Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function

Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p p p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p p p Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies

Fizjoterapia w radikulopatii szyjnej

W pracy przedstawiono przypadek 46-letniej kobiety ze zdiagnozowaną radikulopatią szyjną C4–C6 skierowanej na 4-tygodniowy turnus rehabilitacyjny. Celem badania była ocena skuteczności fizjoterapii u pacjenta ze zdiagnozowaną radikulopatia szyjną. U pacjentki zastosowano fizjoterapię w postaci: mobilizacji drobnych stawów odcinka C, ćwiczeń izometrycznych mięśni szyi, TENS, masażu podwodnego oraz ultradźwięków.Do oceny postępów terapii wykorzystano: skale VAS, pomiar ruchomości odcinka szyjnego taśmą centymetrową i pomiar zakres ruchu stawu ramiennego goniometrem, test dwupunktowy, badanie zaburzenia czucia temperatury ciepłą i zimną wodą, dynamometr, ISOMETER, kwestionariusz NDI.Przeprowadzona terapia wpłynęła pozytywnie na: poziom bólu, zakres zgięcia i wyrostu szyi, siłę ścisku ręki oraz mięśni szyi i grup mięśniowych unerwionych przez segment C5 i C6. W rezultacie poprawiła się jakość życia codziennego pacjenta. Forum Reumatol. 2019, tom 5, nr 4: 203–20

Amplified Vasodilatation within the Referred Pain Zone of Trigger Points Is Characteristic of Gluteal Syndrome—A Type of Nociplastic Pain Mimicking Sciatica

Gluteal syndrome (GS) mimicking sciatica is a new disease that has been recently recognized and included in the International Classification of Diseases, 11th Revision. The present study examines nociplastic pain involvement in GS and sciatica patients using a new Skorupska protocol (SP) test that provokes amplified vasodilatation in the area of expected muscle-referred pain. A positive test is confirmed if there is (i) a development of autonomic referred pain (AURP) and (ii) an increase in the delta of average temperature (Δ₸°) > 0.3 °C at the end of the stimulation and during the observation SP phases. Chronic GS (n = 20) and sciatica (n = 30) patients were examined. The SP test confirmed muscle-referred pain for (i) all GS patients with 90.6% positive thermograms (Δ₸° 0.6 ± 0.8 °C; maximum AURP 8.9 ± 13.6% (both p < 0.05)) and (ii) those sciatica (n = 8) patients who reported pain sensation during the test with 20.6% positive thermograms (Δ₸° 0.7 ± 0.7 °C; maximum AURP 15.1 ± 17.8% (both p < 0.05)). The remaining sciatica (n = 22) patients did not report pain during the test and presented a Δ₸° decrease and the AURP size below 1%. Conclusion: Amplified vasodilatation suggesting nociplastic pain involvement was confirmed for all GS and sciatica patients who reported painful sensations in the zone typical for gluteus minimus referred pain during the test

E-learning During the Coronavirus Pandemic – Creating Educational Resources for Teaching Medical Students

As a result of the epidemiological situation in Poland that occurred as a consequence of the SARS-CoV-2 pandemic, all classroom study was suspended in March 2020 and schools were required to deliver online education. There number of teachers who create educational resources for medical e-education, also those including interactive elements, is still insufficient. Teachers’ IT skills must be continuously improved and they have to take part in e-learning course design training programmes, taking into account the characteristics of the teaching process in medical sciences and health studies. The existing examples of effective e-classes, particularly for medical training, are important sources of knowledge on how to build e-learning courses for beginners and an inspiration for others in subsequent implementations. This knowledge is needed immediately, and the time available for acquiring it is shorter than previously, as the epidemic does not allow for full-range training schemes. This paper presents such results, collected from the period from March to June 2020 at the Poznan University of Medical Sciences by teachers who had started working on e-learning resources in 2019 and are successfully implementing these in the educational offer made available to their students as part of various curricula

Retrospective Analysis of Functional Pain among Professional Climbers

Climbing became one of the official Olympic sports in 2020. The nociplastic pain mechanism is indicated as important in professional sports. Functional pain, which has not been examined in climbers until now, can be an example of nociplastic pain. This study aimed to determine functional pain locations in climbers according to gender and dominant climbing style. Climbers (n = 183) and healthy subjects (n = 160) completed an online survey focused on functional pain occurrence in the head, spine, and upper limbs. The logistic regression showed that climbing predisposes one to functional pain at: Gleno-humeral joint (odds ratio (OR): 3.06; area under the curve (AUC): 0.635), elbow (OR: 2.86; AUC: 0.625), fingers (OR: 7.74; AUC: 0.733), all (p p < 0.05). Climbing predisposes one to functional pain development in the upper limb. While the male climbers mainly suffered from finger functional pain, the female climbers reported functional pain in the GHJ and the thoracic and lumbosacral spine. Further studies on functional pain occurrence are recommended

Ocena przydatności wybranych związków spożywczych jako substancji czynnych o zdolności modulującej gorzki smak czekolady

Numerous compounds with pro-health activity are present in the cocoa bean. Cocoa contains polyphenols such as anthocyanins, catechins, flavan-3-ol proanthocyanidins. The catechins include (-)-epicatechin, (+)-catechin and pigments responsible for cocoa beans color such as cyanidin-3-β-O-galactoside and cyanidin-3-α-L-arabinoside. In addition to polyphenols, cocoa is also rich in alkaloids such as methylxanthine, i.e. caffeine, theobromine and theophylline. The presence of these compounds in dessert chocolate determines its health-promoting properties, but at the same time has a bitter taste, often undesirable by consumers. The aim of the work was to assess the suitability of selected raw materials as a source of active compounds that are modulators of bitter taste in chocolate. Psyllium, eggshells, carrot extract, maltodextrin, vanilla aroma and whey protein concentrate (WPC) were tested. These compounds have not previously been used as taste modulators in dark chocolate, with exception of vanilla aroma and whey protein. Therefore, the results of this study will allow for an evaluation of novel pro-health ingredients as taste modulators. Sensory evaluation in chocolate, allowing the assessment of the impact of the masking effect of the bitter taste, were examined sensitively - using the five-point method. The selected additives were evaluated for cytotoxic activity on the MCF 7 breast cancer cell line. The effectiveness of selected ingredients as modulators of bitter taste has been confirmed in application tests. In chocolate trials, the best effect masking the bitter taste was found for trials with carrot extract and whey protein concentrate in combination with vanilla. It was shown that the proposed additives that modulate the bitter taste such as eggshells are not cytotoxic in relation to breast cancer cells. The addition of plant raw materials, eggshells and WPC proteins may affect the bitter taste of the chocolate and at the same time increase the health-promoting effect.W ziarnie kakaowym obecne są liczne związki o działaniu prozdrowotnym. Kakao zawiera polifenole, takie jak antocyjany, katechiny, flawan-3-ol proantocyjanidyny. Do katechin zalicza się: (-) - epikatechinę, (+) - katechinę oraz barwniki odpowiadające za barwę ziaren kakaowych, takie jak cyjanidyn-3-β-O-galaktozyd i cyjanidyn-3-α-L-arabinozyd. Oprócz polifenoli kakao bogate jest również w alkaloidy, takie jak metyloksantyna, czyli kofeina, teobromina i teofilina. Obecność tych związków w czekoladzie deserowej decyduje o jej prozdrowotnych właściwościach, ale jednocześnie ma gorzki smak, często niepożądany przez konsumentów. Celem pracy była ocena przydatności wybranych surowców jako źródła związków aktywnych będących modulatorami gorzkiego smaku w czekoladzie. Zbadano babkę płesznik, skorupki jaj, ekstrakt z marchwi, maltodekstrynę, aromat waniliowy oraz koncentrat białka serwatkowego (WPC). Związki te nie były wcześniej stosowane jako modulatory smaku w ciemnej czekoladzie, z wyjątkiem aromatu wanilii i białka serwatki. Dlatego wyniki opisanego badania pozwolą na ocenę nowych składników prozdrowotnych jako modulatorów smaku. Oceny sensoryczne w czekoladzie, pozwalające na ocenę wpływu efektu maskującego gorzkiego smaku, zostały zbadane wrażliwie - metodą pięciopunktową. Wybrane dodatki oceniono pod kątem działania cytotoksycznego na linii komórkowej raka piersi MCF 7. Skuteczność wybranych składników jako modulatorów gorzkiego smaku została potwierdzona w badaniach aplikacyjnych. W badaniach z czekoladą najlepszy efekt maskowania gorzkiego smaku uzyskano w próbach z ekstraktem z marchwi i koncentratem białka serwatkowego w połączeniu z wanilią. Wykazano, że proponowane dodatki modulujące gorzki smak, takie jak skorupki jaj, nie są cytotoksyczne w stosunku do komórek raka piersi. Dodatek surowców roślinnych, skorupek jajek i białek WPC może wpłynąć na gorzki smak czekolady, jednocześnie zwiększając prozdrowotny efekt

Biomechanical Examination of Wrist Flexors and Extensors with Biodex System Dynamometer—Isometric, Isokinetic and Isotonic Protocol Options

Background and Objectives: Biodex System® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation of the human musculoskeletal system, no universal and acceptable protocol for wrist examination has been proposed for patients with wrist pathology. In this study, the authors aim to identify the most appropriate protocol for testing the biomechanical parameters of flexors and extensors of the wrist. Materials and Methods: A group of 20 patients with symptomatic tennis elbow and 26 healthy volunteers were examined using three different protocols: isokinetic, isometric and isotonic. Protocol order for each study participant was assigned at random with a minimum of a 24 h break between protocols. All protocol parameters were set according to data obtained from a literature review and an earlier pilot study. Following completion of each protocol, participants filled out a questionnaire-based protocol, assessing pain intensity during the exam, difficulty with exam performance and post-exam muscle fatigue. Results: The isotonic protocol showed the best patient tolerance and the highest questionnaire score. There was a significant difference (p Conclusions: The isotonic protocol is most suitable for testing the flexors and extensors of the wrist. It gives the most biomechanical data of all protocols, is well tolerated by patients and rarely causes pain during examination even in symptomatic participants