RESUMEN
Abstract Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.
Resumo A artrite reumatoide (AR) é uma causa bem e amplamente reconhecida de síndrome do túnel do carpo (STC). No punho acometido pela artrite reumatoide, a expansão sinovial, as erosões articulares e a frouxidão ligamentar resultam em compressão do nervo mediano decorrente do aumento da pressão intracarpal. Avaliaram-se os estudos publicados para determinar a prevalência de STC e as características do nervo mediano na AR e sua associação com parâmetros clínicos, como a atividade e duração da doença e a soropositividade. Preencheram os critérios de elegibilidade 13 estudos. Os dados agrupados dos oito estudos com seleção aleatória de pacientes com AR revelaram que 86 de 1.561 (5,5%) indivíduos tinham STC. Por outro lado, a STC subclínica teve uma prevalência combinada de 14% (30/215). A área de seção transversa do nervo mediano dos pacientes com AR sem STC foi semelhante à de controles saudáveis. A grande maioria dos estudos (8/13) não apresentou relação significativa entre os achados no nervo mediano e os parâmetros clínicos ou laboratoriais na AR. A ligação entre a AR e as anormalidades do nervo mediano foi excessivamente valorizada em toda a literatura. A prevalência de STC na AR é semelhante à da população em geral, sem qualquer correlação entre as características do nervo mediano e os parâmetros clínicos da AR.
Asunto(s)
Humanos , Artritis Reumatoide/patología , Articulación de la Muñeca/patología , Síndrome del Túnel Carpiano/patología , Nervio Mediano/patología , Artritis Reumatoide/complicaciones , Síndrome del Túnel Carpiano/etiología , Incidencia , PrevalenciaRESUMEN
Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.
Asunto(s)
Artritis Reumatoide/patología , Síndrome del Túnel Carpiano/patología , Nervio Mediano/patología , Articulación de la Muñeca/patología , Artritis Reumatoide/complicaciones , Síndrome del Túnel Carpiano/etiología , Humanos , Incidencia , PrevalenciaRESUMEN
BACKGROUND: Neurological involvement occurs throughout the leprosy clinical spectrum and is responsible for the most feared consequences of the disease. Ultrasonography (US) provides objective measurements of nerve thickening and asymmetry. We examined leprosy patients before beginning multi-drug therapy aiming to describe differences in US measurements between classification groups and between patients with and without reactions. METHODOLOGY/PRINCIPAL FINDINGS: Eleven paucibacillary (PB) and 85 multibacillary (MB) patients underwent nerve US. Twenty-seven patients had leprosy reactions (type 1, type 2 and/or acute neuritis) prior to US. The ulnar (at the cubital tunnel-Ut-and proximal to the tunnel-Upt), median (M) and common fibular (CF) nerves were scanned to measure cross-sectional areas (CSAs) in mm2 and to calculate the asymmetry indexes ΔCSA (absolute difference between right and left CSAs) and ΔUtpt (absolute difference between Upt and Ut CSAs). MB patients showed greater (p<0.05) CSAs than PB at Ut (13.88±11.4/9.53±6.14) and M (10.41±5.4/6.36±0.84). ΔCSAs and ΔUtpt were similar between PB and MB. The CSAs, ΔCSAs and ΔUtpt were similar between PB patients with reactions compared to PB patients without reactions. MB patients with reactions showed significantly greater CSAs (Upt, Ut and M), ΔCSAs (Upt and Ut) and ΔUtpt compared to MB patients without reactions. PB and MB showed similar frequencies of abnormal US measurements. Patients with reactions had higher frequency of nerve thickening and similar frequency of asymmetry to those without reactions. CONCLUSIONS/SIGNIFICANCE: This is the first study to investigate differences in nerve involvement among leprosy classification groups using US before treatment. The magnitude of thickening was greater in MB and in patients with reactions. Asymmetry indexes were greater in patients with reactions and did not significantly differ between PB and MB, demonstrating that asymmetry is a characteristic of leprosy neuropathy regardless of its classification.
Asunto(s)
Lepra Tuberculoide/patología , Nervio Mediano/patología , Nervio Peroneo/patología , Nervio Cubital/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Nervio Mediano/diagnóstico por imagen , Persona de Mediana Edad , Nervio Peroneo/diagnóstico por imagen , Nervio Cubital/diagnóstico por imagen , Ultrasonografía , Adulto JovenRESUMEN
A macrodactilia é uma anomalia congênita infrequente, caracterizada pelo crescimento desproporcional dos tecidos ósseo, gorduroso, nervoso, vascular e dérmico nos dedos das mãos ou dos pés. Existem muitas teorias sobre a sua etiopatogenia, sendo a mais aceita a hiperestimulação por fatores de crescimento enviados através dos nervos. Foram descritos alguns casos associados com a síndrome do túnel do carpo. Apresenta-se um caso clínico de síndrome do túnel do carpo por hipertrofia do nervo mediano, evidenciando um aumento de conteúdo dentro do retináculo flexor, o qual foi tratado cirurgicamente com sucesso pela realização de uma retinaculotomia do ligamento anular do carpo junto a um retalho de transposição tenar adipofascial reverso da região tenariana hipertrofiada visando à cobertura do nervo mediano na região do punho.
Macrodactyly is a rare congenital anomaly characterized by the disproportionate growth of bone, fat, nervous, vascular, and dermal tissue in the digits . There are many different theories about its etiopathogenesis, the most accepted being a hyperstimulation by growth factors conducted through nerves. A few cases have been described in conjunction with carpal tunnel syndrome. Here, a clinical case of carpal tunnel syndrome due to hypertrophy of the median nerve is presented, showing an increase of content within the flexor retinaculum. Successful surgical treatment was accomplished by conducting a retinaculotomy of the anterior annular ligament along with a reverse transposition adipofascial flap of the hypertrophied thenar region for coverage of the median nerve at the wrist.
Asunto(s)
Humanos , Masculino , Adolescente , Historia del Siglo XXI , Colgajos Quirúrgicos , Anomalías Congénitas , Muñeca , Deformidades Congénitas de la Mano , Literatura de Revisión como Asunto , Síndrome del Túnel Carpiano , Procedimientos de Cirugía Plástica , Gigantismo , Mano , Hipertrofia , Nervio Mediano , Colgajos Quirúrgicos/cirugía , Anomalías Congénitas/cirugía , Muñeca/cirugía , Hormona del Crecimiento , Deformidades Congénitas de la Mano/cirugía , Síndrome del Túnel Carpiano/cirugía , Síndrome del Túnel Carpiano/patología , Procedimientos de Cirugía Plástica/métodos , Gigantismo/cirugía , Gigantismo/patología , Mano/cirugía , Hipertrofia/cirugía , Nervio Mediano/cirugía , Nervio Mediano/crecimiento & desarrollo , Nervio Mediano/patologíaRESUMEN
RESUMOObjetivos:verificar os itens componentes das contas hospitalares, conferidos por enfermeiros auditores, que mais recebem ajustes no momento da pré-análise; identificar o impacto dos ajustes no faturamento das contas analisadas por enfermeiros e médicos auditores e identificar as glosas relacionadas aos itens conferidos pela equipe de auditoria.Método:pesquisa quantitativa exploratória, descritiva, do tipo estudo de caso único.Resultados:após a análise de 2.613 contas constatou-se que o item mais incluído por enfermeiros foram gases (90,5%) e o mais excluído medicamentos de internação (41,2%). Materiais de hemodinâmica; gases e equipamentos foram os que mais impactaram nos ajustes positivos. Os ajustes negativos decorreram de lançamentos indevidos nas contas e não geraram prejuízos de faturamento. Do total de glosas 52,24% referiu-se à pré-análise dos enfermeiros e 47,76% a dos médicos.Conclusão:a presente investigação do processo de pré-análise fornece subsídios que contribuem para o avanço no conhecimento sobre a auditoria de contas hospitalares.
RESUMENObjetivos:comprobar los elementos que componen las cuentas del hospital, controladas por enfermeras auditores que reciben más ajustes en el momento de pre-análisis, identifi car el impacto de los ajustes a la facturación de las cuentas examinadas por las enfermeras y los médicos auditores; identifi car las glosas relacionadas con los puntos otorgados por equipo de auditoría.Método:estudio cuantitativo, exploratorio, descriptivo, tipo de investigación de caso único.Resultados:después de análisis de 2613 cuentas se encontró que el elemento más incluido por el enfermeros fue gas (90,5%) y lo más excluido fue hospitalización medicamentos (41,2%). Materiales de gases y equipos hemodinámicamente fueron los más afectados en los ajustes positivos. Los ajustes negativos fueron el resultado de errores en las cuentas y no generan pérdidas de ingresos. El rechazo total fue de 52,24% en relación a la pre-análisis de las enfermeras y de 47,76% de los médicos.Conclusión:esta investigación del proceso de preanálisis proporciona subsidios que contribuyen al avance de los conocimientos sobre la auditoría de las cuentas de los hospitales.
ABSTRACTObjectives:to determine which component items of hospital bills, examined by nurse auditors, were adjusted the most during pre-analysis; to identify the impact upon revenue caused by the adjustments to bills analyzed by physician and nurse auditors; and to identify disallowances related to items checked by the audit team.Method:quantitative, exploratory, descriptive, singlecase study.Results:after analysis of 2,613 bills, it was found that the item most included by nurses was gas (90.5%) and the most excluded was inpatient drugs (41.2%). Hemodynamics materials, gases and equipment had the greatest impact on upward adjustments. Downward adjustments were the result of improper entries on bills and did not generate revenue losses. Of total disallowances, 52.24% were related to the pre-analysis of nurses and 47.76% to that of physicians.Conclusion:this study of the pre-analysis process provides input that enhances knowledge about hospital bill audits.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Síndrome del Túnel Carpiano/diagnóstico , Imagen de Difusión Tensora , Imagen por Resonancia Magnética , Nervio Mediano/patología , Articulación de la Muñeca/patología , Área Bajo la Curva , Síndrome del Túnel Carpiano/patología , Ligamentos/patología , Curva ROC , Sensibilidad y EspecificidadRESUMEN
This study evaluated the functional and quantitative differences between the early and delayed use of phototherapy in crushed median nerves. After a crush injury, low-level laser therapy (GaAs) was applied transcutaneously at the injury site, 3 min daily, with a frequency of five treatments per week for 2 weeks. In the early group, the first laser treatment started immediately after surgery, and in the delayed group, after 7 days. The grasping test was used for functional evaluation of the median nerve, before, 10, and 21 days after surgery, when the rats were killed. Three segments of the median nerve were analyzed histomorphometrically by light microscopy and computer analysis. The following features were observed: myelinated fiber and axon diameters, myelin sheath area, g-ratio, density and number of myelinated fibers, and area and number of capillaries. In the proximal segment (site of crush), the nerves of animals submitted to early and delayed treatment showed myelinated fiber diameter and myelin sheath area significantly larger compared to the untreated group. In the distal segment, the myelin sheath area was significantly smaller in the untreated animals compared to the delayed group. The untreated, early, and delayed groups presented a 50, 57, and 81% degree of functional recovery, respectively, at 21 days after injury, with a significant difference between the untreated and delayed groups. The results suggest that the nerves irradiated with low-power laser exhibit myelinated fibers of greater diameter and a better recovery of function.
Asunto(s)
Láseres de Semiconductores/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Nervio Mediano/lesiones , Traumatismos de los Nervios Periféricos/terapia , Fototerapia/métodos , Animales , Femenino , Nervio Mediano/patología , Compresión Nerviosa , Traumatismos de los Nervios Periféricos/patología , Traumatismos de los Nervios Periféricos/fisiopatología , Ratas , Ratas WistarRESUMEN
La mano y la muñeca son frecuentemente implicadas en síndromes de dolor regional, inflamatorios y degenerativos. La ultrasonografía ha demostrado ser más sensible que los exámenes clínicos y de radiología convencional para la detección de sinovitis y erosiones. También ha podido revelar una participación subclínica en pacientes con artritis crónica. Las indicaciones de la ultrasonografía a nivel de la mano y la muñeca son amplias e incluyen el diagnóstico de la afección articular y el tendón, la patología de poleas, los cambios morfoestructurales a nivel del nervio mediano en el túnel carpiano; puede servir como guía para las infiltraciones, así como para la valoración del tratamiento en pacientes con artritis crónica. El objetivo de esta revisión es mostrar el resultado de las alteraciones más frecuentes en las que la ultrasonografía ha demostrado ser útil.
The hand and wrist are frequently involved by regional pain syndromes, inflammatory and degenerative conditions. Ultrasonography had demonstrated to be more sensitive than both clinical examination and conventional radiology for the detection of synovitis and erosions. It has also able to reveal a subclinical involvement in patients with chronic arthritis. The indications of ultrasonography at hand and wrist level is wide and include: diagnosis of joint and tendon involvement, pulleys pathology, morphostructural changes at median nerve level into to carpal tunnel, guidance for infiltrations into and treatment monitoring in patients with chronic arthritis. The aim of this review is to show the most frequent alterations in which ultrasound has proven useful.
Asunto(s)
Humanos , Artropatías , Mano/patología , Mano , Artritis Psoriásica , Artritis Reumatoide , Síndromes de Dolor Regional Complejo , Enfermedad de De Quervain , Gota , Muñeca/patología , Muñeca , Nervio Mediano/patología , Osteoartritis , Síndrome del Túnel CarpianoAsunto(s)
Humanos , Masculino , Preescolar , Fibroma/diagnóstico , Fibroma/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Neoplasias del Sistema Nervioso Periférico/patología , Fibroma/clasificación , Hamartoma , Nervio Mediano/patología , Extremidad SuperiorRESUMEN
A síndrome do túnel do carpo é uma neuropatia compressiva periférica que consiste na compressão do nervo mediano no canal do carpo. Apresenta maior incidência no sexo feminino e está associada ao esforço repetitivo. Os sinais e sintomas mais freqüentes são fraqueza, hipotrofia dos músculos tenares e dos dois primeiros lumbricais, retração do adutor do polegar e dos músculos flexores profundos e superficiais dos dedos, perda da mobilidade no deslizamento longitudinal e transversal do nervo mediano. Esses estão associados a edema, inflamação e retração do tecido conjuntivo neural. O objetivo deste estudo foi mostrar a aplicação da técnica de mobilização neural, como tratamento para a síndrome do túnel do carpo. Tal técnica tem como principal objetivo restaurar o movimento e a elasticidade tecidual do nervo periférico.
The carpal tunnel syndrome is a peripheral compressive neuropathy that consists in median nerve compression in the carpal tunnel. It occurs more often in females and is associated with repetitive strain. The more frequent signals and symptoms are weakness, hypertrophy of the tenhar and the first two lumbrical muscles, retraction of adductor of thumb and the deep and superficial flexor finger muscles, loss of mobility in the longitudinal and transverse sliding of the median nerve. These signals and symptoms are associated with swell, inflammation and retraction of the conjunctive neural tissue. The objective of the study aimed to show the use of neural mobilization technique as treatment for the carpal tunnel syndrome. Such technique has as main objective to restore range of motion and elasticity of the peripheral nerve tissue.
Asunto(s)
Síndrome del Túnel Carpiano , Enfermedades del Sistema Nervioso Periférico/complicaciones , Enfermedades del Sistema Nervioso Periférico/patología , Nervio Mediano , Nervio Mediano/patología , Muñeca/anomalías , Muñeca/patologíaRESUMEN
OBJECTIVE: To measure the median nerve cross-sectional area (MNCSA) at the carpal tunnel (CT) level by sonography (S) in a Mexican population. METHODS: A comparative cross-sectional design study with a nonprobabilistic sampling with 50 women and 50 men in good health were submitted for measuring MNCSA at the level of the CT. Other variables like sex; side and degree of daily hand activity were also studied. The analysis was made by descriptive statistics, and Mann-Whitney U or Kruskal-Wallis tests. RESULTS: The mean MNCSA was 0.063 +/- 0.015 cm(2), in women; in men it was 0.072 +/- 0.018 cm(2); the difference was significant (p < 0.004). The median MNCSA among women was 0.062 cm(2) in the right side and 0.060 cm(2) in the left (90th percentile for both hands of 0.084 cm(2)); in men, it was of 0.070 cm(2) in the right hand and of 0.069 cm(2) in the left (90th percentile for both hands of 0.097 cm(2)). The difference between women and men was significant in each side, but not between right and left hands (p = 0.21). There was no correlation between age and MNCSA on either side, or with hand activity. CONCLUSIONS: A MNCSA value of 0.1 cm(2) for men and 0.09 cm(2) for women is proposed as a standard parameter for the Mexican population.
Asunto(s)
Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/patología , Nervio Mediano/diagnóstico por imagen , Nervio Mediano/patología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía , Adulto JovenRESUMEN
Introduction: Magnetic resonance imaging (MRI) is an essential tool for the study of central nervous system disorders. Several studies consider the application of diffusion tensor imaging (DTI) and tractography in the study of peripheral nerves. Methodology: We performed tractography and DTI in two female patients, one with a confirmed carpal tunnel syndrome and the other in good health conditions. Values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded. Results: The average FA valué of the fiber was 0.461 (case) and 0.632 (control). No differences were reported between the average valúes of the ADC of the fiber. Discussion: We were able to represent the tract of the median nerve by using a software fortractography reconstruction. The morphology and valúes of quantitative analysis of DTI depend directly on the reconstruction algorithm used, mainly on the minimum FA value of the fiber to be reconstructed. The value of the FA, obtained by zone, was the most constant variable, being lower for the case.
Introducción: La resonancia magnética es una herramienta indispensable en el estudio de enfermedades del sistema nervioso central. Varios estudios consideran la aplicación del tensor de difusión (DTI) y tractografía en el estudio de nervios periféricos. Metodología: Se realizó tractografía y DTI en dos mujeres, una con síndrome del túnel carpiano confirmado y otra sin patología. Se consignaron valores de fracción de anisotropía (FA) y coeficiente de difusión aparente (ADC). Resultados: El valor promedio de FA de la fibra fue 0,461 (caso) y 0,632 (control). No hubo diferencias entre valores promedios de ADC de fibras. Discusión: Se logró representar el tracto del nervio mediano utilizando software de reconstrucción de tractografía. La morfología y valores del análisis cuantitativo del DTI dependen directamente del algoritmo de reconstrucción utilizado, especialmente del umbral mínimo de FA de la fibra a reconstruir. El valor más constante es FA, obtenido por zona, siendo menor en el caso.
Asunto(s)
Humanos , Femenino , Adulto , Anisotropía , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/patología , Imagen de Difusión por Resonancia Magnética , Nervio Mediano/patología , Procesamiento de Imagen Asistido por ComputadorRESUMEN
OBJECTIVE: To compare clinical evaluation, electrophysiological investigation and magnetic resonance findings in assessing the severity of idiopathic carpal tunnel syndrome. PATIENTS AND METHODS: Seventy-four patients with idiopathic carpal tunnel syndrome were prospectively recruited. Clinical evaluation included symptoms severity score and two-point discrimination, sensory and motor nerve conduction velocities were determined by electroneuromyography and imaging parameters were obtained after wrist magnetic resonance. The Wilcoxon test was used to define the differences between measurements of median nerve area. The Pearson and Spearman correlation tests were used to determine the relationships between all the measured parameters. RESULTS: Cross-sectional area of median nerve was smaller at hamate level than at radio-ulnar joint and pisiform levels (p<0.001). With exception of median nerve area at hamate level, there was a lower degree of correlation between MRI parameters and findings obtained by clinical assessments and electrophysiological measurements. The median nerve area at hamate level correlated negatively with duration of symptoms, two-point discrimination, symptoms severity score and positively with sensory nerve conduction velocity (p<0.01). CONCLUSION: In patients with idiopathic carpal tunnel syndrome, median nerve area measured by wrist magnetic resonance at hamate level may be considered as a valuable indicator to grading the severity of disease.
Asunto(s)
Síndrome del Túnel Carpiano/patología , Síndrome del Túnel Carpiano/fisiopatología , Nervio Mediano/patología , Conducción Nerviosa/fisiología , Nervio Cubital/patología , Potenciales de Acción/fisiología , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Síndrome del Túnel Carpiano/complicaciones , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Nervio Cubital/fisiopatologíaRESUMEN
Presentamos tres pacientes con un tumor benigno infrecuente denominado hamartoma fibrolipomatoso del nervio mediano, el cual puede estar o no asociado a macrodistrofia lipomatosa.
Asunto(s)
Hamartoma/etiología , Hamartoma , Nervio Mediano/patología , Fibroma , Lipomatosis , Espectroscopía de Resonancia Magnética , Radiografía , UltrasonografíaRESUMEN
Experimentally predegenerated nerve grafts have been demonstrated to improve recovery. In a 12 month-long study, we compared the degree of recovery of conventional and predegenerated grafts in rat median nerve repair. To induce predegeneration the ulnar donor nerve was crushed and grafting to the median nerve was performed 2 weeks later. The day of recovery and the improvement of finger flexion strength were studied by the grasping test. At 3, 6, 9, and 12 months after surgery retrograde labeling studies and flexor carpi radialis muscle ATPase histochemistry were performed. In the predegenerated grafts, the recovery of finger flexion occurred 19.6+/-1.5 days after surgery and was significantly faster than that in the conventional group. Twelve months after surgery, a similar rate of 85% of grasping strength recovery in relation to the normal control rats was demonstrated for the conventional and predegenerated grafts. After grafting, a larger number of motoneurons, compared to the normal controls, were retrograde labeled in the median nerve. This surplus of retrograde labeled motoneurons in the predominantly sensory branch of the median nerve represented misdirected motor fibers. There was a time-related decrease in the number of labeled motoneurons, which correlated to functional grasping strength recovery. Muscle reinnervation induced a predominance of type I over type II muscle fibers. Forty percent of type I fibers were grouped indicating that collateral sprouting plays a prominent role during muscle reinnervation. Regeneration in predegenerated grafts was faster but the final rate of recovery was similar to conventional grafts.
Asunto(s)
Nervio Mediano/lesiones , Nervio Mediano/patología , Degeneración Nerviosa/patología , Tejido Nervioso/trasplante , Animales , Conducta Animal/fisiología , Femenino , Fuerza de la Mano/fisiología , Nervio Mediano/fisiopatología , Neuronas Motoras/fisiología , Fibras Musculares de Contracción Rápida/fisiología , Fibras Musculares de Contracción Lenta/fisiología , Tejido Nervioso/patología , Tejido Nervioso/fisiología , Ratas , Ratas Sprague-Dawley , Nervio Cubital/lesionesRESUMEN
Fibrolipomatous hamartoma is a rare benign neoplasm that in some cases is associated with macrodactylia. We describe a 31-year-old man who had a tissue enlargement in the wrist, second and third fingers of the left hand since infancy. At 23-years-old he began with continuous, progressive and high intensity pain that occurred more frequently at night, localized in the left hand. It was associated with paraesthesias and hypostesias predominantly at the fingers described above. Investigation with X-ray, ultrasonography, electrodiagnosis, magnetic resonance image of the left wrist and hand showed carpal tunnel syndrome with macrodactylia by fibrolipomatous hamartoma of the median nerve. The patient did not a have good response to clinical therapy, so he was submitted to a surgical decompression of the left carpal tunnel, and after three months of follow up is asymptomatic.
Asunto(s)
Síndrome del Túnel Carpiano/etiología , Hamartoma/complicaciones , Nervio Mediano/patología , Neuropatía Mediana/patología , Adulto , Síndrome del Túnel Carpiano/patología , Síndrome del Túnel Carpiano/cirugía , Dedos/anomalías , Dedos/cirugía , Hamartoma/patología , Hamartoma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Nervio Mediano/cirugía , Neuropatía Mediana/complicaciones , Neuropatía Mediana/cirugía , Dolor/etiología , Parestesia/etiologíaRESUMEN
Fibrolipomatous hamartoma is a rare benign neoplasm that in some cases is associated with macrodactylia. We describe a 31-year-old man who had a tissue enlargement in the wrist, second and third fingers of the left hand since infancy. At 23-years-old he began with continuous, progressive and high intensity pain that occurred more frequently at night, localized in the left hand. It was associated with paraesthesias and hypostesias predominantly at the fingers described above. Investigation with X-ray, ultrasonography, electrodiagnosis, magnetic resonance image of the left wrist and hand showed carpal tunnel syndrome with macrodactylia by fibrolipomatous hamartoma of the median nerve. The patient did not a have good response to clinical therapy, so he was submitted to a surgical decompression of the left carpal tunnel, and after three months of follow up is asymptomatic.
O hamartoma fibrolipomatoso é neoplasia benigna rara que em alguns casos esta associada com macrodactilia. Descrevemos o caso de homem de 31 anos que apresentava desde o nascimento aumento de volume em região de punho, segundo e terceiro quirodáctilos da mão esquerda. Aos 23 anos iniciou dor contínua, de forte intensidade, predominante no período noturno e de evolução progressiva em mão esquerda. Associada à dor havia hipoestesia e parestesias de predomínio nos segundo e terceiro quirodáctilos esquerdos. A investigação complementar com radiografia, ultrassonografia, estudo eletrofisiológico e ressonância magnética de mão e punho esquerdos confirmaram a suspeita de síndrome do túnel do carpo secundária a macrodactilia com hamartoma fibrolipomatoso do nervo mediano. O paciente foi submetido à descompressão cirúrgica do túnel do carpo esquerdo devido a ausência de resposta ao tratamento clínico e evoluiu com melhora dos sintomas em avaliação após três meses do procedimento.
Asunto(s)
Humanos , Masculino , Hamartoma/complicaciones , Nervio Mediano/patología , Neuropatía Mediana/patología , Síndrome del Túnel Carpiano/etiología , Adulto , Dedos/anomalías , Dedos/cirugía , Dolor/etiología , Hamartoma/patología , Hamartoma/cirugía , Imagen por Resonancia Magnética , Nervio Mediano/cirugía , Neuropatía Mediana/complicaciones , Neuropatía Mediana/cirugía , Parestesia/etiología , Síndrome del Túnel Carpiano/patología , Síndrome del Túnel Carpiano/cirugíaRESUMEN
Extrapulmonary tuberculosis, and especially articular, is less frequent than their pulmonary form. We report a 59 year-old men that requests medical attention for suggestive symptoms of carpal tunnel syndrome, of which is operated, being demonstrated in the carpo a granulomatous tissue including the median nerve suggestive of sarcoidosis or tuberculosis. In sputum the presence of Micobacterium tuberculosis was demonstrated. The respiratory symptoms of pulmonary tuberculosis were for the patient less excellent symptoms in relation to those produced by compression of the median nerve. The relationship between the tuberculosis and the carpal tunnel syndrome is demonstrated.
Asunto(s)
Síndrome del Túnel Carpiano/microbiología , Tuberculosis Osteoarticular/microbiología , Tuberculosis Pulmonar/microbiología , Síndrome del Túnel Carpiano/diagnóstico , Síndrome del Túnel Carpiano/cirugía , Descompresión Quirúrgica/métodos , Electromiografía , Humanos , Masculino , Nervio Mediano/patología , Nervio Mediano/cirugía , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Radiografía Torácica , Esputo/microbiología , Resultado del Tratamiento , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
INTRODUCTION: The treatment selection in the carpal tunnel syndrome according to the damage of the median nerve is important and all of these have adverse effects. A good alternative without undesired reactions is irradiation of the carpal tunnel with not coherent light between 920 and 940 nm emitted by gallium arsenide diodes, resembling the physic and therapeutic laser effects. PATIENTS AND METHODS: Twenty-six female patients with idiopathic middle carpal tunnel syndrome were irradiated 15 minutes daily during three weeks. The median nerve motor and sensitive neuroconduction was studied before and immediately after the treatment. RESULTS: The abnormal neuroconduction variables (latency, amplitude and velocity conduction) did not modify when treatment concluded, in spite of all the patients reported disappearance of pain and numbness in damaged hands. CONCLUSIONS: Not coherent light does not change the fibers functional state explored by conventional neuroconductions techniques. It remains to know if this light produces fine fibers improvement.
Asunto(s)
Síndrome del Túnel Carpiano/fisiopatología , Síndrome del Túnel Carpiano/terapia , Rayos Láser , Nervio Mediano/fisiología , Fototerapia , Arsenicales/uso terapéutico , Síndrome del Túnel Carpiano/patología , Femenino , Galio/uso terapéutico , Humanos , Masculino , Nervio Mediano/patología , Persona de Mediana Edad , Conducción Nerviosa , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Dentro do contexto das patologias esqueléticas observadas com frequência no paciente dialisado, a síndrome do túnel do carpo ocupa os primeiros lugares na taxa de incidência. Embora seja relatada com percentagens diversas por vários autores, geralmente a mesma aparece de 5 a 8 anos após a hemodiálise, com um percentual de 50 por cento após 15 anos e de 100 por cento após 20 anos. Os A.A., examinando os dados relevados pela casuística própria e aqueles relatados na literatura, voltaram sua atençäo para a maior incidência das síndromes monolaterais do lado do acesso vascular e para a precocidade do aparecimento das mesmas. Com base nessas premissas, formularam a hipótese da possibilidade de uma intervençäo profilática ou de um rígido follow-up a nível do membro contralateral nos pacientes submetidos a ligamentotomia do membro sede do acesso vascular, visto que a intervençäo eletiva de ligamentotomia, mesmo sendo resolutiva para a sintomatologia álgica, näo permite a recuperaçäo morfo-funcional do nervo mediano