1/12. Bilateral median neuropathy and growth hormone use: a case report.A male elite bodybuilder suffered bilateral median nerve neuropathy during a self-administered course of growth hormone (GH). Nerve conduction velocities revealed bilateral median neuropathy consistent with carpal tunnel syndrome (CTS). This is the first case of GH-induced CTS occurring in an athlete. Contrary to earlier studies, this report demonstrates that GH-induced CTS is not an age-related phenomenon and alerts physicians to include GH abuse as a possible etiology of median neuropathy in athletes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Bilateral carpal tunnel syndrome as a clue for the diagnosis of systemic amyloidosis.A 60-year-old Swiss woman presented with a 1-year history of periorbital hemorrhagic papules, a tendency to develop hematoma due to minor trauma and shortness of breath. The personal medical history included surgery for bilateral carpal tunnel syndrome (CTS) 2 years ago. Clinical and laboratory findings included macroglossia, Bence-Jones proteinuria, reticular lung infiltrates, thickening of the ventricular walls in echocardiography and increase in atypical plasma cells in the bone marrow. The coexistence of the specific symptoms of CTS, macroglossia and cutaneous lesions should immediately alert the physician to the probable existence of plasma-cell-dyscrasia-related systemic amyloidosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. arnold-chiari malformation with syrinx presenting as carpal tunnel syndrome: a case report.A 26-year-old administrative assistant presented with 3 years of left-hand dysesthesia involving primarily the first 3 digits. Her symptoms increased at night and with keyboard use. Through 12 visits to primary and specialty care physicians over 3 years, she experienced minimal improvement with splints and moderate improvement with gabapentin. On presentation, careful questioning revealed an abrupt onset of symptoms 3 years previously, related to a 2-week episode of gastritis associated with recurrent emesis. Examination revealed a negative Tinel sign over the median nerve at the wrist, decreased left biceps reflex, positive Spurling test, and decreased sensation over the palmar and dorsal surfaces of the left hand in the C5-6 distribution. The atypical onset of symptoms, poor response to therapy, and physical findings suggested the possibility of a radicular or central neurologic etiology for the patient's hand numbness. magnetic resonance imaging demonstrated a Chiari I malformation with a syrinx extending from C2 to T10, with the greatest diameter at C4. Neurosurgical decompression led to a decrease in symptoms. A meticulous history and physical examination should be performed on patients with presumed carpal tunnel syndrome with an atypical onset of symptoms or response to therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Schwannoma of the median nerve (even outside the wrist) may mimic carpal tunnel syndrome.Over the last 3 years we have observed 5 cases of median nerve schwannoma that clinically simulated carpal tunnel syndrome (CTS). We describe the atypical clinical-neurophysiological picture indicating to perform ultrasonography (US). We retrospectively re-evaluated 5 cases of schwannoma that clinically simulated CTS. Five consecutive patients were referred to the neurophysiopathology laboratory. All patients complained of symptoms and had a neurophysiological examination that might have indicated CTS. Nevertheless we performed US because of some incongruous aspects. In cases of atypical abnormalities at neurophysiological and clinical examination, or dissociation between neurophysiological and clinical findings, physicians should consider the presence of a median nerve tumour. Here, US evaluation is very useful as supporting diagnostic methodology to assess the anatomopathological condition of the nerve lesion and must not be limited to the wrist.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Repetitive strain injuries. How to deal with 'the epidemic of the 1990s'.Occupational trends, especially the mushrooming of computer use in the united states, have brought with them a virtual epidemic of repetitive strain injury of the upper limb. What can you as a primary care physician do to stem the tide? In this article, the authors fill you in on treatment of the most common injuries as well as remark on the ramifications for business and industry.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. A report of three cases.Steroid injection can provide symptomatic relief in patients with carpal tunnel syndrome (CTS). Its role should be limited to a diagnostic aid in cases in which symptoms are atypical, a temporizing agent in patients with severe symptoms either who are awaiting surgery or in whom spontaneous remission might be expected, and as a definitive treatment in patients who do not desire surgery. Injection should be performed using proper technique by physicians skilled in carpal tunnel surgery. A soluble preparation of dexamethasone is recommended. Immediate paresthesia in the median nerve distribution or exacerbation of symptoms beyond 48 hours following injection is suspect for inadvertent nerve injury; therefore, early surgical decompression is indicated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. Rheumatologic conditions of the wrist.With the exception of the arthritis associated with rubella, acute wrist conditions have no pathognomonic physical findings. The primary physician can diagnose and treat the majority of wrist problems presented. Referral to a rheumatologist is necessary only when confronted with an anxious patient or an individual having persistent wrist pain and swelling of obscure etiology. This article focuses on rheumatologic problems of the wrist that are most likely to come to the attention of the primary physician.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/12. Response of vitamin B-6 deficiency and the carpal tunnel syndrome to pyridoxine.The specific activities and percentage deficiencies of the glutamic oxaloacetic transaminase of erythrocytes (EGOT) were determined for patients with carpal tunnel syndrome (CTS) diagnosed by clinical examination and electrical conduction data; the EGOT data revealed a severe deficiency of vitamin B-6. After double-blind treatment with pyridoxine and placebo, two physicians identified those receiving pyridoxine (clinically improved) and those receiving placebo (did not improve) without error, P less than 0.0078. Correcting a deficiency of the coenzyme at receptors of existing molecules of the apoenzyme appears to take place within days; correction of the deficiency in the number of molecules of the transaminase takes place over 10-12 weeks. The clinical response, appraised by the diminution of the symptoms of CTS, was correlated only with the restored levels of the transaminase which presumably results from a translational long-term increase in the number of molecules of EGOT by a mechanism activated by correcting a deficiency of pyridoxal 5'-phosphate. Apparent Km values of EGOT were identical for groups of patients with CTS and others without CTS but with identical specific activities, indicating that CTS is a primary deficiency of vitamin B-6 rather than one of a dependency state. Clinical improvement of the syndrome with pyridoxine therapy may frequently obviate hand surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality--application of low level laser.female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury" (RSI) or "carpal tunnel syndrome" (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpation, they have pain and tenderness at the spinous processes C5-T1 and the medial angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5-T1. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers, and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labelled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremities which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting the abnormal head, neck and shoulder posture by taping, cervical collars, and clavicle harnesses as well as improved work ergonomics.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome.The physician treating carpal tunnel syndrome needs to be aware of the possible concomitant occurrence of thoracic outlet syndrome, the so-called double crush syndrome. palpation is used to differentiate carpal tunnel syndrome from thoracic outlet syndrome. Such palpatory examination assists the physician in planning the initial treatment, including osteopathic manipulation and self-stretching maneuvers, targeted specifically at the most clinically significant pathologic region. Supplemental physical medicine modalities such as ultrasound may enhance the treatment response. Some illustrative cases are reported.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
| | Next -> |