Reproducibility of sonographic measurements of the median nerve.

OBJECTIVE: The purpose of this study was to evaluate the reproducibility of median nerve cross-sectional area (CSA) measurements using the indirect method (ellipsoid formula) and the direct or tracing method. METHODS: The median nerve CSA was measured in 22 wrists of patients with carpal tunnel syndrome by means of high-frequency sonography. Measurements were made at the level of the pisiform bone by a standardized sonographic examination protocol. Two observers with different levels of experience performed the measurements, independently and blinded. An analysis of reliability was carried out, and the concordance between the methods was determined with parametric statistical tests. RESULTS: The results point to good reproducibility of the median nerve CSA measurements obtained by both methods, whether performed by an experienced observer or by an inexperienced observer after a short learning period. CONCLUSIONS: The results suggest sonography for median nerve CSA measurements is reproducible by either the direct or indirect method when a standardized sonographic examination protocol is used.     

Ultrasound imaging of the carpal tunnel during median nerve compression

Median nerve (MN) compression is a recognized component of carpal tunnel syndrome (CTS). In order to document compressive changes in the MN during hand activity, the carpal tunnel was imaged with neuromuscular ultrasound (NMUS). Ten patients with CTS and five normal controls underwent NMUS of the MN at rest and during dynamic stress testing (DST). DST maneuvers involve sustained isometric flexion of the distal phalanges of the first three digits. During DST in the CTS patients, NMUS demonstrated MN compression between the contracting thenar muscles ventrally and the taut flexor tendons dorsally. The mean MN diameter decreased nearly 40%, with focal narrowing in the mid-distal carpal canal. Normal controls demonstrated no MN compression and a tendency towards MN enlargement, with an average diameter increase of 17%. Observing the pathologic mechanism of MN injury during common prehensile hand movements could help better understand how to treat and prevent CTS.     

Ultrasound effects on electroneuromyographic measures in sensory fibers of the median nerve

The purpose of this study was to clarify the available literature and study the influence of ultrasound on the conduction velocity and amplitude of evoked sensory potentials in the median nerve. Thirteen subjects were assigned to either Experimental or Control Groups for ultrasound or placebo treatments. We compared sensory-nerve conduction velocity in the median nerve after 10 minutes of ultrasound treatment at three intensity levels (0.5, 1.0, and 1.5 W/cm2) with sensory-nerve conduction velocity in the median nerve after 10 minutes of placebo ultrasound treatment (0.0 W/cm2). No significant differences were noted between groups at any of the three ultrasound intensity levels, nor were the interaction effects significant. A hypothetical model, based on the available literature, proposes that ultrasound-induced changes in sensory-nerve conduction velocity may not progress in a direct linear fashion relative to the duration of treatment.     

In-continuity neuroma of the median nerve at the elbow

Neuromas are a hyperplastic disorganised proliferation of cells that represent an attempt at nerve regeneration after trauma. They can be classified into terminal and in-continuity neuromas; the latter are observed when the nerve stumps are both connected. We present here the case of a 46-year-old male who sustained a deep cut at the volar aspect of the right elbow while repairing a glass. The injury caused partial transection of the median nerve, which was initially unrecognised. After several months, the patient presented pain at the volar aspect of the elbow, worsening with manual compression at the site of previous injury. Ultrasound showed an in-continuity neuroma with a hypoechoic and enlarged median nerve at the site of the sutured wound. The case report shows that ultrasound may be helpful in confirming the clinical diagnosis of neuroma and that it is useful to evaluate the percentage of the area affected by the lesion.     

Ultrasound elastographic evaluation of the median nerve in hemodialysis with carpal tunnel syndrome

Purpose

The aim of this study was to compare the elasticity of the median nerve (MN) between hemodialysis (HD) patients without carpal tunnel syndrome (CTS) and with CTS, and to evaluate the diagnostic usefulness of the elasticity of the MN in HD-CTS.

Materials and methods

The MN in 22 HD patients without CTS and 49 HD-CTS patients was studied. The cross-sectional area (CSA) and the elasticity of the MN, which was measured as the subcutaneous fat/median nerve (SF/MN) strain ratio, were evaluated.

Results

The mean SF/MN strain ratio in the groups that had received hemodialysis for 0–5, >5–10, and >10–15 years was 1.4 ± 0.28, 1.7 ± 0.18, and 2.0 ± 0.67, respectively. The mean CSA of the MN in the three groups was 9.9 ± 1.30, 11.6 ± 1.61, and 13.4 ± 2.14 mm², respectively. The presence of CTS was predicted by means of SF/MN strain ratio and CSA cutoff values of 1.8 and 11 mm², respectively. Both the SF/MN strain ratio and the CSA in the patients with CTS were higher than those in the patients without CTS (P < 0.05). The sensitivity and specificity of the SF/MN strain ratio and CSA of the MN were 75 and 92 % and 79.2 and 84 %, respectively.

Conclusion

Sonoelastography helps to improve the diagnostic accuracy of the ultrasonographic assessment of CTS.

     

针刺廉泉穴结合舌尖梅花针治疗脑卒中失语症的效果及对血液流变学的影响

目的:从血液流变学角度探讨针刺廉泉穴为主结合舌尖梅花针点刺治疗脑卒中后失语的机制。方法:全部51例患者按随机单盲法分为观察组30例,对照组21例。观察组以针刺廉泉结合舌尖梅花针点刺;对照组以头皮针运动区、语言区Ⅰ,Ⅱ,Ⅲ针刺,均以30d为1个疗程。1个疗程后观察疗效。结果:观察组总有效率为97%(29/30),治愈率为23%(7/30);对照组21例,总有效率为76%(16/21),治愈率为5%(1/21),两组疗效差异有显著性意义(χ2=8.107,P<0.05)。观察组血液流变学各项指标,除血沉指数和红细胞硬化指数外,其余治疗前后均有显著性意义(P<0.01或P<0.05);对照组患者红细胞聚集指数、血沉方程K与红细胞硬化指数在治疗前后差异有显著性意义(P<0.01或P<0.05)。并且观察组与对照组在全血黏度方面差异有显著性意义(P<0.05)。结论:针刺廉泉穴结合舌尖梅花针为主治疗脑卒中性失语症的临床疗效很显著,优于头皮针组。     

Funicular localization in partial median nerve injury at the wrists.

The funiculi of the median nerve at the wrist carrying the motor and sensory fibers innervating the hand were described in 1945 by Sunderland after an extensive anatomic study. In an attempt to confirm clinically the findings of that study, 7 patients with partial median nerve laceration at the wrist are presented. The findings in these patients support the schema developed from Sunderland's study except for the funiculi subserving the 1st and 2nd lumbricals which appear to be more dorsally placed. They also tend to confirm Sunderland's finding that the mixing of nerve fibers from different funiculi and the formation of intraneural plexuses occur more proximal than at the levels of injuries in the patients studied.     

Local anesthesia blocks the antiemetic action of P6 acupuncture.

The incidence of postoperative illness was monitored for 6 hours in 74 women premedicated with nalbuphine, 10 mg, and undergoing short gynecologic operations of similar duration under methohexitalnitrous oxide-oxygen anesthesia. Each patient received P6 acupuncture for 5 minutes at the time of administration of premedication. In random order the site of the acupuncture had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. This demonstrates the ability of a local anesthetic administered at the point of stimulation to block the antiemetic action of P6 acupuncture in a manner similar to that shown by others for analgesia.     

Best evidence topic report. Ultrasound placement of needle in three-in-one nerve block

A short cut review was carried out to establish whether ultrasound placement of three‐in‐one block is better than placement using a nerve stimulator. 137 papers were found, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is that ultrasound guidance is better than electrical nerve stimulation at obtaining a good quality three in one femoral block.     

超声定量测定正中神经诊断腕管综合征

目的 研究高频超声定量测定正中神经诊断腕管综合征,并探索有价值的诊断指标及其标准.方法 对32例经电生理检查确诊的腕管综合征患者及30例正常人的腕管行高频超声检测,两组间的差异采用t检验,超声诊断标准的确定采用ROC曲线分析.结果 除掌侧位移(PD)和钩骨钩水平膨胀率(SR3)外,腕管综合征患者正中神经的内径(D)、腕管3个水平的横径(a)、前后径(b)、横截面积(CSA)、扁平率(FR)以及SR2均较正常组增大,差异均有统计学意义(t分别=2.45、2.56、3.16、2.51、2.66、2.78、3.05、2.28、4.11、2.89、3.37、2.89、3.06、2.76,P均＜0.05).其中正中神经豌豆骨水平CSA临床诊断价值最大,当其临界值定为＞0.11 cm2时,对应的敏感度、特异度分别为89.60%、95.30%.结论 高频超声测定正中神经是一种能够准确诊断腕管综合征的新方法,其中以豌豆骨水平CSA的诊断价值最大.     

固定静脉输液针时输液贴间距及方法的探讨

采用周围静脉输液时,传统的固定方法为3条胶布固定法[1]。冯秉华[2]对输液固定方法进行改进时采用创可贴。通过临床实践发现,传统的固定方法费时、费物,而且易致穿刺失败,有时外观也不美。为此,在临床工作中,对输液贴固定的最佳距离进行观察,认为输液输液贴间平行或V型粘贴效果较好。现报道如下。1资料与方法1.1资料选择门诊输液病人400例,男216例,女184例,年龄35d至78岁,其中手背静脉穿刺312例,头皮静脉穿刺78例,手指、足背等特殊部位穿刺10例。1.2分组方法采用自身对照法进行观察。血管选择为同一病人左右手背或同一手背或头皮静脉穿刺的…     

稳定期COPD患者CAT评分与6 min步行距离相关性研究

目的 探讨CAT量表与6 min步行距离(6MWD)及肺功能指标之间的相关性.方法 横断面调查稳定期COPD患者104例,进行CAT评分、6 min步行实验和肺功能的检查.结果 稳定期COPD患者的CAT评分为(17.4士7.3)分;CAT评分与肺功能指标及6 min步行距离间的相关性差异有显著意义(P＜0.05);CAT评分的分级法与6MWD分级在评估轻度、中度COPD患者的病情时符合率较高.结论 CAT量表对于总体评价COPD对患者的影响是可靠的;对评价COPD患者病情相对较重(重度及极重度)时,CAT评分和6 min步行实验都能进行有效评估.     

Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsion

OBJECTIVE: To investigate the relation between median and ulnar nerve health and wrist kinematics in wheelchair users. DESIGN: Case series. SETTING: Biomechanics laboratory and electrodiagnostic laboratory at a Veterans Health Administration medical center and a university hospital, respectively. PARTICIPANTS: Thirty-five people with spinal cord injury who use manual wheelchairs. INTERVENTION: Subjects propelled their own wheelchair on a dynamometer at 0.9 and 1.8m/s. Bilateral biomechanic data were obtained by using force and moment sensing pushrims and a kinematic system. Bilateral median and ulnar nerve conduction studies were also completed. MAIN OUTCOME MEASURES: Wrist flexion, extension, radial and ulnar deviation peaks, and ranges of motion (ROMs) as related to median and ulnar motor and sensory amplitudes. A secondary analysis included peak pushrim forces and moments and stroke frequency. RESULTS: There was a significant, positive correlation between flexion and extension ROM and both ulnar motor amplitude (r=.383, P<.05) and median motor amplitude (r=.361, P<.05). CONCLUSIONS: Contrary to our hypothesis, subjects using a greater ROM showed better nerve function than subjects propelling with a smaller ROM. Subjects using a larger ROM used less force and fewer strokes to propel their wheelchairs at a given speed. It is possible that long, smooth strokes may benefit nerve health in manual wheelchair users.