ankle showed a millimetric bony overgrowth of the upper pole of the navicular bone, irritative to the deep peroneal nerve. Infiltration at overgrowth of the navicular provided a partial and temporary decrease in pain symptoms. Surgical nerve decompression was then considered. PMID:26376569

  19. [Ogilvie's syndrome. Benefits of repeat colonoscopic decompression on its developmental course].

    PubMed

    Estrada Saiz, R V; Loscos Valerio, J M; Gines Herraiz, M A; Estrada Perez, V

    1995-11-01

    Seven cases of Ogilvie's syndrome are described. In six of ther good recovery was related to repeated endoscopic colonic decompressions. This is the safest and most precise procedure in the diagnosis and treatment of the disease. We emphasize the usefulness of repeated decompressions in the outcome of Ogilvie's syndrome. One of patients in which decompression was not attempted died of a colonic rupture. PMID:8804167

  20. Major SSC tunneling begins

    SciTech Connect

    Not Available

    1993-01-11

    In Texas, work has been completed on the first on the Superconducting Supercollider's major shafts. Now a boring machine has started driving the fifty-four mile elliptical accelerator tunnel. To date, contracts let for the tunnel have come in far below preliminary estimates. Five of the main fourteen foot diameter tunnel contracts have been awarded for a total of 107.4 million dollars, about forty million dollars below estimates. These contracts represent %60 percent of the total tunneling project.

  1. The Tunnels of Samos

    NASA Technical Reports Server (NTRS)

    Apostol, Tom M. (Editor)

    1995-01-01

    This 'Project Mathematics' series video from CalTech presents the tunnel of Samos, a famous underground aquaduct tunnel located near the capital of Pithagorion (named after the famed Greek mathematician, Pythagoras, who lived there), on one of the Greek islands. This tunnel was constructed around 600 BC by King Samos and was built under a nearby mountain. Through film footage and computer animation, the mathematical principles and concepts of why and how this aquaduct tunnel was built are explained.

  2. Evaluation of safety of hypobaric decompressions and EVA from positions of probabilistic theory.

    PubMed

    Nikolaev, V P

    1998-01-01

    Formation and subsequent evolution of gas bubbles in blood and tissues of subjects exposed to decompression are casual processes in their nature. Such character of bubbling processes in a body predetermines probabilistic character of decompression sickness (DCS) incidence in divers, aviators and astronauts. Our original probabilistic theory of decompression safety is based on stochastic models of these processes and on the concept of critical volume of a free gas phase in body tissues. From positions of this theory, the probability of DCS incidence during single-stage decompressions and during hypobaric decompressions under EVA in particular, is defined by the distribution of possible values of nucleation efficiency in "pain" tissues and by its critical significance depended on the parameters of a concrete decompression. In the present study the following is shown: 1) the dimensionless index of critical nucleation efficiency for "pain" body tissues is a more adequate index of decompression stress in comparison with Tissue Ratio, TR; 2) a priory the decompression under EVA performed according to the Russian protocol is more safe than decompression under EVA performed in accordance with the U.S. protocol; 3) the Russian space suit operated at a higher pressure and having a higher "rigidity" induces a stronger inhibition of mechanisms of cavitation and gas bubbles formation in tissues of a subject located in it, and by that provides a more considerable reduction of the DCS risk during real EVA performance. PMID:11541599

  3. Variable Density Tunnel

    NASA Technical Reports Server (NTRS)

    1931-01-01

    Variable Density Tunnel in operation. Man at far right is probably Harold J. 'Cannonball' Tuner, longtime safety officer, who started with Curtiss in the teens. This view of the Variable Density Tunnel clearly shows the layout of the Tunnel's surroundings, as well as the plumbing and power needs of the this innovative research tool.

  4. Squeezable electron tunneling junctions

    NASA Astrophysics Data System (ADS)

    Moreland, J.; Alexander, S.; Cox, M.; Sonnenfeld, R.; Hansma, P. K.

    1983-09-01

    We report a versatile new technique for constructing electron tunneling junctions with mechanically-adjusted artificial barriers. I-V curves are presented for tunneling between Ag electrodes with vacuum, gas, liquid or solid in the barrier. An energy gap is apparent in the measured I-V curve when tunneling occurs between superconducting Pb electrodes.

  5. Gender and Decompression Sickness: A Critical Review and Analysis

    NASA Technical Reports Server (NTRS)

    2004-01-01

    The author addressed the following questions: are women at greater risk of decompression sickness and venous gas emboli at certain times in their reproductive cycle, is risk modified by the use of birth control pills (BCP), and is there a difference in overall risk between men and women under the same decompression dose? The summary considers information from the few abstracts and reports that were available. Except for the observation of more Type II DCS in women, particularly in women who fly after diving, there was no compelling evidence of a difference in DCS risk between men and women SCUBA divers. Many women that presented with DCS symptoms seemed to be in or near menses, with statistically fewer cases reported as time increased from menses. There was no compelling evidence that the use of BCP in SCUBA divers increases the risk of DCS. There were insufficient data about VGE from SCUBA diving to make any conclusion about the incidence of VGE and gender. In contrast, there were ample data about VGE from research in altitude chambers. Women produced less VGE and less Grade IV VGE compared to men under the same decompression dose, certainly when resting oxygen prebreathe (PB) was performed prior to ascent to altitude. Dual-cycle ergometry exercise during PB tends to reduce the differences in VGE between men and women. There was no compelling evidence that the risk of altitude DCS was different between men and women. However, a large number of DCS cases were associated with menses, and the use of BCP did seem to put women at a slightly greater risk than those that did not use BCP. There were substantial observations that women comprised a larger number of difficult cases that required complicated medical management.

  6. SLAP repair with arthroscopic decompression of spinoglenoid cyst

    PubMed Central

    Hashiguchi, Hiroshi; Iwashita, Satoshi; Ohkubo, Atsushi; Takai, Shinro

    2016-01-01

    Introduction: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP) lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. Methods: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. Results: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS) score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. Discussion: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders. PMID:27163090

  7. Diving decompression models and bubble metrics: modern computer syntheses.

    PubMed

    Wienke, B R

    2009-04-01

    A quantitative summary of computer models in diving applications is presented, underscoring dual phase dynamics and quantifying metrics in tissue and blood. Algorithms covered include the multitissue, diffusion, split phase gradient, linear-exponential, asymmetric tissue, thermodynamic, varying permeability, reduced gradient bubble, tissue bubble diffusion, and linear-exponential phase models. Defining relationships are listed, and diver staging regimens are underscored. Implementations, diving sectors, and correlations are indicated for models with a history of widespread acceptance, utilization, and safe application across recreational, scientific, military, research, and technical communities. Presently, all models are incomplete, but many (included above) are useful, having resulted in diving tables, underwater meters, and dive planning software. Those herein employ varying degrees of calibration and data tuning. We discuss bubble metrics in tissue and blood as a backdrop against computer models. The past 15 years, or so, have witnessed changes and additions to diving protocols and table procedures, such as shorter nonstop time limits, slower ascent rates, shallow safety stops, ascending repetitive profiles, deep decompression stops, helium based breathing mixtures, permissible reverse profiles, multilevel techniques, both faster and slower controlling repetitive tissue halftimes, smaller critical tensions, longer flying-after-diving surface intervals, and others. Stimulated by Doppler and imaging technology, table and decompression meter development, theory, statistics, chamber and animal testing, or safer diving consensus, these modifications affect a gamut of activity, spanning bounce to decompression, single to multiday, and air to mixed gas diving. As it turns out, there is growing support for many protocols on operational, experimental, and theoretical grounds, with bubble models addressing many concerns on plausible bases, but with further testing or

  8. Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis

    PubMed Central

    Cheung, Jason Pui Yin; Cheung, Prudence Wing Hang; Cheung, Kenneth Man Chee

    2016-01-01

    Study Design Retrospective series. Purpose Assess results of decompression-only surgery for low-grade degenerative spondylolisthesis with consideration of instability. Overview of Literature There is no consensus on whether fusion or decompression-only surgery leads to better outcomes for patients with low-grade degenerative spondylolisthesis. Current trends support fusion but many studies are flawed due to over-generalization without consideration of radiological instability and their variable presentations and natural history. Methods Patients with surgically treated degenerative spondylolisthesis from 1990–2013 were included. Clinical and radiological instability measures were included. Any residual or recurrence of symptoms, revision surgery performed and functional outcome scores including the numerical global rate of change scale, visual analogue scale, and modified Barthel index were measured. Follow-up periods for patients were divided into short-term (<5 years), mid-term (5–10 years) and long-term (>10 years). Results A total of 64 patients were recruited. Mechanical low back pain was noted in 48 patients and most (85.4%) had relief of back pain postoperatively. Radiological instability was noted in 4 subjects by flexion-extension radiographs and 12 subjects with prone traction radiographs by increased disc height and reduction of olisthesis and slip angle. From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period. All functional scores improved from preoperative to postoperative 1-year follow-up. Conclusions Decompression-only for low-grade degenerative spondylolisthesis has good long-term results despite instability. Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option. PMID:26949462

  9. Bilateral Carpal Spasm Under Spinal Anaesthesia During Abdominal Hysterectomy: A Case Report

    PubMed Central

    Naithani, Udita; Betkekar, Sneha Arun; Verma, Devendra; Dindor, Basant Kumar

    2016-01-01

    Acute hypocalcaemia is a medical emergency that can have catastrophic implications like tetany, seizures, cardiac arrythmias or laryngospasm if left untreated. We are presenting a case of a 30-year-old female patient undergoing total abdominal hysterectomy with bilateral salpingoopherectomy under spinal anaesthesia. She developed unexpected bilateral carpal spasm intraoperatively which was promptly diagnosed and successfully managed with intravenous calcium administration. We conclude that the anaesthetist should be aware of the clinical presentation of acute hypocalcaemia, its causes and emergency management in the perioperative period to prevent any adverse outcomes. PMID:26894157

  10. [Aseptic bone flap osteonecrosis following cranioplasty after decompressive cranietomy].

    PubMed

    Smoll, Nicolas R; Stienen, Martin N; Schaller, Karl; Gautschi, Oliver P

    2013-06-19

    This case report discusses a case of aseptic osteonecrosis in a cranioplasty bone flap after decompressive craniectomy, which is a known, but rare complication after autologous cranioplasty. We suggest that the pathophysiology of cranial bone flap necrosis may have a similar pathophysiology to free flap necrosis/failure. The key suggested problem causing the osteonecrosis is vessel thrombosis within the smaller vessels of the bone flap due to the prothrombotic effects of the factors released during drilling of the bone flap. Suspicious local findings like wound dehiscence or fluid leakage should lead to a head computed tomography in order to discuss a prophylactic artificial second cranioplasty if necessary. PMID:23773942

  11. Ischiofemoral Space Decompression Through Posterolateral Approach: Cutting Block Technique

    PubMed Central

    Howse, Elizabeth A.; Mannava, Sandeep; Tamam, Cüneyt; Martin, Hal D.; Bredella, Miriam A.; Stubbs, Allston J.

    2014-01-01

    Ischiofemoral space impingement has become an increasingly recognized extracapsular cause of atypical hip, deep gluteal, and groin pain that can be treated endoscopically. We present a minimally invasive posterolateral technique that preserves the attachment of the iliopsoas tendon and quadratus femoris insertion while decompressing the ischiofemoral space by resecting the lesser trochanter. Furthermore, we present tips to perform this technique in a manner that minimizes the potential for damage to the sciatic nerve. This technique also allows the surgeon to treat concurrent hip pathology arthroscopically. PMID:25685670

  12. Surgical decompression for notalgia paresthetica: a case report.

    PubMed

    Williams, Eric H; Rosson, Gedge D; Elsamanoudi, Ibrahim; Dellon, A Lee

    2010-01-01

    Notalgia paresthetica is a rare nerve compression. From the Greek word noton, meaning "back," and algia, meaning "pain," "notalgia paresthetica" implies that symptoms of burning pain, itching, and/or numbness in the localized region between the spinous processes of T2 through T6 and the medial border of the scapula constitute a nerve compression syndrome. The compressed nerve is the dorsal branch of the spinal nerve. It is compressed by the paraspinous muscles and fascia against the transverse process of these spinal segments. This is the first report of symptomatic relief by decompression of this nerve. PMID:19790177

  13. Degassing of H2O in a phonolitic melt: A closer look at decompression experiments

    NASA Astrophysics Data System (ADS)

    Marxer, Holger; Bellucci, Philipp; Nowak, Marcus

    2015-05-01

    Melt degassing during magma ascent is controlled by the decompression rate and can be simulated in decompression experiments. H2O-bearing phonolitic melts were decompressed at a super-liquidus T of 1323 K in an internally heated argon pressure vessel, applying continuous decompression (CD) as well as to date commonly used step-wise decompression (SD) techniques to investigate the effect of decompression method on melt degassing. The hydrous melts were decompressed from 200 MPa at nominal decompression rates of 0.0028-1.7 MPa·s- 1. At final pressure (Pfinal), the samples were quenched rapidly at isobaric conditions with ~ 150 K·s- 1. The bubbles in the quenched samples are often deformed and dented. Flow textures in the glass indicate melt transport at high viscosity. We suggest that this observation is due to bubble shrinkage during quench. This general problem was mostly overlooked in the interpretation of experimentally degassed samples to date. Bubble shrinkage due to decreasing molar volume (Vm) of the exsolved H2O in the bubbles occurs during isobaric rapid quench until the melt is too viscous too relax. The decrease of Vm(H2O) during cooling at Pfinal of the experiments results in a decrease of the bubble volume by a shrinking factor Bs: At nominal decompression rates > 0.17 MPa·s- 1 and a Pfinal of 75 MPa, the decompression method has only minor influence on melt degassing. SD and CD result in high bubble number densities of 104-105 mm- 3. Fast P drop leads to immediate supersaturation with H2O in the melt. At such high nominal decompression rates, the diffusional transport of H2O is limited and therefore bubble nucleation is the predominant degassing process. The residual H2O contents in the melts decompressed to 75 MPa increase with nominal decompression rate. After homogeneous nucleation is triggered, CD rates ≤ 0.024 MPa·s- 1 facilitate continuous reduction of the supersaturation by H2O diffusion into previously nucleated bubbles. Bubble number

  14. Relationship between right-to-left shunts and cutaneous decompression illness.

    PubMed

    Wilmshurst, P T; Pearson, M J; Walsh, K P; Morrison, W L; Bryson, P

    2001-05-01

    The presence of a large right-to-left shunt is associated with neurological decompression illness after non-provocative dives, as a result of paradoxical gas embolism. A small number of observations suggest that cutaneous decompression illness is also associated with a right-to-left shunt, although an embolic aetiology of a diffuse rash is more difficult to explain. We performed a retrospective case--control comparison of the prevalence and sizes of right-to-left shunts determined by contrast echocardiography performed blind to history in 60 divers and one caisson worker with a history of cutaneous decompression illness, and 123 historical control divers. We found that 47 (77.0%) of the 61 cases with cutaneous decompression illness had a shunt, compared with 34 (27.6%) of 123 control divers (P<0.001). The size of the shunts in the divers with cutaneous decompression illness was significantly greater than in the controls. Thus 30 (49.2%) of the 61 cases with cutaneous decompression illness had a large shunt at rest, compared with six (4.9%) of the 123 controls (P<0.001). During closure procedures in 17 divers who had cutaneous decompression illness, the mean diameter of the foramen ovale was 10.9 mm. Cutaneous decompression illness occurred after dives that were provocative or deep in subjects without shunts, but after shallower and non-provocative dives in those with shunts. The latter individuals are at increased risk of neurological decompression illness. We conclude that cutaneous decompression illness has two pathophysiological mechanisms. It is usually associated with a large right-to-left shunt, when the mechanism is likely to be paradoxical gas embolism with peripheral amplification when bubble emboli invade tissues supersaturated with nitrogen. Cutaneous decompression illness can also occur in individuals without a shunt. In these subjects, the mechanism might be bubble emboli passing through an 'overloaded' lung filter or autochthonous bubble formation

  15. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  16. Correlation between decompression sickness and circulating bubbles in 232 divers.

    PubMed

    Gardette, B

    1979-03-01

    Doppler monitoring examinations were carried out during 67 simulated helium-oxygen dives in the pressure chambers of the Centre d'Etudes Hyperbares (CEH) COMEX Marseille, and involved a total of 232 COMEX professional divers. Three to five detections were done in each 24-h period, each consisting of an observation at rest and an observation after deep knee bends. Recordings of the Doppler signals were subsequently analyzed by experienced listeners and graded according to the system described by Spencer and Johanson (1974). The two vestibular decompression accidents in this series were associated with bubble scores of grade 3 at rest; one occurred during the rapid initial phase of a bounce dive decompression and the other after return to the storage depth after an excursion dive. Twenty-five cases of muscular or joint pains were observed. A higher incidence of this type of problem was found with higher bubble grades in general, although it was not possible to predict pain. PMID:462655

  17. A very high speed lossless compression/decompression chip set

    NASA Technical Reports Server (NTRS)

    Venbrux, Jack; Liu, Norley; Liu, Kathy; Vincent, Peter; Merrell, Randy

    1991-01-01

    A chip is described that will perform lossless compression and decompression using the Rice Algorithm. The chip set is designed to compress and decompress source data in real time for many applications. The encoder is designed to code at 20 M samples/second at MIL specifications. That corresponds to 280 Mbits/second at maximum quantization or approximately 500 Mbits/second under nominal conditions. The decoder is designed to decode at 10 M samples/second at industrial specifications. A wide range of quantization levels is allowed (4...14 bits) and both nearest neighbor prediction and external prediction are supported. When the pre and post processors are bypassed, the chip set performs high speed entropy coding and decoding. This frees the chip set from being tied to one modeling technique or specific application. Both the encoder and decoder are being fabricated in a 1.0 micron CMOS process that has been tested to survive 1 megarad of total radiation dosage. The CMOS chips are small, only 5 mm on a side, and both are estimated to consume less than 1/4 of a Watt of power while operating at maximum frequency.

  18. Decompression syndrome (Caisson disease) in an Indian diver

    PubMed Central

    Phatak, Uday A.; David, Eric J.; Kulkarni, Pravin M.

    2010-01-01

    Acute decompression syndrome (Caisson’s disease) is an acute neurological emergency in divers. It is caused due to release of nitrogen gas bubbles that impinge the blood vessels of the spinal cord and brain and result in severe neurodeficit. There are very few case reports in Indian literature. There are multiple factors in the pathogenesis of Acute decompression syndrome (Caisson’s disease) such as health problems in divers (respiratory problems or congenital heart diseases like atrial septal defect, patent ductus arteriosus etc), speed of ascent from the depth and habits like smoking that render divers susceptible for such neurological emergency. Usually, immediate diagnosis of such a condition with MRI is not possible in hospitals in the Coastal border. Even though, MRI is performed, it has very low specificity and sensitivity. Facilities like hyperbaric oxygen treatment are virtually non-existent in these hospitals. Therefore, proper education of the divers and appropriate preventive measures in professional or recreational divers is recommended. PMID:21085532

  19. Gender not a factor for altitude decompression sickness risk

    NASA Technical Reports Server (NTRS)

    Webb, James T.; Kannan, Nandini; Pilmanis, Andrew A.

    2003-01-01

    INTRODUCTION: Early, retrospective reports of the incidence of altitude decompression sickness (DCS) during altitude chamber training exposures indicated that women were more susceptible than men. We hypothesized that a controlled, prospective study would show no significant difference. METHODS: We conducted 25 altitude chamber decompression exposure profiles. A total of 291 human subjects, 197 men and 94 women, underwent 961 exposures to simulated altitude for up to 8 h, using zero to 4 h of preoxygenation. Throughout the exposures, subjects breathed 100% oxygen, rested or performed mild or strenuous exercise, and were monitored for precordial venous gas emboli (VGE) and DCS symptoms. RESULTS: No significant differences in DCS incidence were observed between men (49.5%) and women (45.3%). However, VGE occurred at significantly higher rates among men than women under the same exposure conditions, 69.3% and 55.0% respectively. Women using hormonal contraception showed significantly greater susceptibility to DCS than those not using hormonal contraception during the latter two weeks of the menstrual cycle. Significantly higher DCS incidence was observed in the heaviest men, in women with the highest body fat, and in subjects with the highest body mass indices and lowest levels of fitness. CONCLUSION: No differences in altitude DCS incidence were observed between the sexes under our test conditions, although men developed VGE more often than women. Age and height showed no significant influence on DCS incidence, but persons of either sex with higher body mass index and lower physical fitness developed DCS more frequently.

  20. Diving behaviour and decompression sickness among Galapagos underwater harvesters.

    PubMed

    Westin, A A; Asvall, J; Idrovo, G; Denoble, P; Brubakk, A O

    2005-01-01

    Diving conditions, dive profiles, vascular bubbles, and symptoms of decompression sickness (DCS) in a group of Galapagos commercial divers are described. They harvest sea cucumbers from small boats with surface supplied air (hookah). Dive profiles for 12 divers were recorded using dive loggers, and bubble formation was measured in the pulmonary artery. DCS symptoms were assessed by interview. A total of 380 immersions were recorded over a nine day period. The divers did on average 6.3 immersions per day, in a yo-yo pattern. Mean overall depth was 34.5 FSW. Maximum recorded depth was 107 FSW. Average bottom time per day per diver was 175 minutes. 82 % of all ascents exceeded the recommended maximum ascent rate of 30 FSW/ min. High bubble grades were observed on six occasions, but the test was unreliable. Muscle and joint pain was reported on five occasions, in three different divers. Symptoms were typically managed by analgesics, in-water recompression or not at all. The divers were extremely reluctant to seek professional help for DCS symptoms, mostly due to the high costs of treatment. We conclude that the fishermen dive beyond standard no-decompression limits, and that DCS symptoms are common. PMID:16119309