The effect of provocative tests on electrodiagnosis criteria in clinical carpal tunnel syndrome

Introduction and objectiveNerve conduction study is the most sensitive test for diagnosis of carpal tunnel syndrome (CTS). This test is normal in some patients with mild CTS. Median nerve conduction study evaluation after a provocative test (e.g. wrist flexion) may be helpful for diagnosis of mild CTS. This study aimed to determine the effect of wrist flexion on median nerve conduction in patients suspected to CTS and in healthy subjects.Materials and methodsIn this case-control study, 20 patients (20 hands) with clinical signs of CTS and normal routine electrodiagnosis test results and 20 healthy subjects were investigated. Measured parameters included: median nerve distal sensory latency (DSL), nerve conduction velocity (NCV) across wrist, compound nerve action potential (CNAP), distal motor latency (DML) and compound muscle action potential amplitude (CAMPAMP). The above noted parameters were measured before and after 5 min of full wrist flexion. Data were analyzed using paired T-test.ResultsDistal sensory latency increment and NCV decrimental after 5 min of wrist flexion in the patients group were statistically significant (p < 0.01). The same parameters did not show significant incremental or detrimental changes in the control group.ConclusionMedian nerve DSL and NCV measurement after 5 min of wrist flexion may be helpful in determining more sensitive parameters in the electrodiagnosis of CTS.     

Physiologic changes of compound muscle action potentials related to voluntary contraction and muscle length in carpal tunnel syndrome.

The affect of muscle length and voluntary contraction upon compound muscle action potentials (CMAPs) in subjects with carpal tunnel syndrome (CTS) has been evaluated. Twenty-five hands in a CTS patient group and 29 hands in a normal subject control group were studied. The CMAPs from the abductor pollicis brevis induced by median nerve stimulation at the wrist were obtained for five thumb positions: neutral, abduction for shortening with and without contraction, and adduction for lengthening with and without contraction. Upon muscle shortening with relaxation, CMAP duration decreased in both groups, whereas waveform amplitude increased in the control group and showed no significant change in the CTS group. Muscle shortening with contraction afforded decreased CMAP duration and increased CMAP amplitude in both groups. Upon muscle lengthening with relaxation, both groups showed a reduction in CMAP amplitude and an increase in CMAP duration. Upon lengthening with contraction, CMAP duration decreased in the control group; in contrast, the CTS group showed further amplitude reduction and the waveform duration returned to the neutral value. These results demonstrate that, in patients with CTS, physiologic CMAP summations by muscle shortening or contraction may be less effective, whereas decreases in amplitude and increases in duration may be accentuated by lengthening and contraction.     

A reappraisal of the strength-duration test to assess neuromuscular impairment of critically ill patients

IntroductionNeuromuscular impairment (NMI) affects almost half of critically ill patients. The purpose was to investigate the role of neuromuscular electrical stimulation (NMES) to gain more insight into the nature of the NMI associated with ICU admission. To this aim, we analyzed the strength-duration (S-D) curves of the rectus femoris muscles of ICU patients compared to healthy volunteers.MethodsS-D curves were recorded from 44 healthy volunteers and 29 ICU patients. Three electrophysiological parameters were used to classify the neuromuscular function, from grade 0 (normal function), to grade 3 (no evocable muscle contraction). ICU patients underwent electroneurographic peroneal nerve testing (PENT) to analyze NMI by electroneurography (ENG).ResultsThree patients were classified as Grade 0; nine as mild NMI (Grade 1), 13 as Grade 2, and four showed unexcitable muscles (Grade 3). Mean CMAP amplitudes were 6.1, 3.4, 2.9 and 0.81 mV from Grade 0 to Grade 3, respectively. CMAP was inversely correlated to NMI grade (−1.7 mV, R² = 0.946, p < 0.05).ConclusionsThe normative parameters of the S-D curves obtained by NMES in healthy volunteers allowed identification of NMI in ICU patients. NMES was an affordable tool to evaluate NMI in ICU patients, providing additional information to that obtained by ENG.     

Test–retest reliability of cardinal plane isokinetic hip torque and EMG

The objective of the present study was to establish test–retest reliability of isokinetic hip torque and prime mover electromyogram (EMG) through the three cardinal planes of motion. Thirteen healthy young adults participated in two experimental sessions, separated by approximately one week. During each session, isokinetic hip torque was evaluated on the Biodex Isokinetic Dynamometer at a velocity of 60 deg/s. Subjects performed three maximal-effort concentric and eccentric contractions, separately, for right and left hip abduction/adduction, flexion/extension, and internal/external rotation. Surface EMGs were sampled from the gluteus maximus, gluteus medius, adductor, medial and lateral hamstring, and rectus femoris muscles during all contractions. Intraclass correlation coefficients (ICC – 2,1) and standard errors of measurement (SEM) were calculated for peak torque for each movement direction and contraction mode, while ICCs were only computed for the EMG data. Motions that demonstrated high torque reliability included concentric hip abduction (right and left), flexion (right and left), extension (right) and internal rotation (right and left), and eccentric hip abduction (left), adduction (left), flexion (right), and extension (right and left) (ICC range = 0.81–0.91). Motions with moderate torque reliability included concentric hip adduction (right), extension (left), internal rotation (left), and external rotation (right), and eccentric hip abduction and adduction (right), flexion (left), internal rotation (right and left), and external rotation (right and left) (ICC range = 0.49–0.79). The majority of the EMG sampled muscles (n = 12 and n = 11 for concentric and eccentric contractions, respectively) demonstrated high reliability (ICC = 0.81–0.95). Instances of low, or unacceptable, EMG reliability values occurred for the medial hamstring muscle of the left leg (both contraction modes) and the adductor muscle of the right leg during eccentric internal rotation. The major finding revealed high and moderate levels of between-day reliability of isokinetic hip peak torque and prime mover EMG. It is recommended that the day-to-day variability estimates concomitant with acceptable levels of reliability be considered when attempting to objectify intervention effects on hip muscle performance.     

Electromyographic responses of erector spinae and lower limb’s muscles to dynamic postural perturbations in patients with adolescent idiopathic scoliosis

The aim of this study was to evaluate electromyographic (EMG) responses of erector spinae (ES) and lower limbs’ muscles to dynamic forward postural perturbation (FPP) and backward postural perturbation (BPP) in patients with adolescent idiopathic scoliosis (AIS) and in a healthy control group. Ten right thoracic AIS patients (Cobb = 21.6 ± 4.4°) and 10 control adolescents were studied. Using bipolar surface electrodes, EMG activities of ES muscle at T10 (ES_T10) and L3 (ES_L3) levels, biceps femoris (BF), gastrocnemius lateralis (G) and rectus femoris (RF) muscles in the right and the left sides during FPP and BPP were evaluated. Muscle responses were measured over a 1s time window after the onset of perturbation. In FPP test, the EMG responses of right ES_T10, ES_L3 and BF muscles in the scoliosis group were respectively about 1.40 (p = 0.035), 1.43 (p = 0.07) and 1.45 (p = 0.01) times greater than those in control group. Also, in BPP test, at right ES_L3 muscle of the scoliosis group the EMG activity was 1.64 times higher than that in the control group (p = 0.01). The scoliosis group during FPP displayed asymmetrical muscle responses in ES_T10 and BF muscles. This asymmetrical muscle activity in response to FPP is hypothesized to be a possible compensatory strategy rather than an inherent characteristic of scoliosis.     

Ultrasound-Guided Pulsed Radiofrequency for Carpal Tunnel Syndrome: A Single-Blinded Randomized Controlled Study

Objective

We assessed the therapeutic efficiency of ultrasound-guided pulsed radiofrequency (PRF) treatment of the median nerve in patients with carpal tunnel syndrome (CTS).

Methods

We conducted a prospective, randomized, controlled, single-blinded study. Forty-four patients with CTS were randomized into intervention or control groups. Patients in the intervention group were treated with PRF and night splint, and the control group was prescribed night splint alone. Primary outcome was the onset time of significant pain relief assessed using the visual analog scale (VAS), and secondary outcomes included evaluation of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) results, cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity (SNCV) of the median nerve, and finger pinch strength. All outcome measurements were performed at 1, 4, 8, and 12 weeks after treatment.

Results

Thirty-six patients completed the study. The onset time of pain relief in the intervention group was significantly shorter (median onset time of 2 days vs. 14 days; hazard ratio = 7.37; 95% CI, 3.04–17.87) compared to the control group (p < 0.001). Significant improvement in VAS and BCTQ scores (p < 0.05) was detected in the intervention group at all follow-up periods compared to the controls (except for the severity subscale of BCTQ at week 1). Ultrasound-guided PRF treatment resulted in a lower VAS score and stronger finger pinch compared to the control group over the entire study.

Conclusions

Our study shows that ultrasound-guided PRF serves as a better approach for pain relief in patients with CTS.

Trial Registration

ClinicalTrials.gov NCT02217293     

Premature ventricular contractions of the right ventricular outflow tract: is there an incipient underlying disease? New insights from a speckle tracking echocardiography study

ContextPremature ventricular contractions (PVCs) originating in the right ventricular outflow tract (RVOT) are traditionally considered idiopathic and benign. Echocardiographic conventional measurements are typically normal.AimsTo assess whether right ventricle longitudinal strain, determined by two-dimensional speckle tracking echocardiography, differ between RVOT PVCs patients (treated with catheter ablation) and healthy controls.MethodsWe retrospectively selected patients with PVCs from the RVOT who underwent electrophysiological study and catheter ablation between 2016 and 2019. Patients with documented structural heart disease were excluded. Transthoracic echocardiography was performed and right ventricle global longitudinal strain (RV-GLS), free wall longitudinal strain (RVFW-LS) and left ventricle global longitudinal strain (LV-GLS) were determined as well as conventional ultrasound measurements of RV and LV function.ResultsWe studied 21 patients with RVOT PVCs and 13 controls. Patients with PVCs from the RVOT had lower values of RV-GLS and RVFW-LS compared with the control group (?19.4% versus ?22.5%, P = 0.015 and ?22.1% versus ?25.5, P = 0.041, respectively). They also had lower values of LV-GLS, although still within the normal range (?19.1% versus ?20.9%, P = 0.047). Regarding RVOT PVCs patients only, RV-GLS and RVFW-LS had no correlation with the PVCs burden prior to catheter ablation and they did not differ between the patients in whom the catheter ablation was successful and those in whom it was not. RV-GLS also had a positive correlation with RVOT proximal diameter (r = 0.487, P = 0.025).ConclusionsIn this group of RVOT PVCs patients, we found worse RV longitudinal strain values (and therefore sub-clinical myocardial dysfunction) when compared to healthy controls.     

El carcinoma diferenciado incidental de tiroides es menos prevalente en la enfermedad de Graves que en el bocio multinodular

ObjectiveRisk factors for differentiated thyroid carcinoma (DTC) are poorly understood, but serum TSH levels, thyroid nodularity, and presence of autoimmunity are well-recognized factors that modulate DTC prevalence. TSH stimulates proliferation of both normal and neoplastic follicular cells. Consequently, thyroid-stimulating immunoglobulins (TSI), because of its TSH-like action, should induce DTC progression in patients with Graves’ disease (GD). The study objective was to compare the prevalence of incidental DTC in patients undergoing thyroidectomy for benign thyroid disease.MethodsThe pathology reports of 372 patients with preoperative diagnosis of euthyroid multinodular goiter (EMG) or hyperthyroidism were reviewed. Scintigraphy results and serum TSI levels were used to diagnosed either GD or hyperactive MG (HMG) to hyperthyroid subjects. Prevalence of DTC in each category was calculated using a Chi-square test.ResultsEMG, GD, and HMG were diagnosed in 221, 125, and 26 patients. There were 58 DTCs, distributed as follows [n (%)]: EMG, 49 (22.2%); GD, 8 (6.4%), and HMG, 1 (3.8%). Difference in prevalence of incidental DTC between the groups was statistically significant (p < 0.001). After adjustment for age, patients with EMG had a greater DTC prevalence than GD patients, with an OR of 4.17 (p < 0.001). Tumor size (mm, mean ± SD) was 6.92 ± 11.26, 1.97 ± 1.85, and 9.0 for EMG, GD and HMG respectively (p = 0.017).ConclusionsIncidental DTC was less prevalent in GD as compared to EMG irrespective of age. This finding may suggest a predisposition to develop DTC in patients with thyroid nodular disease and/or a potential effect of autoimmunity to protect against development of neoplastic disease.     

Anatomic guided ablation of the atrial right ganglionated plexi is enough for cardiac autonomic modulation in patients with significant bradyarrhythmias

IntroductionCardiac autonomic system modulation by endocardial ablation targeting atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe functional bradyarrhythmias, although no consensus exists on the best ablation strategy. The aim of this study was to evaluate if a simplified approach by a purely anatomical guided ablation of just the atrial right GP is enough for the treatment of these patients.MethodsWe prospectively enrolled patients with significant functional bradyarrhythmias and performed endocardial ablation purely guided by 3D electroanatomic mapping directed at the atrial right GP and accessed parameters of parasympathetic modulation and recurrence of bradyarrhythmias.ResultsThirteen patients enrolled (76.9% male, median age 51, 42–63 years). After ablation, a median RR interval shortening of 28.3 (25.6–40.3)% occurred (1111, 937.5–1395.4 ms to 722.9, 652.2–882.4 ms, p = 0.0002). The AH interval also shortened (19, 10.5–35.7%) significantly after the procedure (115, 105–122 ms to 85, 71–105 ms, p = 0.0023) as well as Wenckebach cycle length (11.1, 5.9–17.8% shortening) from 450, 440–510 ms to 430, 400–460 ms, p = 0.0127. On 24-h Holter monitoring there was significant increase in heart rates (HR) of patients after ablation (minimal HR increased from 34 (26–43)bpm to 49 (43–56)bpm, p = 0,0102 and mean HR from 65 (47–72)bpm to 78 (67–87)bpm, p = 0.0004). No patients had recurrence of symptoms or significant bradyarrhythmias during a median follow-up of 8.4 months.ConclusionsA purely anatomic guided procedure directed only at the atrial right ganglionated plexi seems to be enough as a therapeutic approach for cardioneuroablation in selected patients with significant functional bradyarrhythmias.     

Effect of pain location on spatial reorganisation of muscle activity

IntroductionWe aimed to determine whether the changes in muscle activity (in terms of both gross electromyography (EMG) and motor unit (MU) discharge characteristics) observed during pain are spatially organized with respect to pain location within a muscle which is the main contributor of the task.MethodsSurface and fine-wire EMG was recorded during matched low-force isometric plantarflexion from soleus (from four quadrants with fine-wire EMG and from the medial/lateral sides with surface EMG), both gastrocnemii heads, peroneus longus, and tibialis anterior. Four conditions were tested: two control conditions that each preceded contractions with pain induced in either the lateral (Pain_L) or medial (Pain_M) side of soleus.ResultsNeither the presence (p = 0.28) nor location (p = 0.19) of pain significantly altered gross muscle activity of any location (lateral/medial side of soleus, gastrocnemii, peroneus longus and tibialis anterior). Group data from 196 MUs show redistribution of MU activity throughout the four quadrants of soleus, irrespective of pain location. The significant decrease of MU discharge rate during pain (p < 0.0001; Pain_L: 7.3 ± 0.9–6.9 ± 1.1 Hz, Pain_M: 7.0 ± 1.1 to 6.6 ± 1.1 Hz) was similar for all quadrants of the soleus (p = 0.43), regardless of the pain location (p = 0.98). There was large inter-participant variation in respect to the characteristics of the altered MU discharge with pain.ConclusionResults from both surface and fine-wire EMG recordings do not support the hypothesis that muscle activity is reorganized in a simple systematic manner with respect to pain location.     

The accuracy of needle electrode placement by trainees in selected forearm muscles using verification by neuromuscular ultrasound

IntroductionAnatomic landmarks alone may not always be sufficient to accurately guide electromyography (EMG) electrode needle placement.MethodsSenior residents and fellows (n = 11) targeted 4 forearm muscles with anatomic landmarks alone versus with audiovisual EMG feedback. Accuracy of EMG needle placement was verified using neuromuscular ultrasound imaging.ResultsWhile relatively large and superficial FCR muscle was sampled at a rate of 100% with and without audiovisual EMG feedback, accuracy of deeper and/or smaller forearm muscles (FPL, EIP, and SUP) diminished significantly without audiovisual EMG feedback.DiscussionOur study suggests that in clinical scenarios in which an electrodiagnostician relies on anatomic landmarks alone to target small and deep muscles, the risk of misplacement of needle electrode is increased. Consideration for neuromuscular ultrasound to augment training and/or real time guidance in EMG practice may be appropriate.     

A method to quantify frequency and duration of sustained low-level muscle activity as a risk factor for musculoskeletal discomfort

AimThe purpose of this paper was to describe and evaluate different aspects of muscle activity patterns associated with musculoskeletal discomfort/pain.MethodSurface electromyography (sEMG) of the right upper trapezius and the right extensor digitorum muscles was conducted continuously during one working day in 19 male forest machine operators driving harvesters, 20 driving forwarders and 20 researchers at the Forest Research Institute.Perceived discomfort/pain in the right side of the neck and the right forearm was rated morning, noon and afternoon with Borg’s CR-10 scale. Static, median and peak levels of muscle activity were analyzed and the number and total duration of EMG gaps (muscular rest) were calculated. Sustained low-level muscle activity (SULMA) was defined as continuous muscle activity above 0.5% of the maximal EMG activity quantified into 10 periods of predetermined duration intervals from 1.6 to 5 s up to above 20 min. The number of SULMA periods is presented within each interval and as cumulative periods above the already determined levels. The operators handled control levers seated in a fixed position while the researchers performed mainly PC work and other varied tasks.ResultsA positive correlation was found between discomfort/pain in the right upper trapezius muscle region in the afternoon and cumulative SULMA periods above 10 min duration, and a negative correlation to cumulative SULMA periods also including the short durations. No specified patterns were found for discomfort/pain in the right extensor digitorum or for the other EMG measurements. All EMG measurements distinguished to some extent between the occupational groups, especially between machine operators driving harvesters and researchers.ConclusionsNumber of SULMA periods longer than 10 min per hour was positively correlated, and predominantly short periods were negatively correlated, to complaints in the neck region. This seems promising in order to find duration limits for sustained low-level muscle activity as a risk factor for musculoskeletal disorders.     

Relationships between skinfold thickness and electromyographic and mechanomyographic amplitude recorded during voluntary and non-voluntary muscle actions

IntroductionThe purpose of this study was to examine possible correlations between skinfold thicknesses and the a terms from the log-transformed electromyographic (EMG_RMS) and mechanomyographic amplitude (MMG_RMS)-force relationships, EMG M-Waves, and MMG gross lateral movements (GLM).MethodsForty healthy subjects performed a 6-s isometric ramp contraction from 5% to 85% of their maximal voluntary contraction with EMG and MMG sensors placed on the vastus lateralis (VL) and rectus femoris (RF). A single electrical stimulus was applied to the femoral nerve to record the EMG M-waves and MMG GLMs. Skinfold thickness was assessed at the site of each electrode. Pearson’s product correlation coefficients were calculated comparing skinfold thicknesses with the a terms from the log-transformed EMG_RMS-and MMG_RMS-force relationships, EMG M-waves, and MMG GLMs.ResultsThere were no significant cor1relations (p > 0.05) between the a terms and skinfold thicknesses for the RF and VL from the EMG_RMS and MMG_RMS-force relationships. However, there were significant correlations (p < 0.05) between skinfold thicknesses and the EMG M-waves and MMG GLMs for the RF (r = −0.521, −0.376) and VL (r = −0.479, −0.484).DiscussionRelationships were only present between skinfold thickness and the amplitudes of the EMG and MMG signals during the non-voluntary muscle actions.     

Tratamiento y evolución del síndrome de tormenta de citoquinas asociados a infección por SARS-CoV-2 en pacientes octogenarios

IntroductionCytokine storm syndrome (CTS) is a serious complication of patients with SARS-CoV-2 infection. Treatment and evolution in octogenarians are not well defined. Our objective is to describe its clinical characteristics, the treatments and its clinical evolution.Patients and methodRetrospective observational study of consecutive patients admitted in the period between March 23 and April 12, 2020 with confirmed SARS-CoV-2 infection, with pneumonia by radiological study or chest tomography, whith STC criteria and who received treatment. We classified patients as those who received only glucocorticoid (GC) pulses, or GC and tocilizumab pulses. We determined serum levels of ferritin, CRP and D-dimers. The final variable was survival.Results21 patients, (80-88 years). The mean ferritin was 1056 microg/L (317-3,553), CRP 115.8 mg/dL (22-306) and D-dimers 2.9 m/L (0.45-17.5). All patients received GC pulses and in 2 cases simultaneously tocilizumab. The mean follow-up time was 13.7 days (8-21). The overall mortality was 38.1% (8/21 patients). The 2 patients who received tocilizumab died. The deceased had significantly higher levels of ferritin (1,254 vs. 925 microg/L; P = .045) and CRP (197.6 vs. 76 mg / dL; P = .007). At the end of the follow-up, a decrease in the biochemical parameters was observed with ferritin of 727 microg/L, CRP of 27 mg/dl and D-dimers of 1.18 mg/L. In 13/21 patients (61.9%), the CTS was controlled without the need to add other treatments.ConclusionsSTC mortality from SARS-CoV-2 is high despite treatment. A greater inflammatory response was associated with a higher mortality. Although it seems that the early use of GC pulses could control it, and the use of other treatments such as tocilizumab shouldo be, with the study design and its limitations, this conclusion cannot be stablished.     

The acute effects of local muscle vibration frequency on peak torque,rate of torque development,and EMG activity

PurposeVibratory stimuli enhance muscle activity and may be used for rehabilitation and performance enhancement. Efficacy of vibration varies with the frequency of stimulation, but the optimal frequency is unclear. The purpose of this study was to examine the effects of 30 Hz and 60 Hz local muscle vibration (LMV) on quadriceps function.MethodsTwenty healthy volunteers (age = 20.4 ± 1.4 years, mass = 68.1 ± 11.0 kg, height = 170.1 ± 8.8 cm, males = 9) participated. Isometric knee extensor peak torque (PT), rate of torque development (RTD), and electromyography (EMG) of the quadriceps were assessed followed by one of the three LMV treatments (30 Hz, 60 Hz, control) applied under voluntary contraction, and again immediately, 5, 15, and 30 min post-treatment in three counterbalanced sessions. Dependent variables were analyzed using condition by time repeated-measures ANOVA.ResultsThe condition × time interaction was significant for EMG amplitude (p = 0.001), but not for PT (p = 0.324) or RTD (p = 0.425). The increase in EMG amplitude following 30 Hz LMV was significantly greater than 60 Hz LMV and control.ConclusionsThese findings suggest that 30 Hz LMV may elicit an improvement in quadriceps activation and could be used to treat quadriceps dysfunction resulting from knee pathologies.     

Robot-assisted rehabilitation of hand function after stroke: Development of prediction models for reference to therapy

BackgroundRecovery of hand function after stroke represents the hardest target for clinicians. Robot-assisted therapy has been proved to be effective for hand recovery. Nevertheless, studies aimed to refer patients to the best therapy are missing.MethodsWith the aim to identify which clinical features are predictive for referring to robot-assisted hand therapy, 174 stroke patients were assessed with: Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Reaching Performance Scale (RPS), Box and Block Test (BBT), Modified Ashworth Scale (MAS), Nine Hole Pegboard Test (NHPT). Moreover, patients ability to control the robot with residual force and surface EMG (sEMG) independently, was checked. ROC curves were calculated to determine which of the measures were the predictors of the event.ResultssEMG control (AUC = 0.925) was significantly determined by FMA upper extremity (FMUE) (>24/66) and sensation (>23/24) sections, MAS at Flexor Carpi (<3/4) and total MAS (>4/20). Force control (AUC = 0.928) was correlated only with FMUE (>24/66).ConclusionsFMUE and MAS were the best predictors of preserved ability to control the device by two different modalities. This finding opens the possibility to plan specific therapies aimed at maximizing the highest functional outcome achievable after stroke.     

Feasibility of a Novel Functional Sensibility Test as an Assisted Examination for Determining Precision Pinch Performance in Patients with Carpal Tunnel Syndrome

To understand the feasibility of a novel functional sensibility test for determining precision pinch performance in patients with carpal tunnel syndrome, this study investigates the validity, sensitivity and specificity of functional sensibility derived from a pinch-holding-up activity (PHUA) test. Participants include 70 clinically defined carpal tunnel syndrome (CTS) patients with 119 involved hands and 70 age- and gender-matched controls. To examine the discriminating ability of the functional sensibility test, the differences in the ability of pinch force adjustments to the inertial load of handling object between CTS and control subjects are analyzed. The results of functional sensibility are correlated with the severity of CTS to establish concurrent validity. The receiver operating characteristic (ROC) curve is constructed to demonstrate the accuracy of the proposed test. The functional sensibility score significantly discriminates the patients and control groups (respectively, 12.94±1.72 vs. 11.51±1.15N in peak pinch force (FP_Peak), p<0.001; 2.92±0.41 vs. 2.52±0.24 in force ratio, p<0.001) and is moderately correlated (r = 0.42–0.54, p<0.001) with the results of traditional sensibility tests (touch-pressure threshold and two-point discrimination test). In addition, there is a statistical difference in the results of functional sensibility (p<0.001) among the subgroups of CTS severity based on electrophysiological study. The sensitivity and specificity are 0.79 and 0.76, respectively, for the functional sensibility test. The areas under the ROC curve are 0.85 and 0.80 for the force ratio and FP_Peak, respectively. In conclusion, the functional sensibility test could be feasibly used as a clinical tool for determining both the sensibility and precision pinch performance of hands for the patients with CTS.     

Changes in muscle activation patterns and subjective low back pain ratings during prolonged standing in response to an exercise intervention

BackgroundLow back pain (LBP) development has been associated with occupational standing. Increased hip and trunk muscle co-activation is considered to be predisposing for LBP development during standing in previously asymptomatic individuals. The purpose of this work was to investigate muscle activation and LBP responses to a prescribed exercise program. Pain-developing (PD) individuals were expected to have decreased LBP and muscle co-activation following exercise intervention.MethodsElectromyography (EMG) data were recorded from trunk and hip muscle groups during 2-h of standing. An increase of >10 mm on visual analog scale (VAS) during standing was threshold for PD categorization. Participants were assigned to progressive exercise program with weekly supervision or control (usual activity) for 4 weeks then re-tested.ResultsForty percent were categorized as PD on day 1, VAS = 24.2 (±4.0) mm. PD exercisers (PDEX) had lower VAS scores (8.93 ± 3.66 mm) than PD control (PDCON) (16.5 ± 6.3 mm) on day 2 (p = 0.007). Male PDEX had decreased gluteus medius co-activation levels (p < 0.05) on day 2.DiscussionThe exercise program proved beneficial in reducing LBP during standing. There were changes in muscle activation patterns previously associated with LBP. Predisposing factors for LBP during standing were shown to change positively with appropriate exercise intervention.