Distal Motor Research Articles

Short-term effectiveness of kinesio taping as therapeutic tool in conservative treatment of carpal tunnel syndrome: Asystematic review and meta-analysis.

Carpal tunnel syndrome is the most common peripheral neuropathy of the upper extremities and kinesio taping is one of the tools used as a complementary tool within the conventional treatment of carpal tunnel syndrome. To investigate the short-term effects of kinesio taping on pain, functionality, strength, and nerve conduction in subjects suffering from carpal tunnel syndrome. Systematic review with meta-analysis. Seven electronic databases (MEDLINE-Pubmed, Web of Science, Scopus, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were searched for full-text articles published from inception to March 1st , 2023. Studies had to meet the following inclusion criteria: randomised clinical trials, including patients of legal age with mild, moderate, or severe symptoms of carpal tunnel syndrome without associated pathologies, and treating the studied body area with kinesio taping, whether or not in combination with other therapies. The DerSimonian and Laird method was employed using random effects models to calculate the pooled estimate of the effect size with confidence intervals of 95%. The risk of bias was assessed with the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation approach was used to judge the certainty of the evidence for all outcomes. Thirteen studies were included, comprising 665 participants with carpal tunnel syndrome. This meta-analysis revealed a strong effect of kinesio taping on distal sensory latency and a weak effect on functionality and pain, while no significantly superior effects were found on the symptom severity, strength, or neurophysiological outcomes (distal motor latency and sensory conduction velocity) compared to other physical therapy techniques or untreated control group in the short term, with moderate-certainty evidence. Kinesio taping is a complementary tool to the conventional treatment of carpal tunnel syndrome that improves functionality, pain, and distal sensory latency in the short term.

Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity.

It remains unclear whether physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index on CTS severity is not well characterized. Unilateral and bilateral CTS patients were seen from October of 2014 to February of 2021. Obese and nonobese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ), and six-item Carpal Tunnel Symptom Score (CTS-6) measures were obtained. Nerve conduction studies recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used Wilcoxon signed rank testing for paired continuous variables, Mann-Whitney U testing for nonpaired continuous variables, and chi-square testing for continuous variables, with a significance level of P < 0.05. A total of 109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score ( P < 0.0001), CTS-6 score ( P < 0.0001), DML ( P < 0.0001), and DSL ( P < 0.01). Bilateral patients also had higher symptom severity scale ( P < 0.01) and DSL ( P < 0.001) outcomes compared with unilateral patients. Obese patients had higher median nerve CSA ( P < 0.01), prolonged DML, and prolonged DSL ( P < 0.0001) values despite similar CTS severity (BCTSQ and CTS-6). Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS and BCTSQ). Obesity increases median nerve CSA and prolongs nerve conduction studies without influencing CTS severity. This information can be used when considering which diagnostic test to order for CTS.

Study of ultrasound and nerve electromyogram in diagnosis of carpal tunnel syndrome and its severity in the elderly

ABSTRACT Objective: To explore the diagnostic value of ultrasound and nerve electromyography (EMG) in the diagnosis of carpal tunnel syndrome (CTS) and its severity in the elderly. Methods: The data of 140 elderly CTS patients were retrospectively analyzed. The data of 80 patients with other diseases with similar symptoms and high suspicion of CTS during the same period were retrospectively analyzed. Pearson method was used to analyze the correlation between cross-sectional area (CSA) and motor nerve conduction velocity (MCV), distal motor latency (DML), compound muscle action potential (CMAP), sensory conduction velocity (SCV), middle-latency (ML) and sensory nerve action potential (SNAP) levels. The value of CSA, MCV, DML, CMAP, SCV, ML and SNAP in the diagnosis of CTS and its severity was analyzed by receiver operating characteristic (ROC) curve. Results: CSA in mild, moderate and severe groups was positively correlated with DML (P < 0.001) and negatively correlated with CMAP (P < 0.001). The area under the curve (AUC) values of CSA, MCV, DML, CMAP, SCV, ML and SNAP in the diagnosis of normal people and mild CTS were 0.877, 0.787, 0.921, 0.730, 0.860, 0.688 and 0.904. The AUC values of CSA, DML, CMAP, SCV, ML and SNAP in the diagnosis of mild and moderate CTS were 0.863, 0.890, 0.760, 0.848, 0.850 and 0.739, respectively. The AUC values of CSA, MCV, DML and CMAP in the diagnosis of mild and moderate CTS were 0.683, 0.660, 0.870 and 0.693. Conclusion: Ultrasound and nerve EMG are effective in the diagnosis of CTS.

INFLUENCE OF AGING AND LIMB DOMINANCE ON REFERENCE VALUES OF MEDIAN AND ULNAR NERVE CONDUCTION STUDIES

&amp;lt;p class=&amp;quot;MsoNormal&amp;quot; style=&amp;quot;text-align: justify; line-height: 200%;&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; Median and ulnar nerves are mixed upper limb nerves. The aim of the research was to determine refer ence values, and influence of aging and limb dominance on electrophysiological parameters of these nerves.&amp;lt;/p&amp;gt; &amp;lt;p class=&amp;quot;MsoNormal&amp;quot; style=&amp;quot;text-align: justify; line-height: 200%;&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; In 46 women and 14 men, aged 24 to 81, we de termined the conduction velocity (CV), the amplitude, and the distal motor latency (DML) on both nerves and their change with aging and limb dominance. In the group of women the influence of the postmenopausal period on the electrophysiological parameters of the median nerve was observed.&amp;lt;/p&amp;gt; &amp;lt;p class=&amp;quot;MsoNormal&amp;quot; style=&amp;quot;text-align: justify; line-height: 200%;&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; With aging, there was a significant decrease in the CV of sensitive fibers, amplitude of the motor part and DML of both nerves. In the median nerve, there was the decrease in the CV of motor fibers. On the dominant limb, there was the significant decrease in the CV of sensitive fibers of medi an nerve and amplitude of the sensitive part of ulnar nerve. On the dominant limb, aging caused the decrease of CV and the amplitude of the dorsal branch of the ulnar nerve, and CV of the motor fibers and DML of the median nerve. In postmenopausal women, the amplitude of the motor part of the median nerve decreased on the non-dominant limb.&amp;lt;/p&amp;gt; &amp;lt;p class=&amp;quot;MsoNormal&amp;quot; style=&amp;quot;text-align: justify; line-height: 200%;&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;There is the influence of age and dominance on the electrophysiological parameters of the investigated nerves. The postmenopausal period in women, apart from the influence of aging, does not represent a specific influ encing factor on the investigated parameters.&amp;lt;/p&amp;gt;

Biallelic variants in COQ7 cause distal hereditary motor neuropathy with upper motor neuron signs.

COQ7 encodes a hydroxylase responsible for the penultimate step of coenzyme Q10 (CoQ10) biosynthesis in mitochondria. CoQ10 is essential for multiple cellular functions, including mitochondrial oxidative phosphorylation, lipid metabolism, and reactive oxygen species homeostasis. Mutations in COQ7 have been previously associated with primary CoQ10 deficiency, a clinically heterogeneous multisystemic mitochondrial disorder. We identified COQ7 biallelic variants in nine families diagnosed with distal hereditary motor neuropathy with upper neuron involvement, expending the clinical phenotype associated with defects in this gene. A recurrent p.Met1? change was identified in five families from Brazil with evidence of a founder effect. Fibroblasts isolated from patients revealed a substantial depletion of COQ7 protein levels, indicating protein instability leading to loss of enzyme function. High-performance liquid chromatography assay showed that fibroblasts from patients had reduced levels of CoQ10, and abnormal accumulation of the biosynthetic precursor DMQ10. Accordingly, fibroblasts from patients displayed significantly decreased oxygen consumption rates in patients, suggesting mitochondrial respiration deficiency. Induced pluripotent stem cell-derived motor neurons from patient fibroblasts showed significantly increased levels of extracellular neurofilament light protein, indicating axonal degeneration. Our findings indicate a molecular pathway involving CoQ10 biosynthesis deficiency and mitochondrial dysfunction in patients with distal hereditary motor neuropathy. Further studies will be important to evaluate the potential benefits of CoQ10 supplementation in the clinical outcome of the disease.

Dominant aminoacyl-tRNA synthetase disorders: lessons learned from in vivo disease models.

Aminoacyl-tRNA synthetases (ARSs) play an essential role in protein synthesis, being responsible for ligating tRNA molecules to their corresponding amino acids in a reaction known as 'tRNA aminoacylation'. Separate ARSs carry out the aminoacylation reaction in the cytosol and in mitochondria, and mutations in almost all ARS genes cause pathophysiology most evident in the nervous system. Dominant mutations in multiple cytosolic ARSs have been linked to forms of peripheral neuropathy including Charcot-Marie-Tooth disease, distal hereditary motor neuropathy, and spinal muscular atrophy. This review provides an overview of approaches that have been employed to model each of these diseases in vivo, followed by a discussion of the existing animal models of dominant ARS disorders and key mechanistic insights that they have provided. In summary, ARS disease models have demonstrated that loss of canonical ARS function alone cannot fully account for the observed disease phenotypes, and that pathogenic ARS variants cause developmental defects within the peripheral nervous system, despite a typically later onset of disease in humans. In addition, aberrant interactions between mutant ARSs and other proteins have been shown to contribute to the disease phenotypes. These findings provide a strong foundation for future research into this group of diseases, providing methodological guidance for studies on ARS disorders that currently lack in vivo models, as well as identifying candidate therapeutic targets.

Changes of Motor Control of Distal Joint and Motor Learning in Badminton Hitting Skills According to the Visual Feedback Types (Focused on Performance Curves)

OBJECTIVES This study aims to compare the change of motor control of distal joint while badminton hitting on novice in accordance with visual feedback type.METHODS We offered digitized graph and 3D animation of upper limb to quantitative feedback(QN) group, and qualitative feedback(QL) group respectively. Dependent variables are kinematic variable of wrist joint. 27 young men were recruited into three groups, asked to perform forehand-underclear. 20trials for pre-test, 150trials for practice, each 20trials for post-test and retention-test were progressed. After each 10trials in practice step, we offered each feedbacks to each groups. Two-way repeated ANOVA was used to investigate the results.RESULTS Maximum extension angle of wrist joint improved more on QN then QL. Maximum flexion angular velocity of wrist joint improved more in QL than QN on eary phase of learning and retention-test. CONCLUSIONS Through this, it can be interpreted that QN has a positive effect on the motion control of the angular variable in the striking task, and QL has a positive effect on the faster improvement and retention than QN in the motor control of the angular velocity variable in the striking task. In conclusion, this study presents a new direction for the mechanism of motor control and cognitive structure for the distal joint of motor skills forming proximal-distal coordination patterns.

An Atypical Presentation of Immune-mediated, Demyelinating Polyneuropathy with Multiple Antibodies to Nerve and Myelin Proteins Following SARS-CoV2 mRNA Vaccination (P10-5.009)

<h3>Objective:</h3> This case describes an atypical demyelinating polyneuropathy temporally associated with SARS-CoV2 mRNA vaccination and characterized by the presence of multiple co-existing autoantibodies. <h3>Background:</h3> A 62-year-old woman developed distal, symmetric upper and lower extremity sensorimotor impairments and areflexia three weeks after SARS-CoV2 booster vaccination (Pfizer-BioNTech). Initial cerebrospinal fluid analysis demonstrated cytoalbuminologic dissociation (protein 76mg/dL). Intravenous immunoglobulin (IVIg) (2 gm/kg total) was prescribed. The patient’s symptoms and signs resolved. Asymmetric, proximal appendicular weakness, distal appendicular sensory loss, gait impairment, and areflexia reoccurred approximately one week later. Plasma exchange (PLEX) was completed, resulting in marked clinical improvement. Clinical worsening again reoccurred in the weeks following PLEX completion. Electrodiagnostic and serologic studies were obtained. Immunomodulatory therapies were escalated with IVIg (repeat 2 gm/kg), corticosteroid, and rituximab therapies prescribed. Sustained symptom improvement was evidenced. <h3>Design/Methods:</h3> Case report with literature review. <h3>Results:</h3> Nerve conduction and electromyography studies demonstrated absent F-waves, prolonged distal motor latencies, and reduced recruitment of normal motor units consistent with a demyelinating polyneuropathy. Ga1NAc-GD1a IgG, beta-tubulin IgG, and neurofascin-155 IgG antibodies were detected in serum samples obtained prior to IVIg therapy (Washington University Neuromuscular Laboratory Demyelinating Neuropathy Panel). <h3>Conclusions:</h3> The patient’s clinical syndrome was ultimately consistent with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The asymmetric pattern of weakness, robust initial treatment response(s), and severe fluctuations were atypical for classical CIDP, but consistent with demyelinating disease marked by specific autoantibodies. Uniquely, Ga1NAc-GD1a IgG, beta-tubulin IgG, and neurofascin-155 IgG antibodies were identified. Antibodies against axons and myelin proteins have been recently reported in patients with acute and chronic demyelinating polyneuropathies. Antibodies to neurofascin isoforms, anti-tubulin and Ga1NAc-GD1a can result in severe phenotypes with variable treatment responses, including robust treatment response to B-cell targeted therapies. To our knowledge, this is a novel case due to multiple co-existing, potentially pathogenic, autoantibodies. A possible immune-mediated mechanism precipitated by SARS-CoV2 vaccination requires further investigation. <b>Disclosure:</b> Dr. Saban has nothing to disclose. Dr. Leech has nothing to disclose. Dr. Carlson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medscape. Dr. Carlson has received research support from Horizon Therapeutics. Dr. Carlson has a non-compensated relationship as a Health Service Subcommittee Member with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Sauer has nothing to disclose. The institution of Dr. Ragole has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. The institution of Dr. Ragole has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Ragole has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. The institution of Dr. Ragole has received research support from Alexion Pharmaceuticals.

Histopathology of Skeletal Muscle in a Distal Motor Neuropathy Associated with a Mutant CCT5 Subunit: Clues for Future Developments to Improve Differential Diagnosis and Personalized Therapy.

Genetic chaperonopathies are rare but, because of misdiagnosis, there are probably more cases than those that are recorded in the literature and databases. This occurs because practitioners are generally unaware of the existence and/or the symptoms and signs of chaperonopathies. It is necessary to educate the medical community about these diseases and, with research, to unveil their mechanisms. The structure and functions of various chaperones in vitro have been studied, but information on the impact of mutant chaperones in humans, in vivo, is scarce. Here, we present a succinct review of the most salient abnormalities of skeletal muscle, based on our earlier report of a patient who carried a mutation in the chaperonin CCT5 subunit and suffered from a distal motor neuropathy of early onset. We discuss our results in relation to the very few other published pertinent reports we were able to find. A complex picture of multiple muscle-tissue abnormalities was evident, with signs of atrophy, apoptosis, and abnormally low levels and atypical distribution patterns of some components of muscle and the chaperone system. In-silico analysis predicts that the mutation affects CCT5 in a way that could interfere with the recognition and handling of substrate. Thus, it is possible that some of the abnormalities are the direct consequence of defective chaperoning, but others may be indirectly related to defective chaperoning or caused by other different pathogenic pathways. Biochemical, and molecular biologic and genetic analyses should now help in understanding the mechanisms underpinning the histologic abnormalities and, thus, provide clues to facilitate diagnosis and guide the development of therapeutic tools.

Appearance of F-wave during electrophysiological study of

To evaluate the appearance of F-wave in patients with carpal tunnel syndrome through electrophysiological study. Fifty patients with carpal tunnel syndrome(CTS) of the median nerve who were diagnosed clinically and through electrophysiological study for median and ulnar nerve. Fifty normal subjects of healthy volunteers of similar age and gender were compared to the patients and examined for nerve conduction study. Nerve conduction study for median and ulnar nerve (motor and sensory) were done for each patient and subject in neurophysiology department to study the distal motor and sensory latency (DML,DSL), compound motor and sensory action potentials (CMAP,SNAP) ,motor and sensory nerve conduction velocities (MNCV,SNCV) and F-wave latencies(maximum, mean and minimum). There are prolonged distal motor and sensory latency, decrease of compound motor and sensory action potential, decrease of motor and sensory nerve conduction velocity and prolongation of F-wave latencies( minimum, mean and maximum.) of the median nerve (motor) in carpal tunnel syndrome patients compared with the controls and these differences are statistically significant p-value &lt; 0.01. The F-wave parameters for median nerve must be added in electrophysiological study to establish the diagnosis of carpal tunnel syndrome.

Clinical and Electrophysiological Characteristics of Very Early Guillain-Barré Syndrome.

This study compared the clinical and electrodiagnostic (EDX) features and long-term outcomes of patients with very early Guillain-Barré syndrome (VEGBS, duration of illness ≤4 days) and those with early/late (>4 days)-presenting GBS. One hundred patients with GBS were clinically evaluated and categorized into VEGBS and early/late GBS groups. Electrodiagnostic studies were performed on the bilateral median, ulnar, and fibular motor nerves and the bilateral median, ulnar, and sural sensory nerves. Admission and peak disability were assessed using the 0 to 6 Guillain-Barré Syndrome Disability Scale (GBSDS). The primary outcome was disability at 6 months, which was categorized as complete (GBSDS ≤1) or poor (GBSDS ≥2). The secondary outcomes were frequencies of abnormal electrodiagnostic findings, in-hospital progression, and mechanical ventilation (MV). Patients with VEGBS had higher peak disability (median 5 vs. 4; P = 0.02), frequent in-hospital disease progression (42.9% vs. 19.0%, P < 0.01), needed MV (50% vs. 22.4%; P < 0.01), and less frequent albuminocytologic dissociation (52.4% vs. 74.1%; P = 0.02) than those with early/late GBS. Thirteen patients were lost to follow-up at 6 months (nine patients with VEGBS and four patients with early/late GBS). The proportion of patients with complete recovery at 6 months was comparable (60.6% vs. 77.8%; P = ns ). Reduced d-CMAP was the most common abnormality, noted in 64.7% and 71.6% of patients with VEGBS and early/late GBS, respectively ( P = ns). Prolonged distal motor latency (≥130%) was more common in early/late GBS than in VEGBS (36.2% vs. 25.4%; P = 0.02), whereas absent F-waves were more frequent in VEGBS (37.7% vs. 28.7%; P = 0.03). Patients with VEGBS were more disabled at admission than those with early/late GBS. However, 6 month's outcomes were similar between the groups. F-wave abnormalities were frequent in VEGBS, and distal motor latency prolongation was common in early/late GBS.

SORD-related peripheral neuropathy in a French and Swiss cohort: Clinical features, genetic analyses, and sorbitol dosages.

Biallelic variants in SORD have been reported as one of the main recessive causes for hereditary peripheral neuropathies such as Charcot-Marie-Tooth disease type 2 (CMT2) and distal hereditary motor neuropathy (dHMN) resulting in lower limb (LL) weakness and muscular atrophy. In this study, phenotype and genotype landscapes of SORD-related peripheral neuropathies were described in a French and Swiss cohort. Serum sorbitol dosages were used to classify SORD variants. Patients followed at neuromuscular reference centres in France and Switzerland were ascertained. Sanger sequencing and next generation sequencing were performed to sequence SORD, and mass spectrometry was used to measure patients' serum sorbitol. Thirty patients had SORD peripheral neuropathy associating LL weakness with muscular atrophy, foot deformities (87%), and sometimes proximal LL weakness (20%) or distal upper limb weakness (50%). Eighteen had dHMN, nine had CMT2, and three had intermediate CMT. Most of them had a mild or moderate disease severity. Sixteen carried a homozygous c.757delG (p.Ala253Glnfs*27) variant, and 11 carried compound heterozygous variants, among which four variants were not yet reported: c.403C > G, c.379G > A, c.68_100 + 1dup, and c.850dup. Two unrelated patients with different origins carried a homozygous c.458C > A variant, and one patient carried a new homozygous c.786 + 5G > A variant. Mean serum sorbitol levels were 17.01 mg/L ± 8.9 SD for patients carrying SORD variants. This SORD-inherited peripheral neuropathy cohort of 30 patients showed homogeneous clinical presentation and systematically elevated sorbitol levels (22-fold) compared to controls, with both diagnostic and potential therapeutic implications.

Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release.

Background: This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). Methods: We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Results: Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, p < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, p < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, p < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, p < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, p < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm2, p < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm2, p = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, p < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, p < 0.01). Conclusions: Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level of Evidence: Level III (Therapeutic).

Comparison efficacy of ultrasound-guided needle release plus corticosteroid injection and mini-open surgery in patients with carpal tunnel syndrome.

This retrospective study was to compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection vs. mini-open surgery in patients with carpal tunnel syndrome (CTS). From January 2021 to December 2021, 40 patients (40 wrists) with CTS were analyzed in this study. The diagnosis was based on clinical symptoms, electrophysiological imaging, and ultrasound imaging. A total of 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A), and the other 20 wrists were treated with mini-open surgery (Group B). We evaluated the Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of the median nerve), and ultrasound parameters (cross-sectional area, flattening ratio, and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time, and complications were also recorded for the two groups. The Boston carpal tunnel questionnaire and electrophysiological and ultrasound outcomes at preoperatively and 3 months postoperatively had a significant difference for each group (each with P < 0.05). There were no complications such as infection, hemorrhage, vascular, nerve, or tendon injuries in both groups. Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment, and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.

Morphological and electrophysiological evaluation of median and ulnar nerve in complex regional pain syndrome type 1.

Complex regional pain syndrome (CRPS) can be distinguished as type I without and type II with electrophysiological evidence of major nerve lesion. The pathophysiology of both subgroups is still under investigation. The aim of this research is to demonstrate the nerve morphology and electrophysiology in CRPS type I patients. Bilateral median and ulnar nerve cross-sectional areas were evaluated with ultrasound and also median and ulnar nerve conduction studies of both hands were performed. Cross-sectional areas of median and ulnar nerves and nerve conduction studies in healthy controls were also obtained and compared with the patients. Twenty-five male patients and 11 healthy male controls were enrolled in the study. The mean age of the patients was 24.08 ± 5.50 years and controls was 23.18 ± 5.09 (p> 0.05). Compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the diseased side were found significantly lower than the healthy side (p< 0.05). Both median and ulnar nerve distal motor latency values were significantly higher in the patient group (p< 0.05). There was no significant difference in the median and ulnar nerve cross-sectional area when compared with the opposite extremity and healthy volunteers. The lower SNAP and CMAP amplitudes of the median and ulnar nerves compared to the healthy side and the prolongation of the affected side median and ulnar nerve distal motor latencies of the affected individuals may indicate axonal involvement in patients with CRPS type 1. Decreased CMAP amplitudes may also indicate muscle atrophy due to a decrease in the number of functional motor units.

Efficacy of platelet-rich plasma injection versus other conservative treatments of carpal tunnel syndrome: A meta-analysis

Objective: Injection of platelet-rich plasma (PRP) as a proposed treatment for carpal tunnel syndrome (CTS) is a recent innovation. The aim of this analysis is to evaluate the functional and objective outcomes after PRP injection versus other conservative treatments of CTS. Methods: We systematically searched the electronic databases for trials that met our inclusion criteria. Two reviewers screened the studies, extracted the data, evaluated the methodological quality, and performed data analysis. Subgroup analysis was stratified by the follow-up periods. Results: Five randomized controlled trials (RCTs) and one prospective cohort trial met the inclusion criteria. A total of 318 subjects were reported including 160 with PRP injection and 158 with other conservative treatments. The quality of the included studies was high. The meta-analysis showed that no significant differences were detected in the visual analog scale (VAS), the Boston Carpal Tunnel Syndrome Questionnaire-the syndrome (BCTQ-S) and the Boston Carpal Tunnel Syndrome Questionnaire-the functional status (BCTQ-F) at 6 months, changes of VAS, BCTQ-S and BCTQ-F, distal motor latency (DML) and sensory conduction velocity (SCV) between the PRP injection and other conservative treatments. However, the BCTQ-S and BCTQ-F score at 3 months of PRP injection were significantly lower than other conservative treatments. Conclusion: Current evidence revealed that there were no significant differences between PRP injection and other conservative treatment in relief pain, improving clinical symptom and functional status and electrophysiological findings at the final follow up period. However, PRP injection could improve the clinical symptom and functional status at the early period (3 months) of treatment.

A "Clear" Carpal Tunnel Syndrome Diagnosis on Ultrasound Examination Does Not Predict Improved Outcomes When Compared With a "Borderline" Diagnosis.

Nerve conduction studies (NCS) and ultrasound (US) remain imperfect compared with clinical diagnosis and/or diagnostic tools such as carpal tunnel syndrome-6 (CTS-6) for diagnosis of carpal tunne syndrome (CTS). One potential reason for the discrepancy between clinical diagnosis and testing is "borderline" case inclusion. This study aims to compare clinical outcomes after carpal tunnel release (CTR) between "borderline" and "clear" patients with CTS determined by NCS and US. This was a retrospective review of patients who underwent CTR. We collected NCS and US measurements of the median nerve cross-sectional area (MNCSA) at the carpal tunnel inlet, and the Boston Carpal Tunnel Questionnaire (BCTQ) scores comprised of the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS). Ultrasound measurements defined patients as having "borderline" (MNCSA < 13 mm2) or "clear" (MNCSA ≥ 13 mm2) CTS. The study included 94 unilateral patients with CTS. "Borderline" CTS was diagnosed in 58 patients (62%), and "clear" CTS was diagnosed in 36 patients (38%). No significant differences in BCTQ scores were found between groups. At greater than 6-month follow-up, the mean FSS was 1.44 and 1.45 for clear and borderline groups, respectively (P = .97) and the mean SSS was 1.47 and 1.51, respectively (P = .84). However, a significant difference between groups when comparing distal motor latency (DML) and distal sensory latency (DSL) existed. The mean DSL was 3.71 and 4.44 for the clear and borderline groups, respectively (P = .02). The mean DML was 4.59 and 5.36 (P = .048). Categorizing CTS diagnosis into "borderline" and "clear" based on preoperative US and NCS testing did not correlate with BCTQ changes after CTR. It remains unclear whether the BCTQ is a valid postoperative assessment tool, despite its frequent use in literature.

Spared Premotor Areas Undergo Rapid Nonlinear Changes in Functional Organization Following a Focal Ischemic Infarct in Primary Motor Cortex of Squirrel Monkeys.

Recovery of motor function after stroke is accompanied by reorganization of movement representations in spared cortical motor regions. It is widely assumed that map reorganization parallels recovery, suggesting a causal relationship. We examined this assumption by measuring changes in motor representations in eight male and six female squirrel monkeys in the first few weeks after injury, a time when motor recovery is most rapid. Maps of movement representations were derived using intracortical microstimulation techniques in primary motor cortex (M1), ventral premotor cortex (PMv), and dorsal premotor cortex (PMd) in 14 adult squirrel monkeys before and after a focal infarct in the M1 distal forelimb area. Maps were derived at baseline and at either 2 (n = 7) or 3 weeks (n = 7) postinfarct. In PMv the forelimb maps remained unchanged at 2 weeks but contracted significantly (-42.4%) at 3 weeks. In PMd the forelimb maps expanded significantly (+110.6%) at 2 weeks but contracted significantly (-57.4%) at 3 weeks. Motor deficits were equivalent at both time points. These results highlight two features of plasticity after M1 lesions. First, significant contraction of distal forelimb motor maps in both PMv and PMd is evident by 3 weeks. Second, an unpredictable nonlinear pattern of reorganization occurs in the distal forelimb representation in PMd, first expanding at 2 weeks, and then contracting at 3 weeks postinjury. Together with previous results demonstrating reliable map expansions in PMv several weeks to months after M1 injury, the subacute time period may represent a critical window for the timing of therapeutic interventions.SIGNIFICANCE STATEMENT The relationship between motor recovery and motor map reorganization after cortical injury has rarely been examined in acute/subacute periods. In nonhuman primates, premotor maps were examined at 2 and 3 weeks after injury to primary motor cortex. Although maps are known to expand late after injury, the present study demonstrates early map expansion at 2 weeks (dorsal premotor cortex) followed by contraction at 3 weeks (dorsal and ventral premotor cortex). This nonlinear map reorganization during a time of gradual behavioral recovery suggests that the relationship between map plasticity and motor recovery is much more complex than previously thought. It also suggests that rehabilitative motor training may have its most potent effects during this early dynamic phase of map reorganization.

Reverse End-to-Side Transfer to Ulnar Motor Nerve: Evidence From Preclinical and Clinical Studies.

The disappointing outcomes of conventional nerve repair or grafting procedures for proximal ulnar nerve injuries have led the scientific community to search for better alternatives. The pronator quadratus branch of the anterior interosseous nerve has been transferred to the distal ulnar motor branch in a reverse end-to-side fashion with encouraging results. This transfer is now becoming commonly used as an adjunct to cubital tunnel decompression in patients with compressive ulnar neuropathy, underscoring the need for this knowledge transfer to the neurosurgical community. However, the mechanism of recovery after these transfers is not understood completely. We have reviewed the existing preclinical and clinical literature relevant to this transfer to summarize the current level of understanding of the underlying mechanisms, define the indications for performing this transfer in the clinic, and identify the complications and best practices with respect to the operative technique. We have also attempted to identify the major deficiencies in our current level of understanding of the recovery process to propose directions for future research.

A PROSPECTIVE STUDY FOR THE EVALUATION OF NERVE CONDUCTION ABNORMALITIES IN NEWLY DIAGNOSED TYPE 2 DIABETIC PATIENTS

Objectives: Peripheral neuropathy is the one of the frequently encountered complication of type 2 diabetes mellitus (T2DM). Although, the prevalence of diabetic peripheral neuropathy is associated with the diabetes duration, in some cases, the state of neuropathy is evident at the time of diagnosis. In this backdrop, the present study was carried out to evaluate the nerve conduction abnormalities in newly diagnosed T2DM. Methods: This was a prospective study carried out on 30 newly diagnosed T2DM within a time range of 1 month. The patient symptoms such as weakness, burning and tingling senzation, hyperesthesia, and foot ulcer and gait abnormalities were recorded. Nerve conduction analysis of upper limb and lower limb of non-dominant hand side was done using neuro pack S1 machine. Results: Thirty newly diagnosed T2DM patients were enrolled in the present study. The mean age of the patients was found to be 58.12±15.28 years. Distal motor latencies were elevated in T2DM patients as compared to the controls (p&lt;0.05). Further, there was significant prolongation of F-wave latencies in the upper and Lower limbs of the patients as compared to the controls (p&lt;0.05). In addition, there was a significant decrease in sensory conduction velocities in T2DM patients as that of the controls (p&lt;0.05). Conclusion: The study concludes that newly diagnosed T2DM is susceptible to DPN with high incidence rates. Hence, it is essential to perform the nerve conduction studies in newly diagnosed T2DM patients for the early detection and better management and also to prevent the complications.