Asymptomatic Hands Research Articles

Boundaries of task-specificity: bimanual finger dexterity is reduced in musician’s dystonia

Task-specific dystonia leads to loss of sensorimotor control for a particular motor skill. Although focal in nature, it is hugely disabling and can terminate professional careers in musicians. Biomarkers for underlying mechanism and severity are much needed. In this study, we designed a keyboard device that measured the forces generated at all fingertips during individual finger presses. By reliably quantifying overflow to other fingers in the instructed (enslaving) and contralateral hand (mirroring) we explored whether this task could differentiate between musicians with and without dystonia. 20 right-handed professional musicians (11 with dystonia) generated isometric flexion forces with the instructed finger to match 25%, 50% or 75% of maximal voluntary contraction for that finger. Enslaving was estimated as a linear slope of the forces applied across all instructed/uninstructed finger combinations. Musicians with dystonia had a small but robust loss of finger dexterity. There was increased enslaving and mirroring, primarily during use of the symptomatic hand (enslaving p = 0.003; mirroring p = 0.016), and to a lesser extent with the asymptomatic hand (enslaving p = 0.052; mirroring p = 0.062). Increased enslaving and mirroring were seen across all combinations of finger pairs. In addition, enslaving was exaggerated across symptomatic fingers when more than one finger was clinically affected. Task-specific dystonia therefore appears to express along a gradient, most severe in the affected skill with subtle and general motor control dysfunction in the background. Recognition of this provides a more nuanced understanding of the sensorimotor control deficits at play and can inform therapeutic options for this highly disabling disorder.

Spatial Relationship of the Median Nerve and Transverse Carpal Ligament in Asymptomatic Hands.

The spacing between the median nerve and transverse carpal ligament (TCL) within the carpal tunnel can potentially affect the nerve morphology. This study aimed to quantify the spatial relationship between the median nerve and transverse carpal ligament in asymptomatic hands. Twelve subjects were recruited to image the carpal tunnel using robot-assisted ultrasound. The median nerve and TCL were segmented from each image and three-dimensionally reconstructed using kinematic information from the robot. The TCL-median nerve distance, nerve cross-sectional area, circularity, and position were measured along the entirety of the nerve length within the carpal tunnel. Results were averaged at every 5% of nerve length. At the nerve length percentages of 0% (distal), 25%, 50%, 75%, and 100% (proximal), the TCL-median nerve distance (±SD) was 0.7 ± 0.4, 0.7 ± 0.2, 0.5 ± 0.2, 0.5 ± 0.2, and 0.6 ± 0.3 mm, respectively. The corresponding nerve cross-sectional area was 9.4 ± 1.9, 10.6 ± 2.6, 11.2 ± 2.1, 11.2 ± 1.7, and 9.7 ± 1.9 mm2. A one-way analysis of variance showed no significant differences between the respective percentages of nerve length for TCL-median nerve distance (p = 0.219) and cross-sectional area (p = 0.869). Significant (p < 0.0001) but weak correlations were observed between the TCL-median nerve distance with cross-sectional area (r = -0.247) and circularity (r = -0.244). This study shows that the healthy median nerve morphology is consistent along the continuous nerve length within the carpal tunnel, supporting the use of 2D imaging in the evaluation of the healthy nerve.

Static and Dynamic Ultrasound Evaluation of the Median Nerve Morphopathology in Carpal Tunnel Syndrome Diagnosis.

Objective:The current study included a total of 10 patients, both males and females, who gave their consent to participate in the study and underwent clinical and ultrasound examinations. All patients had a history of carpal tunnel symptoms like tingling, numbness, nocturnal paraesthesia and weakness of the hand (loss of pinch and grip strength) for more than 12 months. Aim: The aim of our study was to investigate the morphopathology of the median nerve in clinically diagnosed carpal tunnel thought static and dynamic ultrasound assessment. Material and methods: The present study included a small group of 10 patients aged over 18, both males and females, who had a history of carpal tunnel symptoms for over 12 months and a positive Tinel's and reverse Phalen's tests during clinical examination. Ultrasound was performed by an experienced orthopaedic surgeon with musculoskeletal ultrasound training. Ultrasound evaluation was made using a standardized method and included transverse and longitudinal static examination and dynamic examination of the median nerve in the carpal tunnel. Side-to-side evaluation was performed and differences of more than 10 mm width in the median nerve have been recorded, which was considered to be a positive test for carpal tunnel syndrome. Furthermore, the major advantage of the dynamic evaluation brought by performing the palmar hand and finger flexion test, while investigating the movement trajectory of the median nerve in the carpal tunnel, provides superior imagistic documentation of this pathology. Results:Dynamic evaluation of the median nerve has shown a decreased mobility of the nerve in the carpal tunnel on the side that also had an increased area value of the median nerve width. If in the asymptomatic hand at the time of dynamic evaluation, the median nerve would suddenly slide under the flexor tendons; therefore, we noted results only of a slight translational movement of the nerve in the carpal tunnel on the affected side. A side-to-side difference in the median nerve area, with values ranging between 3 mm up to 9 mm, was found in our patients. Furthermore, thenar atrophy has been discovered in patients with pre-existing carpal tunnel symptoms for more than 24 months. Conclusion:The present study highlights the importance of ultrasound assessment as an accessible static and dynamic evaluation tool. Ultrasound can be used as an in-office imaging tool to complete the clinical diagnosis of carpal tunnel syndrome by studying the morphology and morphopathology of the median nerve in the carpal tunnel through a bilateral standardized examination technique.

Nonhealing Violaceous Plaque of the Hand Following a Splinter Injury.

A 70-year-old immunocompetent man presented to the dermatology department with a progressive asymptomatic hand wound of 2 years’ duration following a splinter injury in Belize. Prior treatment included oral antibiotics without improvement.

Efficiency of 90-Min Extended EMLA-Induced Stimulated Skin-Wrinkling Test in the Diagnosis of Carpal Tunnel Syndrome.

Background:Previous researchers have used a 30-min eutectic mixture of local anesthetic (EMLA) test, which assesses the sympathetically mediated vasomotor function, in diagnosing carpal tunnel syndrome (CTS). However, its specificity was low, limiting its clinical diagnostic utility. In this study, we assessed the efficiency of 90-min extended EMLA-induced stimulated skin-wrinkling (SSW) test in CTS diagnosis.Methods:A cross-sectional study was designed among patients clinically diagnosed with CTS. Hands of healthy volunteers and the asymptomatic hands of selected patients served as control. The Boston symptom severity scale (SSS) and the neuropathic pain severity inventory (NPSI) were used to assess symptom severity, and nerve conduction study (NCS) was used to assess electrophysiological severity. EMLA-induced SSW was visually graded after 90 min of application and correlated with symptom and NCS severities.Results:Forty-two symptomatic hands and 30 asymptomatic hands were enrolled as cases and controls, respectively. The diagnostic efficiency of the extended EMLA test was found to be 83.4% for digit 2 and 87.3% for the lateral 4 digits (mean), whereas the diagnostic efficiency of standard NCS was 88.1%. Boston SSS and NPSI were better correlated with EMLA positivity than NCS positivity. A linear regression analysis showed negative correlation of wrinkling grade with NCS grade.Conclusion:With its improved diagnostic efficiency, the 90-min extended EMLA test can feasibly be used as an alternative to NCS, especially in general practice settings. Its potential clinical utility should be explored in a large population of CTS patients showing varying clinical and electrophysiological severities.

Association between carpal tunnel syndrome and trigger finger: a clinical and electrophysiological study

BackgroundCarpal tunnel syndrome is a prevalent mononeuropathy. Trigger finger is a flexor stenosing tenosynovitis. The aim of the study was to assess the concomitant occurrence of carpal tunnel syndrome and trigger finger in the same hand among patients presented with idiopathic carpal tunnel syndrome or idiopathic trigger finger. The study included 110 hands (75 patients) presented with carpal tunnel syndrome or trigger finger and 60 asymptomatic hands (46 apparently healthy individuals). Clinical assessment and neurophysiological evaluation were done.ResultsRegarding the presenting clinical complaints, there were 76 hands (69.1%) from 48 patients (64.0%) presented with idiopathic carpal tunnel syndrome. There 34 hands (30.9%) from 27 patients (36.0%) presented with idiopathic trigger finger. Classification of the patients into three groups depending on the final diagnosis: (I) carpal tunnel syndrome group, 57 hands (51.8%) with only carpal tunnel syndrome from 36 patients (48.0%); (II) trigger finger group, 25 hands (22.7%) with only trigger finger from 22 patients (29.3%); and (III) carpal tunnel syndrome with trigger finger group, 28 hands (25.5%) with both conditions from 24 patients (32.0%); and among them, seven patients had contralateral hand carpal tunnel syndrome only. The duration of complaints among the carpal tunnel syndrome with trigger finger group was significantly shorter than that in the other two groups. There were statistically significantly higher values of patient global assessment of hand symptoms and effect of hand symptoms on function and quality of life among the carpal tunnel syndrome with trigger finger group versus the other two groups. There was no statistically significant difference between the carpal tunnel syndrome with trigger finger group versus the carpal tunnel syndrome group regarding different classes of the Padua neurophysiological classification scale. The most common digit to have trigger finger was the middle finger in 19 hands (35.8%).ConclusionsThe concurrent presentation of idiopathic carpal tunnel syndrome and idiopathic trigger finger in the same hand is common. Each of them could be associated with the other one. The symptoms of one of them usually predominate the patient’s complaints. The identification of this association is essential for proper diagnosis and comprehensive management of patients presented with these conditions.

Hand Strength Deficit in Patients with Neurogenic Thoracic Outlet Syndrome.

Neurogenic thoracic outlet syndrome (NTOS) is a chronic painful and disabling condition. Patients complain about upper-limb paresthesia or weakness. Weakness has been considered one of the diagnostic criteria of NTOS, but objective comparisons to healthy controls are lacking. We compared the grip and the key pinch strengths between NTOS patients and healthy controls. Grip strength was evaluated with a hydraulic hand dynamometer and the key pinch with a pinch gauge. All the patients with NTOS completed a QuickDASH. We included prospectively 85 patients with NTOS, 73% female and 27% male. The mean age was 40.4 ± 9.6. They were compared to 85 healthy subjects, 77.6% female and 22.4% male. Concerning the grip, symptomatic hands of NTOS patients had significantly 30% less strength compared to control hands (p ≤ 0.001), and 19% less strength compared to asymptomatic hands (p = 0.03). Concerning the key pinch, symptomatic hands of patients with NTOS had significantly 19.5% less strength compared to control hands (p ≤ 0.001). Grip and key pinch strengths had a significant correlation with the QuickDASH (r = −0.515 and r = −0.403, respectively; p ≤ 0.001). Patients with NTOS presented an objective hand strength deficit compared to healthy controls. This deficit was significantly correlated to the upper-limb disability. These findings confirm the interest of hand strength evaluation in the diagnostic process of patients with NTOS.

The bilaterality of idiopathic carpal tunnel syndrome among manual workers.

To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61.

Impaired Fine Motor Function of the Asymptomatic Hand in Unilateral Parkinson's Disease.

The early detection of Parkinson’s disease (PD) still remains a challenge to date. Although studies have previously reported subtle motor function abnormalities in early PD patients, it is unclear whether such clinical signs can be better detected while patients are concurrently performing a cognitive task, and whether they can be useful in predicting patients’ clinical conversion state. Seventy-two right-handed participants (40 drug-naive patients with idiopathic unilateral PD and 32 age-matched healthy controls) were enrolled in this study. All participants were asked to perform the Purdue Pegboard test (PPT) either alone (single-task condition) or during a concurrent mental subtraction-by-3 task (dual-task condition). A 4-year telephone follow-up was later conducted to determine whether PD patients converted to bilateral signs. We found that PD patients showed a significant reduction in dexterity on the PPT compared to the controls in both single- and dual-task conditions. Yet patients’ performance in the dual-task condition revealed a greater interference effect when patients performed the task with their right hand than with their left hand. PPT also revealed reasonable discriminative ability for prediagnosing PD. However, dual-tasking did not have added value in differentiating early patients and controls. At follow-up, the baseline PPT performance of the asymptomatic hands was positively correlated with time to convert from unilaterally to bilaterally affected states (r = 0.62, P = 0.031). Together, these findings suggest that PPT can serve as a useful auxiliary tool in evaluating early PD, and shed light on the neuroplasticity mechanism of fine motor deficit at this very early stage.

Predominant ultrasonographic extracapsular changes in symptomatic psoriatic dactylitis: results from a multicenter cross-sectional study comparing symptomatic and asymptomatic hand dactylitis.

Despite diffuse digital swelling, dactylitis may sometimes be asymptomatic. The objective of this study was to compare the clinical and ultrasonographic features of symptomatic with asymptomatic psoriatic arthritis (PsA) dactylitis. One hundred and twenty-five hand dactylitis were evaluated in a multicenter cross-sectional study for the presence of pain, subjective functional limitation, and tenderness (4-points scale) with the calculation of a Leeds Dactylitis Index (LDI) score. Fingers were subsequently investigated using high-frequency ultrasound (US) both in gray-scale (GS) and power Doppler (PD), for the presence and grading of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDUS), extensor tendon involvement, and joints synovitis. Clinical and US characteristics of symptomatic dactylitic fingers were compared with the asymptomatic dactylitic ones. Symptomatic fingers (n = 80) had a significantly lower dactylitis duration compared to asymptomatic fingers (n = 36) (p < 0.001). Values of LDI, patient VAS-pain, and VAS-functional score were significantly higher in fingers with symptomatic dactylitis (p < 0.001 and p = 0.010, respectively). Symptomatic dactylitis had a higher prevalence of flexor tenosynovitis of grade >2, soft tissue edema and subcutaneous PDUS signal (p < 0.001). Asymptomatic dactylitis showed a greater prevalence of joint synovitis (both in GS and in PD) than symptomatic dactylitis (p < 0.001). Digital tenderness and pain are linked to US tenosynovitis of grade >2 and extra synovial abnormalities and conversely asymptomatic dactylitis is associated with joint-based synovitis.Key Points• Digital tenderness and local pain in psoriatic arthritis dactylitis are strongly associated with flexor tenosynovitis of grade>2, soft tissue edema, and subcutaneous PD signal.• In psoriatic arthritis, asymptomatic dactylitis showed a greater prevalence of joint synovitis than symptomatic dactylitis.• In psoriatic arthritis, ultrasound inflammatory abnormalities are present in about 70% of cold dactylitis which is linked for disease chronicity.• In psoriatic arthritis, the flexor tendon and adjacent soft tissues play a significant role in symptomatic dactylitis.

The Association Between Conditioned Pain Modulation and Manipulation-induced Analgesia in People With Lateral Epicondylalgia.

Objectives:Conditioned pain modulation (CPM) and manipulation-induced analgesia (MIA) may activate similar neurophysiological mechanisms to mediate their analgesic effects. This study assessed the association between CPM and MIA responses in people with lateral epicondylalgia.Materials and Methods:Seventy participants with lateral epicondylalgia were assessed for CPM followed by MIA. A single assessor measured pressure pain thresholds (PPT) before, during, and after cold water immersion (10°C) of the asymptomatic hand and contralateral lateral glide (CLG) mobilization of the neck. For analyses, linear mixed models evaluated differences in CPM and MIA responses. Pearson partial correlations and regression analyses evaluated the association between CPM and MIA PPT.Results:There was a significant increase (CPM and MIA, P<0.001) in PPT from baseline during the interventions (CPM mean: 195.84 kPa for elbow and 201.87 kPa for wrist, MIA mean: 123.01 kPa for elbow and 126.06 kPa for wrist) and after the interventions (CPM mean: 126.06 kPa for elbow, 114.24 kPa for wrist, MIA mean: 123.50 kPa for elbow and 122.16 kPa for wrist). There were also significant moderate and positive partial linear correlations (r: 0.40 to 0.54, P<0.001) between CPM and MIA measures, controlling for baseline measures. Regression analyses showed that CPM PPT was a significant predictor of MIA PPT (P<0.001) and the models explained between 73% and 85% of the variance in MIA PPT.Discussion:This study showed that CPM and MIA responses were significantly correlated and that the CPM response was a significant predictor of MIA response.

Cortical Activation Changes in Hirayama Disease After Anterior Cervical Decompression and Fusion

Spinal cord injury may cause cortical reconstruction. We, therefore explored the changes in cortical activation before and after anterior cervical decompression and fusion surgery in patients with Hirayama disease (HD). In total, 17 cases with HD underwent anterior cervical decompression and fusion surgery. Blood oxygenation level-dependent functional magnetic resonance imaging scan was performed preoperatively, 3 months, 6 months, and 1 year after surgery. Activated voxels were compared between both hands after adjusting for head motion, slice timing, spatial normalization, and image smoothing. Grip strength also was tested in both hands. A retrospective review indicated that the grip strength of the asymptomatic hand was significantly stronger than the symptomatic hand at the time point before the surgery, 3 months after surgery, 6 months after surgery, and 1 year after surgery (P < 0.001). The grip strength of both symptomatic and asymptomatic hands continuously increased within 6 months after surgery (P < 0.05), but it stopped at 1 year after the surgery. The symptomatic limb tends to produce bilateral activation in the primary motor area (M1) during motor tasks. Both contralateral and ipsilateral M1 activation were stronger in symptomatic hand tasks preoperatively (P < 0.05). Both contralateral and ipsilateral activation in M1 during symptomatic hand tasks began to reduce after surgery, and statistical significance was observed 6 months after surgery (P<0.05). Contralateral activation was relatively even over 6 months of the surgery (P > 0.05). After surgery, pathologic reconstruction may have occurred in the primary motor cortex. Recovery of motor function in the symptomatic limb was accompanied by decreased ipsilateral and contralateral M1 activation, as well as symptom improvement. These findings suggested that postoperative cortical activation changes may reflect functional recovery in HD.

ROLE OF ULTRASONOGRAPHY IN THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME

Background: Carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy. The use of sonography for investigation and diagnosis of musculoskeletal conditions has been rapidly increasing over the past few decades. Recent studies have demonstrated advantages of sonographic techniques in the diagnosis of carpal tunnel syndrome (CTS). Objective: Assessing the utility of ultrasonography in the diagnosis of carpal tunnel syndrome (CTS) and grading its severity. Patients and Methods : Sixty hands in 46 patients with clinically and electro-physiologically confirmed carpal tunnel syndrome, and sixty asymptomatic hands in 34 healthy individuals as control group were included in the study and underwent high-resolution ultrasonography of the wrists. In ultrasonographic assessment the cross-sectional area (CSA) of the median nerve at the distal crease of the wrist and flattening ratio (FR) of the median nerve in the carpal tunnel as well as palmar bowing (PB) of the flexor retinaculum were measured. Ultrasonographic Data from the patients group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) curve analysis. Sensitivity and specificity of ultrasonographic measurements were evaluated. Ultrasonographic measurements were correlated with severity of CTS according to nerve conduction studies (NCS). Results: The CSA of the median nerve and PB of the flexor retinaculum were significantly larger in the CTS hands compared to the normal control hands. However, FR of the median nerve showed no significant difference between both groups. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a CSA cut-off value of 10 mm² provided a diagnostic sensitivity of 93.3 % and specificity of 98.3 % and PB cut-off value of 3.3 mm provided a diagnostic sensitivity of 90 % and specificity of 85 %. No significant differences in CSA and PB were found among patients with mild, moderate and severe carpal tunnel syndrome so that CSA and PB did not reflect the severity of the condition. Conclusion: Ultrasonography is a useful non-invasive method for the diagnosis of carpal tunnel syndrome but not assessing its severity.

Use of Multiple Ultrasonographic Parameters in Confirmation of Carpal Tunnel Syndrome.

Ultrasonography (US) of the median nerve has been increasingly studied and used for confirmation of carpal tunnel syndrome (CTS). However, a consensus on the choice of parameters to be evaluated is still not established. The aim of this diagnostic accuracy study was to assess the diagnostic value of multiple parameters individually, as well as in different combinations of variable complexity, and to find an optimal approach for US-based confirmation of a CTS diagnosis. All participants completed clinical and electrophysiologic evaluations, and their hands were scanned with a 5-13-MHz linear US transducer. Eighty-six patients with CTS (135 symptomatic hands) and 50 control participants (93 asymptomatic hands) were analyzed. The median nerve was recorded transversely at the forearm, at the carpal tunnel inlet, in the mid tunnel, and at the carpal tunnel outlet. For determining the parameters' diagnostic value, sensitivities, specificities, and area under the curve (AUC) values were calculated. The inlet cross-sectional area, inlet circumference, and outlet cross-sectional area of the median nerve had the highest AUCs (0.962, 0.920, and 0.913, respectively), sensitivities (87.4%, 80.0%, and 74.1%), and specificities (94.6%, 91.4%, and 92.5%) among single-measurement parameters. An analysis of 2-level parameters (wrist-to-forearm-ratio, inlet-to-outlet-ratio, outlet-to-forearm-ratio, and inlet-outlet mean) yielded the highest AUC (0.974) for the mean cross-sectional area of the median nerve [(inlet + outlet cross-sectional area)/2], with high sensitivity (93.5%) and specificity (91.1%). A compound regression-based index yielded a marginally higher AUC (0.989) than the previously mentioned parameters. Results of the study show that the mean cross-sectional area and inlet cross-sectional area may be valid and easy-to-acquire parameters for routine clinical use in confirming CTS.

Non-invasive volumetric analysis of asymptomatic hands using a 3-D scanner.

Hand swelling is one of the symptoms often seen in practice, but none of the available morphometric methods can quickly and efficiently quantify hand volume in an objective manner, and the current gold-standard volume measurement requires immersion in water, which can be difficult to use. Therefore, we aimed to analyze the accuracy of using 3-dimensional (3-D) scanning to measure hand volume. First, we compared the hand volume calculated using the 3-D scanner to that calculated from the conventional method among 109 volunteers to determine the reliability of 3-D measurements. We defined the beginning of the hand as the distal wrist crease, and 3-D forms of the hands were captured by the 3-D scanning system. Second, 238 volunteers (87 men, 151 women) with no disease or history of hand surgery underwent 3-D scanning. Data collected included age, height, weight, and shoe size. The wrist circumference (WC) and the distance between distal wrist crease and tip of middle finger (DDT) were measured. Statistical analyses were performed using linear regression to investigate the relationship between the hand volume and these parameters. In the first study, a significantly strong positive correlation was observed [R = 0.98] between the hand volume calculated via 3-D scanning and that calculated via the conventional method. In the second study, no significant differences between the volumes, WC or DDT of right and left hands were found. The correlations of hand volume with weight, WC, and DDT were strong. We created a formula to predict the hand volume using these parameters; these variables explained approximately 80% of the predicted volume. We confirmed that the new 3-D scanning method, which is performed without touching the hand and can record the form of the hand, yields an accurate volumetric analysis of an asymptomatic hand.

Effect of manual therapy and neurodynamic techniques vs ultrasound and laser on 2PD in patients with CTS: A randomized controlled trial

Study DesignRandomized controlled trial. IntroductionTwo-point discrimination (2PD) test can be used to assess both clinical condition and the effects of therapy in carpal tunnel syndrome (CTS) patients. Purpose of the StudyTo determine whether there are specific differences in 2PD between symptomatic and asymptomatic hands in CTS patients and to evaluate the impact of 2 therapy regimes on 2PD in patients with CTS. MethodsTherapy for the neurodynamic mobilization group was based on manual therapy and neurodynamic techniques. Therapy for the electrophysical modalities group was based on red and infrared laser and ultrasound therapy using a contact method applied in the transverse ligament area. Therapeutic cycle consisted of 20 therapy sessions delivered at twice-weekly intervals. ResultsAfter therapy, 2PD in the symptomatic limbs in the neurodynamic mobilization and electrophysical modalities groups significantly improved (p < .001). However, there was no statistically significant difference between the treatment groups. ConclusionsBoth therapy programs used in this study were beneficial for improving 2PD. Level of evidence2.

Should neurophysiological criteria for diagnosis of carpal tunnel syndrome be different for patients with diabetes mellitus?

Background: Diabetes mellitus (DM) is a common association with CTS. The gold standard of diagnosis is nerve conduction studies. Boston Carpal Tunnel Questionnaire (BCTQ) is a self applied questionnaire which evaluates the severity of the symptoms and the functional status in CTS.Objectives: We aimed to find out whether accepted neurophysiological criteria for diagnosis of CTS are applicable to patients with DM.Patients and method: Following neurophysiological parameters were measured in clinic patients with DM; median motor distal latency (MMDL), median and ulnar-sensory distal latency difference (MUDLD), median and ulnar sensory nerve conduction velocity difference (MUNCVD). Distal latencies were compared with normal values available for the same laboratory. Patients with BCTQ score of zero was considered as asymptomatic and others; symptomatic. Percentages of subjects fulfilling different neurophysiological criteriato diagnose CTS were calculated i.e. MMDL ≥ 4.5 m/s, median sensory nerve conduction velocity (MSNCV) ≥40 m/s, MUNCVD ≥ 10 m/s, MUDLD ≥ 1 m/s.Results: Among the 70 normal controls the mean MMDL was3.36 ms ± 0.53. In of 51 (females 68.6%, mean age 59.86 years) consented patients 102 hands were tested. There were 61 asymptomatic hands with zero BCTQ. Mean ± SD of MMDL in themwas 4.30 ± 1.01. According to the above neurophysiological criteria 31.14%, 60.6%, 16.3% or 32.78% will be misdiagnosed as CTS. Among the symptomatic subjects mean MMDL was4.92 ± 1.74. The corresponding proportions according to neurophysiological criteria for symptomatic patients were 48.87%, 48.87, 32% or 60.97%.Conclusion: Accepted neurophysiological criteria will over-diagnose CTS in patients with DM. Different diagnostic criteria should be used in them to confirm CTS. Background: Diabetes mellitus (DM) is a common association with CTS. The gold standard of diagnosis is nerve conduction studies. Boston Carpal Tunnel Questionnaire (BCTQ) is a self applied questionnaire which evaluates the severity of the symptoms and the functional status in CTS. Objectives: We aimed to find out whether accepted neurophysiological criteria for diagnosis of CTS are applicable to patients with DM. Patients and method: Following neurophysiological parameters were measured in clinic patients with DM; median motor distal latency (MMDL), median and ulnar-sensory distal latency difference (MUDLD), median and ulnar sensory nerve conduction velocity difference (MUNCVD). Distal latencies were compared with normal values available for the same laboratory. Patients with BCTQ score of zero was considered as asymptomatic and others; symptomatic. Percentages of subjects fulfilling different neurophysiological criteriato diagnose CTS were calculated i.e. MMDL ≥ 4.5 m/s, median sensory nerve conduction velocity (MSNCV) ≥40 m/s, MUNCVD ≥ 10 m/s, MUDLD ≥ 1 m/s. Results: Among the 70 normal controls the mean MMDL was3.36 ms ± 0.53. In of 51 (females 68.6%, mean age 59.86 years) consented patients 102 hands were tested. There were 61 asymptomatic hands with zero BCTQ. Mean ± SD of MMDL in themwas 4.30 ± 1.01. According to the above neurophysiological criteria 31.14%, 60.6%, 16.3% or 32.78% will be misdiagnosed as CTS. Among the symptomatic subjects mean MMDL was4.92 ± 1.74. The corresponding proportions according to neurophysiological criteria for symptomatic patients were 48.87%, 48.87, 32% or 60.97%. Conclusion: Accepted neurophysiological criteria will over-diagnose CTS in patients with DM. Different diagnostic criteria should be used in them to confirm CTS.

Abnormal surround inhibition does not affect asymptomatic limbs in people with cervical dystonia

Surround inhibition is a neural mechanism hypothesized to facilitate goal-directed action by disinhibiting agonist muscle activity while simultaneously inhibiting antagonist and other uninvolved muscle activity. The present study was designed to investigate if abnormalities in surround inhibition are found in asymptomatic body parts (the hand) of people with focal cervical dystonia (neck). Participants with (n=7) and without (n=17) cervical dystonia completed a protocol in which they abducted their index finger while EMG was recorded from the first dorsal interosseous (agonist) and abductor digiti minimi (uninvolved) muscles. Transcranial magnetic stimulation was delivered over the primary motor cortex at intervals ranging from 0 to 950+ms after the onset of agonist muscle activity. Motor-evoked potential (MEP) amplitudes from both muscles were compared. In control participants, MEPs from the uninvolved muscle were significantly lower than agonist MEPs at intervals from 0 to 480ms. Similarly, in the hands of participants with cervical dystonia – the asymptomatic body part – MEPs from the uninvolved muscle were significantly lower than agonist MEPs from 0 to 175ms. These findings suggest that surround inhibition in people with focal dystonia may be intact in asymptomatic hands. In other words, abnormalities in surround inhibition may be restricted to the dystonic limb.

Subclinical pronator syndrome in patients with carpal tunnel syndrome: An electrophysiological study

Aim of the workThe aim of the present study was to detect subclinical pronator syndrome (PS) in patients with carpal tunnel syndrome (CTS) with the utility of the anterior interosseous/median (AIM) score. Patients and methodsThe present study included 90 clinically diagnosed CTS hands and 60 asymptomatic hands of healthy volunteers as a control group. Clinical examination was done for all patients. The following tests were done: (1) Sensory nerve conduction studies: median and ulnar nerves; (2) Motor nerve conduction studies: median and ulnar nerves as well as the anterior interosseous nerve recording the pronator quadratus muscle with calculation of the AIM score. AIM score is a ratio of the antecubital motor latency of the anterior interosseous nerve to that of the median nerve. ResultsThere were 71 CTS hands (78.9%) with a median distal latency (DL) exceeding the reference value and the AIM score was decreased in 63 (70%) of them. Eight hands (8.9%) had a prolonged median DL associated with an AIM score within the reference range raising the probability of having PS. Five (5.6%) of these eight hands had electrophysiological findings in consistency with an established PS. The sensitivity of AIM for the concomitant detection of PS with CTS was 100% and the specificity 95.4%. None of the controls had PS. ConclusionsSubclinical PS is found in CTS patients and could be searched for electrophysiologically in those patients with evidence of moderate to severe degrees of CTS and the AIM score is useful in this aspect.

OP0051 The Extraarticular Patterns of Icg-Enhanced Fluorescence Optical Imaging in Psoriatic Arthritis

BackgroundICG-enhanced fluorescence optical imaging (FOI) is a novel technology for the assessment of inflammation in arthritis [1,2]. Previous studies were mainly focused on articular findings. Extraarticular changes have not yet...