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Article
COMPLICATIONS OF SURGERY FOR CARPAL TUNNEL SYNDROME

Authors: Avadis A Muradian --- Kareem Jasim
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 1 Pages: 82-85
Publisher: Basrah University جامعة البصرة

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Abstract

The carpal tunnel release is usually a curative treatment for the carpal tunnel syndrome (CTS), but not without complications, it may ranges from wound infection to nerve laceration. Study population included 150 patients (157 wrists) who had surgery for CTS. Patients were observed for the outcome and associated problems during and after operative procedure. Thirty seven wrists (23%) developed complications, these complications were; intraoperative in 7 wrists, early postoperative (within first 2 weeks) in 10, and late postoperative (after 2 weeks) in 20.This finding indicates that failure or complications following surgical release may occur, and in some situations may relate to the dissection or operating surgeon


Article
Intraoperative Steroid Irrigation in Carpal Tunnel

Author: Sabah Hassan Naji صباح حسن ناجي
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 108-110
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper limb due to compression of the median nerve at the wrist. Objectives: to test the benefit of steroid irrigation of the wound to alleviate the post operative pain. Methods: Forty patients had carpal tunnel release were divided into two groups with and without steroid irrigation. Results: Forty patients 38 female and 2 male with forty CTS had open surgical release were studied for postoperative pain at the wrist area. Group 1 (patients treated with surgery alone) and group 2 (patients treated with surgery and steroid).In group1, 11 patients (55%) had persistent agonizing pain at the ulnar side of the wrist not responding to analgesic. In group2 none of the patients experienced such type of pain. Conclusion: Steroid irrigation has beneficial effect on post operative pain with no added drawbacks.


Article
Carpal Tunnel Syndrome: A cross - Sectional Study in 928 Patients in Iraq
متلازمه النفق الرسغي : دراسه مقطعيه ل 928 حاله مرضيه في العراق

Author: Hikmet kadum Abbas حكمت كاظم عباس
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2012 Volume: 3 Issue: 1 Pages: 19-26
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Carpal tunnel syndrome is caused by entrapment of the median nerve and results in pain, tingling and numbness in the wrist and hand. It is a common condition in general practice. Objectives: This study was done to determine the epidemiological and clinical features of CTS. Methods A cross-sectional study was carried out on Carpal tunnel syndrome [CTS] cases diagnosed over a 14 years period, from May 1998 to May 2012 by the researcher. All data regarding the age at presentation, gender, pregnancy, hypertension, DM, salty food, response to conservative treatment, response to surgical treatment, a total number of 928 cases were included in this study. Results; Among the 928 CTS patients; there were (0.107%) below 15 years,( 25.64%) from 15-30 years, (50.75%) from 31-45 years, (20.68%) from 46-60 years, and (2.80%) above 60.According to gender distribution, there were (0.969%) male,( 99.03%) female. In this study there were (13.27%) pregnant,( 86.72%) not pregnant, (5.92%) hypertensive,( 94.07%) not hypertensive, (8.40 %) diabetic,( 91.59%) not diabetic, (44.40%) eating salty food, (55.60%) not eating salty food .According to response to treatment, (58.72%) respond to conservative treatment,( 41.27%) not respond to conservative treatment, (94.51%) good response to surgical treatment,( 5.48%) not respond to surgical treatment.Conclusions: This study showed1. The predominant age of patients [females] 31-45 years.2. The ratio of female /male is far higher than in other places of the world.3. The prevalence of pregnant women with CTS is less than other studies.4. There is some statistical significant association between CTS and consuming salty food.5. Surgical treatment is highly successful.Keywords: Carpal tunnel syndrome, Median nerve, Entrapment neuropathy.

الخلفيه: متلازمه النفق الرسغي مصطلح يطلق على حاله تصيب العصب الاوسط اثناء دخوله الرسغ مما يؤدي الى ظهور الم وتنمل وخدر في اليد وهي حاله شائعه.الاهداف: دراسه وبائيه المتلازمه عند المرضى في العراق.طريقه البحث: دراسه مقطعيه على حالات جمعت خلال 14 سنه بلغ عددها928حاله وتم دراسه المتغيرات التاليه: العمر و الجنس, الحمل, ارتفاع ضغط الدم, ملح الطعام, الاستجابه للعلاج التحفظي , الاستجابه للعلاج الجراحي.النتائج:من بين 928 حاله درست تبين ان 50,75% بعمر 31-45سنه بينما 20,68% من 46-60 سنه ونادر الحدوث في الاعمار اقل من 15 واكثر من 60, نسبه اصابه النساء الى الرجال 99الى 1.عدد المصابات اثناء الحمل 13,27% ,المصابات مع ارتفاع الضغط 6%,داء السكر 9% , 44,40 %يتناولون نسبه عاليه من ملح الطعام ,58,72 %استجابو للعلاج التحفظي ,94,5 %استجابو بصوره جيده للعلاج الجراحي.الاستنتاجات:1- نسبه الاصابه عند النساء اعلى بكثير من الرجال مقارنه بالبحوث الاخرى. 2-اعلى نسبة اصابة عند النساء في الثلاثينات حتى منتصف الاربعينات . 3 -.نسبة الاصابة عند الحوامل اقل مما موجود في البحوث الاخرى.4-هنالك علاقة احصائية مؤكدة عن زيادة الاصابات وتناول ملح الطعام بكثرة. 5- العلاج الجراحي له نسبة نجاح عالي .


Article
Assessment of therapeutic efficacy of topical application of steroid in the treatment of carpal tunnel syndrome (CTS

Author: Kamal A. M. Al- Yasiry
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2012 Volume: 5 no 1 Issue: 11 Pages: 1219-1223
Publisher: Kerbala University جامعة كربلاء

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Abstract

Abstract Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy with high incidence rates of the upper limb, occurring due to compression of the median nerve at the wrist (1). Aim: is to determine the therapeutic effect of topical steroid application as an alternative therapy for surgical and local injection of steroids.Method: 30 female patients ranging were selected randomly and divided into 2 groups; 10 of them were selected as control group and 20 of them were selected to test our therapy (topical Clobetasol ointment). EMG and NCS were done before and after the therapy to determine the success of the proposed drug.Results: There was a significant result both clinically and by EMG and NCS finding after 30 days of treatment in which about 80% of patient were approximately free of pain after treatment as a clinical assessment with a significant EMG and NCS finding at P <0.05. Conclusion: topical skin application over carpal tunnel is of a great value as an alternative conservative treatment for CTS.


Article
Electrophysiological response to local steroid injection in carpal tunnel syndrome
الإستجابة الكهروفسيولوجية للزرق الموضعي بالسترويد في متلازمة النفق الرسغي

Authors: Muna M. Ahmad منى منير أحمد --- Mahmood A. Aljumaily محمود عبد الجميلي --- Mohammed I. S. Sabaawi محمد عيسى سليمان السبعاوي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2013 Volume: 39 Issue: 2 Pages: 118-122
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACTBackground: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Local steroid injections are used for its treatment, which is usually associated with improvement in different electrophysiologic parameters of the median nerve. However, evidence for its efficacy has not been established in our community.Objective: The aim of this study is to evaluate the changes in electrophysiological parameters after local steroid injection for mild and moderate idiopathic CTS.Material and methods: The study is a prospective clinical trial assessing the electrophysiological parameters following local steroid injection (Depomedrol-80 mg methylprednisolone acetate) in the treatment of mild and moderate idiopathic CTS. The study was carried out in Mosul Teaching Hospitals during a period from December 2010 to December 2011. The total number of patients was 54 (46 females and 8 males), their mean age was 36.13 ± 9.32 years. Patients with idiopathic CTS were included after clinical confirmation of diagnosis electro-physiologically at preinjection, and electro physiological evaluation repeated 1 and 6 months after local steroid injection.Results: All electrophysiological parameters showed significant improvement (P value is < 0.05) one month after injection except sensory nerve action potential. All median nerve electrophysiological parameters in 6 months post injection showed no significant changes except, compound motor action potential, motor nerve conduction velocity, and sensory nerve action potential which showed significant deterioration (P value is < 0.05). All electrophysiological parameters showed significant deterioration (P value is < 0.05) in comparing results of one month and 6 months after injection.Conclusion: Local steroid injection for CTS provides transient improvement in electrophysiological parameters while causes deterioration in these parameters 6 months after injection. Keywords: Carpal tunnel syndrome, steroid injection electrophysiology.

الخلاصةالخلفية: متلازمة النفق الرسغي حالة شائعة والزرق الموضعي بالستيرويد يستخدم في علاجها وعادة ما يرتبط بتحسن في المتغيرات الكهروفسيولوجيوية للعصب الوسطي ومع هذا فان دلائل فعاليته لم تثبت في مجتمعنا.الأهداف: تهدف الدراسة لتقييم التغيرات الكهروفسيولوجية بعد الزرق الموضعي للستيرويدات في متلازمة النفق الرسغي الخفيفة والمتوسطة.المواد وطريقة العمل: أجريت هذه الدراسة السريرية لتقييم المتغيرات الكهروفسيولوجية بعد زرق 80 ملغم من المثيل بردنزولون استيت في معالجة متلازمة النفق الرسغي الخفيفة والمتوسطة غير المعالجين سابقا. أجريت الدراسة في مستشفيات الموصل التعليمية من كانون الأول 2010 إلى كانون الأول 2011. كان العدد الكلي للمرضى 54 منهم 46 أنثى وكان معدل أعمارهم 36 سنة. شمل بالدراسة مرضى متلازمة النفق الرسغي الخفيفة والمتوسطة بعد تأكيد التشخيص كهروفسيولوجيا للأعصاب وتمت إعادة الفحص كهروفسيولوجيا للعصب الوسطي والزندي بعد شهر و 6 أشهر من زرق الستيرويد الموضعي. النتائج: كل المتغيرات الكهروفسيولوجية أظهرت فرقا معنويا بعد شهر من الزرق الموضعي للستيرويدات عدا الفعل الجهدي الحسي العصبي. وبعد ستة أشهر تبين وجود تدهور في بعض المتغيرات الكهروفسيولوجية عند المقارنة مع ما قبل الزرق الموضعي للستيرويدات. عند المقارنة بين النتائج بعد شهر من الزرق الموضعي للستيرويد وبعد 6 أشهر من الزرق الموضعي للستيرويد المتغيرات الكهروفسيولوجية أظهرت فرقا معنويا بشكل تدهور في كل المتغيرات الكهروفسيولوجية. الخلاصة: الزرق الموضعي للستيرويدات في متلازمة النفق الرسغي يؤدي إلى تحسن مؤقت في المتغيرات الكهروفسيولوجية بينما يسبب تدهور في أكثر هذه المتغيرات بعد 6 أشهر من الزرق.


Article
The role of ultrasound in the diagnosis of carpal tunnel syndrom

Author: Ali Taha Hassan Al-Azzawi
Journal: Muthanna Medical Journal مجلة المثنى الطبية ISSN: 2226146x Year: 2016 Volume: 3 Issue: 2 Pages: 107-116
Publisher: Al-Muthanna University جامعة المثنى

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Abstract

The aim of this study is to confirm the accuracy of sonography in the diagnosis of the carpal tunnel syndrome by measuring the cross-section area of the median nerve. A prospective study of 80 patients suspected of having carpal tunnel syndrome was underwent sonography at Al-Hussein Teaching Hospital in Samawa city from 1/1/2015 to 1/1/2016. The cross sectional area of the median nerve was measured at three levels, immediately proximal to carpal tunnel inlet, at carpal tunnel inlet and carpal tunnel outlet. The average value was measured. The flexor retinaculum was used as a landmark to margin of the carpal tunnel. Sensitivity and specificity of sonography were revealed as (89%) and (90%) respectively. All patients were sent for electro-diagnosis as standard reference test to compare with the values of sonography. The study proved that the sonography is sensitive but in compared with the electrodiagnosis has lower specificity. Demographic information including age, sex, side of the limb affected, and duration of the symptoms and grading of severity of the cases of the carpal tunnel syndrome were revealed. The study revealed associated disorders with the carpal tunnel syndrome such as diabetes mellitus (7 patients), pregnancy (5 patients), trauma (3 patients), hypothyroidism (1 patient), rheumatoid arthritis (1 patient), dorsal wrist ganglia (2 patients), and history of Colles’ fracture (2 patients), obese patient (12 patients), workers at manufacturing industries (3 patients) and two writers. The study proved that the sonography is easily performed, painless, rapid and available for the diagnosis of the carpal tunnel syndrome as adjuvant to electro-diagnosis but is not as substitute to it.


Article
Electrophysiological changes of Asymptomatic Carpal Tunnel Syndrome in Patients with Rheumatoid Arthritis: Frequency Distribution and Correlation to Disease-Related Factors

Authors: Sabah J. Al-Rubaie --- Naseer J. Al-Mukhtar --- Thaier K. Al-Husseiny
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2012 Volume: 9 Issue: 2 Pages: 267-280
Publisher: Babylon University جامعة بابل

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Background: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease characterized by chronic symmetrical and erosive arthritis with various extra articular manifestations. Of main neurological manifestations of RA is carpal tunnel syndrome CTS.Objective: To explore the frequency of asymptomatic CTS in patients with RA and relationships to various RA-related factors. Methods: In this cross sectional case controlled study, fifty consecutive patients with Rheumatoid arthritis were studied at Rheumatologic−Rehabilitation and Neurophysiological departments in Marjan teaching hospital in Hilla city. The study was conducted in the period from January to August 2011. Thirty two healthy individuals, age and gender matched, were included in the study as control. Both patients and control groups had no clinical evidence of carpal tunnel syndrome. Thorough medical history, comprehensive physical examination and nerve conduction study(NCS) of median nerve for CTS were done for both patients and control. Serologic, acute inflammatory response tests, radiographic studies were done for patients.Results: Seventeen patients (34%) all of them were females, were found to have electrophysiological evidence for CTS, versus one female in control group (3%). Asymptomatic CTS was found more prevalent in patients with positive family history of RA, prolonged morning stiffness and duration of the disease, polyarticular joint involvement, wrist swelling and deformity, restriction of wrist movement, prolonged delay in the initiation of Disease Modifying Anti Rheumatic Drugs (DMARDs) therapy, patients with severe RA according to DAS -28, positive CRP, high ESR , positive RF and positive Anti-CCP antibodies and joint erosion. Conclusion: Asymptomatic CTS is a common neurological manifestations of RA (34%), exclusively in female gender with severe disease profiles. Therefore, NCS is essential in RA for detection of asymptomatic CTS.

يعتبر داء المفاصل الرثوي من الامراض الجهازية المزمنة و يمتاز بضرر متواصل في المفاصل مع اختلاطات و أعراض جهازيه غير مفصلية. ان الجهاز العصبي هو احد أهم الأجهزة التي تتأثر بهذا المرض، التناذر الكهفي الرسغي هو من أهم المشاهدات العصبية المرافقة لداء المفاصل الرثوي.أن هدف هذه الدراسة هو استبيان تردد حصول هذا التناذر الغير معلن او مكشوف سريريا عند مرضى داء المفاصل الرثوي في محافظة بابل.حيث اجريت دراسة مقطعية لخمسين مريضا من مرضى داء المفاصل الرثوي في مستشفى مرجان التعليمي من شهر كانون الثاني إلى شهر ّاب لسنة 2011 وتم مقارنتهم مع اثنان وثلاثون شخصا من الأصحاء. لم يشمل في هذه الدراسة أي مريض أو شخص لديه أعراض او تقرير سابق أو احد العوامل الممهدة لهذا التناذر.بعد اخذ التاريخ المرضي والفحص السريري الشامل تم دراسة تخطيط الوظيفي للعصب الوسطي لكلا اليدين ولكلا الفريقين (المرضى والأصحاء) للتحري عن هذا التناذر. كما تم أجراء الفحوص السيرولوجيه و الفحوص المختبرية المبينة لحدة المرض بالإضافة للفحوصات الشعاعية للمفاصل المصابة. شهدت النتائج بوجود 17 مريضا لهم تخطيط عصبي يشير الى وجود التناذر الكهفي الرسغي الغير ملحوظ سريريا مقارنة بشخص واحد من الاصحاء له نفس التشخيص.بينت هذه الدراسة بان داء الرثية المفصلي مع هذا التناذر يكون مصحوبا في اغلب الأحيان بالمظاهر السريرية والمختبرية والشعاعية التي تدل على شدة المرض.نوصي من خلال هذه الدراسة عن الكشف لهذا التناذر من خلال التخطيط الوظيفي للعصب الوسطي لمرضى داء المفاصل الرثوي.


Article
Carpal tunnel syndrome in Iraqi paraplegic patients
متلازمة النفق الرسغي عند مرضى شلل الاطراف السفلى العراقيين

Author: Basim M. Alwan باسم محمد علوان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2012 Volume: 54 Issue: 2 Pages: 172-175
Publisher: Baghdad University جامعة بغداد

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Background: The median nerve in paraplegic patients, who must rely on increased hand activities including transfer and wheel-chair propulsion, may be subjected to increased pressure, so that the incidence of carpal tunnel syndrome (CTS) may be higher than that in the normal population. Objectives: To study the prevalence and the severity of carpal tunnel syndrome in Iraqi paraplegic patients and to identify the effect of duration of the injury as a possible factor related to its occurrence to avoid any chronic problems which interfere with the hand functions since these patients are greatly dependent on their hands for their daily activities.Patients and Methods: Fifty paraplegic patients (100 hands), whose level of spinal cord injury was below D2, and fifty normal control subjects were included in this study. All patients studied in this work had complete spinal cord injury and were stabled medically and neurologically. Clinical examination for the signs and symptoms of CTS as well as nerve conduction studies were carried out in both median and ulnar nerves for their sensory and motor components eliciting values for distal latencies for all patients and the control groups.Results: Thirty percent of the paraplegic patients (15 patients) had signs and symptoms consistent with carpal tunnel syndrome (CTS), and all of them had electrodiagnostic confirmation of this injury. Seventy percent of these paraplegic patients (35 patients) had no signs and symptoms suggestive of CTS, and only nearly about forty eight percent (17 patients) of them had only electrodiagnostic confirmation of CTS. Overall, 64% of the 50 paraplegic patients had CTS (32 patients). Nine paraplegic patients (18%) exhibiting bilateral CTS. Eight paraplegic patients (16%) had abnormal electrophysiological findings involving the ulnar nerve at the wrist and all of them had electrophysiological findings of CTS. There was a sharp increase in incidence of occurrence of CTS from 6.3% in the group 1 to 5 years from injury to 13.7% in the group 6 to 10 years, and to 25% in the group 11 to 15 years, and again a very big increase to 50% in the group 16 years and over from injury.Conclusion: Early testing of the median and ulnar nerve function, even in asymptomatic patients within the first 5 years of the injury, is recommended so for early detection, preventive and/or curative measures to be undertaken considering the fact that these patients are greatly dependent on their hands for their daily activities.Keywords: Carpal tunnel syndrome, Paraplegics

خلفية البحث : العصب الناصف في مرضى شلل الاطراف السفلى المعتمدين بشكل كبير على النشاط الحركي للاطراف العليا في اداء الفعاليات الحيوية اليومية من الممكن ان يتعرض الى ضغط كبير اثناء مروره في النفق الرسغي لذا فأن احتمالية الاصابة بمتلازمة النفق الرسغي تكون اكثر من الاشخاص الاصحاء عموما .اهداف البحث : تهدف الدراسة الى بيان احتمالية وخطورة الاصابة بمتلازمة النفق الرسغي عند مرضى شلل الاطراف السفلى العراقيين .المرضى والطرق : شملت هذه الدراسة مجموعتين الاولى هي مجموعة المرضى المكونة من ( 50 ) مريضا مصابا بشلل الاطراف السفلى وبمستوى تحت الشدفة العصبية الصدرية الثانية والمجموعة الثانية هي مجموعة سيطرة او تحكم تتألف من ( 50 ) شخصا صحيحاً . ان مجموعة المرضى الاولى يشكون جميعا من ضرر الحبل الشوكي الكامل تحت الشدفة الصدرية الثانية وهم في حالة استقرار طبي وعصبي سريري . لقد اجرى فحص سرعة نقل الايعازات العصبية الحسية والحركية مع قياس فترة الكمون العصبي الحسي والحركي في العصب الناصف والعصب الزندي في كلا الجانبين .النتائج : لقد اوضحت الدراسة بأن 30 )% ) من مرضى المجموعة الاولى ( 15 مريضاً ) يشكون من اعراض سريرية واضحة لمتلازمة النفق الرسغي وجميعهم ثبت تشخيصهم باستخدام قياس سرعة توصيل التنبيه العصبي , وكذلك اوضحت الدراسة بأن (70% ) من المجموعة الاولى ( 35 مريضاً ) لا يشكون من اية اعراض سريرية لمتلازمة النفق الرسغي وثبت بأستخدام فحص سرعة توصيل التنبيه العصبي بأن ( 47% ) منهم ( 17 مريضاً ) مصابين بالمتلازمة اعلاه . من المجموعة الاولى عموما ثبت بأن ( 64% ) منهم ( 32 مريضاً ) يشكو من متلازمة النفق الرسغي وكذلك ( 9 مرضى ) ( 18% ) ثبت انهم مصابين بالمتلازمة في كلا الطرفين العلويين , و ( 16% ) من مرضى المجموعة الاولى ثبت انهم مصابين باعتلال العصب الزندي وتبين انهم جميعاً مصابين بمتلازمة النفق الرسغي .الاستنتاجات : اظهرت الدراسة بأن نسبة عالية من مرضى شلل الاطراف السفلى يشكون من متلازمة النفق الرسغي لذا اوصي بضرورة التركيز على موضوع التشخيص المبكر لهذه المتلازمة وذلك كون هؤلاء المرضى يعتمدون بشكل كلي على الطرفين العلويين في اداء الفعاليات الحيوية اليومية .مفتاح الكلمات : شلل الاطراف السفلى , متلازمة النفق الرسغي .


Article
The Importance of Ultrasound in the Diagnosis of Carpal Tunnel Syndrome in Iraqi Subjects
اهمية الموجات الفوق صوتية في تشخيص ضغط العصب الوسطي في العراقيين

Authors: Ahmed Abdul Bari د. احمد عبد الباري --- Shamam Yousif د. شمم يوسف --- Ghalib A. Al Sharefi د. غالب عبد زيد الشريفي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 3 Pages: 247-252
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Background: Carpal tunnel syndrome, a common peripheral entrapment neuropathy, is recognized as one of the most important causes of workplace morbidity. Diagnosis of carpal tunnel syndrome is usually based on a combination of clinical signs and nerve conduction studies. Magnetic resonance image MRI and high-resolution sonography have emerged as feasible, noninvasive imaging tools for evaluating the median nerve in the carpal tunnel.Objective: This study was designed to evaluate the use of ultrasound in diagnosis carpal tunnel syndrome.Setting: The study was held at Consulting Clinic (Rheumatology clinic) in Al Yarmouk Teaching Hospital in cooperation with Radiology department and Neurophysiology section at the period from December 2008 till May 2009.Patients & Methods: This study enrolled 50 patients with symptomatic carpal tunnel syndrome and 100 healthy volunteers as a control, with age & sex matched. Diagnosis of carpal tunnel syndrome was based on the American Academy of Neurology clinical diagnostic criteria .Electro diagnostic evaluations of nerve conduction study of median nerve for all patients group were done .Wrist sonography done by an expert radiologist who unaware of diagnosis for both patients & controls groups. Results: We found the mean of cross section area of median nerve in patients group is 0.161 cm2, while in control group is 0.072 cm2. This study showed the cut off value of cross sectional area of median nerve equal to or more than 0.092cm² give us a sensitivity equal to 90.8% , which is highly suggestive of carpal tunnel syndrome in all symptomatic subjects with carpal tunnel syndrome. The other findings of carpal tunnel syndrome detected by ultrasonography were decrease in echogenicity of median nerve with flattening of median nerve & flexor retinaculum bowing at wrist.Conclusion: From the end results we can conclude that ultrasonography may be used as the first diagnostic procedure considered in subjects with typical clinical features of carpal tunnel syndrome.Keywords: Carpal tunnel syndrome, ultrasound, nerve conduction study, median nerve.

الملخص:الموضوع: هذه الدراسة صممت من اجل بحث اهمية الموجات الفوق صوتية في تشخيص ضغط العصب الوسطي.المرضى وطريقة البحث: هذه الدراسه تضمنت 50 مريض مشخص سريريا بضغط العصب الوسطي و 100 شخص طبيعي متطوع متشابهين مع المرضى حسب العمر والجنس. تم اجراء تخطيط الاعصاب لكل المرضى (جهاز المايكروميد), بينما تم اجراء الفحص بالموجات الفوق صوتية للمجموعتين (جهاز سيمنز) .النتائج: في هذه الدراسة لوحظ بأن مساحة المقطع العرضي للعصب الوسطي تساوي /او اكثر من 0.092 سم2 في 90.8% من المرضى.وجد ايضا عند المرضى الذين فحصوا بواسطة الموجات الفوق صوتية : انخفاض في الصدى مع تسطح للعصب الوسطي , مع ارتفاع في غشاء الاربطة الظامة في الرسغ.الاستنتاج: من النتائج اعلاه نستطيع ان نستنتج بأن الفحص بواسطة الموجات الفوق صوتية يجب ان يكون اول الفحوصات المتبعة لتشخيص الافراد الذين يعانون من علامات سريرية لضغط العصب الوسطي.


Article
PROVOCATIVE TEST'S VERSUS ELECTROPHYSIOLOGICAL STUDIES AS A MEASURE OF SEVERITY GRADES OF CARPAL TUNNEL SYNDROME

Authors: Zaki N. Hasan زكي نوح حسن --- Safaa H. Ali صفاء حسين علي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 3 Pages: 275-279
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Carpal tunnel syndrome (CTS) is the most common nerve entrapment, electrodiagnostic studies are a valid and reliable means of confirming the diagnosis.Objectives:The study aims to find a correlation between the presence of Tinel's sign and Phalen's maneuver and the degree of severity of the CTS and to compare it with severity of nerve conduction study of median nerve.Methods:The study involves 133 patients (102 females and 31 males) with CTS, all were examined for Phalen's maneuver and Tinel's sign and median and ulnar nerves electro physiological study in Al-Yarmouk Teaching Hospital and the Neurosciences Hospital in Baghdad between January 2010 and January 2011. Their ages ranged between (19-87) years. The patients were grouped into mild, moderate and severe CTS according to modified Padua scale of CTS severity. Statistical correlation was done using one way Anova test.Results:Positive Tinel's sign was seen in 25% and positive Phalen's maneuver in 28%, coexistent Tinel's sign and Phalen's maneuver positive at the same time were seen in 47%. Total Tinel's sign was72% and total patients who had positive Phalen's sign was 75%. Mild, moderate and severe CTS were seen in 38%, 41% and 21% out of the total number of the studied patients.Conclusion:The study didn't find association between severity grading and provocative test, added to negative provocative tests in high percentage of patients. These results mandate the use of electrophysiological examination for the diagnosis of carpal tunnel syndrome and assessment of severity.Keywords:Carpal tunnel syndrome, Tinel's sign, Phalen's maneuver

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