Tinel's Test Research Articles

Variation in Interpretation of Provocative Tests for Carpal Tunnel Syndrome

We studied variation in interpretation of specific symptoms during clinical tests for carpal tunnel syndrome to estimate the degree to which surgeons consider pain without paresthesia characteristic of median neuropathy. We invited all upper-extremity surgeon members of the Science of Variation Group to complete a scenario-based experiment. Surgeons read 5-10 clinical vignettes of patients with variation in patient demographics and random variation in symptoms and signs as follows: primary symptoms (nighttime numbness and tingling, constant numbness and loss of sensibility, pain with activity), symptoms elicited by a provocative test (Phalen, Durkan, or Tinel) (tingling, pain), and location of symptoms elicited by the provocative test (index and middle fingers, thumb and index fingers, little and ring fingers, entire hand). Patient factors associated with surgeon interpretation of provocative tests as negative included pain rather than paresthesia during the Phalen, Durkan, or Tinel test and location of symptoms in the entire hand rather than the median nerve distribution. Specialists do not consider pain without paresthesia or a noncharacteristic symptom distribution as characteristic of carpal tunnel syndrome. Awareness that elicitation of pain with Phalen, Durkan, and Tinel tests is regarded by specialists as relatively uncharacteristic of median neuropathy can help limit the potential for both overdiagnosis and overtreatment of median neuropathy as well as underdiagnosis and undertreatment of mental and social health contributions to illness (notable correlates of the intensity and distribution of pain).

Frequency and Localization of Neuromas in Transtibial Residual Limbs

ObjectiveTo describe the frequency and localization of neuromas in residual limbs of individuals with transtibial amputation using ultrasound imaging. DesignCross-sectional study. SettingRehabilitation center research laboratory. ParticipantsAdults who have lived with a transtibial amputation for >12 months were recruited for this study. Participants were included regardless of the presence or absence of residual limb neuropathic pain. Twenty-three participants (24 transtibial residual limbs) with and without residual limb neuropathic pain were enrolled. The etiology of amputation of most participants was peripheral vascular disease and diabetes. InterventionA comprehensive history was collected and a musculoskeletal ultrasound assessment for the presence and location of neuromas in their residual limb was conducted. During the ultrasound evaluation, a sonopalpation Tinel test was performed by applying pressure on each neuroma with the probe. Main Outcome MeasuresNumber of neuromas and their localization in each residual limb examined. ResultsA total of 31 neuromas in the 24 transtibial residual limbs were identified by ultrasound imaging. The average number of neuromas per residual limb was 1.3. All the major peripheral nerves studied could present neuromas, with a predominance of the superficial fibular nerve within our sample. Thirty-five percent of all the neuromas were described as painful. ConclusionsThe presence of terminal neuromas on surgically sectioned nerves in transtibial residual limbs is frequent. Seventy-nine percent of participants had at least one neuroma. Ultrasound imaging is clinically useful to identify neuromas. The evaluator can easily communicate with the patient to diagnose symptomatic neuromas.

Burden of carpal tunnel syndrome and its associated factors among construction industry workers in Gondar town, Ethiopia.

Carpal tunnel syndrome is characterized by symptoms such as pain, numbness, or tingling on the anterior surface of the index, middle, or radial half of the ring finger, which is frequently associated with weakness of hand grip, and nocturnal pain and/or numbness resulting from compression of the median nerve at the carpal tunnel between the carpal bones and the transverse ligament. The construction industry involves many activities aside from the building process, such as landscaping, painting, electrical supply, plastering, paving, and telecommunications. Performing such tasks involves repetition of wrist flexion and extension, forceful grip with the hand, and/or vibrations of the hand and arm. This study aimed to assess the prevalence of carpal tunnel syndrome and its associated risk factors among construction workers. An institutional-based cross-sectional study design was conducted among six construction sectors in Gondar from April to July 2021. An interviewer-administered questionnaire was prepared from the literature with a Katz hand diagram, and a physical examination and a special test (carpal compression test, Phalen's, and Tinel's test) were carried out for those participants who reported pain during the interview. Binary logistic regression was conducted with SPSS 25 to identify the associated risk factors for carpal tunnel syndrome. The strength of the association was detected by the adjusted odds ratio. A total of 333 study participants aged 18-70 years were included in this study. Among the participants, 11.7% (AOR: 95%CI: 8.1-15.3) had carpal tunnel syndrome. Age, cigarette smoking, work experience, and working with finger-pressing tools were risk factors significantly associated with carpal tunnel syndrome among construction workers with a p-value of <0.05. The magnitude of carpal tunnel syndrome was 11.7% among construction workers. Being of older age, having more experience, cigarette smoking, and working with finger-pressing tools were risk factors significantly associated with carpal tunnel syndrome among construction workers. Employers should implement work safety education programs that raise awareness about the risks of cigarette smoking and encourage employers and supervisors to seek early medical intervention and treatment for carpal tunnel syndrome before it becomes a chronic problem.

Mapping Neurophysiological Patterns in Carpal Tunnel Syndrome: Correlations With Tinel's and Phalen's Signs.

Background This study aimed to observe the neurophysiological severity grading of carpel tunnel syndrome (CTS) using nerve conduction studies (NCSs) and the correlation between Tinel's and Phalen's signs. Methodology In this cross-sectional study, 240 patients of CTS were enrolled. NCSs were conducted in 480 hands. Various variables such as distal latency, amplitude, and nerve conduction velocity in both sensory and motor median nerves were recorded. The provocative tests capable of reproducing patients' symptoms such as Phalen's test and Tinel's test were performed on all 480 hands studied. Results Neurophysiological variables were affected in 449 out of 480 hands. Tinel's sign was observed in 59% of cases (265 hands) while Phalen's sign was positive in 37.2% (167 hands) of cases. Severity grading of CTS based on neurophysiological variables resulted in Grade I (mild) in 202 hands, Grade II (mild to moderate) in 56 hands, Grade III (moderate) in 39 hands, and Grade IV (severe) in 152 hands. Provocative tests (Tinel's and Phalen's) used for the diagnosis of CTS were positive in 68 hands (36.66%) and 26 hands (12.8%), respectively, in mild Grade I. However, as the CTS severity grade increased, the provocative test success rate also increased simultaneously. In severe Grade IVCTS, Tinel's and Phalen's tests were positive in 134 (88.1%)hands and 94 (61.8%) hands, respectively. Conclusions This study underscores the unreliability of Tinel's and Phalen's signs as screening methods for CTS severity. With moderate sensitivity and specificity, NCSs are deemed essential for confirming CTS diagnosis and assessing severity, especially in mild cases that might be mistakenly perceived as normal hands by consultants.

Validation of the Root Analysis Score for C5 Viability in Patients With Pan–Brachial Plexus Injury

Pan-brachial plexus injury patients present a reconstructive challenge. The root analysis score, developed from parsimonious multivariable modeling of 311 pan-brachial plexus injury patients, determines the probability of having a viable C5 nerve based on four categories: positive C5 Tinel test, intact C5 nerve on computed tomography myelogram, lack of hemidiaphragmatic elevation, and absence of midcervical paraspinal fibrillations. Root analysis scores were calculated for a separate cohort of patients with pan-brachial plexus injuries. Scores were validated by the presence or absence of a graftable C5 root, based on supraclavicular exploration and intraoperative electrophysiologic testing. Receiver operating characteristic curve, accuracy, and concordance statistic of the scores were calculated. Patients were divided into three root analysis score cohorts: less than 50 (low), 50-75 (average), and 75-100 points (high) based on dividing the score into quartiles and combining the lowest two. The probability, sensitivity, and specificity of each cohort having an available C5 nerve were based on the intraoperative assessment. Eighty patients (mean age, 33.1 years; 15 women and 65 men) were included. Thirty-one patients (39%) had a viable C5 nerve. The root analysis calculator had an overall accuracy of 82.5%, a receiver operating characteristic of 0.87, and a concordance statistic of 0.87, demonstrating high overall predictive value; 6.5% of patients with a score of less than 50 (94% sensitivity and 43% specificity), 16.1% of patients with a score of 50-75 (94% sensitivity and 67% specificity), and 77.4% of patients with a score of 75-100 (77% sensitivity and 90% specificity) had a graftable C5 nerve. The root analysis score demonstrated high accuracy and predictive power for a viable C5 nerve. In patients with a score of less than 50, the necessity of supraclavicular root exploration should balance patient factors, presentation timing, and concomitant injuries. Diagnosis II.

PENGARUH AKTIVITAS RUMAH TANGGA TERHADAP POTENSI TERJADINYA CARPAL TUNNEL SYNDROME

Carpal Tunnel Syndrome (CTS) is a syndrome that occurs due to the median nerve being compressed in the carpal tunnel in the wrist. Housework that is done every day has the potential to cause carpal tunnel syndrome because household work is done repeatedly or continuously every day. To broaden the knowledge of the Ngempeng Bangil community, the author submits a community service proposal with the title The Influence of Household Activities on the Potential for Carpal Tunnel Syndrome (CTS) in the Elderly in Ngempeng Bangil Village. Physiotherapy service activities for the elderly community in Ngempeng Bangil Village on Friday, 17 March 2023 can be implemented smoothly, orderly and on time. This activity was attended by approximately 40 people. Carpal Tunnel Syndrome (CTS) is a syndrome that occurs due to the median nerve being compressed in the carpal tunnel in the wrist. In the elderly in Ngempeng Bangil Village, Arbain Housing, there are 20% of elderly people who are positive for Carpal Tunnel Syndrome. The services used in this activity are cholesterol tests, uric acid tests, tinel tests, phallen tests and starching exercises at young joins.

Anomaly originated flexor digitorum superficialis muscle of the small finger: A case report.

We present a clinical case of flexor digitorum superficialis (FDS) muscle belly of the small finger originating from the palm of a patient undergoing carpal tunnel surgery with a literature review. A 28-year-old right-handed woman visited our hospital with a chief complaint of a continuous tingling sensation and weakness in the right hand, which began after the volar side of her wrist was crushed by a machine during work 2 weeks prior. The patient complained of a continuous tingling sensation in the thumb, index, and middle fingers. The patient had a positive result on Tinel test of the median nerve of the wrist. As electromyography and nerve conduction velocities showed signs of severe injury in the right median nerve, exploration and carpal tunnel release were planned. Carpal tunnel release was performed under regional anesthesia using the classical open approach. The median nerve in the distal forearm and distal portion of the flexor retinaculum appeared to be narrowed and compressed. An anomalous muscle originating from the flexor retinaculum is also observed. The FDS muscle of the small finger was excised at the flexor retinaculum and musculotendinous junction and sutured to the flexor digitorum profundus tendon. At the 37-month follow-up, the patient did not experience any tingling sensation or weakness. She showed excellent range of motion of the right small finger. The grip strength was 20 kg on both the right and left sides. Quick disabilities of the arm, shoulder, and hand score was 2.3. Asymptomatic small finger FDS muscle anomalies can occur, as demonstrated in this case study. Thus, physicians should familiarize themselves with small finger FDS muscle anomalies during interactions with patients to facilitate future treatments of patient complaints related to the hand, as well as wrist laceration or trauma requiring hand exploration.

Clinical Predictors of C5 Spinal Nerve Viability in Pan-Brachial Plexus Injuries.

In pan-brachial plexus injury, distinguishing between preganglionic and postganglionic injuries is crucial to reconstructive planning. This study aimed to identify preoperative factors that would accurately predict a reconstructible C5 spinal nerve. Patients with pan-brachial plexus injury from a single institution between 2001 and 2018 were reviewed. Patient demographics, clinical examination, diagnostic imaging, and electrodiagnostic results were recorded. C5 viability was determined based on supraclavicular exploration and intraoperative electrophysiologic testing. Univariate analysis identified significant factors for regression analysis. A multivariable parsimonious model was created using stepwise high-performance logistic regression. A total of 311 patients (mean age, 29.9 years; 46 women and 265 men; mean Injury Severity Score, 17.2) were included. A total of 134 patients (43%) had a viable C5 nerve, and 50 patients (12%) had a viable C6 nerve. Intact C5 spinal nerve on computed tomographic (CT) myelogram (OR, 5.4), positive Tinel test (OR, 2.6), muscle strength greater than or equal to 4 (according to the modified British Medical Research Council scale) for the rhomboid (OR, 1.3) or greater than or equal to 4 for the serratus anterior (OR, 1.4), and rhomboid needle electromyography (OR, 1.8) were predictive of having a viable C5 spinal nerve. The multivariable parsimonious stepwise model (area under the curve, 0.77) included four factors: positive Tinel test, intact C5 spinal nerve on CT myelogram, hemidiaphragmatic elevation, and midcervical paraspinal fibrillations. In this cohort of pan-brachial plexus patients with major polytrauma, there was a 43% incidence of viable C5 spinal nerve. A positive Tinel test (OR, 2.1) and intact C5 spinal nerve on CT myelogram (OR, 4.9) predicted a viable C5 nerve. In contrast, hemidiaphragmatic elevation (OR, 3.1) and midcervical paraspinal fibrillations (OR, 2.92) predicted root avulsion. Risk, III.

Application of Tinel’s test combed with clinical neurosensory test distinguishes spontaneous healing of lingual nerve neuropathy after mandibular third molar extraction

BackgroundExtraction of the mandibular third molar, the most frequent and important surgical procedure in the clinical practice of oral surgery, is associated with the risk of injury of the lingual nerve. Neuropathy of the lingual nerve poses diagnostic challenges regarding the transient or permanent nature of the injury. No consensus or criteria have been established regarding the diagnosis of lingual nerve neuropathy. We applied both Tinel’s test and clinical neurosensory testing together, which can be easily used at the bedside in the early stages of injury. Therefore, we propose a new method to differentiate between lesions with the ability to heal spontaneously and those that cannot heal without surgery.ResultsThirty-three patients (29 women, 4 men; mean age, 35.5 years) were included in this study. For all patients, the median interval between nerve injury and initial examination was 1.6 months and that between nerve injury and the second examination before determining the need for surgical management was 4.5 months. The patients were assigned to either group A or B. The spontaneous healing group (group A, n = 10) revealed a tendency for recovery within 6 months after tooth extraction. In this group, although there were individual differences in the degree of recovery, a remarkable tendency for recovery was observed based on clinical neurosensory testing in all cases. None of the patients were diagnosed with allodynia. In seven cases, the Tinel test result was negative at the first inspection, and in three cases, the result changed to negative at the second inspection. Conversely, in group B(n = 23), no recovery trend was observed with regard to clinical neurosensory testing, and nine patients had allodynia. Further, the Tinel test result was positive for all patients in both examinations.ConclusionsOur findings indicate that in case of transient lingual nerve paralysis, clinical neurosensory testing findings deteriorate immediately after tooth extraction and gradually recover, while Tinel’s test shows a negative result. Using Tinel’s test and clinical neurosensory testing together enabled early and easy identification of the severity of the lingual nerve disorder and of lesions that would heal spontaneously without surgical management.

Diagnostic Test Accuracy of Provocative Maneuvers for the Diagnosis of Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis.

The purpose of this study was to summarize and evaluate the research on the accuracy of provocative maneuvers to diagnose carpal tunnel syndrome (CTS). The MEDLINE, CINAHL, Cochrane, and Embase databases were searched, and studies that assessed the diagnostic accuracy of at least 1 provocative test for CTS were selected. Study characteristics and data about the diagnostic accuracy of the provocative tests for CTS were extracted. A random-effects meta-analysis of the sensitivity (Sn) and specificity (Sp) of the Phalen test and Tinel sign was conducted. The risk of bias (ROB) was rated using the QUADAS-2 tool. Thirty-one studies that assessed 12 provocative maneuvers were included. The Phalen test and the Tinel sign were the 2 most assessed tests (in 22 and 20 studies, respectively). The ROB was unclear or low in 20 studies, and at least 1 item was rated as having high ROB in 11 studies. Based on a meta-analysis of 7 studies (604 patients), the Phalen test had a pooled Sn of 0.57 (95% CI = 0.44-0.68; range = 0.12-0.92) and a pooled Sp of 0.67 (95% CI = 0.52-0.79; range = 0.30-0.95). For the Tinel sign (7 studies, 748 patients), the pooled Sn was 0.45 (95% CI = 0.34-0.57; range = 0.17-0.97) and the pooled Sp was 0.78 (95% CI = 0.60-0.89; range = 0.40-0.92). Other provocative maneuvers were less frequently studied and had conflicting diagnostic accuracies. Meta-analyses are imprecise but suggest that the Phalen test has moderate Sn and Sp, whereas the Tinel test has low Sn and high Sp. Clinicians should combine provocative maneuvers with sensorimotor tests, hand diagrams, and diagnostic questionnaires to achieve better overall diagnostic accuracy rather than relying on individual clinical tests. Evidence of unclear and high ROB do not support the use of any single provocative maneuver for the diagnosis of CTS. Clinicians should consider a combination of noninvasive clinical diagnostic tests as the first choice for the diagnosis of CTS.

Outcomes of Patellar Replacement Vs Patellar Neurectomy in Total Knee Replacement

Objectives: To compare the outcomes of patellar replacement and patellar neurectomy in Patients undergoing Total Knee Replacement . Materials &amp; Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. Total 30 Patients were enrolled in this study and they were divided into two groups. Group A constitutes of 15 Patients underwent Post tibial neurectomy. And Group B consisting of 15 Patients went through Tibial Resection. All the patients have been assessed through the Tinel test on the painful area and self-administered Patient-Reported Outcome Measurements (PROMs): Patellar replacement also known as patellofemoral arthroplasty, is a surgical procedure that is performed in conjunction with total knee replacement (TKR) to relieve pain in the knee joint caused by patellofemoral arthritis or other conditions affecting the patella. All the patients of Group B were given anesthesia to numb the area. An incision was made in front of the knee to expose the patella and surrounding structures. Removal of the patella: The patella was carefully removed from the knee joint. The underside of the patella was reshaped to fit a prosthetic component that was implanted in its place. The patellar component was attached to the reshaped surface of the patella using bone cement. The patella was repositioned in the knee joint and attached to the femur using sutures. The incision was closed using sutures or staples. The goal of patellar replacement is to reduce pain and improve function in the knee joint. All the group A participants went through Patellar neurectomy. Patellar neurectomy is a surgical procedure that involves cutting or removing the nerve endings that supply sensation to the patella. Results: Total 30 Patients participated in this study. In Group A =15 Patients who underwent patellar Neurectomy and 15 Patients in Group B who experienced Tibia Resection. Total 5 months follow up was done. Group B participants showed excellent Results. NRS score decreased to 0 in Group B. While in patellar Neurectomy group A two patients experienced still moderate pain, Remaining 13 patients although did not experienced pain but felt numbness on limbs. Practical Implication: Patellar neurectomy involves cutting or removing the nerve endings that supply sensation to the patella, interrupting the transmission of pain signals from the patella to the brain. Although it is less time consuming but can cause numbness or altered sensation in the skin over the patella, which may affect the patient's quality of life Does not address underlying patellar instability or misalignment, which can still cause pain and functional limitations Can be associated with a risk of complications such as neuroma, infection, stiffness. Conclusion: Patellar Resection with TKA has better outcomes than Patellar Neurectomy. Patellar denervation with electrocautery is effective in reducing pain and opioid consumption after total knee replacement. Postoperative range of motion is significantly better in patellar denervation group, which means that patellar denervation significantly improves clinical outcome Keywords: Total Knee Replacement, Patellar Replacement, Neurectomy, Neurectomy, Tibia Resection, Pain, Prosthesis

Nucleo CMP Forte™ for the treatment and rehabilitation of patients with carpal tunnel syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common and best well-known cause of peripheral nerve compression. To date, none of the studies have determined the optimal combination of pyrimidine nucleotides and electrical stimulation (ES) in CTS patients. The objective of the study was to evaluate the effectiveness of a novel product containing uridine and cytidine monophosphate (Nucleo CMP Forte™) in combination with ES for the treatment of CTS. Methods: This open-label, randomized, controlled study involved 60 patients with CTS at the Azerbaijan Medical University (Baku, Azerbaijan) and Research Institute of Medical Rehabilitation between 2017 and 2021 years. Patients were randomized to receive the exploratory treatment (Nucleo CMP Forte™ and ES) or single ES treatment for ten days. The combination treatment included two stages: Nucleo CMP Forte™ and ES for ten days (stage one), and Nucleo CMP Forte™ as monotherapy (stage two) for ten days. Results: In the exploratory group, the complete restoration of pain sensitivity was achieved by 17.1% of patients and the narrowing of the existing zone of hypesthesia by 74.3%. Positive Tinel test was revealed in 52.4% of patients after the first and 76.2% after the second stage in the exploratory group, versus 43.8% in the control group. Mean values in the Boston Carpal Tunnel Questionnaire significantly decreased in both groups. Conclusion: Nucleo CMP Forte™ in combination with ES contributes to a more pronounced regression of patients' complaints, clinical manifestations, severity, and neurophysiological indicators in mild-to-moderate CTS.

Endoscopic treatment in carpal tunnel syndrome: a case study in Bucharest – Romania

Background. Carpal tunnel syndrome is currently the most common peripheral nerve compression neuropathy that affects approximately 1% of the population. The incidence of CTS seems to be increasing. The diagnosis is based on clinical symptoms and electrodiagnostic studies. The purpose of this study is to analyze the effects of the endoscopic technique on patients with carpal tunnel syndrome. In addition, we want to demonstrate if this condition occurs more in men than in women. Methods. In a group of 53 patients we used the endoscopic technique for the treatment of carpal syndrome, and as a measure of its effectiveness we used the Phalen, Durken and Tinel tests. Also, for the qualitative analysis of the data, the clinical and demographic characteristics of the patients were taken into account. Results. We identified statistically significant differences between men and women regarding the occurrence of carpal syndrome, women having significantly lower results than men in the Phalen, Durken and Tinel tests (X2Phalen(2) =17.33, X2Durken(2) =15.94, X2Tinel(2) =10.76, p&lt;0.05). There are statistically significant differences between the results of the Phalen, Durken and Tinel tests before and after surgery (WPhalen=111.24, WDurken=139.91, WTinel=102.46, p&lt;0.05).

EFFICACY OF ULTRASOUND GUIDED CORTICOSTEROID INJECTION IN CARPAL TUNNEL SYNDROME

BACKGROUND : Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The etiology can be hereditary, repetitive movements of the wrist in mechanical workers, injury to the wrist, pregnancy, obesity, metabolic disorders, auto immune conditions such as diabetes mellitus, rheumatoid arthritis and in elderly population. Females are affected more than males. A lot of treatment options are available for carpal tunnel syndrome. Corticosteroid injections are very effective in mild to moderate carpal tunnel syndrome on short and in some cases on long term basis.&#x0D; OBJECTIVES:To evaluate the efficacy and clinical outcomes of ultrasound guided corticosteroid injection for treatment of carpal tunnel syndrome.&#x0D; STUDY SETTING: Department of Orthopedic surgery Services Hospital Lahore .&#x0D; STUDY DESIGN: Cross sectional study.&#x0D; STUDY DURATION: From December 2018 to December 2019 &#x0D; METHODOLOGY: This prospective cross sectional study was carried out from Dec 2018 – Dec 2019 on OPD basis. A total number of 80 patients were included in the study. There were 40 males and 40 females in our study. Each patient was injected triamcinolone 40 mg with 2 % xylocaine. After the injection every patient was followed at 6 weeks, 3 months and at 6 months.&#x0D; At each follow up these patients were assessed by Phalen test, Tinel sign, Boston carpal tunnel syndrome severity score, functional assessment scale, electrophysiological studies and nerve conduction study.&#x0D; RESULTS : Our study included 80 patients with 40 males and 40 females. 40 female patients were housewives, 25 male patients were manual workers and remaining 15 patients were computer operator. 30 patients had mild symptoms of carpal tunnel syndrome, 35 had moderate while the remaining 15 patients had severe symptoms of carpal tunnel syndrome. All these patients were having symptoms for the last 6 – 12 weeks which did not improve with the conservative management. These patients were having symptoms of numbness and tingling at the initial presentation. Phalen test was positive in 95 % (76 patients) patients while Tinel test was positive in 80 % patients ( 64 patients ) at the initial presentation . &#x0D; Boston’s severity symptom score was 35.34 +/- 3.59 and functional status scale was 25.43 + 5.82 (At the initial presentation) in all patients. Following corticosteroid injection at 06 weeks the symptoms severity score was 21+/-3.32 ( mean ) and at 03 months 18.80 + 3.41 ( mean ) in 72 patients while 8 patients did not respond to corticosteroid injection while the functional status scale 17.62 +- 5.01 and 13.45 +- 4.2 at 03 months .&#x0D; Electrophysiological study was also improved after 06 weeks and after 03 months&#x0D; CONCLUSION : Corticosteroid injections are very effective regarding the outcomes on short term basis . However , they are effective in small number of patients on long term basis

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.

Foot Drop In A Performing Arts Dance Girl

HISTORY: A 12-year-old performing arts dance girl with history of cerebral cavernous malformations (CCM) presents with pain in left leg and suddenly foot drop. She is involved in a strict strength and conditioning program and her mom referred symptoms began two days after a dance session. PHYSICAL EXAMINATION: examination revealed stepagge gait with an ample sustentation base, left ankle with no active range of motion with stiffness at passive range of motion, strength of tibialis anterior muscle 0/5 in Lovett scale, extensor digitorum longus and extensor hallucis longus muscle 3/5 in Lovett scale. Pain with the manipulation of proximal tibiofibular joint, positive Tinel test and muscle atrophy in calf zone, no abnormal reflexes, no overlying erythema or skin changes were noted. Neurodynamic testing for peroneal nerve reproduced tingle and pain. DIFFERENTIAL DIAGNOSIS:1. Vasculitis 2. Peroneal stress fracture 3. L5 radiculopathy TEST AND RESULTS: laboratory and immunological test results were normal. Brain MRI showed the CCM and knee MRI showed increased intensity and thickness of common peroneal nerve and edema of the tibialis anterior, peroneous longus and extensor digitorum longus suggestive of edema. FINAL WORKING DIAGNOSIS: traction peroneal neuropathy TREATMENT AND OUTCOMES: 1. Splint immobilization at night. 2. Physical therapy with progressive neurodynamic peroneal nerve glide exercises and manual therapy in ankle joint.3. Proprioception exercises. 4. Range of motion and ankle strengthening exercises started 2 weeks post injury. 5. Return to sports 4 months post injury with total resolution of symptomatology.

Evaluation of different physical examination methods for the diagnosis of carpal tunnel syndrome

In the present study, to evaluate the diagnostic value of different physical examination methods for diagnosing carpal tunnel syndrome (CTS), the scratch collapse test (SCT) and hand elevation test were compared with other traditional tests, such as Tinel's, Phalen's and reverse Phalen's tests, in an aim to improve the current diagnostic standards for CTS. The present study examined 236 (465 hands) patients with CTS and 96 (170 hands) controls who were enrolled in the study from December, 2019 to January, 2021. The participants in both groups were of the same age range, with equal male‑to‑female ratios. An examiner who was familiar with all maneuvers performed the Tinel's, Phalen's and reverse Phalen's tests, as well as the SCT and the hand elevation test in the two groups. The examiner was blinded to the patient histories and diagnoses. The sensitivities and specificities of all the tests were as follows: Tinel's test, 0.4194 and 0.7706; Phalen's test, 0.5613 and 0.7353; reverse Phalen's test, 0.5527 and 0.7882; SCT, 0.6774 and 0.7176; and hand elevation test, 0.7548 and 0.6059, respectively. The sensitivities of the SCT and hand elevation test were significantly higher than those of the other three tests. The areas under the receiver operating characteristic curve of the SCT and hand elevation test were 0.6975 and 0.6804, respectively, both of which were higher than those of Tinel's (0.5950), Phalen's (0.6483) and reverse Phalen's (0.6705) tests. On the whole, the present study demonstrates that the SCT is objective, reliable and has a high sensitivity. Furthermore, the hand elevation test is easy to perform, reproducible and has a high sensitivity. These newer tests are valuable for the diagnosis of CTS and can improve the current diagnostic standard system.

An unusual cause of tarsal tunnel syndrome: Schwannoma of the posterior tibial nerve; a rare cause and rare localization.

IntroductionSchwannoma of the posterior tibial nerve is extremely rare.Case presentationA 25-year-old female with a one-year history of left foot pain is presented. Clinical and radiological findings were in favor of a tarsal tunnel syndrome caused by a schwannoma of the posterior tibial nerve, prompting the patient to undergo surgery. We performed a complete excision of the tumor with the aid of a loupe magnification. At the last follow-up, the patient did well, with no recurrent pain and no neurological squeals.DiscussionThe diagnosis of a tibial nerve schwannoma can often be difficult as, in the early stages, a mass may not be palpable and symptoms are often non-specific because of the slow-growing soft tissue mass.ConclusionAlthough schwannoma is a rare cause of tarsal tunnel syndrome, it should be kept in mind by physicians, especially in cases of chronic unexplained foot pain with a positive Tinel's test.

Accuracy of the Most Common Provocation Tests for Diagnosing Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis.

To estimate the screening performances of the most important provocation tests for diagnosing carpal tunnel syndrome (CTS). Diagnostic test accuracy systematic review with meta-analysis. We systematically searched the MEDLINE, Scopus, Web of Science, and Cochrane databases from inception to November 2020. Observational studies comparing the accuracies of the Durkan test (DT), the hand elevation test (HET), the Phalen test (PT), the Tinel test (TT), and the upper-limb neurodynamic test specific to the median nerve (ULNT1) with electrodiagnosis for screening for CTS. Random-effects models for the diagnostic odds ratio (dOR) values computed by Moses' constant for a linear model and 95% confidence intervals (CIs) were used to calculate the accuracy of these tests. Hierarchical summary receiver operating characteristic curve analyses were used to summarize the overall test performance. Thirty-seven studies were included in the meta-analysis, with a total sample of 2662 wrists for DT, 864 wrists for HET, 6361 wrists for PT, 6094 wrists for TT, and 571 wrists for ULNT1. The pooled dORs for screening for CTS were 15.84 (95% CI: 3.78, 66.38) for DT, 128.63 (95% CI: 40.64, 407.12) for HET, 7.23 (95% CI: 4.06, 12.86) for PT, 5.31 (95% CI: 3.49, 8.09) for TT, and 1.78 (95% CI: 0.61, 5.19) for ULNT1. HET has the best clinical performance for detecting CTS and should be considered the first screening test of choice during the physical examination. The most common tests (DT, PT, and TT) have good accuracies for screening for CTS. J Orthop Sports Phys Ther 2022;52(8):522-531. Epub: 19 June 2022. doi:10.2519/jospt.2022.10828.

Techniques to prevent symptomatic neuroma in digital amputations

The occurrence of a symptomatic neuroma on a digital amputation stump, whether traumatic or not, is a frequent complication that affects the patient’s quality of life. The objective of this study was to analyze the complications inherent to the various techniques used to manage the nerves when performing digital amputation. We compared different surgical nerve management techniques to determine if one technique is more effective than another in preventing neuroma occurrence. We reviewed 105 patients over a 5-year period. A DN4 score greater than 4 and the modified Tinel test (percussion) showing a trigger zone allowed us to clinically diagnose symptomatic neuroma-related pain. We found 23 symptomatic neuromas out of 131 digital amputations. Twelve neuromas were found when the nerves had been neglected (12/33), eight were found in nerves treated by stripping (8/60), three when nerves were treated by stripping and thermal ablation (3/18). No neuroma was found in the five cases of centrocentral union of the two proper palmar digital nerves, in the 5 nerves buried in the bone or in the 9 nerves subjected to thermal ablation only. Management of the nerve is essential for the prevention of neuromas in digital amputations. New techniques such as bone burial and centrocentral union of the two stumps appear to be particularly effective.