Wrist Segment Research Articles

The Investigation of Bio-impedance Analysis at a Wrist Phantom with Two Pulsatile Arteries.

Bio-impedance analysis (BIA) has been widely investigated for hemodynamic monitoring. However, previous works rarely modelled two synchronously pulsatile arteries (representing the radial and ulnar arteries) in the wrist/forearm model. This work aims to clarify and quantify the influences of two pulsatile arteries on BIA. First, two blood-filled arteries were structured in a 3D wrist segment using the finite element method (FEM). Afterwards, an easy-to-produce two-arteries artificial wrist was fabricated with two components: gelatine-based surrounding tissue phantom and saline blood phantom. A syringe driver was utilised to constrict the arteries, and the impedance signals were measured using a Multi-frequency Impedance Analyser (MFIA). Both simulation and experimental results demonstrated the non-negligible influences of the ulnar artery on the overall BIA, inducing unwanted resistance changes to the acquired signals from the radial artery. The phantom experiments revealed the summation of the individual resistance changes caused by a single pulsatile artery was approximately equal to the measured resistance change caused by two synchronously pulsatile arteries, confirming the measured impedance signal at the wrist contains the pulsatile information from both arteries. This work is the first simulation and phantom investigation into two synchronously pulsatile arteries under BIA in the distal forearm, providing a better insight and understanding in the morphology of measured impedance signals. Future research can accordingly select either a small spacing 4-spot electrode configuration for a single artery sensing or a band electrode configuration for overall pulsatile arteries sensing. A more accurate estimation of blood volume change and pulse wave analysis (PWA) could help to develop cuffless blood pressure measurement (BPM).

Distal radial artery access for the treatment of complications after ulnar artery catheterization

Objective: to study the effectiveness of the distal radial artery access in the treatment of complications after ulnar artery catheterization. Material and methods. We analyze the outcomes of 1558 catheterizations of the ulnar arteries. Less than 1% of local hemorrhagic complications and 1.5% of post-catheterization occlusions of the ulnar artery were revealed after ulnar artery catheterization, Results. One half of the patients with hemorrhagic complications after ulnar artery catheterization underwent conservative treatment (mechanical compression of the site of complication), the rest of patients underwent surgical treatment. Positive effect was achieved in all patients who underwent endovascular treatment for post-catheterization hemorrhagic complications. In 50% of cases, recanalization of post-catheterization ulnar artery occlusion via the distal radial access was effective. In 1 patient after recanalization of post-catheterization ulnar artery occlusion using the distal radial artery access, the occlusion of radial artery in wrist segment occurred, with preserved blood flow in radial artery of the forearm. Conclusion. Distal radial artery access for correction of post-catheterization complications in ulnar artery is a feasible and safe method. Keywords: distal radial access, ulnar artery, radial artery, occlusion

Survey of body mass index (BMI) on median motor nerve conduction velocity (NCV) in normal population of Malwa region

: Nerve conduction studies reveal technique to work on peripheral nerve being capable in revealing nerve-related issue. It aids in distinguishing from a nerve injury to situation where muscles are affected due to a nerve lesion. While, in that respect much dissimilarity persist in use of Nerve Conduction Velocity (NCV) in different nerves with regard to place, sex, mass & other ethnographical facts i.e. Span of life. This has been viewed in performing nerve conduction studies while ethnograpical part differs for different geological region.: The purpose of present work is to do the Nerve Conduction Variables (NCV) studies in rt. median nerve in usual well young of Malwa region and to study the outcome of B.M.I on it. : A total 110 healthy participants from the periods of 20 and 50 years, with none nerve lesion, being examined at IMCHRC, Indore. All trial were completed on JAVA RMSAleron-201 series. Scrutiny on SPSS 10.0 series. : The mean of NCV firstly rises among periods of 20-30 yrs, 31-40 yrs & 40-50years, preceded by a fall in the mean NCV of elbow–wrist segment which significantly fall while the mean of B.M.I rises with increasing length of life. It is to be noted that NCV was inversely related to an increase in B.M.I in the volunteer the mean NCV of Set 1 > Set2, Set3, Set 4 with P < 0.05 that toply relevant.Usual parameter for conduction in peripheral nerves to be used in the test of peripheral nerve lesion. B.M.I has a definitive effect on NCV. So, this factor has been put into concern during interpretation of results during nerve conduction studies. Therefore, it should also be used for research purposes & in prognosis approach.

Survey of age on median motor nerve conduction variables to well population of Malwa region

Background: Nerve conduction velocities (NCVs) represent correct methods to study the peripheral nerve being capable in estimating nerve-related situation. It aids in distinguishing from a nerve injury to situation where muscles are pretentious due to a nerve lesion, while, in that respect, many dissimilarities in testimonial use to NCV in dissimilar nerves with regard to place, sex, mass, and other ethnographical facts, i.e., span of life. This has been viewed in performing nerve conduction studies while ethnographical part differs for different geological region. Aims and Objectives: The view of present work is to do the NCV studies in right median nerve with usual grown-up people and to study the outcome of age on it. Materials and Methods: A total 110 healthy participants for length of life of 20 and 50 years, with none nerve lesion, examined at IMCHRC, Malwa. Each of the trial had been carried out in JAVA RMS Aleron-201 version. Analysis on SPSS-10 version. Results: The mean of NCV firstly rises among the ages of 20–30 years and 31–40 years, comes after by a fall in the mean NCV of elbow–wrist segment significantly fall while the mean of age rises with proceeding length of life. It is to be noted that NCV was conversely connected with rise in length of life of the volunteer with mean NCV of Set 1 >Set 2, Set3, Set 4 with P < 0.05 which is toply remarkable. Conclusion: Usual parameter for conductivity in peripheral nerves has been used in the test of peripheral nerve lesion. Age has a definitive effect on NCV. Hence, these biotic factors have to be taken into consideration during interpretation of results during nerve conduction studies. Therefore, it should also be used for research purposes and in analytic approach.

Entrapment partly participates in the longitudinal progression of neuropathy with anti-MAG antibodies

Neuropathy with anti-myelin-associated glycoprotein (MAG) antibodies commonly demonstrates distal-dominant prolongation of nerve conduction. However, recent electrophysiological studies have shown that distal motor demyelination is not always a distinct feature. We aimed to elucidate whether the longitudinal progression of nerve impairment occurs in a distal-dominant manner. Seven patients with neuropathy with anti-MAG antibodies were enrolled. Sequential nerve conduction studies revealed nerve conduction reduction only at the wrist segment in the median nerve of the patients, but not in the ulnar nerve. Median nerve entrapment at the wrist may play a role in longitudinal disease progression in neuropathy with anti-MAG antibodies.

Design and control of a parallel mechanism haptic master for robot surgery using magneto-rheological clutches and brakes

This article presents tracking control performances of the repulsive force and torque of a haptic master with 6 degrees of freedom, which can be applied to robot-assisted minimally invasive surgeries. The proposed haptic master is activated by two types of actuators that use magneto-rheological fluid: magneto-rheological clutch and magneto-rheological brake. The body segment (or lower part) of the haptic master generates the repulsive forces for the three translational axes using the magneto-rheological clutch, while the wrist segment (or upper part) generates the repulsive torque for the three rotational axes through the use of the magneto-rheological brake. After analyzing the kinematic and dynamic equations, an appropriately sized haptic master is designed and manufactured. The field-dependent force and torque characteristics of the magneto-rheological actuators are experimentally investigated. Then, for successful tracking control performances, a fuzzy plus proportional–integral–derivative feedback controller is used for the repulsive force while a feed-forward controller associated with a hysteretic compensator for the repulsive torque. The effectiveness of the proposed 6-degree-of-freedom haptic master is experimentally validated by demonstrating high tracking accuracy of the force and torque.

Nerve conduction velocity in median nerve of healthy adult population in Malwa region of Madhya Pradesh with respect to age, gender, and height along with the relation amongst them

Background: Nerve conduction velocities (NCV) represent the most accurate methods to study the peripheral nerves owing to their ability in diagnosing nerve-related conditions. It helps to distinguish between a true nerve disorder and conditions where muscles are affected due to a nerve injury. However, there are considerable differences in reference values for NCV in different nerves with respect to region, gender, population, and various anthropological data such as age, height, body mass index, and temperature. They have to be kept in mind while doing nerve conduction studies as these anthropological factors vary according to the different geographical areas. Aim and Objectives: The aim of this study is to establish the electrophysiological data NCV for the right median nerve in normal healthy adults in Malwa region of Indore, district of Madhya Pradesh, and to study the effect of age, gender, and height on it along with relation among them. Materials and Methods: A total 118 healthy participants (38 females and 80 males) between the ages of 20 and 60 years, with no neurological problem were investigated at Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India. All tests were performed on JAVA record management system Aleron-201 series. Statistical analysis was done using statistical package for social sciences 10.0 version. Results: The mean of NCV initially increases between the ages of 20-30 years and 31-40 years, followed by a decrease in the mean NCV of elbow–wrist segment significantly decreases while mean of age and NCV for males is more than that of females and height increases with advancing age. It was found that NCV was inversely related to an increase in height of the participants the mean NCV of Group 1 > Group 2, Group 3, Group 4 with P < 0.05 which is highly significant. Conclusion: The normal conduction parameter of commonly tested peripheral nerves can be used in the investigation of peripheral nerve injury and for evaluating the peripheral nerve disorder. Age, gender, and height have a definitive effect on NCV. Hence, it could also be utilized for comparative studies and for diagnostic conclusion.

Efficacy of Optimal Recording Electrode Placement for Median-Lumbrical and Ulnar-Interossei/Lumbrical Distal Latency in the Diagnosis of Carpal Tunnel Syndrome.

This study is to determine the diagnostic utility of optimal recording electrode placement for distal latency comparison of median-second lumbrical and ulnar-interossei/third lumbrical (M2L-UI3L) in carpal tunnel syndrome. Sixty-five hands of control and 75 hands of 62 clinically suspected carpal tunnel syndromes were used for the M2L-UI3L and standard conduction studies. To obtain optimal M2L-UI3L, the recording active electrode (E1) was placed at the midpalm over the third metacarpal bone, whereas the reference electrode (E2) was attached to the palmar digital crease area. Then, median and ulnar nerves were stimulated on the wrist each at 8 cm proximal to E1. M2L-UI3L and standard nerve conduction studies were performed. Sensitivity and specificity of M2L-UI3L were measured in the diagnosis of mild carpal tunnel syndrome. For statistical analysis, the receiver operating characteristics and Student t-test were used. The area under the receiver operating characteristic curve of M2L-UI3L was 0.993. Diagnostic cutoff value of M2L-UI3L greater than 0.6 milliseconds yields sensitivity of 93% and specificity of 97%. The distal median motor latency to the second lumbrical alone showed the area under the curve of 0.998, and the diagnostic cutoff value greater than 3.4 milliseconds yields sensitivity of 96% and specificity of 100%. This technique for M2L-UI3L shows high sensitivity and specificity compared with the previous reports on the diagnosis of carpal tunnel syndrome. Furthermore, the values of median-second lumbrical motor latency alone have higher sensitivity and specificity, comparable with the median sensory conduction study across the wrist segment.

The segmental palmar test in diagnosing carpal tunnel syndrome reassessed

ObjectiveTo test our hypothesis that comparing the sensory nerve conduction velocity of the median nerve across the wrist with that of the forearm is more sensitive than comparing it with that of the palm in the electrodiagnostic confirmation of carpal tunnel syndrome (CTS). MethodsOne hundred and fifty seven consecutive patients with clinically defined CTS were prospectively included and electrophysiologically examined. Antidromic nerve conduction velocities were measured in 3 segments of the median nerve: forearm, wrist, and palm. Differences and ratios in nerve conduction velocities were computed between the forearm and wrist and between the palm and wrist segments. ResultsComparing the median nerve conduction velocities of the forearm with the wrist segment provides a greater sensitivity (79.6% and 82.8% for the second and third digit, respectively) than comparing the palm with the wrist segment (65.6% and 65.0%). Applying the ratio leads to slightly higher sensitivities for both comparisons. ConclusionsThe modified segmental palmar test is a sensitive, robust and easily applicable method in diagnosing CTS. SignificanceWe recommend to use the median nerve sensory conduction velocity in the forearm as a reference in the segmental palmar test instead of that in the palm.

Gender differences in the kinematics and ball velocity of overarm throwing in elite team handball players

The aim of this study was to investigate the throwing velocity and kinematics of overarm throwing in team handball of elite female and male handball players. Kinematics and ball velocity of a 7 metre-throw in eleven elite male (age 23.6 ± 5.2 yr, body mass 87.0 ± 6.8 kg, height 1.85 ± 0.05 m) and eleven elite female (age 20.3 ± 1.8 yr, body mass 69.9 ± 5.5 kg, height 1.75 ± 0.05 m) team handball players were recorded. The analysis consisted of maximal joint angles, angles at ball release, maximal angular velocities of the joint movements, and maximal linear velocities of the distal endpoints of segments and their timing during the throw. The ball release velocity of the male handball players was significantly higher than the females (21.1 vs. 19.2 m · s−1; p < 0.05). No major differences in kinematics were found, except for the maximal endpoint velocities of the hand and wrist segment, indicating that male and female handball players throw with the same technique. It was concluded that differences in throwing velocity in elite male and female handball players are generally not the result of changes in kinematics in the joint movements.

The relationship of pre- and postoperative median and ulnar nerve conduction measures to a self-administered questionnaire in carpal tunnel syndrome

Following carpal tunnel release (CTR), only very modest correlations have been found between subjective symptoms and function indexes compared to neurophysiological measures. The objective of this study was to evaluate this relationship by comparing the self-administered Boston symptom severity score and function severity score questionnaire against nerve conduction studies (NCS) before and after CTR using two different electrophysiological techniques. Carpal tunnel release was performed in 51 patients (62 hands). Pre- and postoperative NCS were evaluated using both conventional neurophysiological methods and by means of a new hand-held device. Preoperatively there was almost no correlation between symptom severity and function scores and NCS results. Following surgery however, both symptom severity and function showed a modest, but significant improvement in their correlation to NCS (at highest r=0.405, P<0.01). This improvement in the relation of subjective measures to neurophysiological results was seen in both median nerve sensory and motor conduction as well as in ulnar nerve motor conduction. In addition to median-nerve dysfunction, it might be suggested that ulnar nerve changes can contribute to symptoms of carpal tunnel syndrome in patients. Several associations were found using a median-ulnar sensory latency difference in the finger-wrist segment and a sensory conduction difference in the palm to wrist segment. Significant correlations were established by both conventional NCS and the new hand-held device.

Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome

The objective of this study was to compare the short- and long-term efficacies of splinting (S), splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild or moderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathic CTS who experienced symptoms for over 6 months were included in the study. The patients were evaluated for the baseline and the third and sixth month scores after treatment. Follow-up criteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-seven hands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-three hands were given a single steroid injection and splinted for 3 months, and 11 hands were operated. In the first 3 months, all treatment methods provided significant improvements in both clinical and EMG parameters in which OCTR had better outcomes on median sensorial nerve velocity at palm wrist segment. In the second 3 months, while the clinical and EMG parameters began to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functional capacity score of OCTR group was statistically better than that in conservative methods (P = 0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR in short term. However, these beneficial effects were transient in the sixth month follow-up and OCTR was superior to conservative treatments.

Axonal degeneration in association with carpal tunnel syndrome.

Median nerve entrapment in the palm to wrist segment is known as carpal tunnel syndrome (CTS). Electromyography is the best evaluation test to confirm the disease, as it shows a median reduced conduction velocity and/or conduction block; however, the usual CTS electrodiagnostic tests do not separate segmental demyelination alone from segmental demyelination plus secondary axonal degeneration. We studied 100 hands from CTS patients (classified as mild, moderate, and severe), and 50 hands from normal subjects. The median palmar sensory nerve action potential (SNAP) amplitude was measured and compared between the two groups. It would be expected that SNAP was normal if no axonal degeneration had occurred. The results showed that in mild CTS group and part of moderate CTS group SNAP amplitude was normal, whereas in severe CTS group, and part of moderate group SNAP amplitude was reduced, proving that axonal degeneration was involved. As it is well stated that axonal lesions have worse prognosis than segmental demyelinating ones, this simple test may help to preditic the CTS outcome and treatment.

Comparison of Median Sensory Conduction Values Proximal and Distal to Wrist Segment in Mild Carpal Tunnel Syndrome.

Comparison of Median Sensory Conduction Values Proximal and Distal to Wrist Segment in Mild Carpal Tunnel Syndrome.

AAEM case report #2: The carpal tunnel syndrome

The symptoms and signs which constitute the carpal tunnel syndrome (CTS) result from entrapment or compression of the median nerve within the carpal tunnel. Electrodiagnostic studies may objectively document the presence of median neuropathy within the carpal tunnel and help distinguish CTS from other disorders such as cervical radiculopathy, neurogenic thoracic outlet syndrome, proximal median nerve compression syndromes, and polyneuropathy which may either mimic or occasionally coexist with CTS. Recording median nerve responses with wrist and palm stimulation allows determination of the wrist segment conduction velocity which is a more sensitive nerve conduction parameter than wrist latency measurements. Electrodiagnostic testing permits estimation of severity and relative contribution of axonal versus demyelinative nerve injury. This information can provide prognostic information and help guide therapeutic decisions.

Transcarpal Median Sensory Conduction: Detection of Latent Abnormalities in Mild Carpal Tunnel Syndrome

The major slowing of nerve conduction in the carpal tunnel syndrome is located in the palm to wrist segment. The aim of this study is to develop a reliable, sensitive and accessible approach to measure transcarpal median sensory nerve conduction. For this purpose, a fast recovery amplifier with a stimulus artifact suppressor was designed by the author. On stimulation of digits II or III, evoked orthodromic sensory nerve action potentials were simultaneously recorded at the palm and at the wrist. Distances were determined with a ruler. Median sensory nerve conduction velocity was estimated from digit to palm and from palm to wrist in 80 healthy hands and 253 hands with a presumptive diagnosis of carpal tunnel syndrome. According to conventional criteria, 131 of the 253 hands from those suspected of carpal tunnel syndrome were thought to have median nerve compression. When transcarpal median sensory conduction velocity was taken into account, the diagnostic yield increased by 18.1%. The described technique provides a simple, sensitive and reliable method of diagnosing mild or early carpal tunnel syndrome.

Orthodromic sensory action potentials from palmar stimulation in the diagnosis of carpal tunnel syndrome.

It is known that the major slowing of nerve conduction in the carpal tunnel syndrome occurs in the palm to wrist segment. A technique exploiting this fact and easily applicable in the routine laboratory would be useful in diagnosing early examples of the condition. To this end, orthodromic sensory potentials from stimulation of digits II and V, and of the palmar branches of the median and ulnar nerves were recorded at the wrist in 53 healthy hands, 72 hands with a tentative diagnosis of carpal tunnel syndrome and in 20 hands of patients with unrelated neurological conditions. Using conventional criteria, 53% of the 72 hands from those suspected of carpal tunnel syndrome were thought to have median nerve compression. When conduction velocity in median palm wrist fibres was taken into account, 67% of hands were then considered abnormal. It is concluded that orthodromic sensory action potentials from palmar stimulation provide a rapid, sensitive and acceptable method of diagnosing the carpal tunnel syndrome.

Carpal ankylosis in juvenile rheumatoid arthritis.

Forty-seven of 100 consecutive juvenile rheumatoid arthritis patients with wrist arthritis were found to have ankylosis at the carpal joints. this finding was significantly more frequent in juvenile than in adult rheumatoid arthritis patients. The carpometacarpal wrist segment was the most frequently ankylosed. Ankylosis was not related to any particular feature of the disease, but disease duration was longer in patients with ankylosis. A significant association was found between carpal ankylosis and cervical apophyseal joint fusion.