OBJECTIVE: The aim of the study was to investigate the associations of cross-sectional area (CSA) of the median nerve measured by ultrasonography, the median to ulnar nerve ratio (MUR), the median to ulnar nerve difference (MUD) and the ratio of CSA of the median nerve to height squared (MHS) in relation to electrodiagnostic classification of moderate and severe carpal tunnel syndrome (CTS) and thus to identify patients suitable for surgical treatment. MATERIALS AND METHODS: A prospective study was conducted in patients aged ≥ 18 years who underwent both median and ulnar nerve ultrasonography and electrodiagnostic studies (EDS). 124 wrists of 62 patients were examined. The patients' characteristics were acquired through a questionnaire. CTS was diagnosed using EDS and classified according to the guidelines of the Czech Republic Association of Electrodiagnostic Medicine. The CSA of the median nerve and of the ulnar nerve were measured at the carpal tunnel inlet. RESULTS: Median nerve CSA at the tunnel inlet ≥ 12 mm2 correlates with electrodiagnostic classification of moderate to severe carpal tunnel syndrome. At this cut-off value, the sensitivity of ultrasonography is 82.4%, its specificity is 87.7%, the positive predictive value is 82.4%, the negative predictive value is 87.7%. MUD, MUR and MHS perform worse than the median nerve CSA, as shown by their lower area under the receiver operating characteristic curve. CONCLUSIONS: Ultrasound could help us indicate surgical treatment for CTS, especially in patients with clinical findings. Our results suggest a cut-off value of CSA at the tunnel inlet of ≥ 12mm2.

• MeSH
• lidé MeSH
• nervus medianus * diagnostické zobrazování   MeSH
• prospektivní studie MeSH
• ROC křivka MeSH
• senzitivita a specificita MeSH
• syndrom karpálního tunelu * diagnostické zobrazování   MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Corticosteroid injections are proven to be effective in the management of carpal tunnel syndrome (CTS); however, the optimal injection site still remains unclear. AIM: The aim of this study is to compare the efficacy of perineural vs. peritendinous target sites for corticosteroid injection in CTS. DESIGN: A randomized, single-blind, controlled trial. SETTING: Outpatients, tertiary care center. POPULATION: Forty-six patients were equally randomized into two intervention groups as group A (18 female and five male patients; mean age: 50.0±15.9 years; mean symptom duration: 5.9±3.3 months) and group B (19 female, four male patients; mean age: 54.3±15.0 years; mean symptom duration: 5.9±4.7 months). METHODS: Methylprednisolone acetate (40 mg) and 1 mL of 1% trimecaine hydrochloride was injected next to the median nerve (group A) or among flexor tendons away from the nerve (group B) under ultrasound (US) guidance. The visual analogue scale was used as the primary outcome measure, and the symptom severity scale and functional status scale of the Boston Carpal Tunnel Questionnaire were used as the secondary subjective outcome measures. Two-point discrimination, grip strength, cross-sectional area, and distal motor latency were assessed as objective outcome measures. The data were collected at baseline and at 2, 6 and 12 weeks after the injection. RESULTS: Both groups showed improvement in subjective and objective measures at 2 weeks following the injection - also maintained up to 12 weeks during the follow-up (P<0.05). However, no difference was observed between the two groups (P<0.05). No serious adverse effects were observed in either group. CONCLUSIONS: Both intervention techniques seem to be effective and safe in the conservative treatment of CTS. CLINICAL REHABILITATION IMPACT: Based on this study results, it might be noteworthy that physicians can opt for perineural or peritendinous injections without compromising the treatment efficacy and safety. Herewith, US guidance is, for sure, necessary for performing safe and accurate injections.

• MeSH
• dospělí MeSH
• hormony kůry nadledvin MeSH
• intervenční ultrasonografie MeSH
• jednoduchá slepá metoda MeSH
• lidé středního věku MeSH
• lidé MeSH
• nervus medianus diagnostické zobrazování   MeSH
• senioři MeSH
• syndrom karpálního tunelu * diagnostické zobrazování   farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Objectives: Occupational carpal tunnel syndrome (CTS) due to upper extremity overuse has in recent years been the most commonly recognized occupational disease in the Czech Republic and its prevalence has steadily increased. This pilot observation aimed to assess the effects of exercise techniques and oral enzyme therapy in automotive plant workers with early CTS. Patients and Methods: The observation comprised automotive plant assembly line workers in whom nerve conduction study revealed incipient CTS. The subjects were divided into three groups: a group practicing exercise techniques (exercising; N=15), a group receiving oral enzyme therapy (N=16), and a group of controls (N=14). Subjects in the control group were only observed without any specific intervention, which is a common procedure in incipient CTS. Throughout 9-week observation, the workers did their jobs. Prior to and after that period, the workers' CTS-related symptoms were ascertained through structured interviews with a physician and the following median nerve parameters were measured: sensory conduction velocity (SCV) and distal motor latency (DML). Results: In both the exercise and enzyme therapy groups, statistically significant decreases in the total score for symptoms were achieved (p<0.0001), unlike controls. On final examination, both treated groups demonstrated significantly increased SCV as compared with the initial values (p=0.00013 and p<0.0001, respectively); in controls, the mean SCV did not significantly change. Similarly, a statistically significant shortening of DML was noted in the enzyme therapy group (p=0.008). Conclusion: The results showed the efficiency of both exercise and oral enzyme therapy in incipient CTS. These methods may be recommended for preventing more severe forms of CTS.

• MeSH
• dospělí MeSH
• elektromyografie MeSH
• enzymoterapie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci z povolání diagnostické zobrazování   patofyziologie   terapie   MeSH
• nervové vedení fyziologie   MeSH
• nervus medianus patofyziologie   MeSH
• syndrom karpálního tunelu diagnostické zobrazování   patofyziologie   terapie   MeSH
• techniky fyzikální terapie MeSH
• terapie cvičením * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• botulotoxiny typu A aplikace a dávkování   farmakologie   MeSH
• dědičné degenerativní poruchy nervového systému diagnostické zobrazování   patofyziologie   MeSH
• dystonie * diagnostické zobrazování   etiologie   farmakoterapie   MeSH
• elektromyografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• myoklonus epidemiologie   etiologie   farmakoterapie   MeSH
• syndrom karpálního tunelu diagnostické zobrazování   farmakoterapie   chirurgie   komplikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• dospělí MeSH
• elektromyografie MeSH
• indukovaná hypertermie MeSH
• kineziologie aplikovaná metody   MeSH
• lidé MeSH
• magnetoterapie MeSH
• syndrom karpálního tunelu * diagnostické zobrazování   chirurgie   klasifikace   rehabilitace   MeSH
• techniky fyzikální terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH