Arm and hand function in hemodialysis patients. A cross sectional analytical study

Aims: To investigate the arm and hand function in hemodialysis patients.Methods: Upper limb function using validated questionnaires such as Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Cochin and Boston were applied to 57 chronic renal failure patients on hemodialysis and 60 healthy controls. Epidemiological data, data on pain and paresthesia in the upper limb and handgrip strength were obtained.Results: The three questionnaires showed worse performance of upper limb function in chronic renal failure patients than controls: DASH questionnaire with P = 0.05; Cochin questionnaire with P = 0.0004 and Boston questionnaire with P = 0.03. The questionnaire scores were affected by presence of pain (P = 0.05 for DASH and < 0.0001 for Boston questionnaires) and paresthesia (DASH with P = 0.003; Cochin with P = 0.01 and Boston questionnaire with P < 0.0001). Handgripstrength was lower in hemodialysis patients when compared with controls (P = 0.02) but did not affect the performance of any of the studied questionnaires.Conclusions: Upper limb function is impaired in hemodialysis patients and the main associations found were with pain and paresthesia.

THE BOSTON CARPAL TUNNEL QUESTIONNAIRE /BCTQ/ − A RELIABLE METHOD FOR DIAGNOSIS AND ASSESSMENT OF THE TREATMENT OF CARPAL TUNNEL SYNDROME

CTS is the most common compression neuropathy with an incidence of 125-515/100 000. It is a result of compression of the median nerve by the transverse carpal ligament. It is observed in 2 to 5% of the general population, more frequently in women.In the last few years the scientific society has acknowledged the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and more and more frequently it is being used as a standard in CTS patients. The literature also contains numerous studies on the diagnostics and treatment of CTS using BCTQ.Aim of study. To investigate the effect of a complex of physical factors on the reverse development of symptoms of moderate carpal tunnel syndrome using BCTQ and to compare the results of the BCTQ subjective rating (SSS) (symptom severity scale) and function − FSS (functional status scale) with objective assessment measured by the ENG parameters of n. medianus Materials and methods. 57 patients with mild to moderate degree of carpal tunnel syndrome clinically proven by electroneurographic study were examined. 38.60% of the patients were with right hand affected, 9 patients (15.80%) with left hand affected and 26 patients (45.60%) with bilateral involvement (n=26), In the last group, we examined both hands, i.e. 57 patients and 82 hands were investigated.Based on the analysis of our own studies, we applied the following complex physiotherapeutic program to the patients involved in the study: ultrasound, electrophoresis with Nivalin (Galantamine), and traditional kinesitherapy program.Results and discussion. By analyzing the results of the symptom severity assessment of the first part of the questionnaire we find that subjective complaints of patients decreased statistically significantly at the end of physiotherapy course from an average of 2.67 before treatment to 2.21 at the end of FTP (p <0.01). This trend continues within 1 − 4 months after the end of physiotherapy − average 1.79 and maintains up to 4 − 8 months when the mean of the results is 1.69 (p <0.001). We found that with regard to the recovery of the function of the affected hand and the way it affects some of the activities of daily living, the results of the second part of the BCTQ - functional status scale - show a statistically significant improvement at the end of the physiotherapy course 1.91 to an average of 1.63 (p <0.001), with a tendency for long-term retention and a slight decrease in the average of the results obtained to 1.37 within the first control examination at 1-4 months (p <0.001) and resistance to this trend in the following months (4-8) − 1.31 (p <0.001).Based on the ANOVA analysis and the calculation of the η coefficient, we proved that there is no significant difference in the results obtained from the Boston questionnaire and those from the ENG examination. There is a high percentage of overlap - from 53.10% to 95.60%.Although the results of the questionnaire are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of CТ C studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severityConclusions. In the presented facts of the discussion impression makes the patient's influence both on the subjective complaints and the clinical symptoms as well as on the degree of restoration of the affected hand functions at the end of the physiotherapy course, the continuation of this trend up to 4 months after the end of the treatment and maintaining it for 4 to 8 months.Although the results of BCTQ are based on the subjective assessment of the patient, there is a high percentage of overlap with those of the objective study (ENG), which is a prerequisite for assuming that the questionnaire is highly reliable and valid and can be used as a tool for evaluating and analyzing a number of carpal tunnel studies, which is in line with Leite's findings that the Boston Questionnaire is highly reliable and can replace any other non-standard methods for assessing CTS severity

Functional Outcome Of Mini-Open Carpal Tunnel Release In Carpal Tunnel Syndrome

Introduction: Carpal tunnel syndrome is the most common compression neuropathy in clinical practice and is also the most extensively studied. In Mini-open carpal tunnel release, the transverse carpal ligament is transected using a small open cut at the volar aspect of the proximal palm. The objectives of this study were to determine the functional outcome of mini-open carpal tunnel release procedure, to use the Boston Questionnaire to determine the functional outcome following mini open carpal tunnel release which includes pain, numbness, weakness and fine hand activities. Methods: This descriptive cross-sectional was conducted in National After informed consent, the cases who meet the informed criteria were examined and relevant details were filled up in the proforma preoperatively and two weeks post-operatively. Assessment of the patient’s symptom severity and functional status was done with the Boston questionnaire. Results: CTS was most common in the age group of 25-29 years (36.36%) and was predominant in housewives (18.20%). Mean symptom severity scores per person improved from 3.11 pre-operatively to 1.12 post-operatively. Mean functional status scores per person improved from 2.65 pre-operatively to 1.03 post-operatively. There was a statistically significant improvement in postoperative outcomes in our population. Conclusions: The findings in this study indicate that mini-open carpal tunnel release has a good functional outcome. Keywords: carpal tunnel syndrome; compression neuropathy; transverse carpal ligament.

Endoscopic Carpal Tunnel Release: Results and Complications in 126 cases

Objectives: To report the results and complications of a two portal endoscopic carpal tunnel release (ECTR) with the use of a clear tube for assessing the quality of decompression of the median nerve. Methods: Retrospective analysis of 126 consecutive cases (126 patients) where a two portal ECTR was performed. The demographic and physical examination data were obtained from the medical history. For evaluation, the preoperative and postoperative Quick DASH and the Boston Questionnaire were used and the complications were recorded. Results: The Quick DASH average was 33.7 preoperative (SD 11.05) and 6.8 postoperative (SD 6.44) P<0.001. The Boston Questionnaire´s median average was 1.24 (SD 0.26) for symptoms and 1.18 (SD 0.22) for function. We recorded seven minor complications (5.5%): two cases of transient hypoesthesia and a permanent one of the third web space, three cases of superficial infection, and one case of postoperative neuropathic pain. No major complications or reoperations were documented. Conclusion: Two portal ECTR with the use of a clear tube for assessing the quality of decompression is a safe, effective, predictable and reproducible technique for treatment of idiopathic carpal tunnel syndrome. The complication rate is low when performed by a trained surgeon