ALL libraries (COBIB.SI union bibliographic/catalogue database)
  • Ocjena oštećenja osjetnih i motoričkih živčanih vlakana kod sindroma karpalnog tunela s obzirom na trajanje bolesti : magistarski rad
    Jesenšek Papež, Breda
    Introduction. Carpal tunnel syndrome (CTS) is the most common compressive, canalicular neuropathy. Its clinical picture depends on the duration and degree of the compression of the median nerve (MN). ... The first symptoms affect the sensory nerve fibers, but as the compression persists motor nerve fibers undergo damage as well. The intensity of the injury to individual nerve fibers varies. Clinical symptoms and signs alone are not sufficient for us to confirm the diagnosis. Electrodiagnostic tests are needed for this purpose. Patients and methodology. 44 subjects with CTS were included in the study. Their average age was 47.8 years (ranging from 20 to 60 years). The sample consisted of 26 (59.09%) women and 18 (40.91%) men. 77 hands (40 rights ones and 37 left ones) were analyzed altogether. 47 healthy subjects of comparable gender and age structure to those of the CTS patients served as a control group. The CTS patients were divided into four groups according to the duration of their disease. The first group consisted of those who experienced symptoms for up to six months, the second those from seven to twelve months, the third those from thirteen months and the fourth group those who had problems for over nineteen months. The Mendelec, Saphire 1L device was used tocarry out electrophysiological tests of motor nerve functions and motor nerve functions and motor conduction testing. In evaluating these we considered the electrophysiological parameters of the distal latency, the amplitude of M wave and the motor conduction velocity. In order to get optimal insight into the condition of sensory nerve fibers, we analyzed mediansensory ortodromic stimulation in the area of the middle phalanx of the second, the third and the fourth fingers. In addition, we placed the recording electrode over the median nerve 14 cm away from the wrist. In testing sensory fibers we used the latency and the amplitude of the ortodromic sensory action potentials and the sensory conduction velocity of the median nerve. Electrodiagnostic tests were carried out by surface electrodes, 20 subjects with CTS (five from each group) were given individually shaped splints to immobilize their wrist and palm in a neutral position. The subjects were instructed to wear the splints for a period of 12 weeks, especially at night, and during the day only when they had more severe pains and paresthesia. Results. The study found a higher percentage of CTS in women. The difference between women and men in this respect is statistically significant (p<0.013). 75% of the patients had symptoms in both hands, of the remaining 25%, 90% had problems with their dominant hand. 67% of the patients experienced disturbed sensory functions, 64% insomnia, 61% the Hoffmann-Tinel sign and 50% the Phalen sign. We found that the latency of sensory action potential in the second, the third and the fourth finger increases with a longer duration of the symptoms, while the amplitude of sensory action potential and sensory conduction velocity decreases. There is a high degree of correlation between the mentioned electrodiagnostic parameters and the duration of the disease. Electrodiagnostic values for both hands are not statistically different (p>0.01) in subjects with the same duartion of the disease. This at the same time confirms that dominant hand does not have an effect on the degree of the injury of motor and sensory nerve fibers in as far as they depend on the duration of the disease. The comparison of the four groups shows a statistically significant prolongation of the latency of sensory potential and slower sensory conduction in the second and the third fingers in fourth group when disease lasts 19 months or longer, whereas for the fourth finger this already occurs in the third group with 13 to 18 months of symptoms. The highest degree of variation was observed in the case of the amplitude of sensory action potentials. The commonly tested parameters in CTS diagnostic (the latency, the amplitude of the sensory action potentials and the sensory conduction velocity) showed diviations from the normal first in the test of the fourth finger. Still, a test of the fourth finger is not recommended because of the variation in the sensory innervation, which may result in statistically insignificant results. 60% of patients reported an improvement in their symptoms during the first days of wearing splints, 15% after 14 days, and only 25% did not report any improvement. Electrodiagnostic tests however, did not show any statistically difference before and after the use of splint. Conclusion. CTS is the most common canalicular neuropathy in upper extremities. The difference in the presence of CTS in women and men is statistically significant. Middle-aged women are particularly affected. In most cases, both hands are afflicted or, in the case of just one hand, usually the dominant one. Typical symptoms include tingling, pain and insomnia. The latency of the sensory action potentials in the second, third and fourth fingers increase with the prolonged duration of the disease, while the amplitude of the sensory action potential and sensory conduction velocity decrease. A statistically significant change was found in patients whose symptoms lasted 19 months or longer. No single electroadiagnostic test, however, is capable of identifying all patients with CTS. The dominance of the hand has no effect on the degree of injury of sensory and motor fibers in the median nerve in as far as this depends on the duration of the disease. Even though immobilization (wrist splint in neutral position) does not affect sensory and motor conduction velocity in the median nerve, this caused the disappearance of clinical symptoms in 75% of the patients.
    Type of material - master's thesis ; adult, serious
    Publication and manufacture - Zagreb : [B. Jesenšek Papež], 2001
    Language - croatian
    COBISS.SI-ID - 1020479

Library/institution City Acronym For loan Other holdings
MF, Central Medical Library, Ljubljana Ljubljana CMK outside loan 1 cop.
loading ...
loading ...
loading ...

Shelf entry