Clinical diagnosis of carpal tunnel syndrome: Old tests–new concepts

Yasser El Miedany, Samia Ashour Sally Youssef, Annie Mehanna and Fatma A. Meky

The aim of this study was to examine the relationship between the clinical manifestations of CTS with the outcome of the diagnostic tools (nerve conduction tests and ultrasonography), and its implication for clinical practice. All patients and controls completed a patient oriented questionnaire, were subjected to clinical testing for provocative tests for carpal tunnel syndrome (Tinel’s, Phalen’s, Reverse Phalen’s and carpal tunnel compression tests), nerve conduction testing as well ultrasonographic assessment of the carpal tunnel and median nerve. The results of this study revealed that Tinel’s, Phalen’s, Reverse Phalen’s and carpal tunnel compression tests are more sensitive, as well as being specific tests for the diagnosis of tenosynovitis of the flexor muscles of the hand, rather than being specific tests for carpal tunnel syndrome and can be used as an indicator for medical management of the condition.

Joint Bone Spine, June 2008, article in press

doi:10.1016/j.jbspin.2007.09.014

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Management of chronic low back pain in 2007-2008.

Raspe H.

PURPOSE OF REVIEW: To report and critically appraise the current state of managing chronic (and subacute) low back pain as reflected in recently published guidelines and results from latest trials.

SUMMARY: At present, an individualized clinical approach seems most appropriate. Patients and doctors are free to choose, according to their experiences and preferences, from recommended treatments.

Current Opinion in Rheumatology. 2008 May

DOI:10.1097/BOR.0b013e3282f94256

Link to abstract

Acute Carpal Tunnel Syndrome

Kent A. Schnetzler, MD

Carpal tunnel syndrome is considered the most common of the chronic compressive neuropathies. Its cause is generally unknown. Acute carpal tunnel syndrome, which is much less common, is more often directly related to fractures and fracture-dislocations about the wrist, hemorrhagic conditions, and vascular disorders involving the wrist. Many rare and unusual causes have been described, including chronic conditions that may be associated with acute carpal tunnel syndrome, such as rheumatologic disorders and anomalous anatomy. In contrast to the more common chronic idiopathic form, the acute form of carpal tunnel syndrome requires urgent surgical intervention to avoid or diminish serious sequelae.

Journal of the American Academy of Orthopaedic Surgeons, May 2008, 276-282.

Link to original article

Exercise for Fibromyalgia: A Systematic Review.

Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA

This study evaluated the effects of exercise training on global well-being, selected signs and symptoms, and physical function in individuals with fibromyalgia (FM). Metaanalysis of 6 studies provided moderate-quality evidence that aerobic-only exercise training at ACSM-recommended intensity levels has positive effects on global well-being and physical function and possibly on pain and tender points. Strength and flexibility remain under evaluated; however, strength training may have a positive effect on FM symptoms.

Aerobic-only training has beneficial effects on physical function and some FM symptoms. Strength-only training may improve FM symptoms, but requires further study.

Journal of Rheumatology, 2008 May 1

Link to Abstract

Open versus closed kinetic chain exercises for patellar chondromalacia.

Bakhtiary AH, Fatemi E

This study was designed to compare the effect of straight leg raise (SLR) and semi-squat exercises on the treatment of patellar chondromalacia. 32 participants with patellar chondromalacia were randomly assigned to either SLR or semi-squat exercise. Both groups then followed a 3-week programme of quadriceps muscle strengthening exercises starting with 20 exercises twice a day and increasing each session by 5 exercises every 2 days. Reduced Q angle and crepitation, and an increase in the MIVCF of the quadriceps and thigh circumference were found in semi-squat group compared with SLR group. However, patellofemoral pain was decreased significantly in both groups.

The results of this study indicate that semi-squat exercises (closed kinetic chain) are more effective than SLR exercise (open kinetic chain) in the treatment of patellar chondromalacia.

British Journal of Sports Medicine, 2008, 42(2), 99-102

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Sacroiliac joint fusion and the implications for manual therapy diagnosis and treatment.

Dar G, Khamis S, Peleg S, Masharawi Y, Steinberg N, Peled N, Latimer B, Hershkovitz I

The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac joint (SIJ) with age. SIJs of 287 patients, aged 22-93 years, were examined for fusion, using 3-D CT images. Presence, side and location of the fusion along the joint borders were recorded. Fusion of the SIJ was found to be gender and age dependent; present in 27.7% of all males in contrast to only 3.0% in females. The phenomenon increased with age in the male population from 5.8% in the 20-39 age cohorts to 46.7% in the 80+ cohort.

As mobilization and/or manipulation of a dysfunctional SIJ are common procedures used by manual therapists, the effect that aging has on SIJ mobility requires therapists to alter or change their method with advancing age.

Manual Therapy, 2008, 13(2), 155-8

Link to Abstract

The relationship between head posture and severity and disability of patients with neck pain

Chris Ho Ting Yip, Thomas Tai Wing Chiu and Anthony Tung Kuen Poon

The objective of this study was to investigate the relationship between head posture with pain and disability in patients with neck pain. The forward head posture was measured via the craniovertebral (CV) angle in 62 subjects with neck pain and 52 normal subjects. The CV angle in subjects with neck pain was found to be significantly smaller than that in normal subjects. The authors also found that there was a moderate negative correlation between CV angle and neck disability.

In conclusion, patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability.

Manual Therapy, 2008, 13(2), 148-154

Link to Abstract

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