Hand Numbness Research Articles

A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies.

Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.

Short-term efficacy and safety of neoadjuvant pyrotinib plus taxanes for early HER2-positive breast cancer: a single-arm exploratory phase II trial.

The effectiveness and safety of pyrotinib have been substantiated in human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer (BC). However, the role of pyrotinib as a single HER2 blockade in neoadjuvant setting among BC patients has not been studied. The objective of this study was to evaluate the efficacy and tolerability of pyrotinib plus taxanes as a novel neoadjuvant regimen in patients with HER2-positive early or locally advanced BC. In this single-arm exploratory phase II trial, patients with treatment-naïve HER2-positive BC (stage IIA-IIIC) received pyrotinib 400 mg once daily and taxanes [docetaxel 75 mg/m2 or nanoparticle albumin-bound (nab)-paclitaxel 260 mg/m2 every 3 weeks, or paclitaxel 80 mg/m2 weekly] for a total of four 21-day cycles before surgery. Efficacy assessment was based on pathological and clinical measurements. The primary endpoint of this study was the total pathological complete response (tpCR) rate. The secondary endpoints included breast pCR (bpCR) rate, investigator-assessed objective response rate (ORR) and adverse events (AEs) profiles. From 1 September 2021 to 30 December 2022, a total of 31 patients were enrolled. One patient was withdrawn due to unbearable skin rash after the second cycle of neoadjuvant therapy. The majority of the intention-to-treat (ITT) population was premenopausal (54.8%), had large tumors (90.3%) and metastatic nodes (58.1%) at diagnosis and hormone-receptor positive tumors (64.5%). Most participants used nab-paclitaxel (74.2%) and received mastectomy (67.7%) after neoadjuvant treatment. The tpCR and bpCR rates were 48.4% [95% confidence interval (CI): 30.8-66%] and 51.6% (95% CI: 34-69.2%), respectively. Grade ≥3 treatment-related AEs were observed in 16.1% (5/31) of the ITT population, including diarrhea (n=2, 6.5%), hand and foot numbness (n=1, 3.2%), loss of appetite (n=1, 3.2%), and skin rash (n=1, 3.2%). AE related dose reduction or pyrotinib interruption was not required. In female patients with HER2-positive non-metastatic BC, neoadjuvant pyrotinib monotherapy plus taxanes appears to show promising clinical benefit and controllable AEs [Chinese Clinical Trial Registry (ChiCTR2100050870)]. The long-term efficacy and safety of this regime warrant further verification.

Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study

BackgroundCarpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life.PurposesThis study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients.MethodWe employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023.ResultsThe results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates.ConclusionThis study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS.

EFFICACY OF NON-PHARMACOLOGICAL APPROACHES TO IMPROVE SLEEP QUALITY INDICES IN POST-STROKE INSOMNIA PATIENTS

Background: Post-stroke insomnia (PSI) is a highly prevalent complication of stroke. Clinical manifestations of PSI include non-refreshing, non-restorative sleep quality and short sleep duration, leading to stroke recovery impediment, cognitive, emotional, and daytime dysfunction, and poor quality of life in stroke patients. PSI can be treated with medications, but studies have reported various adverse effects of hypnotic drugs in PSI. Objective: This study explores non-pharmacological treatments for their efficacy to improve sleep quality in PSI patients. Methods: An electronic search in Medline, Google Scholar, Elsevier, Directory of Open Access Journals (DOAJ), and Semantic Scholar was performed to identify studies examining the efficacy of non-pharmacological approaches to PSI. Results: A total of ten studies examining the efficacy of non-pharmacological approaches to PSI were reviewed. The characteristics of PSI patients in these studies comprised the older population typically at several months after suffering commonly from ischemic type stroke. The evaluated treatments are EEG biofeedback, acupuncture, cognitive-behavioral therapy (CBT), light therapy, and repeated transcranial magnetic stimulation (rTMS). All treatments successfully improved sleep quality, insomnia symptoms, and quality of life in stroke patients as assessed by various measurements including PSQI and actigraphy. Only mild adverse events were reported following acupuncture, such as local hematoma and hand numbness. Conclusion: Non-pharmacological approaches can be considered efficacious in improving sleep quality index, insomnia symptoms, and quality of life of PSI patients. Furthermore, they do not cause severe or long-lasting adverse effects, thus deemed safe for stroke patients.

Comparison of clinical efficacy of open and single channel carpal tunnel release in the treatment of carpal tunnel syndrome

Background. Open or wrist arthroscopic release of carpal tunnel is a relatively safe and reliable method. However, there is still some debate as to which of these various surgical methods is superior. Therefore, this study provides more clinical evidence by comparing the clinical efficacy of open and endoscopic single-channel bowl release in the treatment of carpal tunnel syndrome. Methods. The study conducted a retrospective analysis from January 2010 to January 2021. A total of 105 patients met the inclusion criteria, including 56 patients in the open carpal tunnel Release (OCTR) group and 49 patients in the single channel carpal tunnel release (SCCTR) group. The preoperative, intraoperative, and postoperative symptom improvement and functional recovery of the patients were compared. Results. The results of this study showed that the surgical incision healed well in all patients and complete remission of entrapment symptoms. Compared with the OCTR group, the SCCTR group had reduced surgical and hospital duration, intraoperative blood loss, postoperative scar pain score, and time required to return to normal lifestyle, and the SCCTR group had a lower incidence of sympathetic dystrophy and significantly improved clinical symptoms. Conclusion. Single Channel Carpal Tunnel Release under Carpal Arthroscopy in the treatment of carpal tunnel syndrome can achieve reliable clinical efficacy. It can relieve symptoms such as hand numbness and improve hand function. Postoperative pain and other complications are low, and worthy of clinical promotion.

A Case Report of a Guillain-Barre Syndrome Patient Suspected of Having Acute Transverse Myelitis Treated with Korean Medicine

A 67-year-old female patient diagnosed with acute transverse myelitis visited our hospital in February 2023. Consultation papers indicated that she was diagnosed with acute transverse myelitis and that she complained of quadriparesis and numbness in both hands and feet. However, her spine magnetic resonance imaging (MRI) did not clearly indicate that she suffered from acute transverse myelitis. She was then sent to a high-level hospital and diagnosed with Guillain-Barre Syndrome through electromyography, cerebrospinal fluid test, and spine MRI. On March 2023, she visited our hospital again, still complaining about weakness in both hands and inability to walk. She was treated with Korean medicine, including acupuncture, electroacupuncture, pharmacopuncture, and herbal medicine such as Yanggyeoksanhwatang and <i>Sipimijihwang-tanggami</i>. After three months, she was discharged on cane walking. The manual muscle test (MMT) grade of her upper limbs increased from 3-/3-/3-/3- (shoulder/elbow/wrist/fingers) to 4/4/4/3+, and the MMT grade of her lower limbs increased from 2/2/2/2 (pelvis/knee/ankle/feet) to 4/4/4-/4-. Her numbness in both feet disappeared, and her numbness in both hands decreased from a numeric rating scale of 7 to 2. No adverse events were reported during treatment. This case implies the therapeutic potential of Korean medicine for Guillain-Barre Syndrome, especially for those who had delayed diagnosis and missed the opportunity to get plasma exchange.

Morbidity and Occupational Hazards among Prawn Peelers

Prawn pre-processing, locally called prawn peeling is a labour-intensive activity. More than 90 per cent of the workforce in prawn pre-processing centres are women 1. Occupational health problems among prawn-peeling workers are a matter of serious concern. The workers lack awareness and knowledge of occupational health hazards and safety. In the peeling sheds, they are exposed to cold environments, chlorinated water, and fish protein-related bio-agents. In most of the peeling sheds, women work in a sitting or squatting position, bending forward while peeling. The floor of the peeling sheds is waterlogged, and the women must spend long hours on the wet floor which is the root cause of many of their ailments. Joint pain, low back pain, numbness of hands and legs, and various forms of allergies are health problems attributed to the work environment and work posture.

Case 319: Multisystemic Smooth Muscle Dysfunction Syndrome.

A 7-year-old Chinese girl presented to a local hospital with a 5-day history of progressive right-sided hemiplegia, expressive aphasia, mild bulbar palsy, and reduced general responsiveness. At presentation, her Glasgow Coma Scale was 11/15 (E4 V1M6). Notably, she had two strokelike episodes approximately 7 and 3 months prior to the current episode, with headache, reduced movement, and numbness in the left hand. She also had an extensive medical history at a young age, including congenital mydriasis, patent ductus arteriosus with ligation, dysautonomia, low blood pressure, hypotonic bladder requiring intermittent catheterization, poor bowel transit, and gallstones. Her immunization record was up to date, and her development was otherwise unremarkable. Her parents and younger sibling were healthy. Her blood tests revealed a mildly increased venous lactate level at 2.3 mmol/L (normal range, 0.7-2.1 mmol/L), without acidosis. Results of a coagulopathy work-up (clotting profile and protein C, protein S, antithrombin 3, and fibrinogen levels) were normal. MRI and MR angiography of the brain were performed at presentation.

Bicipitoradial bursitis and biceps tendinitis: Repetitive use versus rheumatoid arthritis

Bicipitoradial bursitis (BRB) is the inflammation of the bicipitoradial bursa, a bursa located in the cubital fossa between the biceps tendon and radial tuberosity. It is a relatively uncommon condition mostly attributed to repetitive use; however, it can be associated with other conditions, including rheumatoid arthritis (RA). We present a 52-year-old woman who presented with novel joint pain with swelling lasting 2 months with elevated rheumatoid factor (RF) 246.2 IU/mL and anti-cyclic citrullinated peptide (CCP) antibodies >1200 IU/mL, highly suggestive of RA. It should be noted the patient works as a butcher, with earlier conditions, including carpal tunnel syndrome (CTS) which was operated on. The patient also had numbness of the right hand with electromyoneurography (EMNG) suggestive of CTS relapse and noticed swelling of the cubital fossae. As a part of the workup, a right elbow ultrasound was done showing a mass, which was confirmed by magnetic resonance imaging as BRB. Given the clinical picture, elevated RF and anti-CCP antibodies, and BRB, it was concluded that the patient likely has early RA, and BRB as a result of both repetitive use in combination with the early RA onset which possibly exacerbated an earlier, stable condition. BRB can be large enough to compress local neural structures causing symptoms, which may be an explanation for the EMNG result of CTS relapse, possibly caused by BRB instead as CTS relapse is relatively uncommon. Although a rare condition usually attributed to repetitive use, BRB can also be associated with other conditions including RA as in our case.

Systemic manifestation of necrotic erythema nodosum leprosum: A case report of a fatal leprosy.

Necrotic erythema nodosum leprosum (ENL) is an uncommon manifestation of type 2 lepra reaction, encountered in lepromatous and borderline lepromatous cases of leprosy. Necrotic ENL is associated with the involvement of multiple organs, therefore delayed diagnosis and treatment will lead to complications and poor prognosis. The aim of this case report was to report a challenging case of necrotic ENL misdiagnosed with multiple cellulitis since there were no signs of prior leprosy nor had any antimycobacterial treatment. A 45-year-old man was presented to the surgery department of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, with complaints of fever, joint pain, and painful tender skin lesions with ulceration over the trunk, extremities, and ears for one month. The patient was diagnosed clinically with multiple cellulitis and underwent a debridement procedure. Clinical improvement was absent, the patient was then consulted to the dermatology department. Physical examination showed normal vital signs, madarosis, inguinal lymphadenopathy, thickening of nerves, and sensation of numbness in both hands and feet. Laboratory examinations on admission showed leucocytosis, anemia, thrombocytopenia, hypoalbuminemia, hypocalcemia, and elevated creatinine and ureum level. A slit skin smears examination yielded positive acid-fast bacilli (AFB) with a bacteriological index (BI) value of 3+ and morphological index (MI) of 72%. The patient was diagnosed with lepromatous leprosy with necrotic ENL reaction. Intravenous methylprednisolone and cefoperazone-sulbactam were given. Multidrug therapy mulitbacillary (MDT-MB) without dapsone, and ofloxacin 400 mg was initiated. On day 17, the patient had septic shock. The patient became unconscious and experienced death. This case highlights that medical professionals should be aware of the various manifestations of necrotic ENL to correctly diagnose and provide treatment as soon as possible to prevent mortality, especially in leprosy-endemic country, Indonesia.

WTP1.12 Axillary Artery Aneurysm in a Patient of Achondroplasia

Abstract Background Axillary artery aneurysms are extremely rare mainly occurring as pseudo-aneurysms. They are most commonly caused by trauma however; fungal infections, atherosclerosis, connective tissue diseases, vasculitis and thoracic outlet syndrome are also among the etiological factors. Case Summary Seventeen years old, unmarried, achondroplasic (three feet height) girl presented to OPD with pulsatile swelling and pian in right axilla for six months. Pain was accompanied by weakness and numbness of hand. The swelling was initially small in size which increased over time. Patient had history of left axillary artery aneurysm back in 2015 for which left axillary repair was done. There was no history of axillary trauma. On physical examination an approximately 4×2 cm lump was palpable in right axilla. It was round in shape, mobile, pulsatile and non-expanding with no overlying skin changes. The patient had hypotonia with power of 3/5 in all limbs. Deep tendon reflexes were reduced. Rest of systemic examination was unremarkable. CT angiography was done which showed brachiocephalic trunck and right proximal subclavian artery normal. There was a lobulated enhancing area along the course of the Right axillary artery measuring 3.5×4.7×3.0 cm. The axillary artery aneurysm was excised and arterial continuity was restored by placement of Reverse Saphenous vein graft. Discussion The conventional method of axillary artery aneurysm repair is aneurysmectomy followed by placement of bypass graft. Owing to long term patency, saphenous vein graft serves as an ideal for reconstruction. Conclusion axillary artery aneurysms should be considered as a differential for pulsatile axillary swellings and should be promptly treated to avoid life threatening complications.

Adenocarcinoma of the lung treated with add-on Ayurveda treatment: A case report

Abstract Studies conducted in 2020 predicted that 1,392,179 people in India suffer from cancer. The six most common sites are breast, lung, mouth, cervix, uterus, and tongue. Among these, lung cancers are reported to have the greatest fatality rate. In the present case, a 49-year-old male patient suffering from adenocarcinoma in the upper lobe of the left lung was managed with herbo-mineral Ayurvedic combinations along with conventional treatment. He had a history of right-sided chest pain after facing a fall from stairs. The chest X-ray showed a right-sided rib fracture. However, as an additional accidental finding, a 3-cm mass on the upper lobe of the left lung was also visible, which was found malignant after the detailed investigations. The patient was initially treated with conventional treatment and surgery, followed by chemotherapy. During chemotherapy, he had complaints of pain, numbness of hands and legs, nausea, anorexia, and severe weakness. Hence, concurrent Ayurvedic treatment was also started after the second cycle of chemotherapy (January 27, 2019), and after completing the modern treatment, Ayurveda treatment was continued till May 27, 2023, accounting for five years approximately. The combination therapy module provided complete symptom alleviation and marked improvement in the positron emission tomography scan that showed marked improvement and did not show any new abnormality in subsequent follow-ups. No recurrences were noticed for the last more than four years. The fact that all of the symptoms have alleviated and investigations show no abnormality is suggestive that the add-on Ayurveda treatment in this case of adenocarcinoma has aided the patient with a more than four year disease-free survival along with the good quality of life as determined by Karnofsky score (90/100).

Case 319.

A 7-year-old Chinese girl presented to a local hospital with a 5-day history of progressive right-sided hemiplegia, expressive aphasia, mild bulbar palsy, and reduced general responsiveness. At presentation, her Glasgow Coma Scale was 11/15 (E4 V1M6). Notably, she had two strokelike episodes approximately 7 and 3 months prior to the current episode, with headache, reduced movement, and numbness in the left hand. She also had an extensive medical history at a young age, including congenital mydriasis, patent ductus arteriosus with ligation, dysautonomia, low blood pressure, hypotonic bladder requiring intermittent catheterization, poor bowel transit, and gallstones. Her immunization record was up to date, and her development was otherwise unremarkable. Her parents and younger sibling were healthy. Her blood tests revealed a mildly increased venous lactate level at 2.3 mmol/L (normal range, 0.7-2.1 mmol/L), without acidosis. Results of a coagulopathy work-up (clotting profile and protein C, protein S, antithrombin 3, and fibrinogen levels) were normal. MRI (Fig 1) and MR angiography of the brain (Fig 2) were performed at presentation.

Submandibular suction lipectomy and single-hole inflator-free endoscopic thyroidectomy with a submental approach: a new surgical technique.

We have successfully carried out single-hole inflator-free endoscopic thyroidectomy through a submental approach, which has the advantages of less trauma, fewer complications, and hidden incisions. However, for patients with submandibular fat accumulation, submental incisions are not easy to hide, which directly affects the cosmetic effect. We developed a new surgical strategy "submandibular suction lipectomy and single-hole inflator-free endoscopic thyroidectomy with a submental approach" for these patients. We initially used submandibular suction lipectomy to reduce the accumulation of submandibular fat and obvious fat protrusion and, thus, restore the normal depression, placing the submental incision back where it is hidden in the submental shadow. Subsequentially, we began to use single-hole inflator-free endoscopic thyroidectomy with a submental approach. We aimed to explore the feasibility and cosmetic effect of this method for the treatment of thyroid disease patients with submandibular fat accumulation. The average operation time was 4.2 hours; and the average hospitalization time was 4.75 days. There were no postoperative complications, such as hoarseness, low calcium, hand and foot numbness, etc., and no special complications and no recurrence or metastasis seen in the 6-month follow-up examination. The aesthetic satisfaction survey results of patients half a year after surgery were satisfactory and above. For thyroid cancer patients with submandibular fat accumulation, this method not only hides the surgical incision in the neck but also meets the patient's requirement for "submental aesthetics"; thus it has good application prospects. It should be pointed out that the current findings are preliminary results, based on data from only four patients.

Efficacy of cryotherapy on chemotherapy-induced peripheral neuropathy in patients with breast cancer: a propensity score-matched study.

This study investigated the effectiveness of cryotherapy in preventing CIPN and its effect on the quality of life (QoL) during chemotherapy. Eligible participants are cancer patients who began therapy with carboplatin, docetaxel, or paclitaxel in the Breast Oncology Unit between May 2022 and October 2022. Patients were distributed into intervention groups that utilized cryotherapy with ice gloves and ice boots and control groups that did not receive cryotherapy. Patient self-report questionnaires were used to quantify patients' symptoms and QoL after treatment. The intervention group exhibited significantly less cold sensitivity, hand and foot numbness, and hand tingling than the control group. Daily CIPN symptoms were substantially milder in the intervention group. Before and after treatment, nerve pain, balance, and muscle and joint discomfort were similar. Intervention and control groups have varied neurotoxicity adverse reaction scores. 2.4% of controls had grade 4 motor neurotoxicity impairment. Physical function and QoL improved in the intervention group. Cryotherapy relieves CIPN symptoms in breast cancer patients receiving carboplatin and paclitaxel chemotherapy. More thorough trials should be carried out to determine the best time limit and duration of cryotherapy.

Case Report: Korean Medicine Treatment for Diabetic Peripheral Neuropathy Concurrent with Chemotherapy-Induced Peripheral Neuropathy

Objectives: This study reports the effectiveness of acupuncture and moxibustion for Diabetic Peripheral Neuropathy concurrent with Chemotherapy-Induced Peripheral Neuropathy.Case presentation: A 58-year-old male was admitted for hand numbness and foot pain after his sixth chemotherapy. He was treated with acupuncture and moxibustion for 18 days. Symptoms were evaluated with a numeric rating scale (NRS). After 18 days of treatment, his foot pain improved from NRS 4 to NRS 2. His hand numbness disappeared.Conclusion: This study suggests that acupuncture and moxibustion can be used for managing diabetic peripheral neuropathy concurrent with chemotherapy-induced peripheral neuropathy.

The effect of central lymph node dissection on the prognosis of cN0 papillary thyroid microcarcinoma: a mid-term follow-up study

BackgroundTo investigate the effect of central lymph node dissection on the prognosis of patients with papillary thyroid microcarcinoma (PTMC) without clinical lymph node metastasis (cN0).MethodsAccording to the inclusion and exclusion criteria, 462 patients with cN0 PTMC underwent surgery in the Second Department of General Surgery, Zhongshan City People’s Hospital from January 1, 2007, to June 31, 2017. They were divided into two groups: the undissection group (262 cases) and the dissection group (170 cases). A comparison was made between the two groups in terms of postoperative complications, recurrences, metastases, etc., as well aslymph node metastasis risk factors in the central region of cN0 PTMC.ResultsThere was no lymphatic leakage or death in all patients after the operation. In the dissection group, 64 cases (37.6%) of central lymph node metastasis were found after the postoperative pathological examination. The undissection group was followed up for (92 ± 28.7) months, and the dissection group was followed up for (86 ± 25.4) months (t=-2.165, P = 0.031). In the two groups, there were no lung metastases, bone metastases, or other distant metastases during the follow-up period. In the undissection group, there were 7 cases, while in the dissection group, there were just 2. Recurrence rates between the two groups did not differ significantly (χ2 = 0.126, P = 0.169); Similarly, disease-free survival curves did not differ significantly (χ2 = 2.565, P = 0.708). Hypoparathyroidism and Hypocalcemia also had no difference between the group. In comparison to the undissection group, the capsular invasion rate (P = 0.026), calcification rate(P < 0.001) incidence of postoperative hoarseness (P = 0.017), and hand and foot numbness rate (P < 0.001) were all considerably greater in the dissection group. Multivariate research revealed that capsular invasion (OR = 9.42, P = 0.002), multifocal (OR = 24.57, P < 0.001), and tumor diameter > 5 mm (OR = 5.46, P = 0.019) were the independent risk factors for central lymph node metastasis in cN0 PTMC.ConclusionsThyroidectomy alone is safe for cN0 PTMC, but longer-term follow-up is still required for changes in central lymph nodes. For cN0 PTMC patients with tumor diameter > 5 mm, multifocal, and capsular invasion, central lymph node metastasis is more likely to occur. Comprehensive evaluation and individualized and precise treatment are essential.

Should I stay or should I go – a qualitative assessment of experiences of recent veterinary graduates in bovine practice

Twenty-three recent graduates (&lt; 8 years in practice) participating in the 2022 AABP Recent Graduate Conference or practicing in the Texas Panhandle were recruited for participation in focus groups to engage in dialogue about why they choose to remain in bovine practice, why they might leave bovine practice, and challenges that they face in bovine practice. All focus groups were recorded and transcribed. Transcription was performed by a commercial source and anonymized for analysis. Full coding and thematic analysis were performed utilizing NVivo software.&#x0D; Recent graduates report that they choose to stay in bovine practice because they love the industry and the associated people. They have a deep respect for their clients and how they care for their animals. However, participants did voice concerns about a career-ending injury causing them to completely leave bovine practice. Multiple participants had already sustained injuries due to the physical demands of bovine practice including a back injury, numbness of arms and hands, and diagnosis of carpal tunnel syndrome. Otherconcerns that were voiced by the participants included unmet needs for mentorship, a feeling of loneliness and isolation, percentage of time spent on-call, and gender inequities in practice.

Lacertus Syndrome: an Outcome Analysis After Lacertus Release

The lacertus fibrosus or bicipital aponeurosis is a sheet of ligamentous tissue just distal to the elbow joint and can be a compression point for the median nerve. Essentially, lacertus syndrome is a subset of pronator syndrome and an uncommon diagnosis by itself. Surgical release of the lacertus consists of a small 2-cm incision that can be performed under local anesthesia. This study aimed to evaluate the outcome of lacertus release in resolving median nerve symptoms. This retrospective study was performed at Prince Court Medical Centre, Kuala Lumpur, Malaysia, from January 2020 until June 2021. Ninety-three patients who presented with numbness of fingers, hand, or upper limb; forearm pain; and muscle weakness. They were diagnosed with lacertus syndrome on the basis of local tenderness at the lacertus fibrosus with either weakness of flexor pollicis longus and flexor digitorum profundus of the index finger or paresthesia over the thenar eminence. The patients underwent 3 months of hand therapy, and those with no symptom improvement were offered lacertus release performed by a single surgeon. The surgical technique consists of a surgical incision starting from a point 2 cm distally and 2 cm radially to the medial epicondyle. The incision projects 2 cm distally in an oblique fashion toward the radial styloid. A wide-awake local anesthesia no tourniquet (WALANT) technqiue was utilized and 20 mL of local anesthesic was injected subcutaneously around this region at least 20 minutes before the surgery. Careful dissection was made subcutaneously, and the lacertus fibrosus was identified as a thickened, shiny white structure and released. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and pinch strength were tested before and after surgery. At 6 months after surgery, the QuickDASH score was again assessed with a WALANT satisfactory questionnaire. A total of 93 patients were included in the study. The mean age of the patients was 38.7 years, and most were women (77.4%). The mean operating time was 70 minutes. The mean preoperative QuickDASH score was 53, which significantly reduced immediately after surgery to 7.8 (P < .001) and remained low at 6 months after surgery (10.6). The mean grip strength showed a significant increase from a preoperative mean of 16 kg to a postoperative mean of 24 kg (P < .001). Pinch strength also significantly increased from a preoperative mean of 9 kg to 13 kg after surgery (P < .001). Lacertus syndrome remains an underdiagnosed disease that can be treated efficiently with a directed minimal surgical incision under wide-awake local anesthesia. Lacertus release appears to significantly reduce pain and numbness with markedly improved hand grip and pinch strength. The corresponding QuickDASH scores also improved significantly after surgery. This study is vital to our understanding of proximal median nerve entrapment and to accurately diagnose it. Therapeutic III.

Study on the effect, safety, prognosis quality and application value of extracorporeal shock wave based neural activity in carpal tunnel syndrome patients

BackgroundMild to moderate CTS is the most common median nerve compression disease in middle-aged and elderly women, mainly manifested by hand numbness and pain. This paper analyzes the extracorporeal shock wave of patients with mild to moderate CTS after nerve mobilization.MethodsThe clinical data of 92 patients with CTS from June 2020 to June 2022 are analyzed and randomly divided into extracorporeal shock wave group (n = 47) and routine group (n = 45). The routine group undergoes nerve mobilization, and the extracorporeal shock wave group receives extracorporeal shock wave therapy on the basis of the routine group. The clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function scores, and ADL scores before and after treatment are observed. The Spearman correlation coefficient is used to analyze the correlation between upper limb function and ADL score, and the incidence of complications after treatment is analyzed.ResultsThe clinical efficacy, symptom improvement, pain score, median nerve electrophysiological examination results, upper limb symptom and function score, ADL score and the incidence of complications in the extracorporeal shock wave group are significantly better than those in the conventional group (P < 0.05). ADL scores are negatively correlated.ConclusionExtracorporeal shock wave combined with nerve mobilization has a significant effect in the treatment of CTS patients, which can significantly improve the symptoms and pain scores of patients, and enhance the function of patients’ upper limbs. At the same time, the incidence of complications in patients is less, and it has high safety.