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Objectification of surgical treatment of carpal tunnel syndrome
Dvořáková, Marie ; Dudová, Agnieszka (advisor) ; Pánek, David (referee)
Title: Objectification of surgical treatment of carpal tunnel syndrome Objectives: The main aim of this work is to evaluate the effectiveness of surgical treatment of carpal tunnel syndrome. Methods: In this work was used a two-point discrimination test, that evaluated tactile sensory of the hand with carpal tunnel syndrome. It evaluated the change of discriminatory sensation after surgical treatment of carpal tunnel syndrome. The results of testing were evaluated by using the SigmaPlot statistic program SigmaStat 9.01 to 3.1 integration. Results: Research found that two-point discrimination in region of median nerve innervated is improved by surgical treatment of carpal tunnel syndrome, it improves the tactile sensory of the hand, which is impaired by carpal tunnel syndrome. Effect of physiotherapy on improvement of the discriminatory sensation after surgery was not demonstrated. However, the physiotherapy after surgical treatment of carpal tunnel syndrom is important. Keywords: carpal tunnel syndrome, sensory discrimination, a two-point discrimination test
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Musculoskeletal Ultrasound in Physical and Rehabilitation medicine: possibilities in the assessment of selected morphological changes of upper limb
Giannelli, Karolína ; Mezian, Kamal (advisor) ; Hrazdíra, Luboš (referee) ; Nedělka, Tomáš (referee)
This thesis deals with the issue of ultrasound diagnostics and ultrasound-guided interventional procedures in selected pathological changes of the upper limb. Ultrasound examination directly in specialists' offices, including rehabilitation physicians, has been a worldwide trend in the last two decades. The main advantages include the possibility of assessing the pathological findings directly related to the clinical examination. The benefit is speeding up the establishment of an accurate diagnosis and initiating adequate treatment. Indirectly, the costs associated with examination by other imaging techniques and therapy are reduced. This thesis aims to present diagnostic and therapeutic options for selected morphological changes in the upper limb, including less common pathologies, such as case reports of intramuscular haemangiomas, whose diagnosis was significantly contributed by ultrasound examination. In addition to diagnosis, ultrasound is used to navigate interventions, increasing the safety and effectiveness of these procedures. The research part of this thesis is focused on identifying the optimal site of median nerve injection in carpal tunnel syndrome. This study is a prospective, randomized, blinded study with 46 patients with carpal tunnel syndrome. We compared the effect of two...
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The carpal tunnel syndrom in university students and individuals of 40-60 age group
Husák, Lukáš ; Hošková, Blanka (advisor) ; Malá, Michaela (referee)
Subject: Carpal tunnel syndrome in university students and people aged 40 - 60 Objectives: The main goal of this work is to determine the population incidence of carpal tunnel syndrome in a group of university students aged 25 - 30 years and a group of adults aged 40 - 60 years. Methods: The research consists of a quantitative method. A questionnaire containing three provocative maneuvers was used to obtain data. These were the Phanel's Test, Compression Test and Wrist Flexion Test. The research was supplemented by measuring the hand grip using a dynamometer, which was to confirm the occurrence of carpal tunnel syndrome. Two groups of probands were tested. The first group were university students aged 25 - 30 and the second group were adults aged 40 - 60. For the measured data was performed statistical analysis. Results: The result of the research assumes one occurrence in a group of university students aged 25 - 30 and two occurrences in a group of adults aged 40 - 60. These probands have three positive examinations and confirmed by a dynamometer still, the occurrence is just probable, that would need to be confirmed by electromyography. Keywords: carpal tunnel, carpal tunnel syndrome, dynamometer, provocative maneuver, researc
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Median Nerve Ultrasonography Examination Correlates for the Diagnosis of Moderate to Severe Carpal Tunner Syndrome
Potužník, Pavel ; Kotas, Rudolf (advisor) ; Štětkářová, Ivana (referee) ; Ehler, Edvard (referee)
Median Nerve Ultrasonography Examination Correlates for the Diagnosis of Moderate to Severe Carpal Tunnel Syndrome Objective: The aim of the study was to investigate the associations of cross-sectional area (CSA) of the median nerve measured by ultrasonography (US), 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 US 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, i.e. at the level of the pisiform bone. Results: The median nerve swells at the wrist in CTS. Median nerve CSA at the tunnel inlet ≥ 12mm2 correlates with electrodiagnostic classification of moderate to severe carpal tunnel syndrome. At...
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The possibilities of physiotherapy of carpal tunnel syndrome by sewers
PLAČKOVÁ, Tereza
This bachelor thesis deals with the issue of carpal tunnel syndrome. The research topic is work of sewers and elimination of health problems, which emerge after a sewer, had performer this work for long time without taking proper compensation. I present theoretic knowledge in the first part that makes foundation for the research part. I refer to upper extremity anatomy and its setting to the motion and I refer to ergonomic principles, which influence the posture quality. In addition to it, I refer to knowledge of carpal tunnel syndrome and possibilities of physiotherapy intervention. The aim of the thesis is to describe the possibilities of physiotherapy of this dysfunction, to suggest a therapy and to focus on adjustment of work environment which should prevent sewers' wrists and their posture from overburdening. The research part utilizes the qualitative methods, which want to evaluate data gained from three probands. The methods I use are observation, comparison, survey, semi-structured dialog and kinesiology analysis. I perform in therapy manual techniques, kinesiotherapeutic and occupational therapy methods and consulting on increasing the quality of sewers work. I noticed after four-month therapy that clinical symptoms of CTS (carpal tunnel syndrome) which the probands were suffering from were reduced because of selected health care. Work condition adjustment of each proband was made through the instruction. Its assessment could not be carried out because I did not have the opportunity to check it. The results did not attest anything after such short period. Even though final neurological screening did not prove the improved median nerve conducting, both aims of the bachelor thesis were successfully accomplished.
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Objectification of surgical treatment of carpal tunnel syndrome
Dvořáková, Marie ; Dudová, Agnieszka (advisor) ; Pánek, David (referee)
Title: Objectification of surgical treatment of carpal tunnel syndrome Objectives: The main aim of this work is to evaluate the effectiveness of surgical treatment of carpal tunnel syndrome. Methods: In this work was used a two-point discrimination test, that evaluated tactile sensory of the hand with carpal tunnel syndrome. It evaluated the change of discriminatory sensation after surgical treatment of carpal tunnel syndrome. The results of testing were evaluated by using the SigmaPlot statistic program SigmaStat 9.01 to 3.1 integration. Results: Research found that two-point discrimination in region of median nerve innervated is improved by surgical treatment of carpal tunnel syndrome, it improves the tactile sensory of the hand, which is impaired by carpal tunnel syndrome. Effect of physiotherapy on improvement of the discriminatory sensation after surgery was not demonstrated. However, the physiotherapy after surgical treatment of carpal tunnel syndrom is important. Keywords: carpal tunnel syndrome, sensory discrimination, a two-point discrimination test
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Carpal tunnel syndrome in spinal patients
Zmeškalová, Petra ; Špaňhelová, Šárka (advisor) ; Lepšíková, Magdaléna (referee)
The aim of this work is confirming of incidence carpal tunnel syndrom in patients with spinal cord lesion. This ailment stem from repetitive loading of hands on propulsion of mechanical wheelchair. Work contains the causes of biginning, risk factors for patients, prevention, conservative and operation therapy. Thesis involves characteristic of patient after spinal cord injury, seat and wheelchair propulsion. The practice task contains case report of patient and suggestion of therapy for her. Powered by TCPDF (www.tcpdf.org)
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Correlations between clinical and electromyographic findings in patients with carpal tunnel syndrome depending on rehabilitation therapy
Koutská, Helena ; Lepšíková, Magdaléna (advisor) ; Rychnovský, Tomáš (referee)
The aim of this study was to evaluate the therapeutic effect of rehabilitation in patients with carpal tunnel syndrome. The study focused on a comparison between electromyographic findings, the findings of physioterapist-led clinical examinations and the patient's subjective feelings, illustrated by a visual analogue scale of pain intensity. These three types of examinations were carried out prior to the commencement of rehabilitation and following 8 rehabilitation sessions (within a period of 2 months) in a cohort of 15 patients, and correlations between them were described. Given the high prevalence of the disease, an effort was made to find objective examination criteria without the need to resort to electromyography. Powered by TCPDF (www.tcpdf.org)
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Specifics of the educational process in patients undergoing elective hand surgery.
VORÁČOVÁ, Radka
The object of this work is to chart an educational process of ambulant patients undergoing a planned arm surgery due to carpal tunnel syndrome or trigger finger and creating a functional educational material that leads to a change of knowledge and skills of those patients and that can be used by nurses during their work. The three questions to achieve the objectives were: 1) How does the educational process of the patient look like before arm surgery? 2) How is the patient educated on post-operative regime? 3) How are the educational activities implemented in patients undergoing arm surgery? The research project was aimed to the qualitative investigation. Generally the research survey was structured into two phases, the results are summarized in the practical part. The first phase was focused on observation of professional object and depth semi-structured interviews with patients who underwent an arm surgery were made. This survey was supplemented by direct structured observation of nurses in the process of educational activities. Six nurses were altogether involved in the survey. In the second phase, the educational material based on the obtained results, was made for the nurses to use during their work. This material includes educational cards and maps of care instructions for given diseases. Effectivnes of this material was subsequently verified by more semi-structured interviews with six patiens. The results of the survey showed that in the workplace where the respondents underwent the surgery, the educatinal process was singificantly eliminated and for its realization the nurses did not have satisfactory conditions, especially time and spatil conditions. During the educatinal process the nurses were using monologues teaching methods. Demonstration and practical methods were missing. Nurses were not using teaching aids that can make the educatinal process more effective. The results of this work can elucidate the educational reality in surgeries and focus attention on this sector, often neglected in expert literature.
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Carpal tunnel syndrome - therapy options by influencing neurophysiology motion from the root joint
ŠUBERT, Daniel
The carpal tunnel syndrome (CTS) is the most common nerve compression syndrome of the upper limb. CTS is caused by repeated and long-term owerloading specific muscles group with successive compression of medianus nerve located in the wrist area also known as carpal tunnel. The lower part consists of 8 wrist bones covered by ligamentum transversum carpi. The tunnel makes a passage for other structures such as vessels and tendons, all of which being swelled can cause the CTS. CTS is more prevalent among females than among males with ratio 4 to 1. The number of patients suffering from the syndrome is growing higher even with advanced medical science and improved care for patients (Bitnar aj., 2009; Ehler, 2005; Mlčoch, 2008). CTS can affect anyone and the chance to suffer from this condition is around 10% for each individual (Mrzena 2006). The world wide patients' number increase is 0.1% (Katna 2006) and the net prevalence among population is within 2.7 - 3% (Mlčoch, 2008). In the USA, around 260,000 patients indicated with the CTS are operated. The compression of the nerve causes increasing pain and paresthesia. The first symptoms are recorded during night usually passing away with stroking of the hand and hand exercises. During later stages of CTS, the patients suffer from the pain even during day. After being examined by a neurologist, the patients are recommended to undergo a chirurgical treatment which is based on cutting of the ligamentum transversum carpi. The good recovery is ensured by immediate rehabilitation. One year after the chirurgical treatment, the patients are expected to regain full hand abilities. Contrary to the expectations, one patient out of four is not able to regain these abilities. A question arises, are the contemporary exercises of limbs upper acra, which are mainly used for rehabilitation of the patients, effective enough? Is it possible to incorporate these exercises into more complex recovery, implement knowledge of the science of neurophysiology and focus the exercises on the root joint to develop more effective recovery? This thesis integrates theory and empirical findings related with the CTS. The general literature part is focused on relevant anatomy, kinesiology, functional ontogenetic of the upper limb, ways to diagnose and therapy of CTS. The experimental sections of the thesis intents to develop and apply recovery treatment concentrated on the neurophysiology of managing movements from root joint and incorporate these treatments into the standard CTS recovery exercises. Furthermore, a short after CTS operation recovery program will be created and conducted. A set of exercises was developed to activation and strengthening of the glenohumeral joint so the effects would be made means of reflexes path to the acrum and also to the more distant stages of stabilizing system. Developed exercises were applied on two probands diagnosed with CTS. Probands participated on six sessions, during which they were treated with manual therapy of the wrist area and hand. Moreover, probands were informed and instructed how to conduct specific exercises of the glenohumeral joint. Afterwards, set of exercises were performed by probands at least once a week with duration of five to ten minutes. A part longer sessions, were devoted to supervision and correction of exercise program to increase effectively of the treatment. The kinesiological analysis was performed on the probands in the beginning and also in the end. The visual analog scale was utilized as subjective evaluation of therapy effectives. Objective evaluation was measured by staple test, goniometric test and grab test by Novak. The both of probands were fully recovered. Disappearance of the pain and improvement of general motion ability by operated limb were observed. Based on subjective as well objective test, the success of the therapy was proven.
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