EVIDENCE-BASED GUIDELINE: NEUROMUSCULAR ULTRASOUND FOR THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME

MICHAEL S. CARTWRIGHT, MD,LISA D. HOBSON-WEBB, MD, ANDREA J. BOON, MD, et al, Muscle Nerve 46: 287-293, 2012

ABSTRACT: Introduction: The purpose of this study was to develop an evidence-based guideline for the use of neuromuscular ultrasound in the diagnosis of carpal tunnel syndrome (CTS).

Methods: Two questions were asked: (1) What is the accuracy of median nerve cross-sectional area enlargement as measured with ultrasound for the diagnosis of CTS? (2) What added value, if any, does neuromuscular ultrasound provide over electrodiagnostic studies alone for the diagnosis of CTS?A systematic review was performed, and studies were classified according to American Academy of Neurology criteria for rating articles of diagnostic accuracy (question 1) and for screening articles (question 2).

Results: Neuromuscular ultrasound measurement of median nerve cross-sectional area at the wrist isaccurate and may be offered as a diagnostic test for CTS (Level A). Neuromuscular ultrasound probably adds value to electrodiagnostic studies when diagnosing CTS and should be considered in screening for structural abnormalities at the wrist in those with CTS (Level B).

Nerve conduction velocities in the lower extremity in patients with Raynaud's phenomenon and clinical applications

Dimitrios Kostopoulos PT, PhD, DSc, Konstantine Rizopoulos PT, FABS and Nikolaos Vartholomeos PT, DPT

Summary

Background and purpose: The purpose of the study is to study the nerve conductivity of the tibial motor, peroneal motor, peroneal sensory, and sural nerves in patients with primary and secondary Raynaud's phenomenon (RP).

Subjects: Twenty each: primary RP, secondary RP, and normal controls.

Methods: Electromyography using distal latency (DL) and nerve conduction velocity (NCV) as dependent variables.

Results: Peroneal nerve DLs were slower and NCVs were weaker for the secondary RP group compared to the primary RP group and controls. Tibial motor nerve DLs from slowest to fastest were: primary RP, secondary RP, and controls. NCV strength order was: secondary RP weakest, primary RP, and controls.

Discussion: Patients with secondary RP generally had the slowest DLs and the weakest NCVs, with differences most pronounced in the motor nerves. With the exception of the tibial motor nerve, patients with primary RP had similar NCVs to the control group. Neural mobilization techniques can be applied to assist with patient symptoms.

Treatment of carpal tunnel syndrome: a review of the non-surgical approaches with emphasis in neural mobilization

Dimitrios Kostopoulos

Abstract: Carpal tunnel syndrome (CTS) results from the entrapment of the median nerve at the wrist. It is the most common entrapment syndrome causing frequent disability especially to working populations. Aside from the surgical release approach there are other non-invasive therapeutic methods for the treatment of CTS. This paper will review the evidence regarding neurodynamic testing and neuromobilization of the median nerve as a treatment approach to CTS.

Reduction of Spontaneous Electrical Activity and Pain Perception of Trigger Points in the Upper Trapezius Muscle Through Trigger Point Compression and Passive Stretching

Dimitrios Kostopoulos, PT, PhD, DSc
Arthur J. Nelson, Jr., PT, PhD
Reuben S. Ingber, MD
Ralph W. Larkin, PhD

ABSTRACT:

Objectives: Investigate the effects of ischemic compression [IC] technique and passive stretching [PS] in isolation and in combination on the reduction of spontaneous electrical activity [SEA] and perceived pain in trigger points [TrPs] located in the upper trapezius muscle.

Methods: Ninety participants with TrPs in the upper trapezius muscle were randomly assigned to three treatment groups: IC, PS, and IC + PS. TrP compression was applied on the TrP for three applications of 60 seconds each, followed by a 30-second rest period. PS was applied for three 45-second applications, with 30-second rest intervals. All patients received the same amount of therapy.

Results: Significant decreases were found in pain perception and on SEA for all study participants. The IC + PS group evidenced greater declines in pain perception and SEA when compared to the IC and PS groups.

Conclusion: Because of ethical considerations, a control group design was not possible, thereby limiting the robustness of the findings. Although each technique significantly reduced pain perception and SEA, the combination of IC and PS was superior, apparently because of the complementary nature of the therapeutic interventions.