This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict ...This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict the positive and negative results of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome. The hand specialist, preceding NCS administered the questionnaire;it was then scored at a later date. Results showed a sensitivity of 86% and specificity of 84% referring to the ability to predict a positive NCS when using a predetermined cut-off score. When analysed with Receiver Operating Characteristics, a threshold score could be determined in order to obtain 100% sensitivity/specificity. This questionnaire can be used as a useful adjunct to assessment of those presenting with suspected Carpal Tunnel Syndrome. Using the questionnaire to identify those patients scoring outside a predetermined threshold range would reduce the need for NCS by nearly 50%, with significant cost and clinical practice implications.展开更多
<span style="font-family:Verdana;">This evaluation of the Carpal Tunnel Questionnaire (CTQ) was designed to establish the validity and flexibility of its potential use both within a primary and seconda...<span style="font-family:Verdana;">This evaluation of the Carpal Tunnel Questionnaire (CTQ) was designed to establish the validity and flexibility of its potential use both within a primary and secondary care setting. The questionnaire was originally designed to predict the positive and negative outcome of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome (CTS). Prior to being seen by the hand specialist patients who had been referred with suspected CTS where asked to complete the CTQ. These questionnaires were coded and filed by t</span><span style="font-family:Verdana;">he clinic nurse. The hand specialist then completed t</span><span style="font-family:Verdana;">he questionnaire w</span><span style="font-family:Verdana;">ith the patient preceding NCS. Questionnaires were scored subsequent to the </span><span style="font-family:Verdana;">appointment. Results for the hand specialist completed questionnaire showe</span><span style="font-family:Verdana;">d an 80% specificity and 92% sensitivity regarding the ability</span><span style="font-family:Verdana;"> of the CTQ to predict a positive NCS using a pre-determine cut-off score. The patient completed questionnaire showed a 70.67% specificity and 72% sensitivity. Using </span><span style="font-family:Verdana;">receiver operating characteristics a threshold score could be determined to achieve 100% sensitivity/specificity for both questionnaires. This que</span><span style="font-family:Verdana;">stionnaire provides a useful addition in the assessment of patients with suspected carpal tunnel syndrome and could be used in a range of clinical settings although the scoring cut-off may need to be adapted depending on whether the questionnaire was completed by the clinician or patient. Using the questionnaire in a clinical setting would reduce the requirement for NCS by 60%, this would offer significant time and cost savings.</span>展开更多
Background: Carpal Tunnel Syndrome (CTS) is the commonest upper limb nerve entrapment syndrome seen in practice. In many centres, nerve conduction studies (NCS) have been adopted as a routine part of the diagnostic pr...Background: Carpal Tunnel Syndrome (CTS) is the commonest upper limb nerve entrapment syndrome seen in practice. In many centres, nerve conduction studies (NCS) have been adopted as a routine part of the diagnostic process. In the United Kingdom, the time taken to access diagnostic tests has been likened to a “hidden waiting list”, lengthening the time taken for a patient to access treatment. In the current healthcare climate with a centrally driven aim to reduce patient waiting time to a maximum of eighteen weeks, including tests, such waiting is even more unacceptable. Aim. This study was performed in order to evaluate a simple handheld device for quantifying median nerve lesions in CTS. Design of study: A prospective blinded cohort study. Setting: Leicester General Hospital, Carpal Tunnel Service Method: Participants were recruited from the nor-mal referral stream. If the clinical findings were consistent with a diagnosis of CTS, they were for-mally consented to the study in which results from the new handheld device were compared with traditional NCS. Final test group consisted of 63 participants. Results: For the new device the correct positive detection rate for abnormal nerve conduction was 91% (74/81 hands). Of the seven abnormal results not picked up by the new device, four were in asymptomatic hands (positive per cent agree-ment in symptomatic hands 95%). There were no false positives with the new system. (Negative per cent agreement 100%) Conclusion: We conclude that this new device demonstrates a high degree of concordance with currently available traditional NCS. The study suggested ways in which the accuracy could be further improved.展开更多
<strong>Background/Aim:</strong> Carpal tunnel syndrome (CTS) is one of the most common compressive, canalicular neuropathies of the upper extremities, causing hand pain and impaired function. This clinica...<strong>Background/Aim:</strong> Carpal tunnel syndrome (CTS) is one of the most common compressive, canalicular neuropathies of the upper extremities, causing hand pain and impaired function. This clinical study was designed to compare the intraoperative median nerve distal motor latency (DML) versus the distal sensory latency (DSL) and sensory nerve conduction velocity (SNCV) during surgical treatment of CTS. <strong>Patients and Methods:</strong> A total number of 36 wrists in 30 patients with CTS diagnosed by preoperative median MNCS who underwent surgical intervention for median nerve release. Intraoperative measurements of motor distal latency (DML) and proximal latency, amplitude, and conduction velocity and distal sensory latency (DSL), amplitude, and conduction velocity of both the median and ulnar nerves before and after division of the flexor retinaculum (FR). <strong>Results:</strong> A significant decrease of the intraoperative median nerve distal motor latency (DML) after release (8.89 ± 0.93) in comparison with the preoperative median nerve DML (6.24 ± 1.06) with (p < 0.001*). But intraoperative distal sensory latency (DSL) and sensory nerve conduction velocity (SNCVM) show non-significant decrease (p = 0.161). <strong>Conclusion:</strong> Intraoperative monitoring of median nerve show rapidly improve Intraoperative motor nerve conduction than the sensory nerve conduction after release the FR during carpal tunnel surgery.展开更多
Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of...Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods： In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow fhll extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland-Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results： Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group＇s latency and compound muscle action potential （CMAP） of each segment at 70° elbow flexion by SSNCS was compared with lull extension position, no statistically significant difference were found （all P 〉 0.05）. Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated （all P 〈 0 elbow （P - 0.43）, and the latency （P = 0.15） and the CMAP （P = 01）, except the latency of segment of 4 cm to 6 cm above 0.06） of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow （2 cm above the elbow and 2 cm below it）, latency at elbow full extension and 70° flexion were strong direct associated（r=0.83, P〈0.01;r=0.55, P〈0.01）,andsodidtheCMAP（r 0.49, P〈0.01;r=0.72, P〈0.01）.Therewasno statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion （P 〉 0.05, respectively）. Conclusions： There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS.展开更多
Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods...Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods：Thirty healthy subjects were included and 60 ulnar nerves were studied by inching studies for normal values.Sixty-six patients who diagnosed CubTS clinically were performed bilaterally by routine MNCSs and SSNCSs.Follow-up for 1-year,the information of brief complaints,clinical symptoms,and physical examination were collected.Results：Sixty-six patients were included,88 of nerves was abnormal by MNCS,while 105 was abnormal by the inching studies.Medial epicondyle to 2 cm above medial epicondyle is the most common segment to be detected abnormally （59.09％）,P ＜ 0.01.Twenty-two patients were followed-up,17 patients＇ symptoms were improved.Most of the patients were treated with drugs and modification of bad habits.Conclusions：（1） SSNCSs can detect lesions of compressive neuropathy in CubTS more precisely than the routine motor conduction studies.（2） SSNCSs can diagnose CubTS more sensitively than routine motor conduction studies.（3） In this study,we found that medial epicondyle to 2 cm above the medial epicondyle is the most vulnerable place that the ulnar nerve compressed.（4） The patients had a better prognosis who were abnormal in motor nerve conduction time only,but not amplitude in compressed lesions than those who were abnormal both in velocity and amplitude.Our study suggests that SSNCSs is a practical method in detecting ulnar nerve compressed neuropathy,and sensitive in diagnosing CubTS.The compound muscle action potentials by SSNCSs may predict prognosis of CubTS.展开更多
Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospi...Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy. Methods The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients （118 patients with DM and 68 with PM） were retrospectively analyzed. Nerve conduction studies （NCSs） of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously. Results There were 71 （38.2%） patients with abnormal NCS findings, 37 （19.9%） with pure motor involvement （decreased compound muscle action potential, CMAP）, and 34 （18.3%） with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 （7.5%） had polyneuropathy, 1 （0.5%） had multiple mononeuropathy, 16 （8.6%） had carpal tunnel syndrome （CTS）, 1 （0.5%） had trigeminal sensory neuropathy, 1 （0.5%） had ulnar sensory neuropathy, and 1 （0.5%） had brachial plexus involvement. The prevalence of malignant disease （3/34, 8.8%）, other connective tissue diseases （CTDs） （7/34, 20.6%） and diabetes （6/34, 17.6%） was significantly greater in DM/PM patients with peripheral neuropathy （X2=15.855, P=0.000） compared with DM/PM patients without involvement of peripheral nerves （5/115, 4.3% and 7/115, 6.1%, respectively）. Conclusions Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.展开更多
Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an infection. The outcome and prognosis of GBS depend on many ...Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an infection. The outcome and prognosis of GBS depend on many factors such as the etiology, clinical features, neurophysiology and immunological parameters. The aim of this study was to assess the factors (clinical, investigatory tools, and therapies) that may affect the outcome of patients with GBS. Patients and methods: this was an analytical observational study that was conducted at Ain Shams university hospitals and Kobri Elkoba Military Hospital including twenty patients with the diagnosis of Guillain Barre Syndrome in the duration from 2016 to 2018. This study included twenty patients with the diagnosis of GBS within two weeks from onset of neurologic symptoms, whom their diagnosis based on the established clinical criteria and verified by investigations. Patients were selected from both genders and aged from 18 to 65 years old. Nerve conduction studies and electromyography were performed within two weeks from admission. Various lines of treatment such as plasma exchange (PE), intravenous immunoglobulins (IVIG) or both were used during the period of admission in hospital. Outcome was assessed by the Hughes functional score (F-score), that was applied to the patients on admission, at end of 4 weeks from onset of neuropathy and at the end of 8 weeks. The final outcome at the end of 8 weeks was classified as follow: Group I: good prognosis (0 - 2) on the Hughes functional score (15 patients) and Group II: poor prognosis (3 - 6) on the Hughes functional score (5 patients). Results: the age of the study population ranged from 18 to 65 years with mean of 36.10 ± 16.08 years. Fifteen (75%) patients were males and 5 (25%) patients were females. There was no statistically significant difference found between poor and good prognosis regarding gender. The most common electrophysiological subtype was demyelinating followed by axonal neuropathy. Most patients (75%) had a good outcome at end of study period. It was found that the different line of treatment administered (plasma exchange or IVIG or both) was not associated with poor or good outcome. The patients who needed mechanical ventilation had significantly poor prognosis. Conclusion: the most common electrophysiological subtype was demyelinating followed by axonal neuropathy. Ascending pattern of weakness was more common than descending pattern in this study population and was not related to prognosis. High Hughes score at admission was associated with poor outcome at 8 weeks.展开更多
Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invas...Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invasive neuroimaging technique can be applied to directly quantify the neuronal activities of individual brain regions that show the persistent symptoms owing to its better spatial resolution and increased signal-to-noise ratio.Therefore,this prospective observational study was conducted in 27 eligible female carpal tunnel syndrome,aged 57.7±6.51 years.Psychometric tests,nerve conduction studies and pCASL neuroimaging assessment were performed.The results showed that the relevant activated brain regions in the cortical,subcrotical,and cerebral regions were correlated with numbness,pain,functionality,median nerve status and motor amplitude of median nerve(K=21–2849,r=–0.77–0.76,P<0.05).There was a tendency of pain processing which shifted from the nociceptive circuitry to the emotional and cognitive one during the process of chronic pain caused by carpal tunnel syndrome.It suggests the necessity of addressing the ignored cognitive or emotional state when managing patients with carpal tunnel syndrome.Approval for this study was obtained from the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West,China(HKU/HA HKW IRB,approval No.UW17-129)on April 11,2017.This study was registered in Clinical Trial Registry of The University of Hong Kong,China(registration number:HKUCTR-2220)on April 24,2017.展开更多
目的:比较电针配合穴位注射与单纯穴位注射治疗糖尿病周围神经病的疗效差异。方法:在血糖控制理想情况下将60例糖尿病周围神经病患者随机分为电针加穴注组与穴注组,每组30例。电针加穴注组采用电针加穴位注射弥可保,电针穴取公孙透泉中...目的:比较电针配合穴位注射与单纯穴位注射治疗糖尿病周围神经病的疗效差异。方法:在血糖控制理想情况下将60例糖尿病周围神经病患者随机分为电针加穴注组与穴注组,每组30例。电针加穴注组采用电针加穴位注射弥可保,电针穴取公孙透泉中、涌泉透太冲为主,穴位注射取三阴交;穴注组采用单纯三阴交穴位注射弥可保。治疗2个疗程后,检测患者尺神经、胫神经神经传导速度,记录治疗前后中医症候积分及糖尿病周围神经病变积分,并评定疗效。结果:电针加穴注组与穴注组总有效率分别为90.0%(27/30)和63.3%(19/30),差异有统计学意义(P<0.05);治疗后电针加穴注组尺神经和胫神经运动神经传导速度(MCV)及感觉神经传导速度(SCV)均高于穴注组(P<0.05,P<0.01);治疗后电针加穴注组中医症候积分低于穴注组(14.36±1.88 vs 26.58±3.52,P<0.01),糖尿病周围神经病变积分亦低于穴注组(12.86±4.28 vs 17.89±4.35,P<0.01)。结论:电针加穴位注射弥可保治疗糖尿病周围神经病临床疗效显著,疗效优于单纯穴位注射弥可保,能够有效提高神经传导速度,控制和改善糖尿病周围神经病症状。展开更多
文摘This service evaluation and pilot study was designed to establish whether a clinical questionnaire could be incorporated within our Secondary Care Carpal Tunnel Service. The purpose of the questionnaire is to predict the positive and negative results of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome. The hand specialist, preceding NCS administered the questionnaire;it was then scored at a later date. Results showed a sensitivity of 86% and specificity of 84% referring to the ability to predict a positive NCS when using a predetermined cut-off score. When analysed with Receiver Operating Characteristics, a threshold score could be determined in order to obtain 100% sensitivity/specificity. This questionnaire can be used as a useful adjunct to assessment of those presenting with suspected Carpal Tunnel Syndrome. Using the questionnaire to identify those patients scoring outside a predetermined threshold range would reduce the need for NCS by nearly 50%, with significant cost and clinical practice implications.
文摘<span style="font-family:Verdana;">This evaluation of the Carpal Tunnel Questionnaire (CTQ) was designed to establish the validity and flexibility of its potential use both within a primary and secondary care setting. The questionnaire was originally designed to predict the positive and negative outcome of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome (CTS). Prior to being seen by the hand specialist patients who had been referred with suspected CTS where asked to complete the CTQ. These questionnaires were coded and filed by t</span><span style="font-family:Verdana;">he clinic nurse. The hand specialist then completed t</span><span style="font-family:Verdana;">he questionnaire w</span><span style="font-family:Verdana;">ith the patient preceding NCS. Questionnaires were scored subsequent to the </span><span style="font-family:Verdana;">appointment. Results for the hand specialist completed questionnaire showe</span><span style="font-family:Verdana;">d an 80% specificity and 92% sensitivity regarding the ability</span><span style="font-family:Verdana;"> of the CTQ to predict a positive NCS using a pre-determine cut-off score. The patient completed questionnaire showed a 70.67% specificity and 72% sensitivity. Using </span><span style="font-family:Verdana;">receiver operating characteristics a threshold score could be determined to achieve 100% sensitivity/specificity for both questionnaires. This que</span><span style="font-family:Verdana;">stionnaire provides a useful addition in the assessment of patients with suspected carpal tunnel syndrome and could be used in a range of clinical settings although the scoring cut-off may need to be adapted depending on whether the questionnaire was completed by the clinician or patient. Using the questionnaire in a clinical setting would reduce the requirement for NCS by 60%, this would offer significant time and cost savings.</span>
文摘Background: Carpal Tunnel Syndrome (CTS) is the commonest upper limb nerve entrapment syndrome seen in practice. In many centres, nerve conduction studies (NCS) have been adopted as a routine part of the diagnostic process. In the United Kingdom, the time taken to access diagnostic tests has been likened to a “hidden waiting list”, lengthening the time taken for a patient to access treatment. In the current healthcare climate with a centrally driven aim to reduce patient waiting time to a maximum of eighteen weeks, including tests, such waiting is even more unacceptable. Aim. This study was performed in order to evaluate a simple handheld device for quantifying median nerve lesions in CTS. Design of study: A prospective blinded cohort study. Setting: Leicester General Hospital, Carpal Tunnel Service Method: Participants were recruited from the nor-mal referral stream. If the clinical findings were consistent with a diagnosis of CTS, they were for-mally consented to the study in which results from the new handheld device were compared with traditional NCS. Final test group consisted of 63 participants. Results: For the new device the correct positive detection rate for abnormal nerve conduction was 91% (74/81 hands). Of the seven abnormal results not picked up by the new device, four were in asymptomatic hands (positive per cent agree-ment in symptomatic hands 95%). There were no false positives with the new system. (Negative per cent agreement 100%) Conclusion: We conclude that this new device demonstrates a high degree of concordance with currently available traditional NCS. The study suggested ways in which the accuracy could be further improved.
文摘<strong>Background/Aim:</strong> Carpal tunnel syndrome (CTS) is one of the most common compressive, canalicular neuropathies of the upper extremities, causing hand pain and impaired function. This clinical study was designed to compare the intraoperative median nerve distal motor latency (DML) versus the distal sensory latency (DSL) and sensory nerve conduction velocity (SNCV) during surgical treatment of CTS. <strong>Patients and Methods:</strong> A total number of 36 wrists in 30 patients with CTS diagnosed by preoperative median MNCS who underwent surgical intervention for median nerve release. Intraoperative measurements of motor distal latency (DML) and proximal latency, amplitude, and conduction velocity and distal sensory latency (DSL), amplitude, and conduction velocity of both the median and ulnar nerves before and after division of the flexor retinaculum (FR). <strong>Results:</strong> A significant decrease of the intraoperative median nerve distal motor latency (DML) after release (8.89 ± 0.93) in comparison with the preoperative median nerve DML (6.24 ± 1.06) with (p < 0.001*). But intraoperative distal sensory latency (DSL) and sensory nerve conduction velocity (SNCVM) show non-significant decrease (p = 0.161). <strong>Conclusion:</strong> Intraoperative monitoring of median nerve show rapidly improve Intraoperative motor nerve conduction than the sensory nerve conduction after release the FR during carpal tunnel surgery.
文摘Background： The appropriate elbow position of short-segment nerve conduction study （SSNCS） to diagnose cubital tunnel syndrome （CubTS） is still controversial. The goal of this study was to determine the effect of different elbow positions at full extension and 70° flexion on SSNCS in CubTS. Methods： In this cross-sectional study, the clinical data of seventy elbows from 59 CubTS patients between September, 2011 and December, 2014 in the Peking University First Hospital were included as CubTS group. Moreover, thirty healthy volunteers were included as the healthy group. SSNCS were conducted in all subjects at elbow fhll extension and 70° elbow flexion. Paired nonparametric test, bivariate correlation, Bland-Altman, and Chi-squared test analysis were used to compare the effectiveness of elbow full extension and 70° flexion elbow positions on SSNCS in CubTS patients. Results： Data of upper limit was calculated from healthy group, and abnormal latency was judged accordingly. CubTS group＇s latency and compound muscle action potential （CMAP） of each segment at 70° elbow flexion by SSNCS was compared with lull extension position, no statistically significant difference were found （all P 〉 0.05）. Latency and CMAP of each segment at elbow full extension and 70° flexion were correlated （all P 〈 0 elbow （P - 0.43）, and the latency （P = 0.15） and the CMAP （P = 01）, except the latency of segment of 4 cm to 6 cm above 0.06） of segment of 2 cm to 4 cm below elbow. Bivariate correlation and Bland-Altman analysis proved the correlation between elbow full extension and 70° flexion. Especially in segments across the elbow （2 cm above the elbow and 2 cm below it）, latency at elbow full extension and 70° flexion were strong direct associated（r=0.83, P〈0.01;r=0.55, P〈0.01）,andsodidtheCMAP（r 0.49, P〈0.01;r=0.72, P〈0.01）.Therewasno statistically significant difference in abnormality of each segment at full extension as measured by SSNCS compared with that at 70° flexion （P 〉 0.05, respectively）. Conclusions： There was no statistically significant difference in the diagnosis of CubTS with the elbow at full extension compared with that at 70° flexion during SSNCS. We suggest that elbow positon at full extension can also be used during SSNCS.
文摘Background：To study lesions＇ location and prognosis of cubital tunnel syndrome （CubTS） by routine motor nerve conduction studies （MNCSs） and short-segment nerve conduction studies （SSNCSs,inching test）.Methods：Thirty healthy subjects were included and 60 ulnar nerves were studied by inching studies for normal values.Sixty-six patients who diagnosed CubTS clinically were performed bilaterally by routine MNCSs and SSNCSs.Follow-up for 1-year,the information of brief complaints,clinical symptoms,and physical examination were collected.Results：Sixty-six patients were included,88 of nerves was abnormal by MNCS,while 105 was abnormal by the inching studies.Medial epicondyle to 2 cm above medial epicondyle is the most common segment to be detected abnormally （59.09％）,P ＜ 0.01.Twenty-two patients were followed-up,17 patients＇ symptoms were improved.Most of the patients were treated with drugs and modification of bad habits.Conclusions：（1） SSNCSs can detect lesions of compressive neuropathy in CubTS more precisely than the routine motor conduction studies.（2） SSNCSs can diagnose CubTS more sensitively than routine motor conduction studies.（3） In this study,we found that medial epicondyle to 2 cm above the medial epicondyle is the most vulnerable place that the ulnar nerve compressed.（4） The patients had a better prognosis who were abnormal in motor nerve conduction time only,but not amplitude in compressed lesions than those who were abnormal both in velocity and amplitude.Our study suggests that SSNCSs is a practical method in detecting ulnar nerve compressed neuropathy,and sensitive in diagnosing CubTS.The compound muscle action potentials by SSNCSs may predict prognosis of CubTS.
文摘Background Involvement of peripheral nerves in dermatomyositis （DM） and polymyositis （PM） is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy. Methods The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients （118 patients with DM and 68 with PM） were retrospectively analyzed. Nerve conduction studies （NCSs） of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously. Results There were 71 （38.2%） patients with abnormal NCS findings, 37 （19.9%） with pure motor involvement （decreased compound muscle action potential, CMAP）, and 34 （18.3%） with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 （7.5%） had polyneuropathy, 1 （0.5%） had multiple mononeuropathy, 16 （8.6%） had carpal tunnel syndrome （CTS）, 1 （0.5%） had trigeminal sensory neuropathy, 1 （0.5%） had ulnar sensory neuropathy, and 1 （0.5%） had brachial plexus involvement. The prevalence of malignant disease （3/34, 8.8%）, other connective tissue diseases （CTDs） （7/34, 20.6%） and diabetes （6/34, 17.6%） was significantly greater in DM/PM patients with peripheral neuropathy （X2=15.855, P=0.000） compared with DM/PM patients without involvement of peripheral nerves （5/115, 4.3% and 7/115, 6.1%, respectively）. Conclusions Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.
文摘Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an infection. The outcome and prognosis of GBS depend on many factors such as the etiology, clinical features, neurophysiology and immunological parameters. The aim of this study was to assess the factors (clinical, investigatory tools, and therapies) that may affect the outcome of patients with GBS. Patients and methods: this was an analytical observational study that was conducted at Ain Shams university hospitals and Kobri Elkoba Military Hospital including twenty patients with the diagnosis of Guillain Barre Syndrome in the duration from 2016 to 2018. This study included twenty patients with the diagnosis of GBS within two weeks from onset of neurologic symptoms, whom their diagnosis based on the established clinical criteria and verified by investigations. Patients were selected from both genders and aged from 18 to 65 years old. Nerve conduction studies and electromyography were performed within two weeks from admission. Various lines of treatment such as plasma exchange (PE), intravenous immunoglobulins (IVIG) or both were used during the period of admission in hospital. Outcome was assessed by the Hughes functional score (F-score), that was applied to the patients on admission, at end of 4 weeks from onset of neuropathy and at the end of 8 weeks. The final outcome at the end of 8 weeks was classified as follow: Group I: good prognosis (0 - 2) on the Hughes functional score (15 patients) and Group II: poor prognosis (3 - 6) on the Hughes functional score (5 patients). Results: the age of the study population ranged from 18 to 65 years with mean of 36.10 ± 16.08 years. Fifteen (75%) patients were males and 5 (25%) patients were females. There was no statistically significant difference found between poor and good prognosis regarding gender. The most common electrophysiological subtype was demyelinating followed by axonal neuropathy. Most patients (75%) had a good outcome at end of study period. It was found that the different line of treatment administered (plasma exchange or IVIG or both) was not associated with poor or good outcome. The patients who needed mechanical ventilation had significantly poor prognosis. Conclusion: the most common electrophysiological subtype was demyelinating followed by axonal neuropathy. Ascending pattern of weakness was more common than descending pattern in this study population and was not related to prognosis. High Hughes score at admission was associated with poor outcome at 8 weeks.
文摘Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invasive neuroimaging technique can be applied to directly quantify the neuronal activities of individual brain regions that show the persistent symptoms owing to its better spatial resolution and increased signal-to-noise ratio.Therefore,this prospective observational study was conducted in 27 eligible female carpal tunnel syndrome,aged 57.7±6.51 years.Psychometric tests,nerve conduction studies and pCASL neuroimaging assessment were performed.The results showed that the relevant activated brain regions in the cortical,subcrotical,and cerebral regions were correlated with numbness,pain,functionality,median nerve status and motor amplitude of median nerve(K=21–2849,r=–0.77–0.76,P<0.05).There was a tendency of pain processing which shifted from the nociceptive circuitry to the emotional and cognitive one during the process of chronic pain caused by carpal tunnel syndrome.It suggests the necessity of addressing the ignored cognitive or emotional state when managing patients with carpal tunnel syndrome.Approval for this study was obtained from the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West,China(HKU/HA HKW IRB,approval No.UW17-129)on April 11,2017.This study was registered in Clinical Trial Registry of The University of Hong Kong,China(registration number:HKUCTR-2220)on April 24,2017.
文摘目的:比较电针配合穴位注射与单纯穴位注射治疗糖尿病周围神经病的疗效差异。方法:在血糖控制理想情况下将60例糖尿病周围神经病患者随机分为电针加穴注组与穴注组,每组30例。电针加穴注组采用电针加穴位注射弥可保,电针穴取公孙透泉中、涌泉透太冲为主,穴位注射取三阴交;穴注组采用单纯三阴交穴位注射弥可保。治疗2个疗程后,检测患者尺神经、胫神经神经传导速度,记录治疗前后中医症候积分及糖尿病周围神经病变积分,并评定疗效。结果:电针加穴注组与穴注组总有效率分别为90.0%(27/30)和63.3%(19/30),差异有统计学意义(P<0.05);治疗后电针加穴注组尺神经和胫神经运动神经传导速度(MCV)及感觉神经传导速度(SCV)均高于穴注组(P<0.05,P<0.01);治疗后电针加穴注组中医症候积分低于穴注组(14.36±1.88 vs 26.58±3.52,P<0.01),糖尿病周围神经病变积分亦低于穴注组(12.86±4.28 vs 17.89±4.35,P<0.01)。结论:电针加穴位注射弥可保治疗糖尿病周围神经病临床疗效显著,疗效优于单纯穴位注射弥可保,能够有效提高神经传导速度,控制和改善糖尿病周围神经病症状。
